THE ANEMIA OF LIVER DISEASE: OBSERVATIONS ON ITS MECHANISM 1

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Abstract
Studies of 20 cirrhotic patients with anemia not caused by blood loss indicate that an extracorpuscular hemolytic process was present which was proportional in severity to the degree of anemia. The mechanism of this hemolysis appears to have consisted in local destruction of red cells, probably through their sequestration in the spleen. Sterile incubation of the patients'' blood elicited an increased mechanical fragility and abnormalities of the osmotic fragility of the red cells. Both serum Fe and serum Fe-binding capacity levels were low, despite normal or increased tissue deposits of Fe. Hemoglobin production, despite persistence of the anemia, did not generally exceed 2 or 3 times the normal rate, which suggests a diminished sensitivity to anoxia. This insufficient capacity to produce hemoglobin may have been impaired further by the ingestion of alcohol. In 4 patients, folic acid deficiency was the factor limiting hematopoiesis.