Autoimmune Thrombocytopenia in Response to Splenectomy in Cirrhotic Patients with Accompanying Hepatitis C

Overview

Journal World J Gastroenterol

Publisher Baishideng Publishing Group

Specialty Gastroenterology

Date 2006 Mar 15

PMID 16534872

Citations 1

Authors

Tetsuro Sekiguchi

Takeaki Nagamine

Hitoshi Takagi

Masatomo Mori

Affiliations

Soon will be listed here.

Abstract

Aim: To estimate the contribution of autoimmune thrombocytopenia to hepatitis C virus-related liver cirrhosis (type C cirrhosis), we evaluated the influence of splenectomy upon platelet-associated immunoglobulin G (PAIgG) levels and platelet numbers.

Methods: PAIgG titers and immune markers were determined in 24 type C cirrhotic patients with an intact spleen, 17 type C cirrhotic patients submitted to splenectomy, and 21 non-C cirrhosis with an intact spleen.

Results: Thrombocytopenia (PLT < 15 x 10(4)/microL) in type C cirrhosis was diagnosed in all patients with an intact spleen, 8 patients submitted to splenectomy, and in 19 non-C cirrhosis with intact spleen. Elevated titers of PAIgG at more than 25.0 ng/10(7) cells were detected in all cirrhotic patients except for one splenectomized patient. PAIgG titers (ng/10(7) cells) were significantly higher in the type C cirrhosis with an intact spleen (247.9+/-197.0) compared with the splenectomized patients (125.6+/-87.8) or non-C cirrhosis (152.4+/-127.4). PAIgG titers were negatively correlated with platelet counts in type C cirrhotic patients with an intact spleen. In comparison with the type C cirrhosis with an intact spleen, the splenectomized patients had a reduced CD4/CD8 ratio and serum neopterin levels. The spleen index (cm2) was negatively correlated with platelet counts in the non-C cirrhosis, but not in the type C cirrhosis.

Conclusion: Our data indicate that the autoimmune mechanism plays an important role in thrombocytosis complicated by HCV-positive cirrhosis. In addition, splenectomy may impair T cells function through, at least in part, a reduction of CD4/CD8 ratio, consequently suppressing PAIgG production.

Citing Articles

Pathogenesis of Thrombocytopenia in Chronic HCV Infection: A Review.

Rawi S, Wu G J Clin Transl Hepatol. 2020; 8(2):184-191.

PMID: 32832399 PMC: 7438357. DOI: 10.14218/JCTH.2020.00007.

References

Samuel H, Nardi M, Karpatkin M, Hart D, Belmont M, Karpatkin S . Differentiation of autoimmune thrombocytopenia from thrombocytopenia associated with immune complex disease: systemic lupus erythematosus, hepatitis-cirrhosis, and HIV-1 infection by platelet and serum immunological measurements. Br J Haematol. 1999; 105(4):1086-91. DOI: 10.1046/j.1365-2141.1999.01469.x. View

Aref S, Mabed M, Selim T, Goda T, Khafagy N . Thrombopoietin (TPO) levels in hepatic patients with thrombocytopenia. Hematology. 2005; 9(5-6):351-6. DOI: 10.1080/10245330400010620. View

Seeff L . Natural history of chronic hepatitis C. Hepatology. 2002; 36(5 Suppl 1):S35-46. DOI: 10.1053/jhep.2002.36806. View

Sanjo A, Satoi J, Ohnishi A, Maruno J, Fukata M, Suzuki N . Role of elevated platelet-associated immunoglobulin G and hypersplenism in thrombocytopenia of chronic liver diseases. J Gastroenterol Hepatol. 2003; 18(6):638-44. DOI: 10.1046/j.1440-1746.2003.03026.x. View

Gregorio G, Choudhuri K, Ma Y, Pensati P, Iorio R, Grant P . Mimicry between the hepatitis C virus polyprotein and antigenic targets of nuclear and smooth muscle antibodies in chronic hepatitis C virus infection. Clin Exp Immunol. 2003; 133(3):404-13. PMC: 1808793. DOI: 10.1046/j.1365-2249.2003.02229.x. View

