Keywords
anemia
ferritin
serum iron
total protein
primary healthcare
How to Cite
Abstract
Introduction. Chronic liver diseases (CLD) remain a significant medical and social problem due to their increasing prevalence, high risk of complications, and substantial impact on patients’ quality of life. One of the common complications is anemia syndrome, the development of which is associated with impaired protein-synthesizing liver function, alterations in iron metabolism, chronic inflammation, nutritional deficiencies, and hemorrhagic manifestations. Early identification of laboratory markers of anemia risk is of particular importance for primary care physicians.
Aim. To determine the clinical and laboratory features and prognostic criteria for anemia development in patients with CLD of different etiologies at the primary healthcare level.
Materials and methods. A total of 73 patients with CLD were examined: 16 with chronic hepatitis C, 17 with alcoholic hepatitis, 12 with mixed-etiology liver cirrhosis, and 28 with metabolic dysfunction-associated fatty liver disease. The patients’ age ranged from 37 to 69 years (mean 46.7 ± 10.4 years). Inclusion criteria were hemoglobin ≤ 105 g/L and ferritin ≤ 100 µg/L. Complete blood count with erythrocyte indices, total protein, serum iron, ferritin, and activated partial thromboplastin time (APTT) were assessed. Statistical analysis was performed using ANOVA and Scheffé’s test.
Results. Clinical and laboratory signs of anemia were detected in all examined patients. The most pronounced changes were observed in patients with liver cirrhosis, including decreased parameters of hemoglobin, erythrocytes, MCV, MCH, total protein, ferritin, and serum iron, corresponding to microcytic anemia and accompanied by coagulation disorders. In the alcoholic hepatitis group, similar but less pronounced changes were found. Patients with chronic hepatitis C were characterized by normocytic anemia with relatively higher ferritin levels, suggesting functional iron deficiency associated with inflammation. In metabolic dysfunction-associated fatty liver disease, mild anemia with minimal laboratory abnormalities was observed. A correlation between total protein levels and parameters of red blood cells and iron metabolism was established.
Conclusions. Decreased total protein levels, impaired iron metabolism parameters, and changes in erythrocyte indices can be considered early predictors of anemia development in patients with CLD. The use of these accessible criteria at the primary healthcare level allows timely risk stratification and optimization of patient management pathways.
References
Nemish, I. I., & Stupnytska, H. Y. (2023). Liver “under control”: Effective use of diagnostic capabilities in clinical practice. Ukrainian Medical Journal, 2(151), 3–6. https://doi.org/10.32471/umj.1680-3051.154.241729
Cheemerla, S., & Balakrishnan, M. (2021). Global epidemiology of chronic liver disease. Clinical Liver Disease, 17(5), 365–370. https://doi.org/10.1002/cld.1061
European Association for the Study of the Liver. (2021). EASL clinical practice guidelines on non-invasive tests for evaluation of liver disease severity and prognosis. Journal of Hepatology, 75(3), 659–689. https://doi.org/10.1016/j.jhep.2021.05.025
Murawska, N., Fabisiak, A., & Fichna, J. (2016). Anemia of chronic disease and iron deficiency anemia in inflammatory bowel diseases. Inflammatory Bowel Diseases, 22(5), 1198–1208. https://doi.org/10.1097/MIB.0000000000000648
Ministry of Health of Ukraine. (2015). Unified clinical protocol of primary and secondary medical care: Iron deficiency anemia (Order No. 709). https://www.dec.gov.ua/wp-content/uploads/2019/11/2015_709_ykpmd_zda.pdf
