Spectrum of Anemia Associated with Chronic Liver Disease

Overview

Journal World J Gastroenterol

Publisher Baishideng Publishing Group

Specialty Gastroenterology

Date 2009 Sep 30

PMID 19787828

Citations 69

Authors

Rosario Gonzalez-Casas

E Anthony Jones

Ricardo Moreno-Otero

Affiliations

Soon will be listed here.

Abstract

Anemia of diverse etiology is a common complication of chronic liver diseases. The causes of anemia include acute or chronic gastrointestinal hemorrhage, and hypersplenism secondary to portal hypertension. Severe hepatocellular disease predisposes to hemorrhage because of impaired blood coagulation caused by deficiency of blood coagulation factors synthesized by hepatocytes, and/or thrombocytopenia. Aplastic anemia, which is characterized by pancytopenia and hypocellular bone marrow, may follow the development of hepatitis. Its presentation includes progressive anemia and hemorrhagic manifestations. Hematological complications of combination therapy for chronic viral hepatitis include clinically significant anemia, secondary to treatment with ribavirin and/or interferon. Ribavirin-induced hemolysis can be reversed by reducing the dose of the drug or discontinuing it altogether. Interferons may contribute to anemia by inducing bone marrow suppression. Alcohol ingestion is implicated in the pathogenesis of chronic liver disease and may contribute to associated anemia. In patients with chronic liver disease, anemia may be exacerbated by deficiency of folic acid and/or vitamin B12 that can occur secondary to inadequate dietary intake or malabsorption.

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References

Young N, Scheinberg P, Calado R . Aplastic anemia. Curr Opin Hematol. 2008; 15(3):162-8. PMC: 3410534. DOI: 10.1097/MOH.0b013e3282fa7470. View

McHutchison J, Manns M, Longo D . Definition and management of anemia in patients infected with hepatitis C virus. Liver Int. 2006; 26(4):389-98. DOI: 10.1111/j.1478-3231.2006.01228.x. View

Amitrano L, Guardascione M, Brancaccio V, Balzano A . Coagulation disorders in liver disease. Semin Liver Dis. 2002; 22(1):83-96. DOI: 10.1055/s-2002-23205. View

Levy J, Fingerhut A, Brott T, Langbakke I, Erhardtsen E, Porte R . Recombinant factor VIIa in patients with coagulopathy secondary to anticoagulant therapy, cirrhosis, or severe traumatic injury: review of safety profile. Transfusion. 2006; 46(6):919-33. DOI: 10.1111/j.1537-2995.2006.00824.x. View

Van Vlierbergh H, Delanghe J, De Vos M . Factors influencing ribavirin-induced hemolysis. J Hepatol. 2001; 34(6):911-6. DOI: 10.1016/s0168-8278(01)00029-0. View

Moreno Otero R, Cortes J . [Nutrition and chronic alcohol abuse]. Nutr Hosp. 2008; 23 Suppl 2:3-7. View

Lindenbaum J, Roman M . Nutritional anemia in alcoholism. Am J Clin Nutr. 1980; 33(12):2727-35. DOI: 10.1093/ajcn/33.12.2727. View

Reverter J . Abnormal hemostasis tests and bleeding in chronic liver disease: are they related? Yes. J Thromb Haemost. 2006; 4(4):717-20. DOI: 10.1111/j.1538-7836.2006.01887.x. View

Laffi G, Marra F, Tarquini R, Abbate R . Coagulation defects in cirrhosis--old dogmas not yet ready for burial. J Thromb Haemost. 2006; 4(9):2068-9. DOI: 10.1111/j.1538-7836.2006.02114.x. View

10.

Ong J, Younossi Z . Managing the hematologic side effects of antiviral therapy for chronic hepatitis C: anemia, neutropenia, and thrombocytopenia. Cleve Clin J Med. 2004; 71 Suppl 3:S17-21. DOI: 10.3949/ccjm.71.suppl_3.s17. View

11.

Young N, Calado R, Scheinberg P . Current concepts in the pathophysiology and treatment of aplastic anemia. Blood. 2006; 108(8):2509-19. PMC: 1895575. DOI: 10.1182/blood-2006-03-010777. View

12.

Ioannou G, Dominitz J, Weiss N, Heagerty P, Kowdley K . The effect of alcohol consumption on the prevalence of iron overload, iron deficiency, and iron deficiency anemia. Gastroenterology. 2004; 126(5):1293-301. DOI: 10.1053/j.gastro.2004.01.020. View

13.

Abraldes J, Bosch J . The treatment of acute variceal bleeding. J Clin Gastroenterol. 2007; 41 Suppl 3:S312-7. DOI: 10.1097/MCG.0b013e318150d3dd. View

14.

Albillos A . Preventing first variceal hemorrhage in cirrhosis. J Clin Gastroenterol. 2007; 41 Suppl 3:S305-11. DOI: 10.1097/MCG.0b013e318150d3c6. View

15.

Cariani E, Pelizzari A, Rodella A, Gargiulo F, Imberti L, Manca N . Immune-mediated hepatitis-associated aplastic anemia caused by the emergence of a mutant hepatitis B virus undetectable by standard assays. J Hepatol. 2007; 46(4):743-7. DOI: 10.1016/j.jhep.2006.11.023. View

16.

Reau N, Hadziyannis S, Messinger D, Fried M, Jensen D . Early predictors of anemia in patients with hepatitis C genotype 1 treated with peginterferon alfa-2a (40KD) plus ribavirin. Am J Gastroenterol. 2008; 103(8):1981-8. PMC: 2752675. DOI: 10.1111/j.1572-0241.2008.01957.x. View

17.

Afdhal N, McHutchison J, Brown R, Jacobson I, Manns M, Poordad F . Thrombocytopenia associated with chronic liver disease. J Hepatol. 2008; 48(6):1000-7. DOI: 10.1016/j.jhep.2008.03.009. View

18.

Marti-Carvajal A, Perez-Requejo J . Antifibrinolytic amino acids for acquired coagulation disorders in patients with liver disease. Cochrane Database Syst Rev. 2007; (1):CD006007. DOI: 10.1002/14651858.CD006007.pub2. View

19.

Lewis G, Wise M, Poynton C, Godkin A . A case of persistent anemia and alcohol abuse. Nat Clin Pract Gastroenterol Hepatol. 2007; 4(9):521-6. DOI: 10.1038/ncpgasthep0922. View

20.

Caldwell S, Hoffman M, Lisman T, Macik B, Northup P, Reddy K . Coagulation disorders and hemostasis in liver disease: pathophysiology and critical assessment of current management. Hepatology. 2006; 44(4):1039-46. DOI: 10.1002/hep.21303. View