Thrombocytosis: A Paraneoplastic Syndrome in Patients with Hepatitis B Related Hepatocellular Carcinoma

Background: The highest incidence of Hepatocellular carcinoma (HCC) is in Asia, accounting for about 76% of all cases worldwide. In South East Asia, hepatitis B is the most common underlying cause. HCC patients manifest a variety of paraneoplastic syndromes. Thrombocytosis was reported in children with hepatoblastoma. Objectives: The aim of this study was to find out the relationship of thrombocytosis with the hepatitis B-related hepatocellular carcinoma. Methods: This observational study was carried out in the Department of Hepatology, BSMMU from January 2012 to December 2013. The study was approved by the Ethical Institutional Review Board (IRB) of BSMMU, Dhaka. The diagnosis of HCC was confirmed by pathological examination or AFP elevation (400ng/ml) combined imaging (CT/MRI) and diagnosis of thrombocytosis was made by platelet count >450 ×109. All images were evaluated by 2 trained radiologists by consensus after exclusion of hepatitis C virus infection (Anti HCV+ve) and significant alcohol intake (>20 gm. /day). All patients were HBsAg positive done by ELISA test. Results: A total 44 patients were included in this study. Among them, 91% were male (n=40) and 09 % were female (n=4).The mean age was 48.2 (±12.9) years with range from 23 to 80. Cirrhosis was 79.5% (n=35) and no cirrhosis was found 20.5% (n=9). Thrombocytosis was found 6.8% (n=3). Among thrombocytosis, cirrhosis and non-cirrhosis were 66.6% (n=02) and 33.4% (n=01) respectively. Mean α-fetoprotein (ng/mL) was higher in HCC patients with thrombocytosis than HCC patients without thrombocytosis (39370 vs13476, P value .036). Conclusions: Thrombocytosis is one of the paraneoplastic syndromes in patients with HBV related HCC. HCC patients with thrombocytosis are associated high serum AFP level.