Knowledge Check

Which of the following is/are true:

a
Thrombocytopenia is less common than leukopenia in patients with cirrhosis
b
Leukocytosis is more common than leukopenia in cirrhosis
c
Cytopenias in patients with cirrhosis occur only in those with alcohol-induced cirrhosis
d
Patients with cirrhosis rarely have anemia
e
Thrombocytopenia is the most common cytopenia in patients with cirrhosis

Which complete blood count is most likely to belong to a patient with cirrhosis?

a
A
b
B
This CBC is from a patient with pyruvate kinase deficiency. The WBC and platelet count are elevated because he is asplenic. The macrocytosis is caused by increased reticulocytes.
c
C
This CBC is from a patient with aplastic anemia. The MCV is frequently elevated in aplastic anemia. The leukopenia and thrombocytopenia are more profound than that typically seen in cirrhosis.

The results above are from a patient with cirrhosis. They include a number of clotting factor levels.

True or false: increased PT/INR in a patient with cirrhosis indicates increased risk of periprocedural bleeding.

a
True
b
False

The above image is from a CT scan of patient with cirrhosis (along with the radiologist’s interpretation of the spleen). True of false: the patient by definition has hypersplenism.

a
True
b
False
Cytopenias are required to diagnose hypersplenism.

True or false: patients with cirrhosis and elevated PT/INR undergoing an invasive procedure should receive prophylactic FFP transfusion.

a
True
b
False

Which of the following strategies is recommended by the AASLD for patients with cirrhosis undergoing invasive procedure (more than one answer may apply):

a
FFP in patient with elevated PT/INR
b
Recombinant FVIIa in a patient with elevated PT/INR
c
Cryoprecipitate or fibrinogen concentrate in a patient with low fibrinogen
d
Nonpeptide TPO agonists in patient with thrombocytopenia

Which of the following TPO agonists are FDA approved for thrombocytopenia in patients with chronic liver disease:

a
Avatrombopag (Doptelet)
b
Romiplostim (Nplate)
c
Eltrombopag (Promacta)
d
Lusutrombopag (Mulpleta)
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