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Thrombopoietin concentrations are low in patients with cirrhosis and thrombocytopenia and are restored after orthotopic liver transplantation
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Abstract

BACKGROUND Thrombocytopenia in cirrhotic patients may be due to deficient production of thrombopoietin.

AIMS To determine the relation between thrombopoietin and thrombocytopenia in cirrhotic patients before and after orthotopic liver transplantation.

METHODS Thrombopoietin concentrations and platelet counts were measured in 43 cirrhotic patients and 21 normal controls and serially for 14 days after transplantation in 23/43 patients.

RESULTS 27 of the 43 patients had thrombocytopenia (platelet count less than 120 × 109/l; group 1) whereas 16 patients had normal platelet count (group 2). Thrombopoietin concentrations were lower in group 1 than in group 2 (92.5 (20.3–286.3) v 226.6 (30.1–848.3) pg/ml, p=0.003) and normal controls (92.5 (20.3–286.3)v 158.3 (22.5–232.9) pg/ml, p=0.028). Post-transplantation thrombopoietin concentrations increased with a peak at day 5. The rise was significant in patients with low pretransplantation platelet count (89.1 (21.29–247.6) to 545.1 (66.2–2569) pg/ml; n=16, p=0.001) but not in those with normal platelet count (262.8 (30.1–848.3) to 315.1 (114–954.6) pg/ml; n=7, p=0.47). No correlation was found pretransplantation between spleen volume and platelet count (r=−0.11, p=0.6) or thrombopoietin concentrations (r=−0.04, p=0.8). However, pretransplantation thrombopoietin concentrations correlated with platelet count (r=0.47, p=0.0015), whereas an inverse correlation was found between peak thrombopoietin concentrations and nadir platelet count (r=−0.41 p=0.049) post-transplantation.

CONCLUSIONS Inadequate thrombopoietin production may contribute to cirrhotic thrombocytopenia. Thrombopoietin production is restored after liver transplantation leading to the resolution of thrombocytopenia.

  • platelets
  • thrombocytopenia
  • thrombopoietin
  • cirrhosis
  • orthotopic liver transplantation
  • Abbreviations

    DIC
    disseminated intravascular coagulation
    HBV
    hepatitis B virus
    HCV
    hepatitis C virus
    OLT
    orthotopic liver transplantation
    TPO
    thrombopoietin
    TIPS
    transjugular intrahepatic portosystemic shunts
    CT
    computed tomography
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  • Abbreviations

    DIC
    disseminated intravascular coagulation
    HBV
    hepatitis B virus
    HCV
    hepatitis C virus
    OLT
    orthotopic liver transplantation
    TPO
    thrombopoietin
    TIPS
    transjugular intrahepatic portosystemic shunts
    CT
    computed tomography
  • View Full Text

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