Anemia in cirrhosis: An underestimated entity

Abstract

Anemia in a patient with cirrhosis is a clinically pertinent but often overlooked clinical entity. Relevant guidelines highlight the algorithmic approach of managing a patient of cirrhosis presenting with acute variceal hemorrhage but day-to-day management in hospital and out-patient raises multiple dilemmas: Whether anemia is a disease complication or a part of the disease spectrum? Should iron, folic acid, and vitamin B complex supplementation and nutritional advice, suffice in those who can perform tasks of daily living but have persistently low hemoglobin. How does one investigate and manage anemia due to multifactorial etiologies in the same patient: Acute or chronic blood loss because of portal hypertension and bone marrow aplasia secondary to hepatitis B or C viremia? To add to the clinician’s woes the prevalence of anemia increases with increasing disease severity. We thus aim to critically analyze the various pathophysiological mechanisms complicating anemia in a patient with cirrhosis with an emphasis on the diagnostic flowchart in such patients and proposed management protocols thereafter.

Cirrhosis-induced oxidative stress in erythrocytes: The therapeutic potential of taurine

“…B 9 ) deficiency 44 [158] Vit. B 12 (cyanocobalamin) deficiency) 31.8 in PBC 43 in NAFLD [158] This table is adapted from reference [17]…”

“…Cirrhosis is a multifaceted clinical complication that affects many organs other than the liver (e.g., brain, kidney, heart, lung, and reproductive organs) [1][2][3][4][5][6][7][8][9][10]. On the other hand, cirrhosis-induced erythrocyte death and anemia are well-characterized complications of this disease that are approximately observed in 75% of cirrhotic patients [11][12][13][14][15][16]. The type of anemia, its etiology, and its prevalence are variable in cirrhotic patients (Table 1).…”

“…The type of anemia, its etiology, and its prevalence are variable in cirrhotic patients (Table 1). Various forms of anemia, including normocytic (prevalence ≈40-54%), microcytic (≈20-28%), and macrocytic (≈44%), have been identified in cirrhosis (Table 1) [17]. The pathological changes in erythrocytes have been documented in various experimental models and human cases of cholestasis/cirrhosis [11][12][13][14]16].…”

“…Various forms of anemia, including normocytic (prevalence ≈40-54%), microcytic (≈20-28%), and macrocytic (≈44%), have been identified in cirrhosis (Table 1) [17]. The pathological changes in erythrocytes have been documented in various experimental models and human cases of cholestasis/cirrhosis [11][12][13][14]16]. Several investigations have revealed that oxidative stress markers are significantly high in the erythrocytes isolat-ed from cirrhotic patients [18].…”

Cytokine Dependent Hematopoietic Cell Linker and Anemia in Liver Cirrhosis Patients

“…The pathophysiological effects of cirrhosis have a major impact on the liver's immunological and synthetic activities. Hematological dysfunctions, such as anemia, are how this manifests (1) .…”