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

Abstract

Summary The incidence of macrocytosis, defined as a mean corpuscular volume (MCV) of > 95 fl and large red cells on peripheral blood film, was determined in 303 alcoholics with liver disease (95 females: 208 males), 60 non‐alcoholics with chronic liver disease (44 females: 16 males) and 35 control subjects (15 females: 20 males). Macrocytosis was found in 70.3% (213/303) of alcoholics with liver disease and in 23.3% (14/60) of non‐alcoholics with liver disease, P < 0.001. MCV values > 100 fl were seen in 49.5% (150/303) of alcoholics, but in only 3.3% (2/60) of non‐alcoholics, P < 0.001. Macrocytosis was more frequent in female, 86.3% (82/95) than in male alcoholics 63.0% (131/208), P < 0.001. Serum folate values < 3 μg/1 were found in 14.5% (44/303) of alcoholics and in 11.7% (7/60) of non‐alcoholics. Low serum folate values were found in 183% (39/213) of alcoholics with macrocytosis and in 35.9% (28/78) of those with macrocytic anaemia. Twenty alcholics with pre‐cirrhotic liver disease were followed over three months. Macrocytosis was present in 85.0% (17/20) at the outset and in 40% (8/20) 3 months later. The changes in MCV were independent of alcohol intake and serum folate values. Macrocytosis is a useful diagnostic indicator of alcoholism. MCV values > 100 fl in patients with liver disease almost invariably indicate alcohol‐related disease. In the short‐term, changes in MCV are of little use in monitoring alcohol intake.

The assessment of serum soluble transferrin receptor in alcoholics

“…Macrocytosis is common in both anemic and nonanemic alcoholics; it appears to be even more common in those without anemia [31]. It has been previously reported that incidence of macrocytosis in female alcoholics was 86% compared to 63% in males [33]. This is in agreement with our study, where almost every second patient had MCV levels above the normal upper borderline.…”

Differentiation of nonalcoholic from alcoholic steatohepatitis: are routine laboratory markers useful?

“…In a study of red blood cell status in alcoholic and nonalcoholic liver disease [32], macrocytic anemia was mostly found in patients with cirrhosis, but in ALD the MCV correlated with the estimated alcohol consumption and decreased after abstinence from alcohol. MCV values > 100 fl in patients with liver disease almost invariably indicated alcohol-related disease [33]. In our study the difference in MCV between ASH and NASH patients seems to be even more marked in fibrosis stages 3 and 4 than in stages 0-2 (Fig.…”

Biochemical detection and monitoring of alcohol abuse and abstinence

“…59 It then takes several months of abstinence for MCV to return to normal, 60 so MCV has no role in monitoring abstinence or relapse. The actual mechanism by which alcohol causes an increase in MCV appears to include a direct toxic effect of alcohol on red blood cells, folic acid de®ciency secondary to alcohol abuse and hepatic damage.…”