Advertisement

Red blood cell status in alcoholic and non-alcoholic liver disease

      Abstract

      Macrocytosis is most commonly associated with vitamin B12 and folic acid deficiency, followed by alcoholism, liver disease, and other pathologic conditions. We studied the red cell and vitamin status in 423 consecutive patients with various liver diseases, including 31 with acute viral hepatitis (AVH), 105 with chronic hepatitis (CH), and 134 with alcoholic liver disease (ALD), who consisted of 84 with non-cirrhotic alcoholic liver disease (NCALD) and 50 with alcoholic liver cirrhosis (ALC), 60 with non-alcoholic liver cirrhosis (NALC), and 93 with hepatocellular carcinoma (HCC). The mean corpuscular volume (MCV) and red cell distribution width (RDW) were significantly higher in patients with ALD and NALC, and among them macrocytosis occurred more frequently in patients with ALC. Macrocytic anemia was mostly found in cirrhotic patients, in which the Child-Pugh score was closely related to the development of macrocytic anemia. In ALD, the MCV was significantly correlated with the estimated alcohol consumption and inversely correlated with the serum folic acid level, which, however, was often maintained within the normal range in patients with macrocytic ALC. After abstinence from alcohol, the MCV and RDW were reduced significantly and were associated with an increasing serum folic acid level. This suggests that macrocytic anemia was a common feature of alcoholic and non-alcoholic liver cirrhosis and that alcohol abuse and folic acid deficiency play a secondary role in macrocytosis. (J Lab Clin Med 2001;138:332-7)

      Abbreviations:

