Nutritional anaemia in cirrhosis of the liver

Abstract

The prevalence and causes of nutritional anaemia were studied in 31 patients with portal, post-necrotic and cryptogenic cirrhosis. Fifty-eight per cent of the patients had a history of drinking alcohol for more than 20 years. Anaemia as defined by a reduction in the haemoglobin and haematocrit levels was found in 77% and 81% respectively. Serum iron was found to be low in 28% while percentage saturation was over 15 in 12% of the patients. The peripheral blood smear showed macrocytosis in 100% and hypochromia in 19%. Low serum folate was found in 42% while red cell folate of every patient was over 100 ng/ml. Serum UFBP and TFBP levels were increased while percent saturation was lower than in normal subjects. Serum vitamin B12 levels were elevated in 94% of patients and all cases had values over 500 pg/ml which resulted in low serum UBBC. There was an increased TCI and decreased TCII, while TCIII was within normal limits in these patients. All these findings indicated than anaemia was quite common in cirrhosis mostly due to the deficiency of iron. The fact that the increased MCV was found in only half of the patients, the neutrophil hypersegmentation was not high and no patients showed biochemical or morphological evidence of megaloblastic anaemia, indicated that the anaemia and macrocytosis in these patients was not due to folate or vitamin B12 deficiency.