Thrombocytopenia is common in those who have chronic liver disease, such as cirrhosis. It can be a diagnostic marker for liver disease.

Thrombocytopenia is a condition that occurs when the platelet count is too low. Platelets are a component of blood that help to heal wounds by creating a blood clot or scab.

Cirrhosis is when scar tissue develops on the liver and replaces healthy tissue, permanently damaging it and limiting its function. As the condition continues to worsen, the liver begins to fail.

This article will explain the link between thrombocytopenia and cirrhosis. It will also mention treatment for both and when to contact a doctor.

a clinician is drawing blood from a manShare on Pinterest
mixetto/Getty Images

Thrombocytopenia is the most common blood disorder found in chronic liver disease patients and occurs in up to 78% of patients with cirrhosis. Thrombocytopenia is usually considered a marker for liver disease.

This condition was previously thought to result from liver problems such as portal hypertension. However, research over the years has found several mechanisms linking thrombocytopenia to cirrhosis.

Learn more about platelet ranges in thrombocytopenia.

Thrombopoietin regulation

The liver and kidneys make the hormone thrombopoietin (TPO), which regulates platelet production. There is a direct correlation between stages of cirrhosis, levels of TPO, and degree of thrombocytopenia.

Increasing amounts of scar tissue on the liver have been shown to decrease levels of TPO, thus reducing the platelet count.

Platelet destruction

Another mechanism by which thrombocytopenia can occur in people with cirrhosis is through platelet destruction. People with cirrhosis are at an increased risk for infections, and inflammatory markers such as tumor necrosis factor-α may contribute to platelet destruction.

An increased rate of platelet destruction can also occur in those with cirrhosis due to the following:

  • increased shear stress
  • increased fibrinolysis
  • bacterial translocation
  • infection

Portal hypertension

Portal hypertension is a notable contributor to thrombocytopenia since it leads to an enlarged spleen or splenomegaly.

Splenomegaly causes up to 90% of platelets to be mass stored in the spleen instead of being spread in the body, according to a 2022 review. Researchers in the review observed an inverse relationship between spleen size and platelet count.

Bone marrow suppression

In some cases of cirrhosis, such as viral or alcoholic hepatitis, bone marrow suppression may occur. This condition happens when bone marrow activity decreases, resulting in fewer red blood cells, white blood cells, and platelets.

Immune-mediated thrombocytopenia (ITP)

Immunological platelet destruction is common in people with autoimmune liver diseases, such as autoimmune hepatitis and primary biliary cirrhosis. This is because increased antiplatelet immunoglobulin results in the immunologic destruction of platelets.

Treating thrombocytopenia is important in managing liver cirrhosis since several procedures have associated bleeding risks.

Standard treatments of thrombocytopenia include:

  • blood transfusions
  • splenectomy
  • splenic artery embolization
  • thrombopoietin receptor agonists
  • medications to help increase platelet counts, such as eltrombopag, romiplostim, and corticosteroids

Learn more about treatment for thrombocytopenia.

If symptoms are not improving with treatment, it is best to seek immediate medical care. Some signs and complications to look out for include the following:

  • blood in your stool or urine
  • wounds or cuts that are not healing
  • bleeding that will not stop
  • fever or other signs of an infection

Thrombocytopenia is a blood disorder characterized by a low platelet count. It is especially common in those who have chronic liver disease, such as cirrhosis.

Research associates the development of thrombocytopenia with cirrhosis and has linked several pathways for how this can occur.

Treating thrombocytopenia is vital in managing cirrhosis since many treatment options come with an increased risk of bleeding. Treating thrombocytopenia alone cannot reverse cirrhosis.

However, treating cirrhosis may help increase the blood platelet count through reduced stress on the body’s hematological system.

Treatment options include medications and surgical interventions. It is essential to watch for complications, and if symptoms are not improving with treatment, it is best to seek immediate medical help.