What is your clinical approach to the evaluation of cytopenias in patients with end-stage liver disease?

Cytopenias may be the new normal for a patient with cirrhosis. However, they may not be. If a patient has isolated thrombocytopenia and a large spleen, I am typically going to monitor labs on the standard labs with each visit. Isolated mild leukopenia is the same pattern as well. Anemia requires a workup to understand that there is no chronic blood loss anemia from the gut in my practice. Burr cell anemia is quite common in cirrhosis, and I often get a smear in the workup of the anemia

In more severe cases of either pancytopenia or isolated cytopenia without a clear understanding, usually requires a complete work up that included hematology evaluation as well. Also, active bleeding with mild trauma is noted or a precipitous drop in the cou...