Thrombocytopenia and its Related Factors: A Hospital-based, Cross-sectional Study

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FULL TEXT: http://www.annals.edu.sg/pdf/39VolNo1Jan2010/V39N1p9.pdf

Original Article

Thrombocytopenia and its Related Factors: A Hospital-based, Cross-sectional

Study

Abstract

Introduction:

The objective of this study was to explore the association between

thrombocytopenia

and its related factors.

Materials and Methods: This was a hospital-based, crosssectional

study. We retrospectively analysed the medical records of all patients who

received

periodic health examinations at a medical centre located at Taichung in Taiwan

between 2000

and 2004. In all, 5585 subjects were included for further analysis. A complete

physical examination,

laboratory survey and abdominal ultrasonography were performed on each subject.

The t-test, chi-square test and multivariate logistic regression analysis were

used.

Results: The

subjects consisted of 3123 men (55.9%) and 2462 women (44.1%). The mean age was

49.4 ±

12.3 years (range, 20 to 87). The overall prevalence of thrombocytopenia was

found to be 0.5%,

higher in men than in women (0.6% vs 0.4%, P = 0.504). After controlling for the

other covariates,

multivariate logistic regression analysis exhibited that the factors

significantly related to

thrombocytopenia were increasing age (OR, 1.04; 95% CI, 1.004-1.08), anti-HCV

positive (OR,

5.24; 95% CI, 2.08-13.20), liver cirrhosis (OR, 7.93; 95% CI, 2.28-27.62), and

splenomegaly

(OR, 18.86; 95% CI, 6.86-51.87).

Conclusion: It is advisable to further check the hepatic status,

if thrombocytopenia is noted.

Ann Acad Med Singapore 2010;39:9-12

1 Department of Family Medicine, China Medical University Hospital, Taichung

City, Taiwan

2 Department of Family Medicine, Jen-Ai Clinic, Taichung County, Taiwan

3 Department of Internal Medicine, China Medical University Hospital, Taichung

City, Taiwan

4 Department of Internal Medicine, Puli Christian Hospital, Nantou County,

Taiwan

5 Department of Family Medicine, Private Clinic, Taichung City, Taiwan

Address for Correspondence: Dr Kuan-Fu Liao, Department of Internal Medicine,

Puli Christian Hospital, No. 1, Tieshan Road, Puli, Nantou County, 545 Taiwan

Email: kuanfuliao@...

Thrombocytopenia and its Related Factors: A Hospital-based, Cross-sectional

Study

Shih-Wei Lai,1MD, Ching-Yi Huang,2MD, Hsueh-Chou Lai,3MD, Kuan-Fu Liao,4MD,

Yen-Miao Lai,5MD,

Chiu-Shong Liu,1MD, Tsann Lin,1MD, PhD

Introduction

Thrombocytopenia is a common clinical problem found

in laboratory results during health examinations. Blood

platelets play an essential role in haemostasis, thrombosis

and coagulation of blood.1 Platelets are the smallest units

of blood cells. They are formed in the bone marrow by the

fragmentation of megakaryocyte cytoplasm.2 The normal

platelet concentration in adult ranges from 150,000 to

450,000//ìL.3 They circulate in the blood for 8 to 12 days.1,2

Bleeding time is generally not prolonged until the platelet

count is below 100,000/ìL.4 However, as long as platelet

counts are more than 20,000/ìL, clinical manifestations may

be mild, often limited to easy bruising.4 If less than 10,000/

ìL, the risk of spontaneous mucocutaneous bleeding,

intracranial haemorrhage or gastrointestinal bleeding

increases markedly.2,4

A previous study revealed that thrombopoietin, a ligand

for the receptor encoded by protooncogene c-mpl, may

play an important role in the regulation of megakaryocyte

development and platelet production.5 The production of

thrombopoietin is mainly from the liver.6 In Streiff et al's

study, patients with hepatitis C infection are more likely

to have low platelet counts.7 The hepatitis virus principally

replicates in the liver and its cardinal manifestation is

progression to chronic liver disease. A decreased production

of thrombopoietin in patients with chronic liver disease can

result in defi cient platelet production by the bone marrow.8,9

In Taiwan, hepatitis B and hepatitis C infections are

hyperendemic, which may lead to liver cirrhosis, and

even hepatocellular carcinoma, after many years. We

hypothesise a link between the 2 conditions, that patients

infected with viral hepatitis may have a higher frequency

of thrombocytopenia.

To date, there is little evidence of a relationship between

thrombocytopenia and its related factors in Taiwan. This

study analysed data collected from a medical centre in

Taiwan to explore the following questions: (i) what is the

prevalence of thrombocytopenia? (ii) what are the related

factors of thrombocytopenia?