Common Causes of Pancytopenia in Patients with Liver Cirrhosis

Pancytopenia, or a decrease in all types of blood cells, is commonly observed in patients with liver cirrhosis. One of the primary reasons for this condition is hypersplenism, which occurs due to increased pressure in the portal venous system. In healthy individuals, blood from the spleen flows through the splenic vein, merges with the portal vein, passes through the liver, and then returns to the heart via the hepatic and inferior vena cava. However, in cirrhotic livers, the organ often shrinks and becomes scarred, leading to elevated pressure within the portal system.

This increased pressure causes congestion in the spleen, resulting in its enlargement and overactivity. Although the spleen primarily functions to remove old or damaged blood cells, when it becomes enlarged, it begins to remove healthy red blood cells, white blood cells, and platelets from circulation at an accelerated rate. This leads to a significant reduction in all three cell lines—hence pancytopenia.

A low white blood cell count can increase the risk of infections, some of which may be severe. Similarly, reduced platelet levels can lead to bleeding complications, particularly gastrointestinal bleeding, which can be life-threatening if not managed promptly. Patients are often advised to undergo endoscopic evaluation to assess the presence and severity of esophageal or gastric varices.

In certain cases where thrombocytopenia (low platelet count) is severe and refractory to medical treatment, splenic artery embolization or surgical splenectomy may be considered as therapeutic options. These procedures aim to reduce the effects of hypersplenism and improve blood cell counts. However, they must be carefully evaluated based on individual patient conditions and risks.