THROMBOCYTOPENIA IN PATIENTS WITH CHRONIC HEPATITIS C VIRUS INFECTION
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 th...
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PAGEPress Publications
2017-03-01
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| Series: | Mediterranean Journal of Hematology and Infectious Diseases |
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| Online Access: | http://www.mjhid.org/index.php/mjhid/article/view/2835 |
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| author | Sumit Dahal Smrity Upadhyay Rashmi Banjade Prajwal Dhakal Navin Khanal Vijaya Raj Bhatt |
| author_facet | Sumit Dahal Smrity Upadhyay Rashmi Banjade Prajwal Dhakal Navin Khanal Vijaya Raj Bhatt |
| author_sort | Sumit Dahal |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-f2af53357c544c7e93c0ade328627792 |
| institution | Kabale University |
| issn | 2035-3006 |
| language | English |
| publishDate | 2017-03-01 |
| publisher | PAGEPress Publications |
| record_format | Article |
| series | Mediterranean Journal of Hematology and Infectious Diseases |
| spelling | doaj-art-f2af53357c544c7e93c0ade3286277922024-12-02T00:00:53ZengPAGEPress PublicationsMediterranean Journal of Hematology and Infectious Diseases2035-30062017-03-0191e2017019e201701910.4084/mjhid.2017.0191677THROMBOCYTOPENIA IN PATIENTS WITH CHRONIC HEPATITIS C VIRUS INFECTIONSumit Dahal0Smrity Upadhyay1Rashmi Banjade2Prajwal Dhakal3Navin Khanal4Vijaya Raj Bhatt5Interfaith Hospital, Department of Medicine, New York, USACreighton University Medical Center, Department of Internal Medicine, Omaha, Nebraska, USA3Montefiore New Rochelle Hospital, Department of Medicine, New York, USAMichigan State UniversityCreighton University Medical Center, Department of Internal Medicine, OmahaUniversity of Nebraska Medical Center, Department of Internal Medicine, Division of Hematology-Oncology, Omaha, Nebraska, USAThrombocytopenia 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.http://www.mjhid.org/index.php/mjhid/article/view/2835Hepatitis C, ChronicHepatitis C, Chronic/ complicationsHepatitis C, Chronic/ drug therapyThrombocytopenia/virologyThrombocytopenia/drug therapyRibavirin/therapeutic useInterferon-alpha/ therapeutic use |
| spellingShingle | Sumit Dahal Smrity Upadhyay Rashmi Banjade Prajwal Dhakal Navin Khanal Vijaya Raj Bhatt THROMBOCYTOPENIA IN PATIENTS WITH CHRONIC HEPATITIS C VIRUS INFECTION Mediterranean Journal of Hematology and Infectious Diseases Hepatitis C, Chronic Hepatitis C, Chronic/ complications Hepatitis C, Chronic/ drug therapy Thrombocytopenia/virology Thrombocytopenia/drug therapy Ribavirin/therapeutic use Interferon-alpha/ therapeutic use |
| title | THROMBOCYTOPENIA IN PATIENTS WITH CHRONIC HEPATITIS C VIRUS INFECTION |
| title_full | THROMBOCYTOPENIA IN PATIENTS WITH CHRONIC HEPATITIS C VIRUS INFECTION |
| title_fullStr | THROMBOCYTOPENIA IN PATIENTS WITH CHRONIC HEPATITIS C VIRUS INFECTION |
| title_full_unstemmed | THROMBOCYTOPENIA IN PATIENTS WITH CHRONIC HEPATITIS C VIRUS INFECTION |
| title_short | THROMBOCYTOPENIA IN PATIENTS WITH CHRONIC HEPATITIS C VIRUS INFECTION |
| title_sort | thrombocytopenia in patients with chronic hepatitis c virus infection |
| topic | Hepatitis C, Chronic Hepatitis C, Chronic/ complications Hepatitis C, Chronic/ drug therapy Thrombocytopenia/virology Thrombocytopenia/drug therapy Ribavirin/therapeutic use Interferon-alpha/ therapeutic use |
| url | http://www.mjhid.org/index.php/mjhid/article/view/2835 |
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