A Case of Persistent Anemia and Alcohol Abuse

Gemma Lewis; Matthew P Wise; Christopher Poynton; Andrew Godkin


Nat Clin Pract Gastroenterol Hepatol. 2007;4(9):521-526. 

In This Article


Alcohol abuse, in the form of both binge drinking and high chronic intake, is becoming increasingly prevalent in many populations and poses a mounting challenge to health-care professionals because of the wide range of physical and psychological illnesses it can cause.[9]

This case demonstrates several important learning points regarding the management of alcohol-related disease. Firstly, it highlights how alcoholism can be complicated by both the problems associated with chronic alcohol ingestion (e.g. cirrhosis, bone-marrow dysfunction, psychological problems) and the acute problem of binge drinking.

Secondly, the case illustrates how misconceptions about the causes of alcohol-related anemia can lead physicians down an erroneous diagnostic pathway. A common misconception is that iron deficiency and blood loss are the major factors contributing to the anemia. Admitting physicians often ask for endoscopic studies to be performed at an early stage in cases of alcohol-related anemia. This decision can be driven in part by the fear of varices (which are often a consequence of chronic liver disease) and the associated morbidity and mortality of variceal hemorrhage. The numerous endoscopic investigations previously undertaken in this case demonstrate this point succinctly and emphasize the difficulties that can be encountered when trying to obtain a correct diagnosis.

Finally, this case highlights how anemia in alcoholics is often a complicated multifactorial disease process. After a complete medical history of the patient has been taken and a full examination performed, essential first-line investigations after the presence of anemia is established should include hematinics and a blood film with reticulocyte count; this information can then be used to guide further investigations and management.

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