Alcoholism-associated Anemia
Kaaren K. Reichard, MD
Key Facts
Terminology
Anemia in setting of known chronic alcoholism
Etiology/Pathogenesis
Anemia of chronic disease
Direct toxicity of ethanol and its byproducts (acetaldehyde) on bone marrow
Nutritional deficiency (notably iron or folate deficiency)
Red blood cell survival defects
Hemodilution
Blood loss
Microscopic Pathology
Bone marrow aspirate shows vacuolated erythroid precursors; some cases show ring sideroblasts
Top Differential Diagnoses
Primary myeloid neoplasm
Other nutritional deficiency, particularly copper
 Peripheral blood smear demonstrates severe anemia in an alcoholic patient. Note the poikilocytosis comprised of target red blood cell forms and fragments  . |
 Iron stain of bone marrow aspirate smear demonstrates increased ring sideroblasts  in a patient with chronic alcoholism and cirrhosis. |
TERMINOLOGY
Definitions
Anemia in setting of known chronic alcoholism
Anemia may be multifactorial
ETIOLOGY/PATHOGENESIS
Variety of Mechanisms
Anemia of chronic disease
Direct toxicity of ethanol and its byproducts (acetaldehyde) on bone marrow
Nutritional deficiency (notably iron or folate deficiency)
Red blood cell survival defects
Hemodilution
Blood loss
