HAEMATOLOGICAL ABNORMALITIES IN DECOMPENSATED CHRONIC LIVER DISEASE
Main Article Content
Keywords
Chronic Liver Disease; Hematological abnormalities; Thrombocytopenia; Prothrombin time; Hypersplenism
Abstract
Decompensated chronic liver disease (DCLD) is frequently associated with hematological abnormalities such as anemia, thrombocytopenia, and coagulation dysfunction, all of which significantly impact disease progression and clinical outcomes. Anemia in DCLD may result from chronic gastrointestinal bleeding, nutritional deficiencies, or hypersplenism. Thrombocytopenia is often due to portal hypertension and reduced thrombopoietin production, while coagulation disorders arise from impaired hepatic synthesis of clotting factors. This prospective observational study was conducted between 2023 and 2024 at the Department of General Medicine, Meenakshi Medical College Hospital and Research Institute. Fifty patients with DCLD were enrolled based on defined inclusion and exclusion criteria. Investigations included complete blood count, peripheral smear, serum iron profile, folate levels, liver function tests, and coagulation studies. Data analysis was performed using SPSS version 21.0, with p < 0.05 considered statistically significant. Anemia was present in 96% of patients, with normocytic anemia being the most common (58.3%), followed by microcytic (29.2%) and macrocytic anemia (12.5%). Thrombocytopenia was observed in 70%, and 17.1% had platelet counts <50,000/µL. Prolonged prothrombin time and elevated international normalized ratio were observed in 66% and 76% of patients, respectively. Gastrointestinal bleeding was significantly associated with both thrombocytopenia (p = 0.045) and coagulation abnormalities (p = 0.011 for PT, p = 0.01 for INR). These findings underscore the high prevalence of hematological complications in DCLD. Early detection and management of anemia, thrombocytopenia, and coagulation disorders are essential to reduce morbidity and improve patient care outcomes.
References
2. Anthony PP, Ishak KG, Nayak NC, Poulsen HE, Scheuer PJ, Sobin LH. The morphology of cirrhosis: definition, nomenclature, and classification. Bull World Health Organ. 1977;55(4):521–40.
3. Ferrell L. Liver pathology: cirrhosis, hepatitis, and primary liver tumors. Update and diagnostic problems. Mod Pathol. 2000;13(6):679–704.
4. Tsai TY, Hung TH, Livneh H, Lin IH, Lu MC, Yeh CC. Chinese herbal medicine therapy and the risk of mortality for chronic hepatitis B patients with concurrent liver cirrhosis: a nationwide population-based cohort study. Oncotarget. 2018;9(26):18214–23.
5. Corrao G, Ferrari P, Zambon A, Torchio P, Aricò S, Decarli A. Trends of liver cirrhosis mortality in Europe, 1970–1989: age-period cohort analysis and changing alcohol consumption. Int J Epidemiol. 1997;26(1):100–9.
6. Liu Z, Jiang Y, Yuan H, Fang Q, Cai N, Suo C, et al. The trends in incidence of primary liver cancer caused by specific etiologies: results from the Global Burden of Disease Study 2016 and implications for liver cancer prevention. J Hepatol. 2019;70(4):674–83.
7. Blachier M, Leleu H, Peck-Radosavljevic M, Valla DC, Roudot-Thoraval F. The burden of liver disease in Europe: a review of available epidemiological data. J Hepatol. 2013;58:593–608.
8. Qamar AA, Grace ND, Groszmann RJ, et al. Incidence, prevalence, and clinical significance of abnormal hematologic indices in compensated cirrhosis. Clin Gastroenterol Hepatol. 2009;7(6):689–95.
9. Qamar AA, Grace ND, Groszmann RJ, Garcia-Tsao G, Bosch J, Burroughs AK, et al. Platelet count is not a predictor of the presence or development of gastroesophageal varices in cirrhosis. Hepatology. 2008;47(1):153–9.
10. Bashour FN, Teran JC, Mullen KD. Prevalence of peripheral blood cytopenias (hypersplenism) in patients with nonalcoholic chronic liver disease. Am J Gastroenterol. 2000;95(10):2936–9.
