THE BLOOD AND BONE MARROW IN PATIENTS WITH CIRRHOSIS OF THE LIVER

Abstract

Abstract The peripheral blood and bone marrow findings in patients with cirrhosis of the liver have been analyzed on the basis of a review of the literature and the authors’ study of 25 patients with diagnoses verified by biopsy of the liver. The principal blood findings are macrocytic or normocytic anemia with normal or elevated mean corpuscular hemoglobin values, lymphopenia and thrombocytopenia in the majority of cases. Anemia may be independent of bleeding, and the severity of anemia or macrocytosis does not appear to be related to the severity of the liver lesion. The consistent change in the bone marrow is extension of the marrow organ so that active hematopoiesis is found in the shafts of the long bones. Regardless of the presence or absence of bleeding or anemia, the marrow of the sternum is of normal or increased cellularity, with normal or increased erythrocytogenesis and megakaryocytogenesis in most cases. Hypocellularity of the marrow is an unusual finding, even in patients with advanced liver lesions. Macronormoblastic erythropoiesis is seen in patients with macrocytic anemia, but megaloblastic erythropoiesis dces not result from cirrhosis of the liver. The presence of peripheral cytopenias (anemia and thrombocytopenia) in spite of normal or increased formation of erythroblasts and megakaryocytes in the marrow is suggestive of hypersplenism in patients with hepatic cirrhosis. In patients with chronic hemorrhage the blood and bone marrow pictures are those of iron deficiency anemia, although other changes such as lymphopenia and thrombocytopenia tend to persist. The combined peripheral blood and sternal marrow examination is often of value in establishing the diagnosis of cirrhosis of the liver.