von Willebrand factor and D-dimer are elevated in cirrhosis with spur cell anemia

The aim of the study is to assess the concentrations of von Willebrand factor (vWF) and D-dimer in patients with liver cirrhosis and spur cell anemia (SCA), and to evaluate their correlation with the proportion of spur cells. A total of 3 ml blood samples were collected in citrate tubes from 27 patients with Child C chronic liver disease (CLD), divided into two groups: group 1 (<10% SCA, n=20) and group 2 (>10% SCA, n=7). Plasma was separated by centrifugation at 3000 rpm for 10 minutes for ELISA based measurements of vWF and D-dimer. Clinical data and laboratory parameters, including indicators of liver dysfunction and the MELD-Na (Sodium - Model of End-Stage Liver Disease) score, were evaluated. Immunohistochemistry was performed to evaluate the expression of vWF in liver tissue. The blood plasma levels of vWF were significantly higher in group 2 compared to group 1 (7.96 ± 1.82 vs 5.76 ± 2.22; p=0.0231). D-dimer levels were also higher in group 2 but not statistically significant (72.80 ± 34.44 vs. 42.36 ± 28.53; p=0.103). Sonoclot assay results indicated that platelet function (PF) was increased in group 2 (2.07 ± 1.49 vs. 0.92 ± 0.89; p=0.039). In contrast, the clot rate and activated clotting time (ACT) showed no significant differences between groups (28.36 ± 8.91 vs 24.63 ± 14.18, p=0.065; 189.33 ± 30.72 vs 215.86 ± 50.42, p=0.2311). Other parameters such as hemoglobin (7.82 ± 1.71 vs 7.43 ± 1.1, p>0.05) and platelet count (70.11 ± 23.75 vs 68 ± 29, p>0.05) were comparable. Patients with higher proportions of spur cells in Child C advanced cirrhosis show elevated levels of VWF, D-Dimer, and PF, suggesting a prothrombotic state potentially driven by endothelial activation and microvascular dysfunction.