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Introduction

Anemia is a condition caused by a lack of healthy red blood cells or hemoglobin, resulting in a reduced ability of the blood to carry oxygen. It can be caused by decreased red blood cell production, increased destruction, or blood loss. Common causes include gastrointestinal bleeding, liver or renal disease, cancer, and poor diet or iron deficiency. Upper gastrointestinal bleeding is a major cause of blood loss and life-threatening anemia, as it requires hospitalization for urgent treatment. Chronic liver disease is also strongly associated with anemia through various mechanisms affected by the damaged liver. This case report describes how a man's alcoholic liver disease progressed to cirrhosis and upper GI bleeding, leading to severe anemia.

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Harvey Gian Javier
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73 views

Introduction

Anemia is a condition caused by a lack of healthy red blood cells or hemoglobin, resulting in a reduced ability of the blood to carry oxygen. It can be caused by decreased red blood cell production, increased destruction, or blood loss. Common causes include gastrointestinal bleeding, liver or renal disease, cancer, and poor diet or iron deficiency. Upper gastrointestinal bleeding is a major cause of blood loss and life-threatening anemia, as it requires hospitalization for urgent treatment. Chronic liver disease is also strongly associated with anemia through various mechanisms affected by the damaged liver. This case report describes how a man's alcoholic liver disease progressed to cirrhosis and upper GI bleeding, leading to severe anemia.

Uploaded by

Harvey Gian Javier
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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INTRODUCTION
Anemia is a condition that develops from a lack of healthy red blood cells. It is defined as an absolute reduction in the quantity of the oxygencarrying pigment hemoglobin (Hgb) in the circulating blood, characterized by a decrease in the number of circulating red blood cells (RBCs), the amount of hemoglobin, or the volume of packed red blood cells (hematocrit). It is further broadly subcategorized into acute and chronic, and it usually is grouped into 3 etiologic categories: decreased red blood cell (RBC) production, increased RBC destruction, and blood loss. The common pathway in anemia is a reduction in the oxygen-carrying capacity of the blood. Depending on the etiology, this may occur with or without reduction in the intravascular volume. It is generally accepted that an acute drop in hemoglobin to a level of 7-8 g/dL found in acute anemia is symptomatic, whereas levels of 4-5 g/dL may be tolerated in chronic anemia, as the body is able to gradually replace the loss of intravascular volume. Anemia is a manifestation of an underlying disease process and is not a diagnosis in itself. A disease may lead to anemia through a combination of mechanisms. For example, a GI malignancy may cause anemia through blood loss, as well as lead to anemia of chronic disease. A wide array of diseases, including inflammations, infections, and malignancies, may at some point be associated with anemia. Common conditions linked with anemia include gastritis, gastric or duodenal ulcer, liver or renal disease, sickle cell disease, hypothyroidism, hypermenorrhea, thrombocytopenia or blood coagulation disorders, cancer or other chronic illness (eg, rheumatic disease), previous history of anemia or blood transfusions, and poor diet especially iron-deficiency. A major cause of anemia is hemorrhage, especially into the

gastrointestinal tract which is divided into two parts the upper and the lower GI tract. The anatomic cut-off for upper GI bleeding is the ligament of Treitz, which connects the fourth portion of the duodenum to the diaphragm near the splenic flexure of the colon. Two of several mechanisms that lead to GI bleeding include disruption of the gastrointestinal mucosa secondary to inflammation, infection, trauma or cancer; and vascular abnormalities, such as vascular ectasias or varices due to portal hypertension. Bleeding from the

4 GI tract may be present in five ways: hematemesis (vomitus of red blood or "coffee grounds" material), melena (black, tarry, foul-smelling stool), hematochezia (passage of bright red or maroon blood from the rectum), occult GI bleeding (blood in the stool in the absence of overt bleeding), and symptoms of blood loss or anemia (e.g., light-headedness or shortness of breath). A massive upper gastrointestinal hemorrhage is one of other lifethreatening causes of anemia. Upper GI bleeds are considered medical emergencies, and require admission to hospital for urgent diagnosis and management. Incidence of hospital admissions for upper GI bleeding in the U.S. and Europe is approximately 100 per 100,000 persons annually. Chronic liver diseases frequently are associated with hematological abnormalities. Anemia of diverse etiology occurs in about 75% of patients with chronic liver disease. The frequent association of anemia with chronic liver disease provides a rationale for examining the role of the liver in the formation and destruction of erythrocytes. Indeed, the liver itself may be implicated in a variety of different mechanisms that contribute to the development of anemia in patients with chronic liver disease. Cirrhosis and other chronic liver diseases are common disease-related causes of death in the US. Almost 27,000 people in the US die each year from chronic liver disease and cirrhosis. The vast majority of cases of cirrhosis could be prevented by eliminating alcohol abuse. This case report presents a cascade of life threatening complications arising from liver disease of an alcoholic man. The patients liver disease due to alcohol addiction progressed to cirrhosis and comorbid upper GI blood loss resulting to anemia.

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