{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T02:00:33Z","timestamp":1791856833550,"version":"4.3.4"},"reference-count":35,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2023,6,29]],"date-time":"2023-06-29T00:00:00Z","timestamp":1687996800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>We performed a retrospective single-center analysis to investigate the diagnostic yield of bone marrow puncture in patients with liver cirrhosis and cytopenia. Liver cirrhosis patients receiving bone marrow aspiration or biopsy for the diagnostic work-up of otherwise unexplained peripheral blood cytopenia at our institution between 2004 and 2020 were enrolled in this study. We evaluated findings from cytologic, histologic and immunologic assessment and final diagnostic outcomes. A total of 118 patients with a median age of 55 years and a median Child\u2013Pugh score of B (8 points) were enrolled. The main etiologies of liver cirrhosis were viral hepatitis (B and C) or chronic alcohol consumption. The majority of patients (60%) exhibited concurrent anemia, leukocytopenia and thrombocytopenia. Bone marrow assessment revealed normal, unspecific or reactive alterations in 117 out of 118 patients (99%). One patient was diagnosed with myelodysplastic syndrome. Our findings suggest that peripheral blood cytopenia in patients with liver cirrhosis is rarely associated with a primary bone marrow pathology.<\/jats:p>","DOI":"10.3390\/jcm12134373","type":"journal-article","created":{"date-parts":[[2023,6,30]],"date-time":"2023-06-30T01:02:41Z","timestamp":1688086961000},"page":"4373","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Bone Marrow Assessment in Liver Cirrhosis Patients with Otherwise Unexplained Peripheral Blood Cytopenia"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5770-1279","authenticated-orcid":false,"given":"Sebastian E.","family":"Koschade","sequence":"first","affiliation":[{"name":"Department of Medicine, Hematology\/Oncology, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1241-5137","authenticated-orcid":false,"given":"Laura M.","family":"Moser","sequence":"additional","affiliation":[{"name":"Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Artur","family":"Sokolovskiy","sequence":"additional","affiliation":[{"name":"Department of Medicine, Hematology\/Oncology, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9305-3691","authenticated-orcid":false,"given":"Florian A.","family":"Michael","sequence":"additional","affiliation":[{"name":"Department of Medicine, Gastroenterology, Hepatology and Endocrinology, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8472-5516","authenticated-orcid":false,"given":"Hubert","family":"Serve","sequence":"additional","affiliation":[{"name":"Department of Medicine, Hematology\/Oncology, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian H.","family":"Brandts","sequence":"additional","affiliation":[{"name":"Department of Medicine, Hematology\/Oncology, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany"},{"name":"University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8559-9910","authenticated-orcid":false,"given":"Fabian","family":"Finkelmeier","sequence":"additional","affiliation":[{"name":"Department of Medicine, Gastroenterology, Hepatology and Endocrinology, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Zeuzem","sequence":"additional","affiliation":[{"name":"Department of Medicine, Gastroenterology, Hepatology and Endocrinology, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonel","family":"Trebicka","sequence":"additional","affiliation":[{"name":"Department of Medicine, Gastroenterology, Hepatology and Endocrinology, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany"},{"name":"Department of Internal Medicine B, University of M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Ferstl","sequence":"additional","affiliation":[{"name":"Department of Medicine, Gastroenterology, Hepatology and Endocrinology, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Ballo","sequence":"additional","affiliation":[{"name":"Department of Medicine, Hematology\/Oncology, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,6,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2936","DOI":"10.1111\/j.1572-0241.2000.02325.x","article-title":"Prevalence of peripheral blood cytopenias (hypersplenism) in patients with nonalcoholic chronic liver disease","volume":"95","author":"Bashour","year":"2000","journal-title":"Am. J. Gastroenterol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1067\/mlc.2001.119106","article-title":"Red blood cell status in alcoholic and non-alcoholic liver disease","volume":"138","author":"Maruyama","year":"2001","journal-title":"J. Lab. Clin. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1016\/j.cgh.2009.02.021","article-title":"Incidence, prevalence, and clinical significance of abnormal hematologic indices in compensated cirrhosis","volume":"7","author":"Qamar","year":"2009","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1365-2893.2010.01366.x","article-title":"Prevalence of thrombocytopenia among patients with chronic hepatitis C: A systematic review","volume":"18","author":"Louie","year":"2011","journal-title":"J. Viral Hepat."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1559","DOI":"10.1056\/NEJMoa2029349","article-title":"Prospective Study of Outcomes in Adults with Nonalcoholic Fatty Liver Disease","volume":"385","author":"Sanyal","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1016\/S0168-8278(94)80115-0","article-title":"Survival and prognostic factors in 366 patients with compensated cirrhosis type B: A multicenter study. The Investigators of the European Concerted Action on Viral Hepatitis (EUROHEP)","volume":"21","author":"Realdi","year":"1994","journal-title":"J. Hepatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1056\/NEJMra1504367","article-title":"Treatment of Patients with Cirrhosis","volume":"375","author":"Ge","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"European Association for the Study of the Liver (2022). EASL Clinical Practice Guidelines on prevention and management of bleeding and thrombosis in patients with cirrhosis. J. Hepatol., 76, 1151\u20131184.","DOI":"10.1016\/j.jhep.2021.09.003"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1177\/000313480206800912","article-title":"Gluteal compartment syndrome and sciatica after bone marrow biopsy: A case report and review of the literature","volume":"68","author":"Roth","year":"2002","journal-title":"Am. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1046\/j.1365-2141.2003.04329.x","article-title":"Bone marrow biopsy morbidity and mortality","volume":"121","author":"Bain","year":"2003","journal-title":"Br. J. Haematol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1111\/j.1365-2702.2010.03485.x","article-title":"A review of pain management interventions in bone marrow biopsy","volume":"20","author":"Watmough","year":"2011","journal-title":"J. Clin. Nurs."