Spectrum of anemia associated with chronic liver disease.
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.
Digestive Disease Service and Center for Investigation of Hepatic and Digestive Diseases, University Hospital La Princesa, Autonomous University of Madrid, Madrid 28006, Spain.
Rosario
R
Gonzalez-Casas
E Anthony
EA
Jones
Ricardo
R
Moreno-Otero
D000740:Anemia / Q000139:chemically induced / Q000175:diagnosis / Q000209:etiology*; D000741:Anemia, Aplastic / Q000209:etiology; D001777:Blood Coagulation; D002908:Chronic Disease; D004912:Erythrocytes / Q000378:metabolism; D006471:Gastrointestinal Hemorrhage / Q000150:complications; D006801:Humans; D006971:Hypersplenism / Q000150:complications / Q000503:physiopathology; D006975:Hypertension, Portal / Q000150:complications / Q000503:physiopathology; D008099:Liver / Q000378:metabolism / Q000502:physiology; D008107:Liver Diseases / Q000150:complications* / Q000503:physiopathology; D008108:Liver Diseases, Alcoholic / Q000150:complications