Hematological spectrum in patients with alcoholic liver cirrhosis: a model of end-stage liver disease score based approach

Jain, Deepak; Aggarwal, Hari Krishan; Rao, Akhilesh; Dahiya, Shaveta; Singla, Suhas

doi:10.18203/2349-3933.ijam20160494

Cited by 9 publications

(8 citation statements)

References 19 publications

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“…In our study mean Leukocyte was 4600 ± 540 and 3500 ± 640 in non-cirrhotic and cirrhotic group of patients respectively. Study done by Jain D et al 21 also showed decreased WBC count with increasing MELD score. The observed neutropenia may be related to impaired neutrophil development in the bone marrow due to toxic effect of alcohol which are more prominent in advanced ALD.…”

Section: Discussionmentioning

confidence: 83%

Clinical Study on Haematological Profile Abnormalities in Alcoholic Liver Disease Patients in a Tertiary Teaching Hospital in North East India

Ray¹,

Barman²,

Pandit³

2019

jebmh

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BACKGROUND Alcoholic Liver Disease (ALD) is the cause of about 14 million premature deaths per year worldwide. 1 Alcohol induced liver injury is the most prevalent cause of liver disease and affects 10-20% of the populations worldwide. 2 Chronic alcohol consumption gives rise to various health hazards including liver disease, pancreatitis, central nervous system disorders, peripheral neuropathies and certain forms of cancer. Various haematological and biochemical changes are also seen in a chronic alcoholic patients that further worsen the clinical condition of the patient. The objective of the present study to evaluate clinical and haematological changes that occur in alcoholic liver disease patients and early identification of abnormalities in haematological indices. METHODS This observational, non-interventional hospital-based study was done at North Bengal Medical College and Hospital in the department of General Medicine for a duration of one year from March 2018 to February 2019. Total 200 cases diagnosed alcoholic liver disease patients were included in the study. Clinical history, examination, biochemical and haematological parameters, and USG of abdomen were studied. RESULTS Patients' age ranged from 30 to 60 years and male to female ratio was 2:1. Majority of the patients were in the age group of 41 to 50 years (42%). Anorexia, abdominal pain, jaundice, ascites and splenomegaly were predominant symptoms and signs. Common haematological abnormalities were anaemia, thrombocytopenia and raised PT. Common types of anaemia were normocytic normochromic (58%) and macrocytic (58%). CONCLUSIONS Long duration excessive alcohol ingestion not only leads to acute and chronic liver disorder but also affect haematological indices. Pancytopenia, megaloblastic anaemia, increased PT, INR are some characteristic haematological abnormality in ALD.

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Section: Discussionmentioning

confidence: 83%

Clinical Study on Haematological Profile Abnormalities in Alcoholic Liver Disease Patients in a Tertiary Teaching Hospital in North East India

Ray¹,

Barman²,

Pandit³

2019

jebmh

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“…In a study conducted by Jain et al, 88 patients with alcoholic liver cirrhosis were divided into 5 groups according to their MELD scores. It was found that hematological abnormalities, such as anemia and leucopenia, were more common in the higher MELD score group [13]. Studies have shown that anemia is a poor prognostic factor in patients with liver cirrhosis, and the severity of anemia increases with the stage of liver disease [14,15].…”

Section: Discussionmentioning

confidence: 99%

Association of liver cirrhosis severity with anemia: does it matter?

