Abstract
Thrombocytopenia is a common hematologic complication seen in patients with chronic liver disease (CLD). The pathophysiology of thrombocytopenia in CLD is multifactorial, primarily stemming from platelet sequestration and decreased platelet production. This review focuses on the pathophysiology and current treatment options in the treatment of thrombocytopenia in chronic liver disease. While platelet transfusions are the gold standard of treatment, considerations ought to be given to CLD patients who can benefit from transjugular intrahepatic portosystemic shunt and splenic artery embolization. Finally, the recent approval of thrombopoietin receptor agonists for use in CLD patients paves a way for a safe and effective alternative method of improving platelet levels and reducing the need for recurrent platelet transfusions.
Highlights
BackgroundThrombocytopenia is a common hematological abnormality in patients with chronic liver disease (CLD)
This review focuses on the pathophysiology and the current treatment strategies for the treatment of thrombocytopenia in chronic liver disease
Severe thrombocytopenia increases the risk of bleeding in patients with chronic liver disease and can often complicate or delay clinical care in these patients
Summary
Thrombocytopenia is a common hematological abnormality in patients with chronic liver disease (CLD). The long-term risk of alloimmunization associated with repeated platelet transfusions causing platelet refractoriness can threaten any future need for emergent management [7] At this time, common practice indicates individuals with thrombocytopenia and CLD undergo prophylactic measures depending on the degree of disease and risk of bleeding in procedures. Its effect on thrombocytopenia has not been widely studied and few studies to date have been published Those that have been studied have documented a significant increase in platelet count in post-TIPS liver cirrhosis patients. A study of 13 patients with cirrhotic hypersplenism who underwent 80% PSE had marked improvement in platelet counts with sustained effect up to 36 months following the procedure [15] Another retrospective analysis of cancer patients with hypersplenism who underwent PSE showed that the percentage volume of infarcted splenic tissue linearly correlated with the magnitude of platelet increase (p= 0.001). The clinical efficacy of long-term use of TPO receptor agonists has not been well studied and as such, these drugs cannot be useful in improving thrombocytopenia for longer durations
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