Rare causes of anemia in liver diseases

Abstract

Anemia is a common finding among patients with liver diseases. Patients who suffer from anemia are at a higher risk of liver function decompensation and hospitalization. It affects significantly their quality of life and contributes to mortality. Anemia is present in 70% of patients with liver cirrhosis and with varying incidence accompanies other liver disorders. As the etiology of anemia in liver diseases is multifactorial, various cases represent different clinical entities. Anemia accompanying hepatic disorders can be broadly divided into several types, such as anemia associated with blood loss, as well as aplastic, hemolytic and micronutrient deficiency anemia. However, it is sometimes difficult to delineate between those types in the clinical practice, as several pathophysiological causes can be present in one patient. It is reported that the most common cause of anemia in liver disease is blood loss and iron deficiency. Still, the incidence of unclear cases reaching over 50% suggests that other types of anemia can be underdiagnosed. This review comprehensively describes less frequent types of anemia associated with liver disease, namely hemolytic and aplastic anemia (AA). Hemolytic anemia can complicate autoimmune liver diseases or be a manifestation of membranopathy of red blood cells, dependent on severe hepatic function impairment or alcoholic liver disease. Aplastic anemia is best known as a sequela of viral hepatitis, but some degree of bone marrow inhibition can complicate virtually all advanced liver diseases.

Zinc supplementation with polaprezinc was associated with improvements in albumin, prothrombin time activity, and hemoglobin in ‍chronic liver disease

“…Thrombocytopenia has been associated with reduced thrombopoietin production and increased splenic function in portal hypertension, ( 18 ) but anemia in CLD is rarely mentioned. ( 19 ) Anemia in CLD is most commonly caused by gastrointestinal bleeding (25%) and iron deficiency (9%), with 53% of cases reported to have an unknown cause. ( 20 ) On the other hand, the involvement of macrocytic anemia has also been reported in cirrhosis, with reports of an association with the severity of liver impairment in patients with hepatitis B virus (HBV)-related decompensated cirrhosis and with folic acid and vitamin B 12 deficiency in cirrhosis.…”

Liver sinusoidal endothelial cells show reduced scavenger function and downregulation of Fc gamma receptor IIb, yet maintain a preserved fenestration in the Glmpgt/gt mouse model of slowly progressing liver fibrosis

“…Interestingly, the bone marrow of Glmp gt/gt mice showed reduced cellularity of the hematopoietic tissue and more fat than WT mice, explaining the previously reported reduction in blood erythrocytes and leukocyte numbers in these mice [ 39 ]. Anemia is a common finding among patients with liver disease, affecting around 70% of patients with liver cirrhosis [ 85 ]. However, bone marrow aplasia in the context of liver disease is rare although cases associated with hepatitis are well reported.…”

“…However, bone marrow aplasia in the context of liver disease is rare although cases associated with hepatitis are well reported. Viral agents are the most common triggers of hepatitis-associated aplastic anemia, but noninfectious causes are also involved in the pathogenesis [ 85 ]. Significantly decreased numbers of hematopoietic stem cells, mesenchymal stem cells, Schwann cells, and neural fibers were reported in bone marrow from patients with advanced liver cirrhosis compared to patients with less severe disease, accompanied with lower hemoglobin and platelet counts [ 86 ].…”

Hematological Abnormalities in Cirrhosis: A Narrative Review

“…Anemia is a condition that occurs due to lower production of healthy red blood cells or lower levels of hemoglobin and often is caused by iron deficiency, or B12 and folate deficiency [ 38 ]. The most common type of anemia observed in cirrhosis patients is normocytic normochromic anemia which is attributed to a chronic inflammatory state [ 39 ]. Patients who were found to have anemia with cirrhosis seem to have a higher hospital mortality rate.…”