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Blood, Vol. 95 No. 3 (February 1), 2000:
pp. 795-801
Thrombopoietin induces rapid resolution of thrombocytopenia after
orthotopic liver transplantation through increased platelet production
Markus Peck-Radosavljevic,
Martina Wichlas,
Johannes Zacherl,
Gabriele Stiegler,
Petra Stohlawetz,
Michael Fuchsjäger,
Anna Kreil,
Sylvia Metz-Schimmerl,
Simon Panzer,
Rudolf Steininger,
Ferdinand Mühlbacher,
Peter Ferenci,
Johann Pidlich, and
Alfred Gangl
From the Departments of Gastroenterology and Hepatology, Transplant
Surgery, Blood Group Serology and Transfusion Medicine, and Radiology,
University of Vienna, Austria.
Thrombopoietin (TPO) deficiency has been proposed as an important
etiologic factor for thrombocytopenia in advanced-stage liver disease.
To clarify the contributions of platelet production, platelet
consumption, coagulation activation, and splenic sequestration to
thrombocytopenia in liver disease, we studied TPO serum levels and
markers of platelet production, platelet activation, and coagulation activation before and 14 days after orthotopic liver transplantation (OLT) in 18 patients with advanced liver cirrhosis. Thrombocytopenia before transplantation occurred with low-normal serum levels of TPO,
normal levels of platelet and coagulation activation markers, and no
increase in bone marrow production of platelets. TPO serum levels
increased significantly on the first day after OLT, preceding the
increase of reticulated platelets by 3 days and peripheral platelets by
5 days. Normalization of the peripheral platelet count occurred in most
patients within 14 days of OLT, irrespective of the change in spleen
size assessed by computed tomography volumetry. Normalization of
platelet counts was not hampered by a certain degree of platelet
activation observed during the steepest increase in the peripheral
platelet count. Bone marrow production of platelets increased
significantly within 2 weeks of transplantation. Low TPO serum levels
with low platelet counts and without platelet consumption suggests low
TPO production in end-stage liver disease. The rapid increase in TPO
serum levels after transplantation induces an increase in the bone
marrow production of platelets. Decreased TPO production in the
cirrhotic liver is an important etiologic factor for thrombocytopenia
in liver disease that is rapidly reversed by transplantation.
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