Correlation of thrombocytopenia with grading of esophageal varices in chronic liver disease patients.

OBJECTIVE

To determine the severity of thrombocytopenia in different grades of esophageal varices.

STUDY DESIGN

Cross-sectional analytical study.

PLACE AND DURATION OF STUDY

Jinnah Postgraduate Medical Centre, Karachi, Medical Unit-III, Ward-7 from January to December 2008.

METHODOLOGY

Subjects were eligible if they had a diagnosis of cirrhosis. Patient with advanced cirrhosis (Child-Pugh class C), human immunodeficiency virus (HIV) infection, hepatocellular carcinoma, portal vein thrombosis, parenteral drug addiction, current alcohol abuse and previous or current treatment with b-blockers, diuretics and other vasoactive drugs were excluded from the study. All patients under went upper gastrointestinal endoscopy after consent. On the basis of platelet count patients were divided into four groups. Group I with platelets (2) 20000/mm(3), Group II with values of 21000- 50000/mm(3), Group III with count of 51000-99000/mm(3) and Group IV with count of 100000-150000/mm(3). Correlation of severity of thrombocytopenia with the grading of esophageal varices was assessed using Spearman's correlation with r-values of 0.01 considered significant.

RESULTS

One hundred and two patients with thrombocytopenia and esophageal varices were included in the study. There were 62 (60.8%) males and 40 (39.2%) females. The mean age of onset of the disease in these patients was 49.49 + or - 14.3 years with range of 11-85 years. Major causes of cirrhosis were hepatitis C (n=79, 77.5%), hepatitis B (n=12, 11.8%), mixed hepatitis B and C infection (n=8, 7.8%) and Wilson's disease (n=3,2.9%). Seven patients had esophageal grade I, 24 had grade II, 35 had grade III, and 36 had grade IV. Gastric varices were detected in 2 patients. Portal hypertensive gastropathy were detected in 87 patients. There was an inverse correlation of platelet count with grading of esophageal varices (r=-0.321, p < 0.001).

CONCLUSION

The severity of thrombocytopenia increased as the grading of esophageal varices increased. Thrombocyte count was significantly and inversely correlated with the grade of esophageal varices.