Prevalence of Peripheral Blood Cytopenias (Hypersplenism) in Patients With Nonalcoholic Chronic Liver Disease

TLDR

Thrombocytopenia and leukopenia in chronic liver disease are commonly attributed to hypersplenism, yet the prevalence of this syndrome in stable non‑alcoholic liver disease remains poorly reported. This study aimed to determine the prevalence of peripheral blood cytopenia in patients with non‑alcoholic cirrhosis or severe fibrosis compared with those having mild or no fibrosis, using a retrospective chart review of 235 biopsy‑confirmed cases. Data from 191 eligible patients were extracted, 28 clinical and laboratory variables were recorded, and statistical analysis was performed with SPSS. Among cirrhotic patients, 64 % had thrombocytopenia (<150 k /µL) versus 5.5 % of non‑cirrhotic patients, leukopenia was rare (5 % vs 3.3 %), and the odds of a platelet count <100 k were nearly 12‑fold higher in cirrhotics.

Abstract

Thrombocytopenia or leukopenia in patients with chronic liver disease is often attributed to functional overactivity of the spleen (hypersplenism). Despite being a fairly common phenomenon, there is a paucity of reports on the prevalence of this syndrome in stable chronic liver disease patients with or without severe fibrosis/cirrhosis. The aim of this study was to establish the prevalence of peripheral blood cytopenia in patients with nonalcoholic cirrhosis/severe fibrosis versus patients with mild or no fibrosis on liver biopsy.This is a retrospective chart review of 235 patients who underwent a liver biopsy. One hundred ninety-one patients met strict criteria for study entry; 28 different clinical and laboratory variables were collected from their charts review, and data were then analyzed using the SPSS statistical package.Of the cirrhotic patients, 64% were noted to have platelet counts consistently below 150,000 (lower limit of normal in our laboratory; mean, 144.6 +/- 89.4; median, 114), whereas only 5.5% of noncirrhotic patients had thrombocytopenia (mean, 252.2 +/- 103.4; median, 238). Leukopenia (WBC, <3,500) was relatively rare in the cirrhotic/fibrotic group, having a prevalence of 5% (7.59 +/- 4.3) versus 3.3% (10.62 +/- 14.2) of noncirrhotic patients.Of the patients with cirrhosis, 64% had thrombocytopenia (platelet count, <150,000). The likelihood ratio of finding a platelet count of <100,000 in patients with cirrhosis, as opposed to patients without cirrhosis, is almost 12.