Thrombocytopenia in patients with chronic hepatitis C virus infection

Sumit Dahal, Smrity Upadhyay, Rashmi Banjade, Prajwal Dhakal, Nabin Khanal, Vijaya R Bhatt

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Thrombocytopenia in patients with chronic hepatitis C virus (HCV) infection is a major problem. The pathophysiology is multifactorial, with auto-immunogenicity, direct bone marrow suppression, hypersplenism, decreased production of thrombopoietin and therapeutic adverse effect all contributing to thrombocytopenia in different measures. The greatest challenge in the care of chronic HCV patients with thrombocytopenia is the difficulty in initiating or maintaining IFN containing anti-viral therapy. Although at present, it is possible to avoid this challenge with the use of the sole Direct Antiviral Agents ( DAAs) as the primary treatment modality, thrombocytopenia remains of particular interest, especially in cases of advanced liver disease. The increased risk of bleeding with thrombocytopenia may also impede the initiation and maintenance of different invasive diagnostic and therapeutic procedures. While eradication of HCV infection itself is the most practical strategy for the remission of thrombocytopenia, various pharmacological and non-pharmacological therapeutic options, which vary in their effectiveness and adverse effect profiles, are available. Sustained increase in platelet count is seen with splenectomy and splenic artery embolization, in contrast to only transient rise with platelet transfusion. However, their routine use is limited by complications. Different thrombopoietin analogues have been tried. The use of synthetic thrombopoietins, such as recombinant human TPO and pegylated recombinant human megakaryocyte growth and development factor (PEG-rHuMDGF), has been hampered by the development of neutralizing antibodies. Thrombopoietin-mimetic agents, in particular, eltrombopag and romiplostim, have been shown to be safe and effective for HCV-related thrombocytopenia in various studies, and they increase platelet count without eliciting any immunogenicity Other treatment modalities including newer TPO analogues- AMG-51, PEG-TPOmp and AKR-501, recombinant human IL-11 (rhIL-11, Oprelvekin), recombinant human erythropoietin (rhEPO), danazol and L-carnitine have shown promising early result with improving thrombocytopenia. Thrombocytopenia in chronic HCV infection remain a major problem, however the recent change in DAAs without IFN, as the frontline therapy for HCV, permit to avoid the dilemmas associated with initiating or maintaining IFN based anti-viral therapy.

Original languageEnglish (US)
Article numbere2017019
JournalMediterranean Journal of Hematology and Infectious Diseases
Volume9
Issue number1
DOIs
StatePublished - Jan 1 2017

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Chronic Hepatitis C
Virus Diseases
Hepacivirus
Thrombocytopenia
Thrombopoietin
oprelvekin
Platelet Count
Therapeutics
Antiviral Agents
Interleukin-11
Hypersplenism
Danazol
Splenic Artery
Platelet Transfusion
Carnitine
Therapeutic Uses
Splenectomy
Erythropoietin
Neutralizing Antibodies
Liver Diseases

Keywords

  • Chronic
  • Chronic complications
  • Chronic drug therapy
  • Direct-acting antivirals therapeutic use
  • Hepatitis C
  • Hepatitis C
  • Hepatitis C
  • Interferon-alpha
  • Ribavirin therapeutic use
  • Therapeutic use
  • Thrombocytopenia drug therapy
  • Thrombocytopenia virology

ASJC Scopus subject areas

  • Hematology
  • Infectious Diseases

Cite this

Thrombocytopenia in patients with chronic hepatitis C virus infection. / Dahal, Sumit; Upadhyay, Smrity; Banjade, Rashmi; Dhakal, Prajwal; Khanal, Nabin; Bhatt, Vijaya R.

In: Mediterranean Journal of Hematology and Infectious Diseases, Vol. 9, No. 1, e2017019, 01.01.2017.

Research output: Contribution to journalArticle

Dahal, Sumit ; Upadhyay, Smrity ; Banjade, Rashmi ; Dhakal, Prajwal ; Khanal, Nabin ; Bhatt, Vijaya R. / Thrombocytopenia in patients with chronic hepatitis C virus infection. In: Mediterranean Journal of Hematology and Infectious Diseases. 2017 ; Vol. 9, No. 1.
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