Cirrhosis is a risk factor for anemia, and anemia can indicate worse cirrhosis outcomes. Cirrhosis may cause anemia, leading to red blood cell destruction, folate deficiency, or internal bleeding. There are various treatments for anemia with cirrhosis.

Cirrhosis is when continuous liver damage causes lesions to form within the liver. It can arise due to disease or exposure to toxins. Cirrhosis can take the form of liver scarring, thickening, or nodules. It affects between 0.15– 0.27% of the population in the United States.

Under some circumstances, cirrhosis can cause anemia. Anemia is when the body has a low red blood cell count.

This article explores the link between these two conditions and details treating and preventing anemia in cirrhosis. It also discusses the complications and outlook for a person having both conditions.

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Cirrhosis is a form of liver injury that arises from long-term harm to the liver. Anemia is when a person has a low red blood cell count.

Anemia and cirrhosis are closely connected through various pathologic processes that are inherent to cirrhosis. People with anemia are at a higher risk of developing cirrhosis than those of the general population.

According to a 2022 study, 66–75% of people with cirrhosis have some form of anemia. Contrastingly, the prevalence of anemia in the general population lies between 10–24%. For this reason, scientists believe that cirrhosis can lead to anemia.

It is worth noting that cirrhosis also seems to be a risk factor for other blood disorders. This includes thrombocytopenia, which is a low platelet count. It also includes leucopenia, which is a low white blood cell count. Both conditions have a higher prevalence in people with cirrhosis.

A 2022 article discusses some mechanisms that link anemia to cirrhosis. Those mechanisms are:

  • Cirrhosis can cause gastrointestinal bleeding, which can be life threatening.
  • Cirrhosis can cause the destruction of red blood cells (hemolysis).
  • Cirrhosis can cause an overactive spleen, which can also lead to hemolysis.
  • Cirrhosis can cause folate deficiency, which can lead to enlarged and dysfunctional red blood cells.

A 2022 study explains that in people with cirrhosis, the treatment for anemia depends on its underlying cause.

For instance, doctors adhere to specific protocols if someone has cirrhosis, anemia, and gastrointestinal bleeding. One important treatment aspect is a red blood cell transfusion. However, doctors will also make use of certain medications, such as:

Although liver transplants are not specific treatments for people with cirrhosis and anemia, they can help.

Iron replacement therapy may also help improve anemia in cirrhosis when iron deficiency is present. Addressing folate, thiamine (B1), cobalamin (B12), and pyridoxine (B6) deficiencies could also help diminish certain types of anemia.

Since anemia is a complication of cirrhosis, managing the latter could prevent the former.

Research has shown that avoiding alcohol is an important aspect of managing cirrhosis. Additionally, responding to folate deficiencies may have some potential to prevent anemia.

Scientists are unsure about the specific complications of anemia in people with cirrhosis. However, a 2017 paper examined iron deficiency anemia in people with this condition. The study authors speculate that this combination of diseases could cause the following complications:

  • cardiovascular problems
  • impaired cognition
  • decreased quality of life

Research into this subject is ongoing.

Scientists do not know whether anemia actually causes a less optimistic outlook in people with cirrhosis. However, a 2019 study explains that having anemia indicates a significantly diminished outlook for people with cirrhosis.

Having anemia increases the likelihood of hospitalization and liver failure. It also indicates worse overall survival rates. These effects become more significant with the increasing severity of anemia.

Anemia can mean that someone with cirrhosis has a less optimistic outlook. It can also indicate life threatening complications of cirrhosis, such as gastrointestinal bleeding. For this reason, it is important that people with cirrhosis contact a doctor if they show the following signs of anemia:

  • weakness
  • lethargy
  • tiredness
  • restless legs
  • shortness of breath

In more severe cases of anemia, a person may experience chest pain or a lower exercise tolerance.

Cirrhosis can cause anemia, which is a condition where the body has a low red blood cell count.

There are many possible causes of anemia in cirrhosis, such as the destruction of red blood cells, an overactive spleen, or folate deficiency. Gastrointestinal bleeding is a common complication of cirrhosis that can also cause anemia.

Treatment depends on the underlying cause. Red blood cell transfusions, vasoconstrictors, and PPIs can help when anemia stems from gastrointestinal bleeding. Liver transplants, iron replacement therapy, and addressing folate deficiencies may help improve anemia that stems from other causes.