11. Lingas EC. Hematological abnormalities in cirrhosis: a narrative review. Cureus. 2023;15(5):e39239.
12. Manrai M, Dawra S, Kapoor R, Srivastava S, Singh A. Anemia in cirrhosis: an underestimated entity. World J Clin Cases. 2022;10(3):777–89.
13. Kaushansky K. Lineage-specific hematopoietic growth factors. N Engl J Med. 2006;354:2034–45.
14. Mitchell O, Feldman DM, Diakow M, Sigal SH. The pathophysiology of thrombocytopenia in chronic liver disease. Hepatic Med Evid Res. 2016;8:39–50.
15. Northup PG, Sundaram V, Fallon MB, et al. Hypercoagulation and thrombophilia in liver disease. J Thromb Haemost. 2008;6(1):2–9.
16. Joeimon JL. A study on haematological abnormalities in chronic liver disease. Univ J Med Med Sci. 2021;7(2).
17. Jose F, Jayaraj PM, Chethan G. Anemia in chronic liver disease and liver failure in adults: a clinical study. Int J Contemp Med Res. 2020;7(2):B33–6.
18. Krithiga E, Kiran CM, Ramdas A, Alexander T. Are hematological parameters associated with disease severity in cirrhotic patients? Indian J Pathol Res Pract. 2018;7(1):45–51.
19. Anbazhagan G, Raj PM, Kalaivalli S, Vishnuprasanth. Red blood cell abnormalities in decompensated chronic liver disease (DCLD). J Evid Based Med Healthc. 2015;2(7):826–33.
20. Kumar EH, Radhakrishnan A. Haematological abnormalities in decompensated chronic liver disease. J Res Med Dent Sci. 2021;9(6):360–7.
21. Shetty V, Yadav SS, Kothari S. Hematological abnormalities in decompensated chronic liver disease: a prospective study from Navi Mumbai. Int J Acad Med Pharm. 2023;5(2):698–701.
22. Sharma A, Bhati MR, Ahmad SW, Jain R. Study of haematological and hemodynamic disorders in chronic liver disease patients in central Rajasthan. Int J Pharm Clin Res. 2022;14(9):9–17.
23. Solomon RT, Aravind A, Selvi CK, et al. A study on hematological abnormalities in chronic liver diseases. IOSR J Dent Med Sci. 2017;16:38–44.
24. Selvamani S, Thomas S. Evaluation of hematological abnormalities in decompensated chronic liver disease patients. IOSR J Dent Med Sci. 2017;16:16–21.
25. Bhatia G, Kaushik S, Kumar R, Kishore S, Bhatia U. Coagulation profile in liver diseases: a study of 300 cases in a tertiary care hospital in Uttarakhand, India. Int J Adv Integr Med Sci. 2017;2(2):61–4.
26. Patil AY, Mudholkar VG. The study of coagulation profile in patients of liver disease. Indian J Pathol Res Pract. 2020;9(2 Pt I):21–6.
27. Ahmed S, Payeng D, Das AK. Etiological profile of cirrhosis of liver from North-East India with reference to their anti-hepatitis A virus seroprevalence. Onc Gas Hep Rep. 2015;4:8–13.
28. Nagarajaiah RB. A clinico-epidemiological profile of liver cirrhosis patients: a hospital-based study. Int J Health Sci Res. 2014;4(2):21–5.
29. Bhattacharyya M, Barman NN, Goswami B. Clinical profile of cirrhosis of liver in a tertiary care hospital of Assam, North East India. IOSR J Dent Med Sci. 2016;15(1):21–7.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Karrolla Shyam Sundhar Reddy
Department of General Medicine, Meenakshi Medical College Hospital and Research Institute, Meenakshi Academy of Higher Education & Research (Deemed to be university), Kanchipuram, India.
Jubeida Aafreen
Department of General Medicine, Meenakshi Medical College Hospital and Research Institute, Meenakshi Academy of Higher Education & Research (Deemed to be university), Kanchipuram, India.
Neelavathi Gopalakrishnan
Department of General Medicine, Meenakshi Medical College Hospital and Research Institute, Meenakshi Academy of Higher Education & Research (Deemed to be university), Kanchipuram, India.
Anbarasu Duraisamy
Department of General Medicine, Meenakshi Medical College Hospital and Research Institute, Meenakshi Academy of Higher Education & Research (Deemed to be university), Kanchipuram, India.