Singh

Manrai

Parvathi

et al. 2020

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Background The etiology of anemia in liver disease is diverse and often multifactorial. Anemia is more severe in advanced stages of liver cirrhosis and can be a predictor of the severity of liver disease. Methods In this cross-sectional observational study, we included 181 cirrhotic patients with anemia owing to liver cirrhosis and its complications. The population was divided into 2 groups based on the model for end-stage liver disease (MELD) score and the severity of anemia was assessed in the 2 groups. Similarly, hemoglobin levels were assessed in 3 groups based on the Child-Turcotte-Pugh (CTP) classification. Results There was a statistically significant correlation between CTP class and hemoglobin (P<0.001), with the lowest hemoglobin levels in CTP C patients. The correlation coefficient between hemoglobin and MELD score was-0.671 and was statistically significant, establishing that hemoglobin levels decrease with increasing severity of liver cirrhosis. Of 58 patients with macrocytosis, 45 (77.6%) had a MELD score of >12, whereas only 13 patients (22.4%) had a MELD score of <12. This difference was statistically significant (P<0.0001). Conclusion This study shows that hemoglobin levels decrease with increasing severity of liver disease; thus, this measure can be used in the initial assessment of patients to give a picture of the severity of the disease. A larger prospective trial is needed to establish the use of hemoglobin levels for assessing severity and predicting mortality in patients with liver cirrhosis.

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“…In another prospective study on 88 patients with alcoholic liver cirrhosis, model for end stage liver disease (MELD) scoring is used to divide them into five different groups, in which group 1 to 5 constitute patients with MELD scores of 1-9, 10-19, 20-29, 30-39 and >40, respectively. (Jain, et al, 2016). All patients in group 1 have normal leukocyte count.…”

Section: Alcohol Disrupts Homeostasis Of Granulopoiesismentioning

confidence: 92%

“…Corticosteroids have been shown to exert various effects on marrow HSPC activities and the defense function of immune effector cells (Dror, et al, 2000;Family, et al, 2018;Hernigou & Beaujean, 1997). Advanced liver diseases are also frequently accompanied with granulocytopenia (Jain, et al, 2016;Ng, et al, 2002;Qamar, et al, 2009) and impairment of neutrophil function (Karakike, et al, 2017;Rolas, et al, 2013). Infectious complications including septic infection occur in approximately 50% of patients with alcoholic liver diseases, which are the main causes of death in these individuals (Karakike, et al, 2017;Bruns, et al, 2014).…”

Section: Treatment With G-csfmentioning

confidence: 99%

Alcohol abuse and disorder of granulopoiesis

Shi

DeLucia

Bao

et al. 2019

Pharmacology & Therapeutics

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Granulocytes are the major type of phagocytes constituting the front line of innate immune defense against bacterial infection. In adults, granulocytes are derived from hematopoietic stem cells in the bone marrow. Alcohol is the most frequently abused substance in human society. Excessive alcohol consumption injures hematopoietic tissue, impairing bone marrow production of granulocytes through disrupting homeostasis of granulopoiesis and the granulopoietic response. Because of the compromised immune defense function, alcohol abusers are susceptible to infectious diseases, particularly septic infection. Alcoholic patients with septic infection and granulocytopenia have an exceedingly high mortality rate. Treatment of serious infection in alcoholic patients with bone marrow inhibition continues to be a major challenge. Excessive alcohol consumption also causes diseases in other organ systems, particularly severe alcoholic hepatitis which is life threatening. Corticosteroids are the only therapeutic option for improving short-term survival in patients with severe alcoholic hepatitis. The existence of advanced alcoholic liver diseases and administration of corticosteroids make it more difficult to treat serious infection in alcoholic patients with the disorder of granulopoieis. This article reviews the recent development in understanding alcohol-induced disruption of marrow granulopoiesis and the granulopoietic response with the focus on progress in delineating cell signaling mechanisms underlying the alcohol-induced injury to hematopoietic tissue. Efforts in exploring effective therapy to improve patient care in this field will also be discussed.

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Hematological spectrum in patients with alcoholic liver cirrhosis: a model of end-stage liver disease score based approach

Cited by 9 publications

References 19 publications

Clinical Study on Haematological Profile Abnormalities in Alcoholic Liver Disease Patients in a Tertiary Teaching Hospital in North East India

Clinical Study on Haematological Profile Abnormalities in Alcoholic Liver Disease Patients in a Tertiary Teaching Hospital in North East India

Association of liver cirrhosis severity with anemia: does it matter?

Alcohol abuse and disorder of granulopoiesis

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