Review article: the pathophysiology of thrombocytopenia in hepatitis C virus infection and chronic liver disease

Summary Background  The pathophystology of thrombocytopenia in patients with chronic liver disease resulting from hepatitis C virus (HCV) infection is complex and involves several complementary mechanisms that likely act in concert. Aim  To summarize the available data on the etiology of thrombocytopenia in patients with chronic liver disease. Results  In patients with untreated hepatitis C, both prevalence and severity of thrombocytopenia increase in parallel with the extent of disease, usually becoming clinically relevant when patients develop extensive fibrosis and/or cirrhosis. Pathogenetic mechanisms include hypersptenism secondary to portal hypertension, bone marrow suppression resulting from either HCV itself or interferon treatment, aberrations of the immune system resulting in the formation of anti‐platelet antibodies and/or immune‐complexes that bind to platelets and facilitate their premature clearance, development of immunologically‐mediated extrahepatic manifestations including mixed cryoglobulinemia with or without associated joint, renal, or cutaneous involvement, and thrombopoietin (TPO) deficiency secondary to liver dysfunction. In chronic liver disease, the natural inverse relationship between TPO and platelet levels is not maintained; therefore, blood TPO levels fail to have clinical relevance or predictive value in assessing the thrombocytopenic status of a given patient. Conclusions  The development of thrombocytopenisa in patients with chronic liver disease is complex and multifactorial.