From the Research
Anaemia in patients with chronic liver disease (CLD) should be managed with a comprehensive approach that addresses the underlying cause, which often involves a combination of factors including blood loss from varices, nutritional deficiencies, hemolysis, and bone marrow suppression due to the liver disease itself, as supported by the most recent study 1.
Key Considerations
- The most common causes of anaemia in CLD patients are gastrointestinal bleeding, iron deficiency, and hypersplenism secondary to portal hypertension, as reported in the study 2.
- Initial management includes iron supplementation, typically ferrous sulfate 325mg daily or every other day, when iron deficiency is confirmed, as recommended in the study 3.
- For patients with vitamin deficiencies, supplementation with vitamin B12 (1000mcg monthly injections) and folate (1mg daily) is recommended, as suggested in the study 4.
- In cases of severe anaemia (hemoglobin <7-8 g/dL) or symptomatic patients, blood transfusions may be necessary, targeting a hemoglobin level of 7-9 g/dL to avoid volume overload, as indicated in the study 2.
- Erythropoiesis-stimulating agents like epoetin alfa (starting at 40,000 units weekly) can be considered for patients with anaemia related to renal dysfunction or those on interferon therapy, aiming for a hemoglobin target of 10-12 g/dL, as recommended in the study 4.
Management of Portal Hypertension-Related Bleeding
- Portal hypertension-related bleeding should be managed with endoscopic therapy, beta-blockers (propranolol 20-40mg twice daily), and potentially transjugular intrahepatic portosystemic shunt (TIPS) in refractory cases, as suggested in the study 2.
Monitoring and Follow-Up
- Regular monitoring of hemoglobin levels, iron studies, and liver function is essential, with frequency determined by the severity of anaemia and liver disease, as recommended in the study 1.