Abnormal Bleeding & Thrombocytopenia in liver cirrhosis

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 Abnormal Bleeding & Thrombocytopenia in liver cirrhosis



Abnormal bleeding in liver cirrhosis can be multifactorial:

1. Elevated Portal pressure & varix formation

2. Reduced hepatic synthesis of coagulation proteins

3. Qualitative platelet dysfunction

4. Thrombocytopenia


Mechanism of thrombocytopenia:


1. Splenic sequestration

2. Impaired production of platlets - reduced thrombopoietin production

3. Marrow suppression: Alcohol & certain viruses 

4. Association of ITP (Immune mediated thrombocytopenia) - autoimmune liver disease & chronic hepatitis C

4. Drugs - interferon / antibiotics / immunosuppressants


Immune mediated thrombocytopenia purpura (ITP)


- Autoimmune pathology 

- Antiplatlet autoantibodies 

- IgG autoantibodies sensitize the circulating platlets & leads to removal of these cells in the spleen

- Triad: low platlet count / purpura / hemorrhagic episodes 

- Etiology: Infections (HIV) / Malignancy / autoimmune diseases


Thrombotic thrombocytopenic purpura (TTP):

- Microangiopathic hemolytic anemia

- Blood disorder in which platlets cause clots to develop in small blood vessels  in the organs of boy. 

- Due to absence or decreased "Von Willibrand factor cleaving protease (ADAMTS13)

- Pentad of: Fever, hemolytic anemia, thrombocytopenia, and , renal and neorologic dysfunction


Prepared By. Dr. Sharad Maheshwari

26.04.2023

Updated: 28.04.2023


References:

1. https://ashpublications.org/hematology/article/2022/1/296/493505/Thrombocytopenia-and-liver-disease-pathophysiology

2. https://www.ncbi.nlm.nih.gov/books/NBK537240/

3. https://www.ncbi.nlm.nih.gov/books/NBK430721/#:~:text=Thrombotic%20thrombocytopenic%20purpura%20(TTP)%20is,and%20renal%20and%20neurologic%20dysfunction.

4. https://www.verywellhealth.com/itp-vs-ttp-5184988

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