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Review
. 2024 Sep 27;16(9):1229-1244.
doi: 10.4254/wjh.v16.i9.1229.

Hematological abnormalities in liver cirrhosis

Oscar Manuel Fierro-Angulo  1 , José Alberto González-Regueiro  1 , Ariana Pereira-García  1 , Astrid Ruiz-Margáin  1 , Fernando Solis-Huerta  2 , Ricardo Ulises Macías-Rodríguez  3
Affiliations
Review

Hematological abnormalities in liver cirrhosis

Oscar Manuel Fierro-Angulo et al. World J Hepatol. .

Abstract

Hematological abnormalities are common in cirrhosis and are associated with various pathophysiological mechanisms. Studies have documented a prevalence of thrombocytopenia, leukopenia, and anemia in patients with compensated cirrhosis of 77.9%, 23.5%, and 21.1%, respectively. These abnormalities carry significant clinical implications, including considerations for invasive procedures, infection risk, bleeding risk, and prognosis. Previously, cirrhosis was believed to predispose patients to bleeding due to alterations observed in classical coagulation tests such as prothrombin time, partial thromboplastin time, international normalized ratio, and thrombocytopenia. However, this understanding has evolved, and cirrhosis patients are now also acknowledged as being at a high risk for thrombotic events. Hemostasis in cirrhosis patients presents a complex phenotype, with procoagulant and anticoagulant abnormalities offsetting each other. This multifactorial phenomenon is inadequately reflected by routine laboratory tests. Thrombotic complications are more prevalent in decompensated cirrhosis and may correlate with disease severity. Bleeding is primarily associated with portal hypertension, endothelial dysfunction, mechanical vessel injury, disseminated intravascular coagulation, endotoxemia, and renal injury. This review comprehensively outlines hematologic index abnormalities, mechanisms of hemostasis, coagulation, and fibrinolysis abnormalities, limitations of laboratory testing, and clinical manifestations of bleeding and thrombosis in patients with liver cirrhosis.

Keywords: Anemia; Bleeding; Cirrhosis; Coagulopathy; Leukopenia; Thrombocytopenia; Thrombosis.

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Conflict of interest statement

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Figures

Figure 1
Figure 1
Liver-related causes of abnormal hematological parameters in patients with cirrhosis.
Figure 2
Figure 2
Clot formation and lysis sections in rotational thromboelastometry and thromboelastography tracings. Detailed explanation is in Table 1. CT: Clotting time; RT: Reaction time; ROTEM: Rotational thromboelastometry; TEG: Thromboelastography.
Figure 3
Figure 3
Hemostatic balance in patients with chronic liver disease. Created with BioRender.com. TAFI: Thrombin-activatable fibrinolysis inhibitor; tPA: Tissue-plasminogen activator; PAI: Plasminogen activator inhibitor.
Figure 4
Figure 4
Relative risk of venous thromboembolism in patients with cirrhosis vs healthy individuals. Created with BioRender.com. VTE: Venous thromboembolism; PE: Pulmonary embolism; PVT: Portal vein thrombosis; DVT: Deep venous thrombosis; RR: Relative risk.
See this image and copyright information in PMC

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