Potential Causes of Anemia in Hepatic Cirrhosis
Short communication
DOI:
https://doi.org/10.5281/zenodo.10096137Keywords:
anemia, , liver cirrhosis, esophageal varices, hemorrhoids, vascular fragility, hypertensive portal gastropathy, thrombocytopenia,, coagulopathy, vitamin K deficiency, splenomegaly, splenic rupture, splenectomy, erythropoietin, thrombopoietin, hepatorenal syndrome, myelodysplastic syndrome, cryoglobulins, amyloidosis, chronic inflammation, iron deficiency, copper deficiency, zinc, lead, vitamin B1, vitamin B2, vitamin B6, vitamin B9, vitamin B12, folic acid, vitamin C, vitamin E, tocopherol, autoimmune hemolytic anemia, microangiopathic hemolytic anemia, Zieve syndrome, acetaldehyde, ring sideroblasts, macrocytes, microcytes, spherocytes, echinocytes, hypochromia, acanthocytes, schizocytes, liver transplantation, hepatic stellate cells, heme synthesis, delta-ALA Dehydratase, delta aminolevulinic acid dehydratase, delta-ALAS, delta aminolevulinic acid synthase, ferrochelatase, spontaneous bacterial peritonitis, Avatrombopag, Lusotrombopag, Eltrombopag, coagulation factors, plasminogen, hemostatics, adrenostasin, etamsylate, tranexamic acid, recombinant, parvovirus B19, malabsorption, emulsification, choleretic, cryoprecipitate, fresh frozen plasma, dysfibrinogenemia, thrombophilia, hyperhomocysteinemia, vaccination, Streptococcus pneumoniae, Neisseria meningitis, Hemophilus influenzae, clarithromycin, proton pump inhibitors, hyperviscosity, Waldenstrӧm macroglobulinemia, immunomodulator, intestinal flora, ADAMTS13, rheumatoid factor, lysophosphocholine-acyl-transferase, coproporphyrinogen oxidase, Prussian blue, NO, nitrogen monoxide, TTP, thrombotic thrombocytopenic purpura, APLS, antiphospholipid syndrome, SOD, superoxide dismutase, TIPS, transjugular intrahepatic portosystemic shunt, deep vein thrombosis, VWF, von Willebrand factor, dimercaptosuccinic acid, succimer, D-penicillamine, midodrine, octeotride, telmipressin, vasopressin, norepinephrine, norfloxacin, biseptol, Congo red, hepcidin, transferrin, ferrireductase, ferroportin, beer, dentures, metallothionein, hemodialysis, hefaestin, ferrioxidase, elemental copper, copper gluconate, optic neuritis, alpha-ceruloplasmin, Coombs test, thermal amplitude of antibodies, biphasic test, Donath-Landsteiner, paroxysmal cold hemoglobinuria, PNH, paroxysmal nocturnal hemoglobinuria, syphilis, agglutination, caplacizumab, rituximab, pentad, tetrad, triad, dyad, lysolecithin, lysocephalin, glutathione, oxidative stress, pyruvate kinase, anaerobic glycolysis, hereditary spherocytosis, Wilson's disease, Clostridium perfringens, Clostridium welchii, TIA, stroke, Transient Ischemic Accident, Cerebrovascular Accident, amyloid, birefringentAbstract
The article looks at the basic mechanisms of anemia in patients with liver cirrhosis (bleeding through esophageal varices, hemorrhoids, vascular fragility, hypertensive portal gastropathy, thrombocytopenia, coagulopathy, vitamin K deficiency, splenic rupture, splenic sequestration of red blood cells in splenomegaly) and also the additional mechanisms of anemia in liver cirrhosis (erythropoietin deficiency, renal injury, chronic inflammation, deficiency of trace elements and vitamins, autoimmune hemolytic anemia, microangiopathic hemolytic anemia, Zieve syndrome). Depending on the Child-Pugh staging of liver cirrhosis, as well as the associated pathologies of the patient with liver cirrhosis, it is possible that there are simultaneously several ways of the appearance of anemia. It is an attempt to achieve more than a simple review of them in a tabular form, focusing not only on physiopathology, but also on diagnostic and therapeutic elements - the latter being briefly mentioned in widely known situations and presented in more detail in the context of the rarer causes of anemia in patients with liver cirrhosis. In conclusion, the differential and positive diagnosis of anemia in liver cirrhosis decisively influences the therapeutic decision and, of course, not only survival, but also the patient's quality of life. Interdisciplinary collaboration (family doctor, gastroenterologist, internist, infectious disease specialist, hematologist, surgeon, ICA, medical imaging, laboratory) is the optimal way to a diagnosis and targeted treatment of the causes of anemia in liver cirrhosis.
References
Lawrence S. Friedman, MD, Chap. 16, Liver, Biliary Tract & Pancreas Disorders in Maxine A. Papadakis, MD, Stephen J. McPhee, MD, Michael W. Rabow, MD, Kenneth R. McQuaid, MD With Associate Authors, Current Medical Diagnosis and Treatment 2022, Sixty-firts edition, McGraw Hill, p. 706 – 709.
