Hematologic complications of alcohol use
- Stanley L Schrier, MD
Stanley L Schrier, MD
- Editor-in-Chief — Hematology
- Section Editor — Myeloproliferative Disorders; Red Blood Cell Disorders
- Professor of Medicine
- Stanford University School of Medicine
Chronic consumption of more than 80 grams of alcohol per day, which translates into a daily intake of approximately 250 mL of hard liquor, more than 500 mL of fortified wine, one bottle (750 mL) of table wine, or 1.5 liters of beer (four 12 ounce cans or bottles), has fairly reproducible effects on the hematologic system.
Alcohol use at this level can have a variety of hematologic effects, including macrocytosis with or without anemia, leukopenia, and/or thrombocytopenia. How this occurs is not completely understood. A direct toxic effect on hematopoietic cells, abnormalities in membrane phospholipids, and interference with folate utilization all may be involved [1,2].
The hematologic manifestations of alcohol abuse will be discussed here. The general subject of alcohol-associated disease is discussed separately. (See "Pathogenesis of alcoholic liver disease" and "Clinical manifestations and diagnosis of alcoholic fatty liver disease and alcoholic cirrhosis" and "Ethanol intoxication in adults".)
MECHANISM OF ALCOHOL TOXICITY
The adverse effects of alcohol on hematopoiesis may be mediated in part by metabolites of alcohol (ethanol). Ingested ethanol is metabolized in the liver in part by alcohol dehydrogenase, which oxidizes alcohol to acetaldehyde, while reducing NAD to NADH. (See "Pathogenesis of alcoholic liver disease", section on 'Alcohol metabolism'.)
It has been suggested that acetaldehyde accounts for some of the hematologic toxicity of alcohol [1,2]. Acetaldehyde can produce RBC protein-acetaldehyde adducts , which may generate immune responses against these modified proteins. Indeed, IgA and IgM anti-acetaldehyde-protein adducts have been found in alcoholics with macrocytic red cells . (See 'Macrocytosis' below.)
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- MECHANISM OF ALCOHOL TOXICITY
- MANIFESTATIONS OF HEMATOLOGIC TOXICITY
- Decreased red cell production
- Bone marrow examination
- Rebound thrombocytosis
- IRON OVERLOAD
- Interaction with existing genetic abnormalities
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS
- Definition of alcohol abuse
- Complicating factors
- Differential diagnosis