Red blood cell status in alcoholic and non-alcoholic liver disease

Macrocytosis is most commonly associated with vitamin B-12 and folic acid d eficiency, followed by alcoholism, liver disease, and other pathologic cond itions. We studied the red cell and vitamin status in 423 consecutive patie nts with various liver diseases, including 31 with acute viral hepatitis (A VH), 105 with chronic hepatitis (CH), and 134 with alcoholic liver disease (ALD), who consisted of 84 with noncirrhotic alcoholic liver disease (NCALD ) and 50 with alcoholic liver cirrhosis (ALC), 60 with non-alcoholic liver cirrhosis (NALC), and 93 with hepatocellular carcinoma (HCC). The mean corp uscular volume (MCV) and red cell distribution width (RDW) were significant ly higher in patients with ALD and NALC, and among them macrocytosis occurr ed more frequently in patients with ALC. Macrocytic anemia was mostly found in cirrhotic patients, in which the Child-Pugh score was closely related t o the development of macrocytic anemia. In ALD, the MCV was significantly c orrelated with the estimated alcohol consumption and inversely correlated w ith the serum folic acid level, which, however, was often maintained within the normal range in patients with macrocytic ALC. After abstinence from al cohol, the MCV and RDW were reduced significantly and were associated with an increasing serum folic acid level. This suggests that macrocytic anemia was a common feature of alcoholic and non-alcoholic liver cirrhosis and tha t alcohol abuse and folic acid deficiency play a secondary role In macrocyt osis.