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CN 22-1108/R
Volume 38 Issue 8
Aug.  2022
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Article Navigation >  Journal of Clinical Hepatology  > 2022  >  38(8): 1806-1812

Features of anemia in patients with alcoholic liver cirrhosis

DOI: 10.3969/j.issn.1001-5256.2022.08.017

  • Clinical Laboratory Center, Beijing YouAn Hospital, Capital Medical University, Beijing 100069, China

Research funding:

Incubating Project for Young and Middle-aged Talents in Beijing YouAn Hospital, Capital Medical University (BJYAYY-XS2019-02)

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  • Corresponding author: ZHAO Dantong, zhaodt@ccmu.edu.cn(ORCID: 0000-0002-4160-3815)
  • Received Date: 2021-12-10
  • Accepted Date: 2022-02-10
  • Published Date: 2022-08-20
    Abstract
  •   Objective  To investigate the laboratory and clinical features of anemia in patients with alcoholic liver cirrhosis.  Methods  A retrospective analysis was performed for the patients who were hospitalized in Beijing YouAn Hospital, Capital Medical University, from December 2020 to May 2021 and were found to have anemia based on reticulocyte hemoglobin (Hb) content (Ret-He) and whole blood cell analysis, and 106 patients with the discharge diagnosis of alcoholic liver cirrhosis who had no history of upper gastrointestinal bleeding or blood transfusion were screened out as subjects. Clinical features and related influencing factors were retrospectively analyzed based on the severity of anemia, the cytomorphological classification of anemia, and Ret-He. The independent samples t-test was used for comparison of normally distributed continuous data between two groups; a one-way analysis of variance was used for comparison between multiple groups, and the SNK-q test and the least significant difference t-test were used for further comparison between two groups. The Mann-Whitney U test was used for comparison of continuous data with skewed distribution between two groups, and the Kruskal-Wallis H test was used for comparison between multiple groups. The chi-square test was used for comparison of categorical data between groups. A Spearman correlation analysis was performed to investigate the correlation of different classification criteria for anemia with laboratory markers and clinical features.  Results  Among the 106 patients, there were 103 male patients (97.2%), with a mean age of 55.07±10.18 years and a mean Hb level of 87.16±18.55 g/L; there were 49 patients (46.2%) with mild anemia, 49 (46.2%) with moderate anemia, and 8(7.5%) with severe anemia; mean Ret-He was 33.65(13.3-46.4) pg, and there were 33 patients (31.1%) with ≤29 pg and 73 patients (68.9%) with Ret-He > 29 pg; among these patients, 46(43.4%) had macrocytic anemia, 34(32.1%) had normocytic anemia, 2(1.9%) had simple microcytic anemia, and 24 (22.6%) had microcytic hypochromic anemia; among these patients, 87(82.1%) had ascites and/or intra-abdominal infection, 82(77.4%) had splenomegaly and/or hypersplenism, 65(61.3%) had esophageal and gastric varices, and 31(29.2%) had hepatic encephalopathy. Compared with the control group (moderate/severe anemia), the mild anemia group had significantly higher Ret-He, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular-hemoglobin concentration (MCHC), serum iron (SI), and transferrin saturation (TS) (all P < 0.05), a significantly higher proportion of patients with Ret-He > 29 pg (83.7% vs 56.1%, P=0.002) or normocytic anemia (44.9% vs 21.1%, P=0.009), a significantly lower unsaturated iron-binding capacity (UIBC) (P < 0.05), and a significantly lower proportion of patients with microcytic hypochromic anemia (6.1% vs 36.8%, P < 0.05). Compared with the microcytic anemia group, the macrocytic anemia group had significantly higher alanine aminotransferase (ALT), Hb, and proportion of patients with ascites and/or intra-abdominal infection (91.3% vs 65.4%, Pc < 0.05) and a significantly lower proportion of patients with severe anemia (2.2% vs 19.2 %, Pc < 0.05) or esophageal and gastric varices (52.2% vs 84.6%, Pc < 0.05); the macrocytic anemia group had significantly higher aspartate aminotransferase (AST) and AST/ALT ratio than the microcytic anemia group and the normocytic anemia group (all Pc < 0.05); the microcytic anemia group had a significantly lower proportion of patients with mild anemia than the macrocytic anemia group and the normocytic anemia group, as well as a significantly higher proportion of patients with moderate anemia than the normocytic anemia group (all Pc < 0.05); compared with the other two groups, the macrocytic anemia group had significantly higher Ret-He, MCV, MCH, MCHC, SI, and TS (all Pc < 0.05) and significantly lower total iron-binding capacity (TIBC) and UIBC (all Pc < 0.05). Compared with the Ret-He > 29 pg group, the Ret-He ≤29 pg group had significantly lower Hb, MCV, MCH, MCHC, SI, TS, and proportion of patients with mild anemia or ascites and/or intra-abdominal infection (all P < 0.05), a significantly higher UIBC (P < 0.05), and a significantly higher proportion of patients with microcytic hypochromic anemia or esophageal and gastric varices (P < 0.05). Hb, Ret-He, MCV, MCH, MCHC, UIBC, SI, and TS were correlated with the severity of anemia, the cytomorphological classification of anemia, and iron deficiency (all P < 0.05), and esophageal and gastric varices and ascites and/or abdominal infection were correlated with the cytomorphological classification of anemia and iron deficiency (all P < 0.05).  Conclusion  The degree of anemia is mostly mild and moderate in the decompensated stage of alcoholic liver cirrhosis, and macrocytic anemia and normocytic anemia are more common. The incidence rate of iron deficiency increases with the severity of anemia, and esophageal and gastric varices and ascites and/or intra-abdominal infection are correlated with the cytomorphological classification of anemia and iron deficiency; therefore, it is necessary to enhance the monitoring of iron deficiency anemia in such patients in clinical practice.

     

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