Ministry of Health of Ukraine. (2014). Unified clinical protocol: Alcoholic hepatitis (Order No. 826). https://www.dec.gov.ua/wp-content/uploads/2019/11/2014_826_ykpmd_ag.pdf
Ministry of Health of Ukraine. (2021). Standards of medical care for hepatitis B in adults (Order No. 49). https://www.dec.gov.ua/wp-content/uploads/2021/01/2021_49_standart_vgv_dor.pdf
Ministry of Health of Ukraine. (2021). Standards of medical care for hepatitis C in adults (Order No. 51). https://www.dec.gov.ua/wp-content/uploads/2021/01/2021_51_standart_vgc_dor.pdf
Ministry of Health of Ukraine. (2017). Clinical guideline: Liver cirrhosis and complications. https://www.dec.gov.ua/wp-content/uploads/2019/11/akn_tsp.pdf
Sirchak, Y. S., Griga, V. I., Petrichko, O. I., & Richkar, Y. I. (2020). Efficiency of using Bifidobacterium infantis in patients with non-alcoholic fatty liver disease. Gastroenterology, 54(1), 8–17. https://doi.org/10.22141/2308-2097.54.1.2020.199136
Chereliuk, N. I., & Gridnyev, O. E. (2023). Main phylotypes of gut microbiota and their association with obesity and liver fibrosis in NAFLD. Modern Gastroenterology, 1(29), 24–30. https://doi.org/10.30978/MG-2023-1-24
Angelico, F., Pastori, D., & Del Ben, M. (2021). Impact of MAFLD on NAFLD classification in Italy. Clinical Gastroenterology and Hepatology, 19(12), 2683–2684. https://doi.org/10.1016/j.cgh.2021.02.015
Stein, J., Dignass, A. U., & Chow, K. U. (2016). Anemia and iron deficiency in gastrointestinal and liver conditions. World Journal of Gastroenterology, 22(35), 7908–7912. https://doi.org/10.3748/wjg.v22.i35.7908
Ray, M., & Autieri, M. V. (2019). Regulation of pro- and anti-atherogenic cytokines. Cytokine, 122, 154175. https://doi.org/10.1016/j.cyto.2017.09.031
Goryainova, N. V., Vydyborets, S. V., Derpak, Y. Y., Kucher, O. V., & Moroz, G. I. (2023). Anemic syndrome and regulation of iron absorption in gastroenterological diseases. Family Medicine. European Practices, 1(103), 11–19. https://doi.org/10.30841/2786-720X.2.2023.282488
Wang, C. C., Cheng, P. N., & Kao, J. H. (2020). Chronic viral hepatitis and metabolic derangement: A systematic review. Alimentary Pharmacology & Therapeutics, 51(2), 216–230. https://doi.org/10.1111/apt.15575
Kaur, J. (2019). A comprehensive review on metabolic syndrome. Cardiology Research and Practice, 2019, 4301528. https://doi.org/10.1155/2019/4301528
Wang, J., Tang, H., & Zhang, C. (2014). Modulation of gut microbiota during probiotic-mediated attenuation of metabolic syndrome. ISME Journal, 9, 1–15. https://doi.org/10.1038/ismej.2014.99
Parola, M., & Pinzani, M. (2016). Liver fibrosis: Pathophysiology and clinical issues. Molecular Aspects of Medicine, 65, 37–55. https://doi.org/10.1016/j.mam.2018.09.002
Van Dievoet, M. A., Eeckhoudt, S., & Stephenne, X. (2020). Primary hemostasis in chronic liver disease and cirrhosis. International Journal of Molecular Sciences, 21(9), 3294. https://doi.org/10.3390/ijms21093294
Garcia-Tsao, G., Abraldes, J. G., Berzigotti, A., & Bosch, J. (2017). Portal hypertensive bleeding in cirrhosis. Hepatology, 65(1), 310–335. https://doi.org/10.1002/hep.28906
Czaja, A. J. (2014). Hepatic inflammation and fibrosis in chronic liver disease. World Journal of Gastroenterology, 20(10), 2515–2532. https://doi.org/10.3748/wjg.v20.i10.2515
Horowitz, J. M., Venkatesh, S. K., Ehman, R. L., Jhaveri, K., Kamath, P., & Ohliger, M. A. (2017). Evaluation of hepatic fibrosis. Abdominal Radiology, 42(8), 2037–2053. https://doi.org/10.1007/s00261-017-1211-7
Vysyochyna, I. L., Nikolaienko-Kamyshova, T. P., Bashkirova, N. S., & Rosytska, O. A. (2023). Iron deficiency conditions in the practice of a general practitioner-family doctor. Dnipro.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.