Question

A patient with alcoholic liver disease has severe anemia. Which of the following explains the development of anemia in this particular patient?

Choose all answers that apply:

1- Alcoholics are often deficient in folate.
2- Gastric ulcers may lead to chronic blood loss.
3- Alcohol suppresses erythropoiesis.
4- Alcohol causes inflammation, which leads to anemia.
5- Liver dysfunction leads to decreased clotting factors.

Answer 1

Anemia in alcoholic liver disease is commonly caused by folate deficiency and chronic blood loss from gastric ulcers. While alcohol can lead to anemia through inflammation and suppression of erythropoiesis, decreased clotting factors due to liver dysfunction contribute to anemia more indirectly.

Step-by-step explanation:

Anemia in patients with alcoholic liver disease can be multifactorial. Notably, several mechanisms are often at play involving nutritional deficiencies, gastrointestinal blood loss, and impaired liver function. Let’s discuss the given options:

• Alcoholics are often deficient in folate: This is a correct assertion since heavy drinking can interfere with the absorption and metabolism of folate, a nutrient critical for the synthesis of red blood cells. Folate deficiency can lead to megaloblastic anemia.

• Gastric ulcers may lead to chronic blood loss: Another valid point. Gastric ulcers, which can be exacerbated by alcohol abuse, can cause chronic blood loss and result in iron-deficiency anemia.

• Alcohol suppresses erythropoiesis: Alcohol can indirectly suppress the production of red blood cells, or erythropoiesis, contributing to anemia. However, direct evidence for this is less commonly cited than the other factors listed here.

• Alcohol causes inflammation, which leads to anemia: Chronic inflammation associated with alcohol abuse can lead to a condition known as anemia of chronic disease, which can indeed contribute to anemia.

• Liver dysfunction leads to decreased clotting factors: While this statement is true, it does not directly cause anemia. However, impaired liver function can exacerbate bleeding, which may indirectly contribute to anemia due to increased blood loss.

Therefore, the development of anemia in a patient with alcoholic liver disease is possibly due to folate deficiency and chronic blood loss from gastric ulcers. While alcohol can both cause inflammation and indirectly contribute to anemia, the correlation between alcohol suppressing erythropoiesis and decreased clotting factors leading to anemia is not as direct as the other factors.