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"489","DOI":"10.12659\/AJCR.889274","article-title":"Retroperitoneal hemorrhage associated with bone marrow trephine biopsy","volume":"14","year":"2013","journal-title":"Am. J. Case Rep."},{"key":"ref_13","first-page":"611","article-title":"Updated S2k-Guideline \u201cComplications of liver cirrhosis\u201d. German Society of Gastroenterology (DGVS)","volume":"57","author":"Gerbes","year":"2019","journal-title":"Z. Gastroenterol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1007\/s00535-021-01788-x","article-title":"Evidence-based clinical practice guidelines for Liver Cirrhosis 2020","volume":"56","author":"Yoshiji","year":"2021","journal-title":"J. Gastroenterol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1002\/hep.26972","article-title":"Evaluation for liver transplantation in adults: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation","volume":"59","author":"Martin","year":"2014","journal-title":"Hepatology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1002\/hep.30866","article-title":"Diagnosis and Treatment of Alcohol-Associated Liver Diseases: 2019 Practice Guidance from the American Association for the Study of Liver Diseases","volume":"71","author":"Crabb","year":"2020","journal-title":"Hepatology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1797","DOI":"10.1097\/HEP.0000000000000323","article-title":"AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease","volume":"77","author":"Rinella","year":"2023","journal-title":"Hepatology"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"European Association for the Study of the Liver (2018). EASL Clinical Practice Guidelines: Management of alcohol-related liver disease. J. Hepatol., 69, 154\u2013181.","DOI":"10.1016\/j.jhep.2018.03.018"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"European Association for the Study of the Liver (2018). EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J. Hepatol., 69, 406\u2013460.","DOI":"10.1016\/j.jhep.2018.08.009"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"European Association for the Study of the Liver (2020). EASL recommendations on treatment of hepatitis C: Final update of the series. J. Hepatol., 73, 1170\u20131218.","DOI":"10.1016\/j.jhep.2020.08.018"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"S135","DOI":"10.1016\/j.jhep.2021.01.027","article-title":"Management of the major complications of cirrhosis: Beyond guidelines","volume":"75","author":"Francoz","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1111\/j.1751-553X.2008.01100.x","article-title":"ICSH guidelines for the standardization of bone marrow specimens and reports","volume":"30","author":"Lee","year":"2008","journal-title":"Int. J. Lab. Hematol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2391","DOI":"10.1182\/blood-2016-03-643544","article-title":"The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia","volume":"127","author":"Arber","year":"2016","journal-title":"Blood"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1111\/liv.14229","article-title":"Prevalence of and risk factors for anaemia in patients with advanced chronic liver disease","volume":"40","author":"Scheiner","year":"2020","journal-title":"Liver Int."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1182\/blood.V4.5.511.511","article-title":"The blood and bone marrow in patients with cirrhosis of the liver","volume":"4","author":"Berman","year":"1949","journal-title":"Blood"},{"key":"ref_26","first-page":"100","article-title":"Bone marrow failure and hematological abnormalities in alcoholic liver cirrhosis","volume":"46","author":"Panasiuk","year":"2001","journal-title":"Rocz. Akad. Med. Bialymst."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"257","DOI":"10.4103\/1319-3767.98431","article-title":"Prevalence of cirrhosis in patients with thrombocytopenia who receive bone marrow biopsy","volume":"18","author":"Sheikh","year":"2012","journal-title":"Saudi J. Gastroenterol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1136\/flgastro-2019-101350","article-title":"Bone marrow dyspoiesis associated with severe refractory anaemia in liver cirrhosis","volume":"12","author":"Varadarajan","year":"2021","journal-title":"Frontline Gastroenterol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"3339","DOI":"10.1172\/JCI26674","article-title":"The molecular mechanisms that control thrombopoiesis","volume":"115","author":"Kaushansky","year":"2005","journal-title":"J. Clin. Invest."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1053\/j.gastro.2018.05.025","article-title":"Avatrombopag Before Procedures Reduces Need for Platelet Transfusion in Patients with Chronic Liver Disease and Thrombocytopenia","volume":"155","author":"Terrault","year":"2018","journal-title":"Gastroenterology"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1192","DOI":"10.1016\/j.cgh.2018.11.047","article-title":"Lusutrombopag Reduces Need for Platelet Transfusion in Patients with Thrombocytopenia Undergoing Invasive Procedures","volume":"17","author":"Hidaka","year":"2019","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1016\/S0140-6736(08)60203-2","article-title":"Efficacy of romiplostim in patients with chronic immune thrombocytopenic purpura: A double-blind randomised controlled trial","volume":"371","author":"Kuter","year":"2008","journal-title":"Lancet"},{"key":"ref_33","first-page":"240","article-title":"Real-world experience of eltrombopag in immune thrombocytopenia","volume":"10","author":"Mishra","year":"2020","journal-title":"Am. J. Blood Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1182\/asheducation-2009.1.338","article-title":"Telomeres and marrow failure","volume":"2009","author":"Calado","year":"2009","journal-title":"Hematology Am. Soc. Hematol. Educ. Program."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"567","DOI":"10.17219\/acem\/145984","article-title":"Rare causes of anemia in liver diseases","volume":"31","author":"Dawidowski","year":"2022","journal-title":"Adv. Clin. Exp. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/13\/4373\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:03:23Z","timestamp":1760126603000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/13\/4373"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,29]]},"references-count":35,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2023,7]]}},"alternative-id":["jcm12134373"],"URL":"https:\/\/doi.org\/10.3390\/jcm12134373","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,29]]}}}