From the Guidelines
Low platelet count and high liver tests require immediate medical attention to rule out potentially life-threatening conditions such as liver disease or cirrhosis, and a healthcare provider should be seen right away for proper evaluation and treatment. This combination of symptoms could indicate several conditions including liver disease, viral hepatitis, autoimmune disorders, medication side effects, or alcohol-related liver damage 1. According to the EASL clinical practice guidelines, patients with cirrhosis frequently acquire substantial alterations in their haemostatic system, which can lead to bleeding complications, but these bleeds are often unrelated to haemostatic failure and are instead caused by portal hypertension or mechanical vessel injury 1.
The liver produces thrombopoietin, which stimulates platelet production, so liver dysfunction can directly impact platelet counts, and an enlarged spleen (often accompanying liver disease) can trap and destroy platelets 1. A study published in Hepatology found that cirrhosis with portal hypertension is well known to cause splenomegaly, which in turn causes platelet sequestration and thrombocytopenia, and that a lower platelet count was significantly associated with increased hepatic venous pressure gradient (HVPG) 1.
Some key points to consider include:
- The absence of high-quality clinical studies represents an additional challenge in constructing guidance, and recommendations should be based on available clinical literature and biochemical studies 1
- Non-invasive liver disease assessment (NILDA) has modest sensitivity and specificity for detection of clinically significant portal hypertension (CSPH), and the best available NILDA for the assessment of CSPH appears to be liver stiffness measurement (LSM) 1
- Treatment depends entirely on the underlying cause, and may involve stopping certain medications, treating infections, managing autoimmune conditions, or addressing alcohol use
- While waiting for medical care, it is essential to avoid alcohol completely, not take non-prescribed medications (especially acetaminophen/Tylenol), and avoid activities with bleeding risk.
It is crucial to seek medical attention promptly to determine the underlying cause of the low platelet count and high liver tests, and to receive appropriate treatment to prevent further complications and improve quality of life.
From the FDA Drug Label
Thrombotic/thromboembolic complications may result from increases in platelet counts with Nplate use. Portal vein thrombosis has been reported in patients with chronic liver disease receiving Nplate. The answer to the question of low platelet and high liver test is that Nplate may increase the risk of thrombotic/thromboembolic complications, including portal vein thrombosis, in patients with chronic liver disease.
- Key points:
- Nplate increases platelet counts
- May cause thrombotic/thromboembolic complications
- Portal vein thrombosis reported in patients with chronic liver disease 2
From the Research
Low Platelet Count and High Liver Test
- A low platelet count, also known as thrombocytopenia, is a common complication of advanced liver disease or cirrhosis, with an incidence of up to 75% 3.
- The pathophysiology of thrombocytopenia in liver disease is multifactorial, including splenomegaly, reduced hepatic synthesis of thrombopoietin, and increased platelet destruction or consumption 3, 4.
- High liver tests can be an indication of liver disease, which can lead to thrombocytopenia due to the liver's reduced ability to produce thrombopoietin, a protein that stimulates platelet production 3, 5.
Causes of Thrombocytopenia in Liver Disease
- Splenic sequestration of circulating platelets due to splenomegaly 4, 3.
- Reduced hepatic synthesis of thrombopoietin, resulting in diminished platelet production and release from the bone marrow 3, 5.
- Increased platelet destruction or consumption 3.
- Immune thrombocytopenia (ITP) may co-occur in patients with liver disease, particularly those with autoimmune liver disease or chronic hepatitis C 4.
- Drugs used for the treatment of liver disease or its complications, such as interferon, immunosuppressants, and antibiotics, may cause thrombocytopenia 4.
Management of Thrombocytopenia in Liver Disease
- Periprocedural management of thrombocytopenia in liver disease depends on both individual patient characteristics and the bleeding risk of the procedure 4.
- Patients with a platelet count higher than or equal to 50,000/µL and those requiring low-risk procedures rarely require platelet-directed therapy 4.
- For those with a platelet count below 50,000/µL who require a high-risk procedure, platelet-directed therapy should be considered, especially if the patient has other risk factors for bleeding 4.
- Thrombopoietin receptor agonists, such as avatrombopag and lusutrombopag, are available for targeted treatment of thrombocytopenia in patients with advanced liver disease undergoing invasive procedures 3, 5.