      ALC (alcoholic liver cirrhosis), ALD (alcoholic liver disease), AVH (acute viral hepatitis), CH (chronic hepatitis), Hb (hemoglobin), HBV (hepatitis B virus), HCC (hepatocellular carcinoma), Hct (hematocrit), HCV (hepatitis C virus), MCH (mean corpuscular hemoglobin), MCHC (mean corpuscular hemoglobin concentration), MCV (mean corpuscular volume), NALC (non-alcoholic liver cirrhosis), NCALD (non-cirrhotic alcoholic liver disease), RBC (red blood cell), RDW (red cell distribution width)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Translational Research
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Wintrobe MM
        • Schumacker Jr, HS
        Occurrence of macrocytic anemia in association with disorder of the liver.
        Bull Johns Hopkins Hosp. 1933; 52: 387-404
        • Berman L
        • Axelrod AR
        • Horman TN
        • Horan TN
        • Jacobson SD
        • Sharp EA
        • et al.
        The blood and bone marrow in patients with cirrhosis of the liver.
        Blood. 1949; 4: 511-533
        • Hall CA
        Macrocytosis of liver disease.
        J Lab Clin Med. 1956; 48: 345-355
        • Bingham J.
        The macrocytosis of hepatic disease. Thin macrocytosis.
        Blood. 1959; 14: 694-707
        • Bingham J.
        The macrocytosis of hepatic disease. Thin macrocytosis.
        Blood. 1960; 15: 244-254
        • Nunnally RM
        • Levine I.
        Macronormoblastic hyperplasia of the bone marrow in cirrhosis.
        Am J Med. 1961; 30: 972-975
        • Katz R
        • Velasco M
        • Guzman C
        • Alessandri H.
        Red cell survival estimated by radioactive chromium in hepatobiliary disease.
        Gastroenterology. 1964; 46: 399-404
        • Kimber C
        • Deller DJ
        • Ibbotson RN
        • Lander H.
        The mechanism of anaemia in chronic liver disease.
        Q J Med. 1965; 34: 33-64
        • Kumar S
        • Dube B
        • Mehrotra PN
        The macrocytosis in cirrhosis of the liver. A clinical and experimental study.
        Acta Haematol. 1966; 35: 30-45
        • Silber R
        • Amorosi E
        • Lhowe J
        • Kayden HJ
        Spur-shaped erythrocytes in Laennec's cirrhosis.
        N Engl J Med. 1966; 275: 639-643
        • Kilbridge TM
        • Heller P.
        Determinants of erythrocyte size in chronic liver disease.
        Blood. 1969; 34: 739-746
        • Cooper RA
        Anemia with spur cells: a red cell defect acquired in serum and modified in the circulation.
        J Clin Invest. 1969; 48: 1820-1831
        • Cooper RA
        • Diloy-Puray M
        • Lando P
        • Greenberg MS
        An analysis of lipoproteins, bile acids and red cell membrane associated with target cells and spur cells in patients with liver disease.
        J Clin Invest. 1972; 51: 3182-3192
        • Cooper RA
        • Kimball DB
        • Durocher JR
        Role of the spleen in membrane conditioning and hemolysis of spur cells in liver disease.
        N Engl J Med. 1974; 290: 1279-1284
        • Smith JA
        • Lonergan ET
        • Sterling K
        Spur cell anemia.
        N Engl J Med. 1964; 271: 396-398
        • Eichner ER
        • Hillman RS
        The evolution of anemia in alcoholic patients.
        Am J Med. 1971; 50: 218-232
        • Wu A
        • Chanarin I
        • Levi AJ
        Macrocytosis of chronic alcoholism.
        Lancet. 1974; 1: 829-831
        • Wu A
        • Chanarin I
        • Slavin G
        • Levi AJ
        Folate deficiency in the alcoholic: its relationship to clinical and haematological abnormalities, liver disease and folate stores.
        Br J Haematol. 1975; 29: 469-478
        • Seppa K
        • Sillanaukee P
        • Koivula T.
        Abnormalities of hematologic parameters in heavy drinkers and alcoholics.
        Alcohol Clin Exp Res. 1992; 16: 117-121
        • Thompson WD
        • Meola T
        • Lipkin Jr, M
        • Freedman ML
        Red cell distribution width, mean corpuscular volume, and transferrin saturation with diagnosis of iron deficiency.
        Arch Intern Med. 1988; 148: 2128-2130
        • McPhedran P
        • Barnes MG
        • Weinstein JS
        • Robertson JS
        Interpretation of electronically determined macrocytosis.
        Ann Intern Med. 1973; 78: 677-683
        • Lieberman FL
        • Reynolds TB
        Plasma volume in cirrhosis of the liver: its relation to portal hypertension, ascites, and renal failure.
        J Clin Invest. 1967; 46: 1297-1308
        • SheeHy TW
        • Berman A.
        The anemia of cirrhosis.
        J Lab Clin Med. 1959; 56: 72-82
        • Subhiyah BW
        • AI-Indawi AY
        Red cell survival and splenic accumulation of radiochromium in liver cirrhosis with splenomegaly.
        Br J Hematol. 1967; 13: 773-778
        • McCurdy PR
        • Pierce LE
        • Rath CE
        Abnormal bone marrowmorphology in acute alcoholism.
        N Engl J Med. 1962; 266: 505-507
        • Meagher RC
        • Sieber F
        • Spivak JL
        Suppression of hematopoietic-progenitor-cell proliferation by ethanol and acetaldehyde.
        N Engl J Med. 1982; 307: 845-849
        • Sullivan LW
        • Herbert V.
        Suppression of hematopoiesis by ethanol.
        J Clin Invest. 1964; 43: 2048-2062
        • Larkin EC
        • Watson-Williams EJ
        Alcohol and the blood.
        Med Clin North Am. 1984; 68: 105-120
        • Beauge F
        • Gallay J
        • Stibler H
        • Borg S.
        Alcohol abuse increases the lipid structural order in human erythrocyte membranes.
        Biochem Pharmacol. 1988; 37: 3823-3828
        • Simon JB
        Red cell lipids in liver disease: relationship to serum lipids and to lecithin-cholesterol acyltransferase.
        J Lab Clin Med. 1971; 77: 891-900
        • Duhamel G
        • Forgez P
        • Nalpas B
        • Berthelot P
        • Chapman MJ
        Spur cells in patients with alcoholic liver cirrhosis are associated with reduced plasma levels of apoA-II, HDL3, and LDL.
        J Lipid Res. 1983; 24: 1612-1625
        • Russel RM
        • Rosenberg IH
        • Wilson PD
        • Iber FL
        • Oaks EB
        • Giovetti AC
        • et al.
        Increased urinary excretion and prolonged turnover time of folic acid during ethanol ingestion.
        Am J Clin Nutr. 1983; 38: 64-70
        • Pierce HI
        • McGuffin RG
        • Lillman RS
        Clinical studies in alcoholic sideroblastosis.
        Arch Intern Med. 1976; 136: 283-289