A Study on Hematological Abnormalities in Chronic Liver Diseases

Abstract

Aim Of The Study: To assess the hematological profile of patients with chronic liver disease and their correlation in patients with GI Bleed. Materials And Methods: To assess the hematological abnormalities in chronic liver disease, a cross sectional analytical study was conducted All patients taken up for the study were evaluated in detail. Oral consent was obtained for clinical examination and lab investigations. Written consent was obtained for procedures such paracentesis, Upper GI endoscopy and viral marker studies. Inclusion Criteria 1. All patients with liver disease whose symptoms and signs persists for more than 6 months 2. Alcoholic cirrhosis, post-necrotic cirrhosis, metabolic causes of liver diseases were taken up for the study Exclusion Criteria 1. Patients with underlying malignancy or known primary hepatocellular carcinoma were excluded 2. Patients with primary coagulation disorder or primary abnormalities of haemostatic function were excluded. 3. Acute hepatic failure was excluded 4. Patients with preexisting anemia due to other causes were excluded. 5. Patients suffering from end stage medical diseases like COPD, Coronary artery disease, cardiac failure, CKD were excluded Observation & Data Analysis: A descriptive study to assess the hematological abnormalities in chronic liver disease was conducted at Department of Digestive Health and diseases, Kilpauk medical college , Chennai from August 2016 to January 2017. 50 patients with chronic liver disease were taken for the study; this included 43 males (86%) and 7 females (14 %). The age range was from 24 to 70. The average age of the patients in the study was 48 yrs. 70 % of the patients were between 40 and 60 years. 52% of the patients had alcoholic cirrhosis were males. The aetiology of chronic liver disease could not be determined in 24 % of cases but all of them had clinical and radiological features of cirrhosis. 6 patients had Hepatitis B and 2 had Hepatitis C; all these 8 patients had cirrhosis. Autoimmune hepatitis and cirrhosis were present in 2 females Results: 50 % of the patients had thrombocytopenia (<1 lakh). Of the 13 patients who had an upper GI bleed 3 patients had normal platelet counts and the rest had counts below 1 lakh. The average platelet count of patients who experienced an upper GI bleed was 92000 vs. 1.2 lakh in patients without a GI bleed. The bleeding time was prolonged only in 6 patients with thrombocytopenia indicating BT as an insensitive test. 36 patients had a prolonged INR. Among the 13 patients with upper GI bleed 9 had prolonged INR; indicating other factors play a role in GI bleed Conclusions: Many conclusive results regarding the hematological abnormalities in chronic liver disease were obtained with this limited study involving 50 patients with cirrhosis ⇒ 50 % of patients had thrombocytopenia. ⇒ The average platelet count of patients with an upper GI bleed was 92000 compared to 1.2 lakh to those without an upper GI bleed; suggesting other factors such functional platelet defects may play a role as well. These need to be confirmed with platelet functional studies. ⇒ Bleeding time was prolonged only in 12 % of patients with thrombocytopenia indicating BT as an insensitive test of platelet number and function. ⇒ The PT-INR was elevated in 72 % of patients. However only 25 % of patients with a prolonged PT-INR had upper GI bleed indicating other factors such as a rebalanced hemostatic system at work, however this A Study on Hematological Abnormalities in Chronic Liver Isease DOI: 10.9790/0853-1606143844 www.iosrjournals.org 39 | Page needs to be confirmed with more extensive studies. This result underlines the fact that clinical status of the patient and not lab values have to be treated, when correcting coagulopathy in a patient with cirrhosis. From this study we can conclude that various hematological alterations are very common in cirrhosis patients that needs to be identified and corrected early to reduce morbidity and mortality.