Liver is one of the underlying organs playing a leading role in iron metabolism in the body. Under physiological conditions, it synthesizes transferrin, which is responsible for iron transport in blood, ceruloplasmin, which manifests its activity as ferroxidase, and the underlying regulator of systemic iron homeostasis, hepcidin.
Chronic liver disease could lead to impaired iron metabolism.
According to various authors, over time 75% of patients with liver cirrhosis (LC) and portal hypertension syndrome develop esophageal varices (EPV). In 30% of them, bleeding occurs within two years, 30-50% of cases end in death, in survivors, in 98% of cases, iron deficiency conditions develop. Another cause of iron deficiency in patients with hepatocellular insufficiency is a decrease in transferrin synthesis.
Anemia, which develops in liver diseases, contributes to the progression of dystrophic changes in the internal organs. Anemia in chronic diffuse liver diseases (CDLD) is characterized by a complex pathogenesis and is caused by complex disorders of erythropoiesis in form of iron metabolism violation with its deficiency, increased autohemolysis and increase in the content of fetal hemoglobin in erythrocytes, changes in the qualitative and quantitative composition of erythrocyte membrane proteins.
Causes of anemia in CDLD
Various pathogenetic variants of anemias could be observed in CDLD, including anemia of chronic diseases, anemia due to blood loss, impaired formation of erythrocytes and hemoglobin, hemolysis of erythrocytes, folic acid and vitamin B12 deficiency.
Besides, anemia may be one of side effects in antiviral treatment for hepatitis C (ribavirin underlyingly). In this case, hemolysis of erythrocytes develops, which is completely reversible at the end of therapy. In addition, the ability of ribavirin metabolites to accumulate in erythrocytes has been established, thereby reducing their lifespan.
Currently, the problem of anemia is extremely relevant in the treatment of patients with chronic diffuse liver diseases. Determination of the mechanisms of its occurrence in CDLD is very important for timely diagnosis, correction and prevention of the progression of both pathological changes in red blood and the underlying liver disease.
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