Further insights into the causes of thrombocytopenia in chronic hepatitis C.

Thrombocytopenia is likely the most common and prevalent haematological abnormality that can be found in patients affected by chronic liver disease [1]. A recent systematic review has shown that, in patients chronically infected with the hepatitis C virus (HCV), the prevalence of thrombocytopenia may vary from 0.16% in a cohort study that identified patients with severe autoimmune cytopenia alone to 45.4% in a study that included only patients with compensated cirrhosis [2-4]. In particular, the results of this review showed that the prevalence of thrombocytopenia in chronic HCV infection depends upon several factors, mainly the threshold used to define the haematological abnormality and the severity of the underlying liver disease in the studied population [4]. However, the most important evidence “hidden” in the data reviewed indirectly pointed to a multi-factorial aetiology of thrombocytopenia in chronic hepatitis C [5]. In the article published in this issue of the Journal of Gastrointestinal and Liver Diseases, Olariu and colleagues evaluated the prevalence of several possible causes for thrombocytopenia in a series of patients with chronic hepatitis C in Romania [6]. The authors provided no information regarding the prevalence of thrombocytopenia in the chronic hepatitis C patients population referred to their centre, but used the most common definition of thrombocytopenia (i.e., platelet count <150x109/L), subdivided their study population according to various platelet cut-offs, and excluded patients on interferon-based antiviral therapy as well as patients with cirrhosis [6]. Although the majority of patients evaluated (97.5%) had at least significant fibrosis and half of them had significant fibrosis – and increasing fibrosis stages have been associated with more prevalent thrombocytopenia [7, 8] – the edITorIal