identify patients with cirrhosis before complications like HCC and variceal bleeding.
Enter the platelet count
Shout out to JAMA's Rational Clin Exam Series & Udell et al's big beautiful systematic review ncbi.nlm.nih.gov/pubmed/22357834
Even in their guidelines for the evaluation of elevated ALT, the brits make a plea for looking at platelet-based scores the minute you realize ALT abnormal (ncbi.nlm.nih.gov/pmc/articles/P…)
So why are platelets low in #cirrhosis?
At least 3 reasons:
- Splenic pooling
- Increased destruction
- Low production
- Sir William Osler (personal correspondence)
Portal hypertension ▶️splenomegaly ▶️platelet pooling
(Osler was one of the first to link cirrhosis and low plts)
So what does this have to do with the cirrhotic coagulopathy?
Despite all this coagulopathy talk, some parting words.
None of this should stop you from:
Fig1: Doing that para
Fig2: Banding that varix
Fig3: Placing that central line