The Blood and Bone Marrow in Patients With Cirrhosis of the Liver

Abstract

The peripheral blood and bone marrow findings in patients with cirrhosis of the liver have been analyzed on the basis of a review of the literature and the authors’ study of 25 patients with diagnoses verified by biopsy of the liver. The principal blood findings are macrocytic or normocytic anemia with normal or elevated mean corpuscular hemoglobin values, lymphopenia and thrombocytopenia in the majority of cases. Anemia may be independent of bleeding, and the severity of anemia or macrocytosis does not appear to be related to the severity of the liver lesion. The consistent change in the bone marrow is extension of the marrow organ so that active hematopoiesis is found in the shafts of the long bones. Regardless of the presence or absence of bleeding or anemia, the marrow of the sternum is of normal or increased cellularity, with normal or increased erythrocytogenesis and megakaryocytogenesis in most cases. Hypocellularity of the marrow is an unusual finding, even in patients with advanced liver lesions. Macronormoblastic erythropoiesis is seen in patients with macrocytic anemia, but megaloblastic erythropoiesis dces not result from cirrhosis of the liver. The presence of peripheral cytopenias (anemia and thrombocytopenia) in spite of normal or increased formation of erythroblasts and megakaryocytes in the marrow is suggestive of hypersplenism in patients with hepatic cirrhosis. In patients with chronic hemorrhage the blood and bone marrow pictures are those of iron deficiency anemia, although other changes such as lymphopenia and thrombocytopenia tend to persist. The combined peripheral blood and sternal marrow examination is often of value in establishing the diagnosis of cirrhosis of the liver.

Patients with stable uncomplicated cirrhosis have normal neutrophil function

“…Humoral disturbances, which include abnormal immunoglobulin production, 8 decreased serum opsonic activity, 43 and the presence of serum inhibitors of chemotaxis 36,44 are well described. Cellular disturbances, including impaired Kuppfer cell, 45 monocyte 6 and lymphocyte 7 function, as well as neutropenia associated with hypersplenism, 46 have been reported. Alterations in the enteric flora and intestinal barrier may also play a role in the pathogenesis of infection in these patients.…”

The role of serum ferritin in the diagnosis of iron deficiency anaemia in patients with liver cirrhosis

“…Anaemia is a frequent manifestation in patients with liver cirrhosis. It is characteristically of moderate severity and may be caused by diverse mechanisms [ 1–3]. As a consequence of gastrointestinal bleeding from peptic ulcers or oesophageal varices, compounded by the haemostatic defects of chronic liver disease, iron deficiency appears to be a major mechanism for anaemia developed in these patients [ 4].…”

Macrocytosis in alcohol-related liver disease: its value for screening

“…In 1884, Gram described macrocytosis as a frequent accompaniment of cirrhosis. Since that time the relationship between macrocytosis or macrocytic anaemia and the presence of liver disease, particularly alcohol related liver disease, has become well established (Wintrobe & Shumacker 1933, Bianco & Jolliffe 1938, Berman et al 1949, Hall 1956, Bingham 1959, 1960, Kumar et al 1966, Wu et al 1974, Buffet et al 1975. More recently attention has been focused on the presence of macrocytosis in alcoholics with little or no liver disease.…”