Hepatic cirrhosis causes pancytopenia: a case report

Abstract

Hepatic cirrhosis is a slow process liver disease, persisting over a long period of time, resulting in a progressive destruction, and is the final common pathological pathway. We report a case of 60-year-old man with hepatic cirrhosis and pancytopenia. He came to emergency room with chronic fatigue, light headed, and abdominal pain. In laboratory examination, hemoglobin 6.0 g/dL, red blood cell counts 2.8×106/mm3, platelets 58.000×103/mm3, leukocytes 3.800×103/mm3, and reactive HbsAg. Abdominal ultrasound revealed small liver with irregular edges, ascitic fluid, and enlarged spleen. The patient was treated with furosemide, spironolactone, lactulose and propranolol. The liver, or the hepatocyte constitutes a significant storage site for iron, produce erythropoietin and thrombopoietin. Hypersplenism causes retention of a large number of leukocytes, erythrocytes, and platelets in the spleen, and the number of retained blood cells can be 5.5-20 times higher than the normal level, thus facilitating capture, phagocytosis or destruction of blood cells by phagocytes resulting in peripheral cytopenias. This case illustrated that hepatic cirrhosis can cause pancytopenia. Therefore, we must look for any cause of pancytopenia in a patient with chronic liver disease. Lack of thrombopoietin and erythropoietin production, lack of iron storage in damaged hepatocyte, also splenic sequestration were the reason of pancytopenia in hepatic cirrhosis. Bone marrow examination is one of modalities that can be use, and still being recommended examination.

Profil Pemeriksaan Hematologi dan Fungsi Hati pada Lansia dengan Sirosis Hepatis

“…Berkurangnya zat besi akan mempengaruhi proses eritropoiesis yang menyebabkan berkurangnya jumlah eritrosit dan kadar Hb dalam tubuh. Sel Hati juga memproduksi eritropoietin walaupun dalam jumlah yang sedikit, bila terjadi kerusakan pada sel hati, hal ini juga dapat menurunkan proses eritropoesis yang berakibat menurunnya kadar Hb (14)(15)(16)(17).…”