Non-alcoholic fatty liver disease: Thrombocytopenia causes major bruising and bleeding


Non-alcoholic fatty liver disease (NAFLD) is a mystifying condition because it is not fully understood what drives it. It has been linked to chronic disease markers, such as obesity, but research is ongoing to pin down the underlying causes. A dangerous condition may ensue causing major bleeding and bruising.

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver injury worldwide.

The condition covers a wide spectrum of hepatic disorders ranging from steatosis and steatohepatitis to liver cirrhosis.

The mechanisms underlying hepatic injury in NAFLD are not fully understood, however, there is evidence to suggest that multiple mechanisms including insulin resistance oxidative stress, inflammation and genetic factors interact to initiate the development of NAFLD.

Thrombocytopenia has been described in some cases of NAFLD, but its features and warning symptoms remain largely unknown.

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According to the Mayo Clinic, thrombocytopenia signs and symptoms may include:

  • Easy or excessive bruising (purpura)
  • Superficial bleeding into the skin that appears as a rash of pinpoint-sized reddish-purple spots (petechiae), usually on the lower legs
  • Prolonged bleeding from cuts
  • Bleeding from your gums or nose
  • Blood in urine or stools.


In a study published in the National Library of Medicine, thrombocytopenia in chronic liver disease was further investigated.

Thrombocytopenia is the most common haematological abnormality encountered in patients with chronic liver disease (CLD), began the study.

“In addition to being an indicator of advanced disease and poor prognosis, it frequently prevents crucial interventions. 

“Multiple factors contribute to the development of thrombocytopenia, and these can broadly be divided into those that cause decreased production, splenic sequestration, and increased destruction.

“Depressed thrombopoietin levels in CLD, together with direct bone marrow suppression, result in a reduced rate of platelet production.

“Thrombocytopenia is the most common haematological abnormality encountered in patients with chronic liver disease (CLD), occurring in 64 to 84 percent of patients with cirrhosis or fibrosis.

“Among patients undergoing bone marrow biopsies for thrombocytopenia of unknown ethology, the prevalence of cirrhosis is as high as 35 percent.

“An in-depth understanding of the pathophysiology of the thrombocytopenia of CLD is crucial when considering treatment strategies.”

Studies have shown that roughly 24 percent of patients with NAFLD suffer with thrombocytopenia.

Dangerous internal bleeding can occur when the platelet count falls below 10,000 platelets per microliter.

Though rare, severe thrombocytopenia can cause bleeding into the brain, which can be fatal.



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