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World J Gastroenterol. Oct 7, 2009; 15(37): 4653-4658
Published online Oct 7, 2009. doi: 10.3748/wjg.15.4653
Spectrum of anemia associated with chronic liver disease
Rosario Gonzalez-Casas, E Anthony Jones, Ricardo Moreno-Otero
Rosario Gonzalez-Casas, E Anthony Jones, Ricardo Moreno-Otero, Digestive Disease Service and Center for Investigation of Hepatic and Digestive Diseases, University Hospital La Princesa, Autonomous University of Madrid, Madrid 28006, Spain
Author contributions: Gonzalez-Casas R and Moreno-Otero R contributed equally to this paper; Jones EA wrote the paper.
Supported by CIBEREHD is funded by the Instituto de Salud Carlos III, Madrid, Spain
Correspondence to: Dr. Ricardo Moreno-Otero, Digestive Disease Service and Center for Investigation of Hepatic and Digestive Diseases, University Hospital La Princesa, Autonomous University of Madrid, Madrid 28006, Spain. rmoreno.hlpr@salud.madrid.org
Telephone: +34-91-5202254 Fax: +34-91-4022299
Received: July 23, 2009
Revised: September 12, 2009
Accepted: September 19, 2009
Published online: October 7, 2009
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.

Keywords: Anemia; Liver disease; Liver failure; Aplastic anemia; Pegylated interferon; Ribavirin; Alcohol