Aster R . Pooling of platelets in the spleen: role in the pathogenesis of "hypersplenic" thrombocytopenia. J Clin Invest. 1966; 45(5):645-57. PMC: 292742. DOI: 10.1172/JCI105380. View

Luiken G, McMillan R, Lightsey A, Gordon P, Zevely S, Schulman I . Platelet-associated IgG in immune thrombocytopenic purpura. Blood. 1977; 50(2):317-25. View

Cines D, Schreiber A . Immune thrombocytopenia. Use of a Coombs antiglobulin test to detect IgG and C3 on platelets. N Engl J Med. 1979; 300(3):106-11. DOI: 10.1056/NEJM197901183000302. View

McGrath K, Stuart J, Richards 2nd F . Correlation between serum IgG, platelet membrane IgG, and platelet function in hypergammaglobulinaemic states. Br J Haematol. 1979; 42(4):585-91. DOI: 10.1111/j.1365-2141.1979.tb01171.x. View

10.

MUELLER-ECKHARDT C, Kayser W, Breidenbach M, Kugel H, Graubner M . The clinical significance of platelet-associated IgG: a study on 298 patients with various disorders. Br J Haematol. 1980; 46(1):123-31. DOI: 10.1111/j.1365-2141.1980.tb05942.x. View

11.

McMillan R, Tani P, Mason D . The demonstration of antibody binding to platelet-associated antigens in patients with immune thrombocytopenic purpura. Blood. 1980; 56(6):993-5. View

12.

Mutchnick M, Lerner E, CONN H . Effect of portacaval anastomosis on hypersplenism. Dig Dis Sci. 1980; 25(12):929-38. DOI: 10.1007/BF01308044. View

13.

Skootsky S, Rosove M, Langley M . Immune thrombocytopenia and response to splenectomy in chronic liver disease. Arch Intern Med. 1986; 146(3):555-7. View

14.

Ware R, Kinney T, Friedman H, Falletta J, Rosse W . Prognostic implications for direct platelet-associated IgG in childhood idiopathic thrombocytopenic purpura. Am J Pediatr Hematol Oncol. 1986; 8(1):32-7. DOI: 10.1097/00043426-198608010-00007. View

15.

Koyanagi N, Iso Y, Higashi H, Kitano S, Sugimachi K . Increased platelet count as a screening test for distal splenorenal shunt patency. Am J Surg. 1988; 156(1):29-33. DOI: 10.1016/s0002-9610(88)80164-8. View

16.

Kuo G, Choo Q, Alter H, Gitnick G, Redeker A, Purcell R . An assay for circulating antibodies to a major etiologic virus of human non-A, non-B hepatitis. Science. 1989; 244(4902):362-4. DOI: 10.1126/science.2496467. View

17.

Yanaga K, Tzakis A, Shimada M, CAMPBELL W, Marsh J, Stieber A . Reversal of hypersplenism following orthotopic liver transplantation. Ann Surg. 1989; 210(2):180-3. PMC: 1357825. DOI: 10.1097/00000658-198908000-00007. View

18.

Shah R, Mahour G, Ford E, Stanley P . Partial splenic embolization. An effective alternative to splenectomy for hypersplenism. Am Surg. 1990; 56(12):774-7. View

19.

Ishibashi H, Higuchi N, Shimamura R, Hirata Y, Kudo J, Niho Y . Sonographic assessment and grading of spleen size. J Clin Ultrasound. 1991; 19(1):21-5. DOI: 10.1002/jcu.1870190106. View

20.

de Noronha R, Taylor B, Wild G, Triger D, Greaves M . Inter-relationships between platelet count, platelet IgG, serum IgG, immune complexes and severity of liver disease. Clin Lab Haematol. 1991; 13(2):127-35. DOI: 10.1111/j.1365-2257.1991.tb00261.x. View