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A case of persistent anemia and alcohol abuse

Nature Clinical Practice Gastroenterology & Hepatology volume 4, pages 521–526 (2007)Cite this article

Abstract

Background A 56-year-old male with a history of excess alcohol consumption for over 10 years and type 2 diabetes mellitus (diagnosed 14 years previously) presented to the accident and emergency department with severe anemia and a 1-day history of nausea and 'coffee ground' vomiting. He had been admitted to hospital on several occasions in the previous 18 months, primarily because of anemia, and had received 30 units of transfused blood during this period. Previous extensive investigations included six esophagogastroduodenoscopies and a colonoscopy, a barium follow-through study, and a radionucleotide Meckel's scan. The prior working diagnosis was anemia secondary to blood loss.

Investigations Laboratory investigations (full blood count [including reticulocytes], microscopic blood film examination, hematinics, liver function tests with direct and indirect bilirubin measurement, prothrombin time, and lactate dehydrogenase level), transjugular liver biopsy and bone-marrow biopsy.

Diagnosis Alcohol-related anemia caused by acute hemolysis, sideroblastic anemia and cirrhosis.

Management Correction of anemia by blood transfusion (6 units), and prevention of recurrence by strict abstinence from alcohol.

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Figure 1: Blood film from the case patient
Figure 2: Laboratory variables for the 18 months preceding the current admission of the case patient
Figure 3: Histological image of a bone-marrow aspirate from the case patient that demonstrates the presence of ringed sideroblasts
Figure 4: An algorithm giving a straightforward approach to the investigation of anemia in alcoholics

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Authors and Affiliations

  1. G Lewis is a Junior Intern in the Department of Integrated Medicine, MP Wise is a Consultant in the Department of Adult Critical Care and C Poynton is a Consultant in the Department of Haematology at the University of Wales, Cardiff, UK.,

    Gemma Lewis, Matthew P Wise & Christopher Poynton

  2. A Godkin is a Consultant Physician in the Department of Integrated Medicine at the University Hospital of Wales and a Reader in Hepatology and Gastroenterology at the School of Medicine, Cardiff University, Cardiff, UK.,

    Andrew Godkin

Authors
  1. Gemma Lewis
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  2. Matthew P Wise
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  3. Christopher Poynton
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  4. Andrew Godkin
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Corresponding author

Correspondence to Andrew Godkin.

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The authors declare no competing financial interests.

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Lewis, G., Wise, M., Poynton, C. et al. A case of persistent anemia and alcohol abuse. Nat Rev Gastroenterol Hepatol 4, 521–526 (2007). https://doi.org/10.1038/ncpgasthep0922

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