Varut Lohsiriwat, Treatment of hemorrhoids: A coloproctologist’s view, World J Gastroenterol 2015 August 21; 21(31): p. 9250, 2015, Baishideng Publishing Group Inc.
Tribus Laura Carina, Ruxandra Sfeacu, Pierderea masei musculare in bolile hepatice avansate: fiziopatologie si management, Editorial Group - Medichub Media, 3.05.2021.
Tudorel Ciurea, Sergiu Cazacu, Dan Ionuţ Gheoanea, Cap. 16, Ciroza hepatică în Victor Stoica, Viorel Scripcariu et al., Compediu de Specialităţi Medico-Chirurgicale, vol. 1, Editura medicală, 2016, p. 309, 311.
Eric Goldberg, MD, Sanjiv Chopra, MD, MACP, Cirrhosis in adults: Overview of complications, general management and prognosis, Up To Date, Wolters Kluver, Up date Sept 13 2021, Review Febr 2023.
George M. Rodgers, Alan B. Grosset, Chapter 55, Acquired Coagulation Disorders in Wintrobe’s Clinical Hematology, 14th Edition, 2019, Wolters Kluver, p. 3787- 3792.
Marshall A. Lichtman, Kenneth Kaushansky, Josef T Prchal, Marcel M. Levi, Linda J. Burns, David C. Lynch, Chap. 26 - Hypersplenism and Hyposplenism Williams Manual of Hematology, 10th Edition, 2022, McGrow Hill LLC, p. 135-140.
Adrian A Maung, MD, FACS, Lewis J Kaplan, MD, FACS, Surgical management of splenic injury in the adult trauma patient, Wolters Kluver, Up date Jan 23, 2023, Review Apr 2023.
Ayalew Tefferi, MD, Approach to the patient with thrombocytosis, Up To Date, Wolters Kluver, Up date Aug 19 2022, Review Apr 2023.
Dr. Alexandru-Laurenţiu Chiotoroiu, Prevenirea şi Managementul Infecţiilor Postsplenectomie în Trauma Lienală în Revista Medicală Romană, vol. LXIII, Nr. 4, 2016, p. 300 – 301.
Marshall A. Lichtman, Kenneth Kaushansky, Josef T Prchal, Marcel M. Levi, Linda J. Burns, David C. Lynch, Chap. 11, Hereditary and Acquired Sideroblastic Anemias, Williams Manual of Hematology, 10th Edition, 2022, McGrow Hill LLC, p. 59-60.
David A. Garcia, MD, Robert Bona, MD, Hematologic complications of alcohol use, Wolters Kluver, Up date Jul 13 2022, Review Febr 2023.
Sassan Pazirandeh, MD, David Al. Burns, MD, Overview of watersoluble vitamins, Up To Date, Wolters Kluver, Up date Febr 03 2023, Review Mar 2023.
Karl E Anderson, MD, FACP, ALA dehydratase porphyria, Up To Date, Wolters Kluver, Up date Jul 28 2022, Review Aug 2022.
Bruce A Runyon, MD, FAASLD, Hepatorenal syndrome, Wolters Kluver, Up date Dec 13, 2022, Review Mar 2023.
Patrice Cacoub, MD, Overview of cryoglobulins and cryoglobulinemia, Up To Date, Wolters Kluver, Up date Sept. 14 2022, Review Febr 2023.
Fernando C Fervenza, MD, PhD, Sanjeev Sethi, MD, PhD, Steve Falmm, MD, Mixed cryoglobulinemia syndrome: Clinical manifestations and diagnosis, Up date, Wolters Kluver, Dec 13 2022, Review Mar 2023.
Peter D Gorevici, MD, Overview of Amyloidosis, Up To Date, Wolters Kluver, Up date Jul 01 2022, Review Jun 2022.
Hortensia Ioniţă, Ioana Ioniţă, Cap. 18.1, Anemia Feriprivă în Victor Stoica, Viorel Scripcariu et al., Compediu de Specialităţi Medico-Chirurgicale, vol. 1, Editura medicală, 2016, p.353-357.
Marshall A. Lichtman, Kenneth Kaushansky, Josef T Prchal, Marcel M. Levi, Linda J. Burns, David C. Lynch, Chap. 5 - Anemia of Chronic (Inflammatory, Neoplastic, and Renal) Disease, Williams Manual of Hematology, 10th Edition, 2022, McGrow Hill LLC, p. 29-31.
Dr. Cristina Mambet, Anemii Microcitare - curs pentru medici rezidenţi, UMF "Carol Davila" Bucureşti, SCUUB, 13.05.2021.
Michael Auerbach, MD, FACP, Causes and diagnosis of iron deficiency and iron deficiency anemia in adults, Up To Date, Wolters Kluver, Up date Jul 7 2022, Review Febr 2023.
Marshall A. Lichtman, Kenneth Kaushansky, Josef T Prchal, Marcel M. Levi, Linda J. Burns, David C. Lynch, Chap. 9 - Iron Deficiency and Iron Overload, Williams Manual of Hematology, 10th Edition, 2022, McGrow Hill LLC, p. 46-56.
