Hematological spectrum in patients with alcoholic liver cirrhosis: a model of end-stage liver disease score based approach
Keywords:Anaemia, Cirrhosis, Leukocytosis, Leukopenia, Thrombocytopenia, MELD score
Background: Patients with alcoholic liver cirrhosis have anaemia, leucocytosis as well as leukopenia and thrombocytopenia in various proportions, which are, to a greater extent, determine mortality and morbidity among them. There is a growing need of a scale to determine the stages at which these hematological parameters could be corrected so as to decrease their adverse impacts on the patients’ lives. The model of end-stage liver disease (MELD) score is built to predict survival in cirrhotic patients undergoing transplantation and to assign priority for liver transplantation. To simplify the task of early identification and management of patients with deranged blood indices, we studied the relationship between various hematological parameters and MELD score.
Methods: This was a prospective observational study in which spectrum of various hematological indices and complications of alcoholic liver disease were observed in 88 patients with stigmata of chronic liver failure on clinical examination substantiated by histopathological evidence and imaging. Hematological parameters including anaemia, leukocyte count and platelet count were assessed in the subjects and were categorized under the different groups of MELD score. The relationship of these variables with MELD score was studied and statistical analysis was done.
Results: We observed a progressive fall in hemoglobin levels with the increase in MELD score. All the patients in group 1 had normal leukocyte count. Leukocytosis predominated in MELD group 2 and 3 patients. In group 4, leukopenia was more prevalent. All the patients in group 5 had leukopenia. Group 1 and 2 patients did not have thrombocytopenia. Thrombocytopenia started occurring in MELD group 3 patients, while involving all the patients of group 4 and 5.
Conclusions: The statistically significant association between the variables and the groups shows that MELD score grouping system could be an important tool in the assessment of these patients. This association strongly depicts that the clinicians could effectively apply the classification in predicting the hematological complications in these patients and take precautions early in preventing the further progression of the disease thus decreasing the mortality in these patients.
Ballard HS. The hematological complications of alcoholism. Alcohol health and research world. 1997;21:42-52.
Khare S, Garg VK, Jain HK, Jatav O. To study haematological profile in patients of chronic liver disease. Intern J Multidiscipl Res Develop. 2015;2(8):378-81.
Shittu BT, Shittu MO, Oluremi AS, Orisadare O, Osemeke J, Bello Lateef. Thrombocytopenia and prolonged prothrombin time in neonatal septicemia. JMSCR. 2014;2:1213-21.
Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology. 2000;31:864-71.
Freeman RB, Wiesner RH, Edwards E, Harper A, Merion R, Wolfe R et al. Results of the first year of the new liver allocation plan. Liver Transpl. 2004;10:7-15.
Qamar AA, Grace ND. Abnormal hematological indices in cirrhosis. Can J Gastroenterol. 2009;23:441-5.
Schmidt KG, Rasmussen JW, Bekker C, Madsen PE. Kinetics and in vivo distribution of 111-in-labelled autologous platelets in chronic hepatic disease: mechanisms of thrombocytopenia. Scand J Haematol. 1985;34:39-46.
Garcia-Pagan JC, De Gottardi A, Bosch J. Review article: the modern management of portal hypertension-primary and secondary prophylaxis of variceal bleeding in cirrhotic patients. Aliment Pharmacol Ther. 2008;28:178-86.
Abraldes JG, Bosch J. The treatment of acute variceal bleeding. J Clin Gastroenterol. 2007;41(3):312-7.
Kravetz D. Prevention of recurrent esophageal variceal haemorrhage: review and current recommendations. J Clin Gastroenterol. 2007;41(3):S318-22.
Gisbert JP, Gomollón F. Spectrum of anaemia associated with chronic liver disease. World J Gastroenterol. 2009;15(37):4653-8.
Aoki Y, Hirai K, Tanikawa K. Mechanism of thrombocytopenia in liver cirrhosis: kinetics of indium-111 tropolone labelled platelets. Eur J Nucl Med. 1993;20:123-9.
Stein SF, Harker LA. Kinetic and functional studies of platelets, fibrinogen, and plasminogen in patients with hepatic cirrhosis. J Lab Clin Med. 1982;99:217-30.
Toghill PJ, Green S. Splenic influences on the blood in chronic liver disease. QJ Med. 1979;48:613-25.
Wolber E, Jelkmann W. Thrombopoietin: the novel hepatic hormone. News Physiol Sci. 2002;17:6-10.
Sungaran R, Markovic B, Chong BH. Localization and regulation of thrombopoietin mRNA expression in human kidney, liver, bone marrow, and spleen using in situ hybridization. Blood. 1997;89:101-7.
Martin TG III, Somberg KA, Meng YG, Cohen RL, Heid CA, de Sauvage FJ, et al. Thrombopoietin levels in patients with cirrhosis before and after orthotopic liver transplantation. Ann Intern Med. 1997;127:285-8.
Witters P, Freson K, Verslype C, Peerlinck K, Hoylaerts M, Nevens F et al. Review article: blood platelet number and function in chronic liver disease and cirrhosis. Aliment Pharmacol Ther. 2008:27:1017-29.
Kajihara M, Kato S, Okazaki Y, Kawakami Y, Ishii H, Ikeda Y et al. A role of autoantibody-mediated platelet destruction in thrombocytopenia in patients with cirrhosis. Hepatology. 2003;37:1267-76.
Kajiwara E, Akagi K, Azuma K, Onoyama K, Fujishima M. Evidence for an immunological pathogenesis of thrombocytopenia in chronic liver disease. Am J Gastroenterol. 1995;90:962-6.
Noguchi H, Hirai K, Aoki Y, Sakata K, Tanikawa K. Changes in platelet kinetics after a partial splenic arterial embolization in cirrhotic patients with hypersplenism. Hepatology. 1995;22:1682-8.
Pereira J, Accatino L, Alfaro J, Brahm J, Hidalgo P, Mezzano D. Platelet autoantibodies in patients with chronic liver disease. Am J Hematol. 1995;50:173-8.
Vardareli E, Saricam T, Demirustu C, Gulbas Z. Soluble p selectin levels in chronic liver disease: relationship to disease severity. Hepatogastroenterology. 2007;54:466-9.
Cotran, Kumar, Collins. Robbins pathologic basis of disease. Philadelphia: W.B Saunders Company.
Strauss E, Ribeiro MFG. Bacterial infections associated with hepatic encephalopathy: prevalence and outcome. Annals of hepatology. 2003;2:41-5.
Gonzalez-Casas R, Jones EA, Moreno- Otero R. Spectrum of anaemia associated with chronic liver disease. World J Gastroenterol. 2009;15(37):4653-8.