Fouad Yasser M
Department of Tropical Medicine, Minia University, Egypt.
Trop Gastroenterol. 2013 Apr-Jun;34(2):58-67. doi: 10.7869/tg.2012.99.
Thrombocytopenia is perhaps the most common haematological abnormality in patients with chronic hepatitis C virus (HCV) infection. In these patients, the presence of thrombocytopenia may be a limiting factor when considering antiviral therapy and may be associated with decreased sustained virological response rates. Thrombocytopenia may interfere with diagnostic procedures such as liver biopsy, because of risk of bleeding. Pathogenetic mechanisms include hypersplenism secondary to portal hypertension, bone marrow suppression resulting from either HCV itself or interferon treatment, and aberrations of the immune system resulting in the formation of anti-platelet antibodies and/or immune-complexes that bind to platelets and facilitate their premature clearance. The ability to increase platelet levels could significantly reduce the need for platelet transfusions and facilitate the use of interferon-based antiviral therapy and other medically indicated treatments in patients with liver disease. Therapeutic options include pharmacological and non-pharmacological therapies. This review summarizes the available data on these therapeutic options.
血小板减少症可能是慢性丙型肝炎病毒（HCV）感染患者中最常见的血液学异常。在这些患者中，血小板减少症的存在可能是考虑抗病毒治疗时的一个限制因素，并且可能与持续病毒学应答率降低有关。血小板减少症可能会干扰诸如肝活检等诊断程序，因为存在出血风险。发病机制包括门静脉高压继发的脾功能亢进、HCV本身或干扰素治疗导致的骨髓抑制，以及免疫系统异常导致抗血小板抗体和/或免疫复合物的形成，这些抗体和/或复合物与血小板结合并促进其过早清除。提高血小板水平的能力可以显著减少血小板输注的需求，并促进在肝病患者中使用基于干扰素的抗病毒治疗和其他医学上有指征的治疗。治疗选择包括药物治疗和非药物治疗。本综述总结了关于这些治疗选择的现有数据。
