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World J Gastroenterol. Mar 14, 2014; 20(10): 2595-2605
Published online Mar 14, 2014. doi: 10.3748/wjg.v20.i10.2595
Management of thrombocytopenia due to liver cirrhosis: A review
Hiromitsu Hayashi, Toru Beppu, Ken Shirabe, Yoshihiko Maehara, Hideo Baba
Hiromitsu Hayashi, Toru Beppu, Hideo Baba, Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
Ken Shirabe, Yoshihiko Maehara, Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
Author contributions: Hayashi H identified the concept and wrote the draft of the review paper; Beppu T, Shirabe K and Maehara Y provided critical revisions for interventional or surgical procedures; Baba H organized the paper and approved the final version to be published.
Supported by Grant-in-Aid for Young Scientists, Ministry of Education, Culture, Sports, Science and Technology of Japan, No. 24791434 (to Hayashi H) and Takeda Science Foundation, Japan (to Hayashi H)
Correspondence to: Hideo Baba, MD, PhD, FACS, Professor, Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan. hdobaba@kumamoto-u.ac.jp
Telephone: +81-96-3735211 Fax: +81-96-3714378
Received: September 23, 2013
Revised: February 9, 2014
Accepted: February 20, 2014
Published online: March 14, 2014
Processing time: 169 Days and 20.8 Hours
Abstract

Thrombocytopenia is a common complication in liver disease and can adversely affect the treatment of liver cirrhosis, limiting the ability to administer therapy and delaying planned surgical/diagnostic procedures because of an increased risk of bleeding. Multiple factors, including splenic sequestration, reduced activity of the hematopoietic growth factor thrombopoietin, bone marrow suppression by chronic hepatitis C virus infection and anti-cancer agents, and antiviral treatment with interferon-based therapy, can contribute to the development of thrombocytopenia in cirrhotic patients. Of these factors, the major mechanisms for thrombocytopenia in liver cirrhosis are (1) platelet sequestration in the spleen; and (2) decreased production of thrombopoietin in the liver. Several treatment options, including platelet transfusion, interventional partial splenic embolization, and surgical splenectomy, are now available for severe thrombocytopenia in cirrhotic patients. Although thrombopoietin agonists and targeted agents are alternative tools for noninvasively treating thrombocytopenia due to liver cirrhosis, their ability to improve thrombocytopenia in cirrhotic patients is under investigation in clinical trials. In this review, we propose a treatment approach to thrombocytopenia according to our novel concept of splenic volume, and we describe the current management of thrombocytopenia due to liver cirrhosis.

Keywords: Liver cirrhosis; Thrombocytopenia; Thrombopoietin; Partial splenic embolization; Splenectomy

Core tip: The major mechanisms for thrombocytopenia in liver cirrhosis are (1) platelet sequestration in the spleen; and (2) decreased production of thrombopoietin in the liver. For thrombocytopenia that is caused by platelet sequestration in the spleen, partial splenic embolization or laparoscopic splenectomy are effective. Thrombopoietin agonists and targeted agents are alternative tools for noninvasively treating thrombocytopenia due to decreased thrombopoietin production, although their ability to improve thrombocytopenia is under investigation in clinical trials. In this review, we describe the current management of thrombocytopenia due to liver cirrhosis, and we propose the novel concept of using the splenic volume to discern the primary cause of thrombocytopenia due to liver cirrhosis.