Thrombopoietin level in HCV Egyptian patients

Thrombocytopenia is a common finding in patients with chronic hepatitis. A variety of pathogenic mechanisms are reported to be implicated in thrombocytopenia related to chronic HCV infection. The aim of the present study is to evaluate the role of thrombopoitin (TPO) in pathogenesis of thrombocytopenia in HCV infected patients and to demonstrate if there is a correlation between TPO level and viral load, degree of inflammation and degree offibrosis. This study was carried out on a group of 30 HCV infected patients recruited from Kasr El-Eini hospital. Liver function tests, polymerase chain reaction (PCR) for HCV (quantitative), complete blood counts, serum TPO levels and abdominal ultrasonography were done to all case. Patients were classified according to their viral load into 3 groups Group I (6 cases) with low viral load Group II (14 cases) with moderate viral load and Group III (10 cases) with high viral load. The results showed that platelets count and serum TPO are significantly higher in patients with mild viremia compared with groups with moderate or high viremia . No statistically significant differences were found between group Hand III. Liver biopsies were donefor 17 patients. It wasfound that the platelets count is significantly higher in patients with mild inflammation (Group A) when compared with patients with moderate»inflammation (Group B). Again TPO was found to be significantly higher in Group A when compared with Group B. When those patients were classified according to degree of fibrosis, the platelet count showed significant variations with degree of fibrosis being higher inpatients with less fibrosis. A positive coirelation between platelets counts and serum TPO level was found. We conclude that in HCV infected patients platelets counts and TPO serum levels were significantly higher inpatients with mild viremia compared with groups with moderate or high viremia, additionally, the higher the grade of inflammation or stage of fibrosis the lower platelet counts and TPO levels , a positive correlation was found between TPO serum levels and platelets counts. We recommend the following: Assessment of serum TPO level pre and post treatment with IFN in HCV infected patient and observe the relation between reduction of viral load and TPO to confirm the role of TPO in thrombocytopenia, Assessment of serum TPO level in HCV infected thrombocytopenic patient to assess the variable response to TPO receptor agonist and accordingly recommend guidelines for benefit of use of TPO receptor agonist in thrombocytopenic patient according to endogenous TPO level.