Jaundice and low platlet count

There are lots of causes that can cause simultaneously jaundice and low platlet count. Among them some are common like chronic liver disease and some rare like Wilson disease. Let’s look into the causes:

  • Acute viral Hepatitis (inflammation of liver tissue)
  • Chronic viral hepatitis
  • Autoimmune hepatitis
  • Cirrhosis
  • G6PD deficiency or Favism
  • Lymphoma and some blood cancers
  • Hemolytic anemia (blood cell destruction in blood stream )
  • Some drugs adverse effect
  • Poisoning by some chemical elements
  • Wilson disease
  • Some bile duct disease

Please consider that listing all the causes of this phenomenon is beyond the scope of this article thus we will try to clarify the most common causes.

About seventy-six percent of people with chronic liver disease have low platelet counts, thrombocytopenia, or decreased blood flow platelets due to liver disorders. May occur with jaundice due to hepatic impairment.

 

Chronic liver disease

Acute or chronic Hepatitis

Hemolytic anemia

Bile duct problems

Hemolytic uremic syndrome or HUS

G6PD deficiency

 

 

Chronic liver disease

There are many different causes that can affect liver functions, some with long lasting sequels, some with sudden and acute consequences and some with late and chronic problems.

When the liver’s function mostly impaired gradually then cascade of problems appear. This chronic impairment of liver function generally is called Chronic liver disease of Cirrhosis.

More than 76 percent of patients with chronic liver disease or CLD have a platelet count of less than one hundred and fifty thousand per microliter of blood, thirteen percent of patients with cirrhosis or liver failure have a platelet count between seventy-five thousand to fifty thousand per microliter of blood.

 

What causes thrombocytopenia or low platelets in chronic liver disease?

  • Trapping of blood platelets in the spleen and destruction of platelets in it or hypersplenism (spleen sequestration) that is caused by cirrhosis or the underlying diseases.
  • Decreased platelet production in the bone marrow
  • Decreased function of hematopoietic cell growth factors or hematopoietic factors that are essential for platelet stimulation and production. The factor that is needed for platelets to be made in the bone marrow is called TPO, which is made by a healthy liver.
  • In chronic diseases and liver failure associated with jaundice, TPO production is greatly reduced.
  • Increased venous pressure in the liver, which increases the trapping and destruction of blood platelets in the spleen.

 

What are the side effects of platelet depletion?

Decreased Platelet or thrombocytopenia is a marker that indicates advanced liver dysfunction and is commonly seen in fibrosis or advanced liver failure (liver cirrhosis).

Low platlet count and jaundice are indicator of progressive liver failure. Gastrointestinal bleeding and intracranial hemorrhage are associated with fetal outcome in individual with liver failure.

 

 Jaundice and low platlet count

Briefly, chronic liver disease that leads to liver failure or cirrhosis, will be associated with a decrease in platelet count in the advanced stages.

 

What are the other symptoms of liver failure or cirrhosis?

In the early stages of liver failure, the symptoms will be mild and nonspecific. As the liver failure progresses; the symptoms will become more prominent and specific. Some of the most common symptoms including:

  • Fatigue
  • Weakness
  • nausea and vomiting
  • Jaundice of the skin and sclera of the eyes
  • Severe itching of the skin
  • Abdominal dehydration or hepatic acidosis
  • Upper and right abdominal pain
  • Swelling of the feet and ankles
  • dizziness
  • Drowsiness
  • Dementia and difficulty concentrating
  • Unconsciousness
  • Ascites

 

Jaundice and low platlet count

 

One of the most dangerous and serious complications in patients with jaundice and low platelet count in chronic liver disease and hypertension of the portal vein of the liver is severe gastrointestinal bleeding that can be life threatening.

 

What are gastrointestinal varicose veins?

Veins in esophagus and stomach wall become swollen, twisted and enlarged because of partial occlusion across their passage in liver.

As the liver failure progresses, these veins become enlarged and become very prone to rupture. Combination of varicose veins and low platelet counts, make gastrointestinal bleeding fetal and severe in one with cirrhosis.

Decreased platelets is a common symptom in chronic liver disease along with jaundice, which occurs for the following two main reasons:

  1. Decreased production of platelet growth factor (TPO) which is necessary for platelet production.
  2. Trapping and destruction or phagocytosis of platelets in the spleen

 

Can decreased platelet itself lead to jaundice?

The answer is yes! One without liver failure may have thrombocytopenia, which means that the number of platelets in blood drops below 150k.

One of the most important functions of platelets in our body is to prevent easy and excessive bleeding.

When the platelet counts are below normal levels, even light pressure and damage on skin may result in bleeding of small vessels and collection of blood inside skin which is called hematoma.

The so-called skin bruises will happen easily. In severe platelet depletion, internal bleeding, especially gastrointestinal bleeding, may occurs easily.

Intracranial hemorrhage may happen by gentle traumas to the head.

When bleeding occurs in the subcutaneous tissue, inside the joints, and inside the skull, red blood cells die and the process of their clearance and absorption begins.

Hemolysis is the process of red blood cells destruction, in which some substances like Bilirubin and Uric acid are released into blood stream. Clearance of these toxic substances is accomplished mainly by liver.

High blood level of Bilirubin accounts for jaundice and unconsciousness.

In advanced stage of cirrhosis and liver dysfunction, there is accumulation of toxic substances in body.

 

Acute or chronic Hepatitis

Some viral infections, such as EBV, HBV and HCV can also be associated with decreased platelets and sometimes jaundice whether suddenly or gradually.

Some medications like acetaminophen may cause hepatitis in large dosages.

The following are the most common causes for hepatitis:

  • Drug induced hepatitis
  • Auto immune hepatitis
  • Alcohol induced hepatitis
  • Bile duct induced hepatitis

 

Hemolytic uremic syndrome or HUS

There is also a rare disorder called hemolytic uremic syndrome, which is associated with increased degradation and lysis of RBCs and decreased platelet count. High levels of bilirubin in the bloodstream may be associated with jaundice in addition to low platlet count.

 

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