From the Guidelines
Yes, cirrhosis of the liver can cause low white blood cell counts (leukopenia). This condition occurs due to several mechanisms related to advanced liver disease, including hypersplenism, which is the enlargement of the spleen that causes it to trap and destroy white blood cells more aggressively than normal 1. Additionally, cirrhosis can suppress bone marrow function, reducing the production of new white blood cells. Portal hypertension, a common complication of cirrhosis, worsens hypersplenism and consequently lowers white blood cell counts.
Key Mechanisms and Complications
- Hypersplenism: The spleen becomes enlarged and traps white blood cells, leading to their destruction.
- Bone marrow suppression: Cirrhosis can reduce the production of new white blood cells by affecting bone marrow function.
- Portal hypertension: This complication exacerbates hypersplenism, further lowering white blood cell counts.
Management and Treatment
Treatment focuses on managing the underlying liver disease, as improving liver function can help normalize white blood cell production. In severe cases with recurrent infections, medications to stimulate white blood cell production, such as growth factors (e.g., G-CSF), might be considered, though these are used cautiously in patients with liver disease 1. Close monitoring is essential, especially during illness, as patients with cirrhosis-related leukopenia are at a higher risk for infections.
Considerations for Patient Care
- Patients with cirrhosis are generally older and have a lower tolerance to treatment, requiring meticulous monitoring and management of side effects.
- The use of growth factors might be helpful in controlling hematological side effects, including leukopenia, in cirrhotic patients undergoing treatment for conditions like hepatitis C 1.
From the Research
Cirrhosis and Leukopenia
- Cirrhosis of the liver can lead to low white blood cell counts, also known as leukopenia, due to various pathophysiological mechanisms 2.
- Studies have documented a prevalence of leukopenia in patients with compensated cirrhosis, with one study finding a prevalence of 23.5% 2.
- Leukopenia in cirrhosis is often associated with hypersplenism, a condition where the spleen is overactive and removes too many white blood cells from the blood 3, 4, 5.
- The presence of leukopenia in cirrhosis can have significant clinical implications, including an increased risk of infection and bleeding 2, 6.
Hypersplenism and Leukopenia
- Hypersplenism is a common manifestation of portal hypertension in cirrhosis, and can lead to leukopenia due to the spleen's increased removal of white blood cells 4, 5.
- Severe hypersplenism, defined as a white blood cell count < 2,000 per mm3, is an independent predictor of variceal bleeding, spontaneous bacterial peritonitis, and death in patients with cirrhosis 4.
- Treatment of hypersplenism, such as partial splenic artery embolization or splenectomy, can increase white blood cell counts, but may not improve patient survival 3, 5.
Clinical Significance of Leukopenia in Cirrhosis
- Leukopenia in cirrhosis is a predictor of death or transplant surgery, and is associated with increased morbidity and mortality 6.
- The combination of leukopenia and thrombocytopenia at baseline is a strong predictor of increased morbidity and mortality in patients with cirrhosis 6.
- The clinical significance of leukopenia in cirrhosis highlights the importance of monitoring hematologic indices in patients with liver disease 2, 6.