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Hayashi H, Beppu T, Shirabe K, Maehara Y, Baba H. Management of thrombocytopenia due to liver cirrhosis: A review. World J Gastroenterol 2014; 20(10): 2595-2605 [PMID: 24627595 DOI: 10.3748/wjg.v20.i10.2595]
World J Gastroenterol. Mar 14, 2014; 20(10): 2595-2605 Published online Mar 14, 2014. doi: 10.3748/wjg.v20.i10.2595
Management of thrombocytopenia due to liver cirrhosis: A review
Hiromitsu Hayashi, Toru Beppu, Ken Shirabe, Yoshihiko Maehara, Hideo Baba
Hiromitsu Hayashi, Toru Beppu, Hideo Baba, Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
Ken Shirabe, Yoshihiko Maehara, Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
Author contributions: Hayashi H identified the concept and wrote the draft of the review paper; Beppu T, Shirabe K and Maehara Y provided critical revisions for interventional or surgical procedures; Baba H organized the paper and approved the final version to be published.
Supported by Grant-in-Aid for Young Scientists, Ministry of Education, Culture, Sports, Science and Technology of Japan, No. 24791434 (to Hayashi H) and Takeda Science Foundation, Japan (to Hayashi H)
Correspondence to: Hideo Baba, MD, PhD, FACS, Professor, Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan. hdobaba@kumamoto-u.ac.jp
Telephone: +81-96-3735211 Fax: +81-96-3714378
Received: September 23, 2013 Revised: February 9, 2014 Accepted: February 20, 2014 Published online: March 14, 2014 Processing time: 169 Days and 20.8 Hours
Core Tip
Core tip: The major mechanisms for thrombocytopenia in liver cirrhosis are (1) platelet sequestration in the spleen; and (2) decreased production of thrombopoietin in the liver. For thrombocytopenia that is caused by platelet sequestration in the spleen, partial splenic embolization or laparoscopic splenectomy are effective. Thrombopoietin agonists and targeted agents are alternative tools for noninvasively treating thrombocytopenia due to decreased thrombopoietin production, although their ability to improve thrombocytopenia is under investigation in clinical trials. In this review, we describe the current management of thrombocytopenia due to liver cirrhosis, and we propose the novel concept of using the splenic volume to discern the primary cause of thrombocytopenia due to liver cirrhosis.
