الفهرس 
THROMBOCYTOPENIAOnly 14 pages are availabe for public view
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Abstract
Liver cirrhosis is widely prevalent worldwide and can be occurred due to different causes, such as obesity, non-alcoholic fatty liver disease, high alcohol consumption, hepatitis B or C infection and autoimmune diseases.
Patients with cirrhosis can be asymptomatic or symptomatic, depending on whether the cirrhosis is clinically compensated or decompensated. It has many complications, portal hypertension, ascites esophageal varices hepatic encephalopathy and splenomegaly. Patients with cirrhosis may have impaired pulmonary function, pleural effusions and hepatopulmonary syndrome.
One of the main complications of liver cirrhosis is low platelets count (thrombocytopenia), which is defined as a platelet count less than 150,000/μL and often is the first abnormality seen in patients with chronic liver disease. Thrombocytopenia affects approximately 6% of patients without cirrhosis and 70% of patients with cirrhosis.
Thrombocytopenia can be used as a marker of advanced liver disease. Thrombocytopenia plays an important role in the management of liver cirrhosis because several procedures have significant bleeding risks associated with them.
Diagnosis of liver cirrhosis can be classified into invasive and noninvasive methods. Liver biopsy has been used for the diagnosis, pathological assessment and staging of liver fibrosis. Elastography, shear wave elastography is an important non-invasive radiological method for assessment of liver stiffness and prediction of the presence of gastro-esophageal varices in cirrhotic patients. It is widely used to assess LS and SS, can sample a much larger area compared to biopsy and is painless and shows a reasonable correlation with the severity of cirrhosis.
So, our cross-sectional study aimed to evaluate the relationship between spleen, liver stiffness measured by elastography and the degree of thrombocytopenia in patients with liver cirrhosis.
Our study includes 50 patients suffering from liver cirrhosis and have thrombocytopenia. All were selected from the Internal Medicine Department of Benha University Hospital and each patient was subjected to full history taking, full Clinical examination and full investigations.
The current study showed that splenomegaly was significantly associated with moderate and severe thrombocytopenia while, platelets count had significant negative correlations with total, direct bilirubin, INR, and significant positive correlations with albumin and PT.
Assessment of liver stiffness in our study by elastography, revealed significant correlation with the degree of thrombocytopenia. Liver stiffness values combined with platelet counts are useful to rule out varices requiring treatment.
Our study has demonstrated that liver stiffness showed significant positive correlations with total, direct bilirubin, INR and no significant correlations with AST and ALT, and significant negative correlations with albumin and PT also, liver stiffness was significantly higher in cases with splenomegaly when compared with those with no splenomegaly and splenic stiffness was significantly correlated with degree of thrombocytopenia. Stiffness of spleen was significantly higher in our cases with splenomegaly when compared with those with no splenomegaly.
SS in the current study had significant positive correlations with total, direct bilirubin, INR, and significant negative correlations with albumin and PT. LS and SS had excellent discrimination between grades of thrombocytopenia, although SS was superior to LS. Moreover, SS and LS were considered as independent predictors for more severe thrombocytopenia in our results, although SS was superior to LS.
In the present study, there were no association was found regarding age gender, and DM with thrombocytopenia grades, Regarding the laboratory data, there were no significant association regarding bilirubin, albumin, AST, ALT, PT, INR, AFP, creatinine, Hb and TLC according to thrombocytopenia.