The pathophysiology of thrombocytopenia in chronic liver disease

Oscar Mitchell,1 David M Feldman,1,2 Marla Diakow,1 Samuel H Sigal3 1Department of Medicine, 2Division of Gastroenterology and Liver Diseases, New York University School of Medicine, Langone Medical Center, New York, 3Division of Gastroenterology and Liver Diseases, Department of Medicine, Montefior...

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Autores principales:	Mitchell O, Feldman DM, Diakow M, Sigal SH
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2016
Materias:	Cirrhosis Thrombocytopenia Thrombopoietin Diseases of the digestive system. Gastroenterology RC799-869
Acceso en línea:	https://doaj.org/article/eba3a73a6086437185bac69f066aa6f2
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spelling	oai:doaj.org-article:eba3a73a6086437185bac69f066aa6f22021-12-02T00:35:08ZThe pathophysiology of thrombocytopenia in chronic liver disease1179-1535https://doaj.org/article/eba3a73a6086437185bac69f066aa6f22016-04-01T00:00:00Zhttps://www.dovepress.com/the-pathophysiology-of-thrombocytopenia-in-chronic-liver-disease-peer-reviewed-article-HMERhttps://doaj.org/toc/1179-1535Oscar Mitchell,1 David M Feldman,1,2 Marla Diakow,1 Samuel H Sigal3 1Department of Medicine, 2Division of Gastroenterology and Liver Diseases, New York University School of Medicine, Langone Medical Center, New York, 3Division of Gastroenterology and Liver Diseases, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA Abstract: Thrombocytopenia is the most common hematological abnormality encountered in patients with chronic liver disease (CLD). In addition to being an indicator of advanced disease and poor prognosis, it frequently prevents crucial interventions. Historically, thrombocytopenia has been attributed to hypersplenism, which is the increased pooling of platelets in a spleen enlarged by congestive splenomegaly secondary to portal hypertension. Over the past decade, however, there have been significant advances in the understanding of thrombopoiesis, which, in turn, has led to an improved understanding of thrombocytopenia in cirrhosis. Multiple factors contribute to the development of thrombocytopenia and these can broadly be divided into those that cause decreased production, splenic sequestration, and increased destruction. Depressed thrombopoietin levels in CLD, together with direct bone marrow suppression, result in a reduced rate of platelet production. Thrombopoietin regulates both platelet production and maturation and is impaired in CLD. Bone marrow suppression can be caused by viruses, alcohol, iron overload, and medications. Splenic sequestration results from hypersplenism. The increased rate of platelet destruction in cirrhosis also occurs through a number of pathways: increased shear stress, increased fibrinolysis, bacterial translocation, and infection result in an increased rate of platelet aggregation, while autoimmune disease and raised titers of antiplatelet immunoglobulin result in the immunologic destruction of platelets. An in-depth understanding of the complex pathophysiology of the thrombocytopenia of CLD is crucial when considering treatment strategies. This review outlines the recent advances in our understanding of thrombocytopenia in cirrhosis and CLD. Keywords: cirrhosis, thrombocytopenia, thrombopoietinMitchell OFeldman DMDiakow MSigal SHDove Medical PressarticleCirrhosisThrombocytopeniaThrombopoietinDiseases of the digestive system. GastroenterologyRC799-869ENHepatic Medicine: Evidence and Research, Vol 2016, Iss Issue 1, Pp 39-50 (2016)
institution	DOAJ
collection	DOAJ
language	EN
topic	Cirrhosis Thrombocytopenia Thrombopoietin Diseases of the digestive system. Gastroenterology RC799-869
spellingShingle	Cirrhosis Thrombocytopenia Thrombopoietin Diseases of the digestive system. Gastroenterology RC799-869 Mitchell O Feldman DM Diakow M Sigal SH The pathophysiology of thrombocytopenia in chronic liver disease
description	Oscar Mitchell,1 David M Feldman,1,2 Marla Diakow,1 Samuel H Sigal3 1Department of Medicine, 2Division of Gastroenterology and Liver Diseases, New York University School of Medicine, Langone Medical Center, New York, 3Division of Gastroenterology and Liver Diseases, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA Abstract: Thrombocytopenia is the most common hematological abnormality encountered in patients with chronic liver disease (CLD). In addition to being an indicator of advanced disease and poor prognosis, it frequently prevents crucial interventions. Historically, thrombocytopenia has been attributed to hypersplenism, which is the increased pooling of platelets in a spleen enlarged by congestive splenomegaly secondary to portal hypertension. Over the past decade, however, there have been significant advances in the understanding of thrombopoiesis, which, in turn, has led to an improved understanding of thrombocytopenia in cirrhosis. Multiple factors contribute to the development of thrombocytopenia and these can broadly be divided into those that cause decreased production, splenic sequestration, and increased destruction. Depressed thrombopoietin levels in CLD, together with direct bone marrow suppression, result in a reduced rate of platelet production. Thrombopoietin regulates both platelet production and maturation and is impaired in CLD. Bone marrow suppression can be caused by viruses, alcohol, iron overload, and medications. Splenic sequestration results from hypersplenism. The increased rate of platelet destruction in cirrhosis also occurs through a number of pathways: increased shear stress, increased fibrinolysis, bacterial translocation, and infection result in an increased rate of platelet aggregation, while autoimmune disease and raised titers of antiplatelet immunoglobulin result in the immunologic destruction of platelets. An in-depth understanding of the complex pathophysiology of the thrombocytopenia of CLD is crucial when considering treatment strategies. This review outlines the recent advances in our understanding of thrombocytopenia in cirrhosis and CLD. Keywords: cirrhosis, thrombocytopenia, thrombopoietin
format	article
author	Mitchell O Feldman DM Diakow M Sigal SH
author_facet	Mitchell O Feldman DM Diakow M Sigal SH
author_sort	Mitchell O
title	The pathophysiology of thrombocytopenia in chronic liver disease
title_short	The pathophysiology of thrombocytopenia in chronic liver disease
title_full	The pathophysiology of thrombocytopenia in chronic liver disease
title_fullStr	The pathophysiology of thrombocytopenia in chronic liver disease
title_full_unstemmed	The pathophysiology of thrombocytopenia in chronic liver disease
title_sort	pathophysiology of thrombocytopenia in chronic liver disease
publisher	Dove Medical Press
publishDate	2016
url	https://doaj.org/article/eba3a73a6086437185bac69f066aa6f2
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The pathophysiology of thrombocytopenia in chronic liver disease

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