الفهرس 
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Abstract
Thrombocytopenia is perhaps the most common haematological abnormality in patients with chronic hepatitis C virus (HCV) infection. In these patients, the presence of thrombocytopenia may be a limiting factor when considering antiviral therapy and may be associated with decreased sustained virological response rates. Thrombocytopenia may interfere with diagnostic procedures such as liver biopsy, because of risk of bleeding.
Pathogenic mechanisms include hypersplenism secondary to portal hypertension, bone marrow suppression resulting from either HCV itself or interferon treatment, and aberrations of the immune system resulting in the formation of anti-platelet antibodies and/or immune complexes that bind to platelets and facilitate their premature clearance. The ability to increase platelet levels could significantly reduce the need for platelet transfusions and facilitate the use of interferon-based antiviral therapy and other medically indicated treatments in patients with liver disease.
Prolactin (PRL) is a protein hormone, as well as a cytokine, which is synthesized and secreted from specialized cells of the anterior pituitary gland, named lactotrophs as well as many extrapituitary tissues. Among these sites of PRL synthesis are cells of the immune system, such as macrophages, natural killer cells, and T- and B-lymphocytes.
In the physiology of the immune system, PRL acts by stimulating the secretion of other cytokines and the expression of cytokine receptors, and also as a growth and survival factor. In pathological conditions, increased levels of PRL could cause deterioration of the subject’s condition.
The current study aims to evaluate PRL level in patients with HCV related thrombocytopenia. It was conducted on (101) subjects aged from 30 years to 60 years. The selected subjects were grouped into 3 groups: Group (I) fourty one chronic hepatitis C patients with thrombocytopenia, Group (II) thirty five chronic hepatitis C patients without thrombocytopenia, Group (III) twenty five healthy individuals of matched sex and age.
Care was taken to exclude patients with other causes of hyperprolactinaemia, Hypothyroidism, Polycystic ovary syndrome or with clinically overt hypo- or hyperthyroidism and other endocrinopathies, Patients taking medications known to induce prolactin, renal failure, splenomegally and decompensated liver disease and thrombocytopenia due to causes other than HCV.
All patients were subjected to thorough history taking, physical examination, investigations including complete blood count, liver profile, blood urea and s. creatinine, serum electrolyte, erythrocyte sedimentation rate, urine analysis, abdominal ultrasound, fibroscan, blood film, ANA and serum prolactin level.
The present study revealed that:
- All groups had been matched with no significant differences between as regard age and sex (P value > 0.05).
- 15.3% of patients with HCV-related thrombocytopenia were found to have HPRL. - There was a statistically significant relationship between the platelet count and the serum ALT levels and there was higher ALT levels in patients with a low platelet count.
- There was a statistically significant relationships between the platelet counts and stage of fibrosis.
- The stage of fibrosis was directly related to the decrease in platelet count. There was inverse relationship between the platelet counts and the stage of fibrosis.
- There was significant difference between studied groups as regard sonographic findings (P < 0.05).