Do most people with liver disease have... - British Liver Trust

British Liver Trust

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Do most people with liver disease have anemia? If so, what kind of anemia.

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I have seen so many people with liver disease with anemia as the first sign of their diagnoses and they are put on iron. I am puzzled by that because most people suffering from ALD has high iron levels. and many other liver diseases tend to have high iron levels.

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Most of us have heard an enlarged spleen commonly seen in advanced liver disease can sequester platelets, but an enlarged spleen can also sequester red blood cells.

The spleen is the organ responsible for recycling old/senescent red cells, & when enlarged, this process can get a bit carried away & start throwing too many red cells into the recycle bin, resulting in anemia.

The "Anemia of Inflammation" commonly called "The Anemia of Chronic Disease" can result from the body putting iron in "lock-down" mode. When infection or inflammation is occurring, the body shuts down iron absorption & transport in an effort to try to keep free iron from contributing to the infection or inflammation.

This can be a healthy response short term, but when inflammation becomes chronic, lack of iron transport can result in anemia, even when there is ample stored iron in the liver.

Doctors sometimes resort to iron supplements and/or infusions in an attempt to get enough iron to the bone marrow where red cells are produced. This often works moderately well, but typically is a short term fix, & the anemia usually returns within a month or so. The anemia of inflammation & advanced liver disease is a very difficult situation to deal with.

Besides iron, the body also needs Folate & Vitamin B-12 to create red cells, so it may be wise to insure these are not deficient when anemia is problematic.

Hi Sophia, this might be a useful article for you to read further to what metonoia is saying. irondisorders.org/anemia-of... . All the best to you. X

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I'd be surprised to hear 18mg iron daily for only 2 months would pop ferritin substantially higher, but then I really don't know. A lot of iron supps contain much higher doses (45-60mg). I've read absorption depends on what kind of supplement you're taking.

Regarding your low-normal labs, I'd be tempted to look to symptoms to determine whether anemia is truly an issue requiring treatment . Rapid pulse, easy fatigue and occasional lightheadedness can indicate anemia is problematic. If you're not experiencing these symptoms and labs aren't trending lower (out of normal range), I'd be tempted to adopt a watchful waiting stance (but then I'm not a doctor!)

Supplementing iron for the anemia of inflammation/chronic disease is controversial. When iron labs are low, this may make sense, but when iron labs are showing you are replete with iron, dumping more iron into the body may cause more inflammation and worsen the bodies lock-down on iron transport. You may see a brief boost in hemoglobin/hematocrit, that falls rather swiftly back to your low-normal range as soon as you discontinue the iron. If you're doc wants you to stay on iron long term, I'd watch my iron labs carefully, as you don't want these rising to the sky.

If you're seeing more than one doctor, I'd make sure all were on the same page regarding the wisdom of treating normal or near normal labs with additional iron.

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If you can beg a referral to a hematologist, this might be the best option.

Hematologist's are blood doctors, & really know much more about anemia and iron issues than your GP or even a Hep-Doc. He/she should also be well read on the latest research from the guru's of hematology in the journals.

Have you been tested for B-12 levels? Will your doc let you do a trial period of supplementation to see if this might help?

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For people with high iron levels in liver disease can be caused by hemachromatosis . Its when to much iron is stored and this condition is usually what caused the liver disease in the first place.

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thanks but I don't have hemachromatosis, usually people with this condition the iron levels are in the thousands with very high saturation.

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No I was not suggesting you did. Im just saying that alot of people who do have high iron it is due to that. Otherwise it seems most have low iron. I had low iron when I first got alc hep

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I didn't think you were suggesting that, not at all, funny , when you are typing things can come out the wrong way. Another thing, DeRitis isn't of concern if your levels are in range because exercise can cause your AST to be over ALT, also older people tend to have them just about equal. Where and Who told you that it applies to labs in range? I am just curious because I know many people with AST higher than ALT. Like I said in a post before many people say after months all their labs are normal but they fail to post their platelets are low, abumin low, GGT high, it usually takes almost a year for all the liver enzymes to go down and sometimes they never go back to normal.

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I read about the deritis ratio mattering even in normal ranges in a few studies about it and had it confirmed by a hepatologist. Yes you are right exercise can increase it and many have ast above alt without liver problems. It isnt always a for sure indicator of liver disease I agree totally. Especially if it is the only marker. As you said GGT Albumin and platlets all are factors of the bigger clinical picture. So if one had low albumin low platelets high GGT and a deritis ratio of say 2:1 even if in normal range it would be pretty fair assumption for a doctor to assume liver disease and move toward more tests like biopsy and scans. But If your Alt Ast was 2:1 but all other bloods in normal than a dr probably wouldnt look to hard into it. The real kicker i think is having a high ast alt ratio in the presence of a high GGT that really makes the assumption clearer. On the other hand some liver issues present with alt being the higher number. If im not mistaken I believe i came across a post earlier today that you posted on another site regsrding this deritis ratio. A chap named moonwatcher posted a whole whack of stuff on it.

In a way we are both right and i believe we are in ways making the same point 😊😊

My Alt/Ast is only 1.2:1 in normal range yet my GGt is 76.. so that together they tell me its liver disease. We will see at the 6 month mark as clinacally that seems to be where they decide to call it chronic liver disease or not. But also agreed some of these enzymes take a while if ever to normalize. And in alcholic liver disease I am told GGT is a real bugger for that.

Best always love!

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Yes, GGT can be a bugger but other things can also cause this, maybe you haven't been sober long enough to see some results. If your platelets/albumin and ALP is within limit, some clean eating and no alcohol can help repair your liver. My doctor stated ALP usually is high normal with a high GGT when it is liver disease. He said, if only GGT is high this can be many causes,fatty liver ,high cholesterol and tissue and bone problems, look also at your ALP, and good luck , we all need some.

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Yes its only been 4 months. Alp has always been in the middle of normal. Yea Ggt can be for othe reasons. For bone problems ALP is usually high on its own absent Ggt

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oh 4 months, i wouldn't be too worried, 4 months really not enough time, especially if your platelets/albumin is normal. Did you have any scans?

Hello Sophia,

I have chronic anemia which needs a 4 weekly iron infusion. Even then I'm loosing ground as the leaks inside are getting worse.

I'm on the transplant list at KCH and they say all the things that afflict me now will be solved with a new liver.

Heres hoping

Best wishes

John

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Keep in mind anemia does not just mean a shortage of something. Anemia also has to with the size shape and colour of the cells as well You can have macrocytosis for example which means you have a normal amount of red blood cells but they are bigger than normal. Macrocytic anemia.

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