Will a history of cirrhosis (liver cirrhosis) cause a decrease in white blood cell (WBC) count?

From the Guidelines

Cirrhosis can indeed cause a decrease in white blood cell (WBC) count, known as leukopenia, due to several mechanisms including splenomegaly and portal hypertension. The damaged liver has reduced ability to filter bacteria from the bloodstream, leading to increased bacterial products in circulation that can suppress bone marrow function where WBCs are produced. Additionally, cirrhosis often causes splenomegaly (enlarged spleen), which can trap and destroy WBCs, further reducing their numbers in circulation. Portal hypertension, a common complication of cirrhosis, can also contribute to hypersplenism and subsequent WBC reduction.

Key Points to Consider

• Patients with cirrhosis-related leukopenia may be at higher risk for infections due to both the reduced number of immune cells and their impaired function.
• Clinicians should monitor WBC counts in cirrhotic patients and maintain a high index of suspicion for infection even without typical inflammatory markers, as these patients may not mount a normal immune response.
• No specific treatment is typically needed for the leukopenia itself, but addressing the underlying liver disease through appropriate management of cirrhosis is important, as noted in recent clinical practice guidelines 1.
• The use of viscoelastic tests, such as thromboelastography (TEG) or rotational thromboelastometry (ROTEM), may provide additional information on the coagulation status of patients with cirrhosis, but their role in predicting post-procedural bleeding is still being explored 1.

Clinical Implications

• Clinicians should be aware of the potential for leukopenia in patients with cirrhosis and take steps to monitor and manage this condition.
• The management of cirrhosis-related leukopenia should focus on addressing the underlying liver disease, rather than the leukopenia itself.
• Further research is needed to fully understand the mechanisms of cirrhosis-related leukopenia and to develop effective strategies for prevention and treatment.

From the Research

Hematological Abnormalities in Liver Cirrhosis

• Hematological abnormalities, including thrombocytopenia, leukopenia, and anemia, are common in patients with liver cirrhosis 2.
• The prevalence of thrombocytopenia, leukopenia, and anemia in patients with compensated cirrhosis is 77.9%, 23.5%, and 21.1%, respectively 2.
• Leukopenia, defined as a white blood cell count < 4000/mm3, can occur in patients with liver cirrhosis, with a median time of occurrence of 30 months 3.

White Blood Cell Count in Liver Cirrhosis

• A history of cirrhosis can lead to a decrease in white blood cell (WBC) count, with leukopenia occurring in approximately 23.5% of patients with compensated cirrhosis 2.
• Baseline leukopenia has been shown to be a predictor of death or transplant in patients with cirrhosis, after adjusting for baseline hepatic venous pressure gradient and Child-Pugh scores 3.
• The hepatic venous pressure gradient (HVPG) has been found to correlate with white blood cell count, with a negative correlation (r = -0.31, P < 0.0001) 3.

Clinical Significance of Abnormal Hematologic Indices

• Abnormal hematologic indices, including leukopenia and thrombocytopenia, can have significant clinical implications, including increased risk of infection, bleeding, and thrombosis 2, 4.
• A combination of leukopenia and thrombocytopenia at baseline has been shown to predict increased morbidity and mortality in patients with cirrhosis 3.