British Liver Trust

Aneamia sudden drop in red blood cell count

Hi all Happy New Year.

Hubby was in hospital over Christmas which wasn't great but he's home now.

His red blood cell and platlet count keeps dropping and no one can explain why. He has 2-3 units of blood feels much better but within a few weeks he's back in hospital again for more blood transfusions

He is not bleeding anywhere and endoscopy doesn't show any new bleeds.

Has anyone else had this happen to them?

Docs just say it's just a side effect of liver disease.

Thank you. Xx

7 Replies

When you have cirrhosis with portal hypertension (which your hubby has) then another side effect is hypersplenism whereby the spleen which cleans up and renews red blood cells actually goes into a sort of overdrive and starts rapidly destroying red blood cells before there are replacement ones in the system. This is a side effect of a struggling liver as your doctors have said and in the absence of any bleeding anywhere then this is the most likely reason for your hubby's sudden drops in red blood count, clotting etc. There can also be vitamin deficiencies which cause anemia too.

Since the spleen at any time usually hold upto 90% of the body's platelets and 45% of the body's red blood cells when it goes into this speeded up working it gobbles up even more red blood cells and platelets causing in very simple terms:-

(a) the spleen to enlarge leading to

(b) the knock on effect of reduced circulating red blood cells which carry (oxygenated blood round the body) known as anemia and also

(c) reduction of circulating platelets (which can lead to blood clotting difficulties and heavy bruising to even the most minor of knocks).

I know that my hubby had an enlarged spleen, very low platelet count (required platelet transfusion before biopsy etc) and also had a period where he was on 3 x 200mg Ferrous Sulphate (iron tablets) each day.

Sounds like the docs did a good job of investigating to rule out anything serious over Christmas and like they say low platelets and low red blood count are pretty standard with your husbands degree of cirrhosis.

Katie xxx


Thank you. That makes sense. I wish they had explained that to us!

I guess it's just another symptom to deal with. He is on ferrous sulfate 200mg 3 X's daily so I'm hoping that helps.

How did they monitor your husbands blood count via GP or consultant?

So much to learn and figure out. Xx


My hubby is under the transplant unit in Edinburgh so we were through there very regularly and he got blood tests there. His anemia gradually reduced and so did his iron tablets.

We are in a slightly different boat now in that my hubby had a procedure which in effect cut off the blood supply to his spleen so he no longer has a fully functioning spleen and as a result of that his blood count and platelet count have risen to absolutely normal. He is not longer anemic and no longer on iron tablets.

Just one word of warning with iron tablets - in my hubby's case they led to 'very immediate' need to defecate scenarios. Very sudden and unannounced although I also understand that in some the situation can go the other way (i.e. constipation). Just something to bear in mind because constipation is dangerous in that the toxins won't get released from body. Just monitor and see how it goes.

Don't hesitate to ask if you end up in similar situations - sometimes, medics either don't tell you enough or tell you in such medical terminology that it is hard to take in - you do gradually get to grips with it but it certainly helps to get it in simple terms sometimes.

All the very best to you both.

Katie x


Thank you xx


Hi yes I have had this for over 2 years on and off since I had a massive GI bleed been taking ferrous sulphate 3 times daily for 2 half years, still it dropß am so I'll when that happens can hardly breathe can't leave the house as when that happens can o ly walk 10 steps, my gp I stead of se ding me to my hemothogist told me to go home and rest, I told him that hemothogist said if iron drops must be sent to hospital straight away, anyway really unwell for 3 months, can't go through this again minute it drops I will get to hospital myself as l do know when it goes down, know exactly what your husband going through, I am going to ask my heptologist if it is the liver, it must be I suppose, hope your husband is well at the moment Annette !!!



Angse your breathlessness sounds like it may be what they call haemolytic anaemia which is when the number of red oxygen carrying blood cells in your body are too low.

This is different to iron deficiency anaemia. People take ferrous sulphate for iron deficiency anaemia, when their iron levels drop. Blood tests will detect low iron levels.

Unfortunately iron supplements do nothing for haemolytic anaemia, when this strikes you are generally advised to rest, so your GP is right as activity with low oxygen is like trying to be active at the top of Mount Everest.

I'm not sure if the docs have diagnosed both iron deficiency anaemia (needing iron supplements) or haemolytic anaemia (needing rest) or just one of those and have not explained it to you properly.


Thank you Bolly no I don't think it has been exp!aimed properly and what you said has given me food for thought, now I feel really well since I can now breathe normally can go out walking and petrified when this comes back, it has been ongoing for 2 half years on and off thanks again Annette


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