Role of Thrombopoietin in Thrombocytopenic Patients with Chronic Viral Hepatitis with and without Liver Cirrhosis

Thrombocytopenia is a common hematological defect among patients with chronic liver diseases. Thrombocytopenia secondary to liver cirrhosis and portal hypertension is a well known complication of advanced stage liver disease, but theories about the underlying pathogenetic mechanisms, mostly concentrating on splenic sequestration i.e. hypersplenism and destruction of platelets, have failed to solve the problem so far. Thrombopoietin (TPO) was recently cloned and identified as the primary cytokine involved in the megakaryocyte mat¬uration and formation of platelets. The predominant site of TPO production is the liver, where parenchymal cells are the TPO-producing cells. Therefore, thrombocytopenia in chronic liver disease may be related to deficient production of thrombopoietin. Thus, altered TPO production in patients with chronic liver disease may in part explain the thrombocytopenia found in these patients.To evaluate the relationship between serum TPO concen-trations, circulating platelet count, and the state of liver pathology in patients with chronic viral hepatitis with and without liver cirrhosis, this study included ninety subjects divided into two main groups. Group A included sixty chronic hepatitis patients and group B included thirty apparently normal age- and sex-matched subjects taken as a control group. Etiology of the chronic hepatitis patients was either HBV or HCV. Group A was further subdivided into subgroup AI including thirty chronic hepatitis patients with liver fibrosis, while subgroup All included thirty chronic hepatitis patients with liver cirrhosis, who were all of Child A group according to Child score. Ultrasonography as well as liver biopsy were used to differentiate the two subgroups.Thorough history taking, full physical examination, as well as biochemical blood tests in the form of serum albumin and total bilirubin were done. Prothrombin time, platelet counts, as well as serum TPO concentrations were all determined in addition to abdominal ultrasonography to evaluate the splenic size.Our data showed that serum albumin level was decreased and serum bilirubin level was increased in both subgroups AI fibrosis and All cirrhosis compared to group B controls. Prothrombin time was prolonged in subgroup All cirrhosis patients compared to both subgroup AI fibrosis and to group B controls. Splenic size was highly significantly increased in subgroup All cirrhosis patients compared to subgroup AI fibrosis patients who showed larger spleen compared to groupB controls as well. Serum TPO levels were significantly increased in subgroup AI fibrosis patients and significantly decreased in subgroup All cirrhosis patients compared to group B controls, moreover, TPO levels were highly significantly decreased in subgroup All patients compared to subgroup AI patients.