Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

Hematologic complications of alcohol use

Stanley L Schrier, MD
Section Editor
William C Mentzer, MD
Deputy Editor
Jennifer S Tirnauer, MD


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".)


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 [3], 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 [4]. (See 'Macrocytosis' below.)


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Apr 2017. | This topic last updated: Jun 25, 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Girard DE, Kumar KL, McAfee JH. Hematologic effects of acute and chronic alcohol abuse. Hematol Oncol Clin North Am 1987; 1:321.
  2. Lieber CS. Metabolism and metabolic effects of alcohol. Semin Hematol 1980; 17:85.
  3. Niemelä O, Parkkila S. Alcoholic macrocytosis--is there a role for acetaldehyde and adducts? Addict Biol 2004; 9:3.
  4. Koivisto H, Hietala J, Anttila P, et al. Long-term ethanol consumption and macrocytosis: diagnostic and pathogenic implications. J Lab Clin Med 2006; 147:191.
  5. Savage D, Lindenbaum J. Anemia in alcoholics. Medicine (Baltimore) 1986; 65:322.
  6. Malik P, Bogetti D, Sileri P, et al. Spur cell anemia in alcoholic cirrhosis: cure by orthotopic liver transplantation and recurrence after liver graft failure. Int Surg 2002; 87:201.
  7. Latvala J, Parkkila S, Niemelä O. Excess alcohol consumption is common in patients with cytopenia: studies in blood and bone marrow cells. Alcohol Clin Exp Res 2004; 28:619.
  8. Seppä K, Sillanaukee P, Saarni M. Blood count and hematologic morphology in nonanemic macrocytosis: differences between alcohol abuse and pernicious anemia. Alcohol 1993; 10:343.
  9. Savage DG, Ogundipe A, Allen RH, et al. Etiology and diagnostic evaluation of macrocytosis. Am J Med Sci 2000; 319:343.
  10. Conrad ME, Barton JC. Anemia and iron kinetics in alcoholism. Semin Hematol 1980; 17:149.
  11. Nakao S, Harada M, Kondo K, et al. Reversible bone marrow hypoplasia induced by alcohol. Am J Hematol 1991; 37:120.
  12. Tavill AS, Qadri AM. Alcohol and iron. Semin Liver Dis 2004; 24:317.
  13. Fletcher LM, Bridle KR, Crawford DH. Effect of alcohol on iron storage diseases of the liver. Best Pract Res Clin Gastroenterol 2003; 17:663.