137 - Hematologic abnormalities in liver diseases
Autor(s): B. Biasioli, M. Golato
Issue: RIMeL - IJLaM, Vol. 6, N. 3-S1, 2010 (MAF Servizi srl ed.)
Page(s): 137-141
The liver plays a key role in the production of blood cells and coagulation factors. The liver diseases affect the hemovascular system homeostasis with abnormalities in the production of red blood cells, white cells and platelets and with defective synthesis on the coagulation factors. The pathogenesis is multifactorial and it can be highlighted both in bone marrow and in peripheral blood. It depends on the direct action of the etiological agent in medullary activity, on the nutritional deficiencies effects and on those deriving from liver disease. Anemia is a common alteration: different causes include hemorrhage, lack of folates, hemolysis, alcoholic bone marrow suppression and inhibition of the medullary activity induced by liver disease. There are several clinical aspects which depend on disease phase: liver disease, if alcoholic, moderate anemia with macrocytic erythrocytes can be released but normocytes and microcysts can also be found. Thrombocytopenia is one of the most frequent alterations detected in the course of liver disease and it is frequently mild or moderate. The pathogenesis can be peripheral for increased destruction resulting from portal hypertension, splenic sequestration and platelet autoantibodies, and it can be central to decreased production in the bone marrow or lung. Infections that cause liver disease can cause leukopenia with neutropenia with multiple pathogenic mechanisms that can coexist in the same patient and they include the lack of production and the decrease of bone marrow reserve.