A rare case of thrombocytosis presentation in patient alcoholic liver disease with portal hypertension gastropathy: a stepwise evaluation

Thrombocytosis is rarely found in patient with chronic liver disease (CLD). The possibility of reactive thrombocytosis could be due to sustained process such as iron deficiency anemia (IDA) because of occult bleeding. Occult bleeding can happen in CLD patient because of portal hypertension gastropathy (PHG) as complication of portal hypertension. A carefully evaluation of anemia can lead to underlying cause of disease, even in limited of supportive evaluationand some other confounding presentation that is thrombocytosis.We report a case of 54 years-old male patient with severe anemia. He had same symptom previously and got transfusion. Peripheral blood smear showed microcytic hypochromic anemia, anisocytosis, and poikilocytosis even pencil cells (pencil cells or cigar cells) with thrombocytosis. No symptom of acute inflammation setting and no clear blood loss was founded. As patient admitted to smoking and heavy alcohol consumption in the past, Ultrasound was performed for screening of underlying disease that cause occult bleeding. Ultrasound of the liver showed generally increased echogenicity suggestive of liver cirrhosis, splenomegaly and minimal ascites. Thus, our patient clinically be suggestive of CLD with portal hypertension that cause PHG.

Multivariate analysls of the portal vein thrombosis in patients with liver clrrhosis / 中国医师进修杂志

ObjectiveTo investigate the related risk factors ot the portal vein thrombosis (PVT) in patients with liver cirrhosis.MethodsThirty-seven liver cirrhosis patients with PVT (PVT group) and 100 liver cirrhosis patients without PVT (control group) from Jan.2007 to Dec.2009 were enrolled.The clinical data of these patients were collected and the related risk factors of PVT were analyzed.ResultsThe increase of D-dimer,severe esophageal varices(EV) and portal hypertension gastropathy(PHG) were the risk factors of PVT in liver cirrhosis patients(OR =12.872,3.916 and 2.851).No significant correlation was found between sex,platelets,albumin and PVT.ConclusionsThe increase of D-dimer,severe EV and PHG are the main risk factors of PVT.The above examinations should be used to monitor patients with liver cirrhosis for early prevention and diagnosis of PVT.