Dynamic changes in erythropoiesis parameters depending on the leading pathogenetic factor and treatment in patients with liver cirrhosis

Introduction. Anemia is the most frequent hematological pathology in patients with liver disease. The combination of pathogenetic factors leads to the iron deficiency anemia (IDA) – the most common type of anemia; anemia of chronic diseases (ACD), B 12 and folate deficiency anemia (ACA), hemolytic and aplastic anemia. Full examination is a necessary component that will make form an algorithm treatment aimed at the leading pathogenetic mechanism of anemia.
Materials and methods. 44 people with cirrhosis were examined: 15 women, 29 men aged from 30 to 70 years. All patients were divided into groups in accordance with the established type of anemia: iron deficiency anemia (IDA), anemia of chronic diseases (ACD) and a combination of IDA and ACD), as well as by the type of therapy performed (therapy with iron preparations, therapy with B vitamins and treatment only of the underlying disease).
Results. A comparative analysis of blood parameters was performed before and after the treatment. A clinically significant increase in hemoglobin and erythrocytes was not observed in any of the studied groups. A statistically significant increase in hematocrit and erythrocyte indices in the IDA group was revealed as a result of the use of iron preparations. When comparing oral and parenteral types of iron preparations in patients with IDA, the effect of therapy was similar without advantages in any of the groups. In the groups of ACD and ACD + IDA were no significant changes in the indices of the red hematopoietic line were revealed in any of the therapy options.
Conclusion. Treatment of the underlying disease alone is not enough to restore hemoglobin. Iron therapy, regardless of the form of administration, can be effective in patients with IDA. Vitamin therapy can only be used as an adjunct in the treatment of anemia. Further monitoring is needed to develop a more effective therapy protocol.

1. Gkamprela E., Deutsch M., Pectasides D. Iron deficiency anemia in chronic liver disease: etiopathogenesis, diagnosis and treatment. Ann Gastroenterol 2017; 30 (4): 405–413. DOI: https://doi.org/10.20524/aog.2017.0152.

2. Stein J., Connor S., Virgin G., et al. Anemia and iron deficiency in gastrointestinal and liver conditions. World J Gastroenterol. 2016; 22(35): 7908–7925. DOI: 10.3748/wjg.v22.i35.7908

3. Ballester-Clau R., Vicente G. T., Ramos M. C., Blanch C. A. et al. Efficacy and Safety of Treatment With Ferric Carboxymaltose in Patients With Cirrhosis and Gastrointestinal Bleeding. Front Med (Lausanne). 2020; 7: 128. DOI: 10.3389/fmed.2020.00128

4. Rybina O.V., Sakhin V.T., Gukin A.V., Sviridova A.V., Rukavitsin O.A. Therapy with parenteral iron supplements for the correction of anemia in patients with gastroenterological diseases. Hematology and transfusiology. Eastern Europe. 2021; 7(3): 383-390. DOI: 10.34883/PI.2021.7.3.011

5. Anemia: a short guide for practicing physicians of all specialties / E. V. Kryukov, V. T. Sakhin, O. A. Rukavitsyn [etc.]; under the general editorship of O. A. Rukavitsyn. – 2nd ed., revised. and additional – Moscow: Geotar-Media, 2021. – 144–226 p.

6. Gubonina I. V., Shchukina O. B., Stuklov N. I. et al. Anemia in inflammatory bowel diseases: approaches to diagnosis, treatment and prevention. Almanac of Clinical Medicine. 2019;47(8):721–732. DOI: 10.18786/2072–0505–2019–47–078

7. Romanenko N. A., Chechetkin A. V., Zhiguleva L. Yu., Grishina G. V., Bondarchuk S. V., Bessmeltsev S. S. Correction of anemia and assessment of the effectiveness of red blood cell transfusions in patients with oncohematological diseases. Clinical oncohematology. 2018;11(3):265–72. DOI: 10.21320/2500–2139–2018–11–3–265–272

8. Singh S, Manrai M, Parvathi V S, Kumar D, Srivastava S, Pathak B. Association of liver cirrhosis severity with anemia: does it matter? Ann Gastroenterol. 2020; 33(3): 272–276. DOI:10.20524/aog.2020.0478

9. Mehta KJ, Farnaud SJ, Sharp PA. Iron and liver fibrosis: Mechanistic and clinical aspects. World J Gastroenterol. 2019;25(5):521–538. DOI:10.3748/wjg.v25.i5.521,

10. Siddique A, Nelson JE, Aouizerat B, Yeh MM, Kowdley KV. Iron deficiency in patients with nonalcoholic Fatty liver disease is associated with obesity, female gender, and low serum hepcidin. Clin Gastroenterol Hepatol 2014; 12: 1170–1178. DOI: 10.1016/j.cgh.2013.11.017

11. Les I, Doval E, FlaviaM, Jacas C, Cardenas G, Esteban R, et al. Quality of life in cirrhosis is related to potentially treatable factors. Eur J Gastroenterol Hepatol. (2010) 22:221–7. DOI: 10.1097/MEG.0b013e3283319975

12. Yang J, Yan B, Yang L, et al. Macrocytic anemia is associated with the severity of liver impairment in patients with hepatitis B virus-related decompensated cirrhosis: a retrospective cross-sectional study. BMC Gastroenterol. 2018;18(1):161. Published 2018 Nov 1. doi:10.1186/s12876–018–0893–9

13. WHO, UNICEF, UNU. Iron Deficiency Anemia: Assessment, Prevention and Control. Report of a joint WHO/UNICEF/UNU consultation. Geneva: World Health Organization; 1998

14. Ko C.W, Siddique Sh.M, Patel A., Harris A., Sultan Sh., Altayar O, Falck-Ytter Yn. AGA Clinical Practice Guidelines on the Gastrointestinal Evaluation of Iron Deficiency Anemia. 2020; 159(3):1085–1094. DOI: 10.1053/j.gastro.2020.06.046.

15. Dignass A. U., Gasche C., Bettenworth D., et al. European consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases. J CrohnsColitis. 2015; 9(3): 211–222. DOI: 10.1093/ecco-jcc/jju009.

16. Weiss G., Ganz T., Goodnough. L. T. Iron metabolism and its disorders. Anemia of inflammation. Blood. 2019; 133 (1): 40–50. DOI: 10.1182/blood-2018–06–856500.