Are there special considerations for managing thrombocytopenia with different types of chronic liver disease?
A number of factors contribute to the development of thrombocytopenia with chronic liver disease, including the liver disease etiology such as hepatitis C. Some of the reasons why patients infected with hepatitis C may have a greater degree of thrombocytopenia may be direct bone marrow suppression by the viral infection and the production of anti-platelet antibodies which may enhance platelet clearance. Patients with hepatitis C may have thrombocytopenia without overt liver disease. Not only can hepatitis C lead to cirrhosis and portal hypertension which causes thrombocytopenia, but the treatment for the viral infection can also lower the platelet count. Between 3–4% of patients treated with pegylated interferon in pivotal trials required dose reduction for thrombocytopenia. In patients treated with pegylated interferon alfa-2a and ribavirin, the dose should be reduced to 90 mcg and discontinued when the platelet count is below 50,000 per cubic millimeter and 25,000 per cubic millimete
