LOW PLATELET COUNT AS AN EARLY INDEX FOR OESOPHAGEAL VARICES IN PATIENTS WITH PORTAL HYPERTENSION
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Abstract
Objective: To determine if low platelet count can be used as an index for detection of esophageal varices in patients
with portal hypertension.
Material and Methods: This cross sectional analytic study was conducted in Bilal Medical Trust Hospital, Pir Baba and
Kuwait Teaching Hospital, Peshawar, Pakistan from January 2015 to December 2015. After approval from the hospital
ethical and research committee the study was conducted and it included patients recruited through non probability
consecutive sampling, presenting to OPD. A detailed history and physical examination was done after which the liver
was thoroughly assessed by a detailed ultrasound of the abdomen. The liver size, echo pattern of established signs of
cirrhosis , uneven hepatic margins, increased parenchymal reflectivity, coarseness, increased echo graphic contrast
between right lobe of liver and right kidney, hypertrophied caudate lobe, and attenuated hepatic veins were assessed
to diagnose cirrhosis. Hepatic focal lesions and portal vein patency and diameter along with splenic size, Portal vein,
hepatic artery, and splenic artery flow and patency were noted. Full blood count, ALT, hepatitis Band C serology was
done at the time of admission. A screening endoscopy was undertaken next to assess the presence or absence of the
varices. The varices after detection was graded according to the Paquet grading system.
Results: Among the total 123 patients examined 60% were females and 40% were males. Minimum age was 30 and
maximum age was 70. Average age was 51. Among different age groups 4 (3.2%) belonged to age group 30 to 40
years, 33(26.2%) belonged to age group 40 to 50 years, 47 (38.2%) aged 50 to 60 years and 40(32.5%) belonged to
60 to 70 years age group. The serology done for hepatitis revealed hepatitis C in all of the cases as an etiology 123
(100%). The platelet count was measured next and the data further stratified accordingly. About 8(6.5%) had a platelet
count between 30-50,000. Around 18(14.6%) had a platelet count in the range of 50-70,000. Of all patients maximum
33(26.8%) had the platelet count in the range of 70-90,000. Also another 31(25.2%) had the same counts in the range of
90-110,000. In about 20(16.2%) the platelet counts were in the range of 110-130,000. Only 13(10.5%) had platelet counts
in the range of 130-150,000. Next the data was analyzed for the esophageal varices. Again the data was subdivided
in to four groups according to the presence and grades of varices. A total of 32(26%) had no varices on endoscopy.
About 31(37%) had Grade 1 varices, whereas 14(12%) had Grade 2 varices. An alarming 31(38%) had Grade 3 varices
on endoscopy. After running correlation the p value for the variables varices and platelet count was 0.098 (significant
at 10%) and as such showed no clear and consistent relationship between the two variables. However on further extrapolating
the study it was found that gender (females) showed a partial relationship (Table 1) between falling platelet
counts and higher grades of varices (p value 0.02).
Conclusion: Low platelet count alone cannot be used as an early index for the presence of esophageal varices in
patients with portal hypertension.
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