Marshall A. Lichtman, Kenneth Kaushansky, Josef T Prchal, Marcel M. Levi, Linda J. Burns, David C. Lynch, Chap. 8 - Folate, Cobalamin, and Megaloblastic Anemias, Williams Manual of Hematology, 10th Edition, 2022, McGrow Hill LLC, p.38-45.
Neeraj Kumar, MD, Copper deficiency myeloneuropathy, Up To Date, Wolters Kluver, Up date Mar 25 2021, Review Mar 2023.
Marshall A. Lichtman, Kenneth Kaushansky, Josef T Prchal, Marcel M. Levi, Linda J. Burns, David C. Lynch, Chap. 10 - Anemia Resulting from Other Nutritional Deficiencies, Williams Manual of Hematology, 10th Edition, 2022, McGrow Hill LLC, p. 55-58.
Sylvya S Bottomley, MD, Sideroblastic anemias: Diagnosis and management, Up To Date, Wolters Kluver, Up date May 03 2023, Review Apr 2023.
Aminat S. Ogun, Neena V. Joy, Menogh Valentine, Biochemistry, Heme Synthesis, NCBI Bookshelf -National Library of Medicine, Bookshelf ID: NBK537329 PMID: 30726014, 2023, StatPearls Publishing LLC, Last Update: May 1, 2023.
Hortensia Ioniţă, Ioana Ioniţă, Cap. 8.2, Anemiile Hemolitice Dobândite, în Victor Stoica, Viorel Scripcariu et al., Compediu de Specialităţi Medico-Chirurgicale, vol. 1, Editura medicală, 2016, p. 358-362.
Marshall A. Lichtman, Kenneth Kaushansky, Josef T Prchal, Marcel M. Levi, Linda J. Burns, David C. Lynch, Chap. 23 - Cryopathic Hemolytic Anemia (cold agglutinin disease, paroxysmal cold hemoglobinuria, cryoglobulinemia), Williams Manual of Hematology, 10th Edition, 2022, McGrow Hill LLC, p. 119-127.
Clifford M Takemoto, MD, Burr cells acanthocytes and target cells: disorders of red blood cell membrane, Wolters Kluver, Up date Febr 15 2023, Review Febr 2023.
Wilma Barcellini, MD, Macrocytosis/Macrocytic anemia, UpToDate, Wolters Kluver, July 8, 2022, review Jan 2023.
Marshall A. Lichtman, Kenneth Kaushansky, Josef T Prchal, Marcel M. Levi, Linda J. Burns, David C. Lynch, Chapter 19 - Fragmentation Hemolytic Anemia, Williams Manual of Hematology, 10th Edition, 2022, McGrow Hill LLC, p. 98-103.
Tudorel Ciurea, Sergiu Cazacu, Dan Ionut Gheoanea, Cap. 16, Ciroza hepatica in Victor Stoica, Viorel Scripcariu et al., Compediu de Specialitati Medico-Chirurgicale, vol. 1, Editura medicala, 2016, p. 303-332.
George M. Rodgers, Alan B. Grosset, Chapter 55, Acquired Coagulation Disorders, Wintrobe’s Clinical Hematology, 14th Edition, 2019, Wolters Kluver, p. 3791.
Marshall A. Lichtman, Kenneth Kaushansky, Josef T Prchal, Marcel M. Levi, Linda J. Burns, David C. Lynch, Chap. 86 - Disseminated intravascular coagulation (DIC), Williams Manual of Hematology, 10th Edition, 2022, McGrow Hill LLC, p. 585-588.
Han-Mou Tsai, Chapter 49, Thrombotic Thrombocytopenic Purpura, Hemolytic–Uremic Syndrome, and Related Disorders Wintrobe’s Clinical Hematology, 14th Edition, 2019, Wolters Kluver, p. 3434-3467.
Miao-Xia Liu, MDa, Xiao-Yu Wen, MD, PhDa, Ying-Kit Leung, MD, PhDb, Yi-Jie Zheng, MD, PhDc, Mei-Shan Jin, MDa, Qing-Long Jin, MD, PhDa, Jun-Qi Niu, MD, PhDa, Hemolytic anemia in alcoholic liver disease: Zieve syndrome, A case report and literature review, Medicine (nov 2017) 96:47(e8742), Published by Wolters Kluwer Health, Inc., received: 26 July 2017, received in final form: 22 October 2017, accepted: 24 October 2017.
Abughanimeh O, Kaur A, Numan L, et al. (February 22, 2019) Zieve’s Syndrome: An Under-reported Cause of Anemia in Alcoholics. Cureus 11(2):e4121. DOI 10.7759/cureus.4121.
Marshall A. Lichtman, Kenneth Kaushansky, Josef T Prchal, Marcel M. Levi, Linda J. Burns, David C. Lynch, Chap. 22 - Hemolytic Anemia Resulting from Warm Reacting Antibodies Williams Manual of Hematology, 10th Edition, 2022, McGrow Hill LLC, p. 116.
Downloads
Published
How to Cite
License
Copyright (c) 2023 RAZVAN JUGANARU, Ana-Maria Deleanu, Mara Alexandra Moldovan
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.