Anemia in Liver Disease
Multiple different types of anemia are associated with liver disease. Portal hypertension related to chronic or acute liver disease may cause gastrointestinal bleeding, which is predisposed by coagulopathy related to liver dysfunction. Acute blood loss anemia in these circumstances is often due to gastroesophageal varices, which also may lead to iron-deficiency anemia with repeated episodes. In addition, chronic bleeding sources in the liver patient include gastrointestinal vascular ectasia and portal hypertensive gastropathy. Liver disease is associated with abnormalities in the composition of red blood cell membranes, leading to variant cells that are prone to hemolysis and splenic consumption, particularly in the setting of hypersplenism. Multiple distinct types of liver disease are associated with anemia, ranging from viral hepatitis-associated aplastic anemia to hemolytic anemia associated with copper accumulation in Wilson’s disease. Excessive alcohol use as well may cause anemia through a variety of mechanisms, including spur cell anemia and bone marrow suppression. Treatment regimens for hepatitis C which utilize ribavirin and pegylated interferon also frequently have anemia as a side effect that often necessitates therapy adjustment. Chronic liver disease may also result in nutrient deficiencies that impair and limit effective bone marrow erythropoiesis. Several different varieties of anemia occur through a myriad of mechanisms in the setting of liver disease and dysfunction that require astute recognition by clinicians.
