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. 1999 May;44(5):754–758. doi: 10.1136/gut.44.5.754

Thrombopoietin concentrations are low in patients with cirrhosis and thrombocytopenia and are restored after orthotopic liver transplantation

J Goulis 1, T Chau 1, S Jordan 1, A Mehta 1, A Watkinson 1, K Rolles 1, A Burroughs 1
PMCID: PMC1727482  PMID: 10205219

Abstract

BACKGROUND—Thrombocytopenia in cirrhotic patients may be due to deficient production of thrombopoietin. 
AIMS—To determine the relation between thrombopoietin and thrombocytopenia in cirrhotic patients before and after orthotopic liver transplantation. 
METHODS—Thrombopoietin concentrations and platelet counts were measured in 43 cirrhotic patients and 21 normal controls and serially for 14 days after transplantation in 23/43 patients. 
RESULTS—27 of the 43 patients had thrombocytopenia (platelet count less than 120 × 109/l; group 1) whereas 16 patients had normal platelet count (group 2). Thrombopoietin concentrations were lower in group 1 than in group 2 (92.5 (20.3-286.3) v 226.6 (30.1-848.3) pg/ml, p=0.003) and normal controls (92.5 (20.3-286.3) v 158.3 (22.5-232.9) pg/ml, p=0.028). Post-transplantation thrombopoietin concentrations increased with a peak at day 5. The rise was significant in patients with low pretransplantation platelet count (89.1 (21.29-247.6) to 545.1(66.2-2569) pg/ml; n=16, p=0.001) but not in those with normal platelet count (262.8 (30.1-848.3) to 315.1 (114-954.6) pg/ml; n=7, p=0.47). No correlation was found pretransplantation between spleen volume and platelet count (r=−0.11, p=0.6) or thrombopoietin concentrations (r=−0.04, p=0.8). However, pretransplantation thrombopoietin concentrations correlated with platelet count (r=0.47, p=0.0015), whereas an inverse correlation was found between peak thrombopoietin concentrations and nadir platelet count (r=−0.41 p=0.049) post-transplantation. 
CONCLUSIONS—Inadequate thrombopoietin production may contribute to cirrhotic thrombocytopenia. Thrombopoietin production is restored after liver transplantation leading to the resolution of thrombocytopenia. 



Keywords: platelets; thrombocytopenia; thrombopoietin; cirrhosis; orthotopic liver transplantation

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Figure 1 .

Figure 1

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Baseline TPO concentrations in cirrhotic patients with or without thrombocytopenia (TCP) and normal controls. Boxes represent the 50% percentile of the values; the inside line represents the median value. 


Figure 2 .

Figure 2

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Correlation between platelet count and spleen index pre-OLT. 


Figure 3 .

Figure 3

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Correlation between TPO concentration and spleen index pre-OLT. 


Figure 4 .

Figure 4

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Correlation between TPO concentrations and platelet (PLT) count at baseline. 


Figure 5 .

Figure 5

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Correlation between maximum TPO and nadir platelet (PLT) count post-OLT. 


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