Immature platelet fraction and thrombopoietin in patients with liver cirrhosis: A cohort study

Thrombocytopenia occurs frequently in patients with cirrhosis. The immature platelet fraction (IPF%) is measured to differentiate the causes of thrombocytopenia. To date the relevance of thrombopoietin (TPO) in the context of cirrhosis is unknown. The aim of our study was to investigate the cause of...

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Bibliographic Details
Published in:PloS one 2018-02, Vol.13 (2), p.e0192271-e0192271
Main Authors: Rauber, Philip, Lammert, Frank, Grotemeyer, Katharina, Appenrodt, Beate
Format: Article
Language:English
Subjects:
Alcoholism
Analysis
Ascites
Bacterial infections
Biology and Life Sciences
Blood platelets
Blood tests
Bone marrow
Care and treatment
Cirrhosis
Cohort analysis
Complications
Complications and side effects
Development and progression
Endoscopy
Enzyme-linked immunosorbent assay
Esophagus
Gastroenterology
Health aspects
Hematology
Hepatitis
Liver
Liver cirrhosis
Liver diseases
Liver transplants
Medicine and Health Sciences
Mortality
Pathogenesis
Patients
Physiological aspects
Platelets
Risk factors
Spleen
Splenomegaly
Studies
Thrombocytopenia
Thrombopoietin
Transplants & implants
Ultrasonic imaging
Variance analysis
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Summary:Thrombocytopenia occurs frequently in patients with cirrhosis. The immature platelet fraction (IPF%) is measured to differentiate the causes of thrombocytopenia. To date the relevance of thrombopoietin (TPO) in the context of cirrhosis is unknown. The aim of our study was to investigate the cause of thrombocytopenia in patients with liver cirrhosis by measuring IPF%, TPO and spleen size. In addition we examined the use of IPF% to evaluate the severity of cirrhosis and its complications. Overall, we included 88 in-patients with cirrhosis in our study. The collected data comprises current health status, blood parameters, severity of cirrhosis evaluated by Child-Pugh score and MELD score, spleen diameter, ascites and esophageal varices. The IPF% was measured using an automatic hematology analyzer. TPO was measured with ELISA. IPF% (p = 0.003) and spleen diameter (p = 0.001) were significantly higher in patients with thrombocytopenia. There was no significant difference in TPO between patients with and without thrombocytopenia. The mean values of IPF% varied significantly (p = 0.044) in Child-Pugh stages. IPF% was significantly (p = 0.005) elevated in patients with esophageal varices. Moreover, IPF% higher than 3.85% displayed sensitivity of 76.6% and specificity of 52.4% with an area under receiver operating curve characteristics of 0.669 for the presence of esophageal varices. On closer examination of the three compartments known to have an influence on platelet count splenomegaly seems to be the major cause of thrombocytopenia in patients with cirrhosis according to current knowledge. Higher IPF% in patients with thrombocytopenia indicates peripheral consumption of platelets. The relation between spleen diameter and platelet count indicates the spleen to be the major place of platelets' consumption. TPO did not differ between patients with and without thrombocytopenia. Furthermore, we cannot exclude an influence of impaired thrombopoietin synthesis on platelet counts. The association between IPF% and platelet count suggests that there is physiological regulation of platelets in patients with cirrhosis. In our study IPF% is associated with esophageal varices and the stage of cirrhosis. Further studies are needed to confirm these results.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0192271