TO STUDY THE HEMATOLOGICAL PROFILE IN PATIENTS WITH ALCOHOLIC LIVER CIRRHOSIS IN A TERTIARY CARE HOSPITAL IN MANIPUR

Abstract

Introduction: Alcoholic liver disease or alcohol-related liver disease (ALD) is damage to the liver caused by excessive alcohol consumption, resulting in serious and life-threatening complications such as cirrhosis, gastrointestinal bleeding, hepatic failure, hepatic encephalopathy and malignancy. Liver cirrhosis is defined as diffuse hepatic fibrosis with replacement of normal liver architecture by nodules. There are also lesser known sequalae including suppression of hematopoiesis due to its toxic effects, hypersplenism and nutritional deficiencies of folic acid and other vitamins. Anemia, leukocytosis, leucopenia and thrombocytopenia occurs in ALD. Most of these hematological parameters are underdiagnosed and understudied. Hence, Manipur being a high ALD prevalence state necessitates this study to evaluate the hematological profile in patients with alcoholic liver cirrhosis and to determine the association between various hematological parameters and different Model of End stage Liver Disease (MELD) scores. Methods: This cross-sectional study was conducted in Regional Institute of Medical Sciences (RIMS), Imphal, Manipur from January 2021 to October 2022.Alcoholic liver cirrhosis patients above 18 years attending Medicine OPD, Liver clinic and those admitted in Medicine ward were enrolled. Blood samples for complete Hemogram, liver function test, kidney function test, prothrombin time, INR, serology (HbsAg, Anti HCV Ab, HIV 1&2) and ANA were collected. Ultrasound whole abdomen and Chest X ray were done whenever indicated. Different types of anemia, leucopenia, leukocytosis, thrombocytopenia in different groups of MELD scores were studied. Result: A total of 146 alcoholic liver cirrhosis patients were enrolled in our study. The mean ± SD age of the patients was 48.63±10.00 years with majority males (91.8%). Anemia detected in >95% of the patients. Severe anemia was detected in 31.5%, moderate anemia in 49.3% and mild anemia in 15.1%. Most of them (47.9%) had leucocytosis and thrombocytopenia was seen in 78.1% patients. Prolonged PT was seen in 89.1% of the patients and elevated INR present in 69.9% of patients. Majority of patients had MELD score between 10-19 and 20-29 (34.2% each). Only 4.1% had MELD score > 40. There is statistically significant association between MELD score of the patients with severity of anemia (p<0.05) and leucocyte count while it is not significant with thrombocytopenia (p=0.139). Conclusion: The prevalence of anemia in the present study was found to be 94.9% with predominant normocytic normochromic anemia (71.2%). There is significant association between MELD score of the patients with severity of anemia and leukocytosis while association with thrombocytopenia was insignificant. This study can now determine the stage at which emergent intervention could help in the recovery and effectively reduce morbidity and mortality of alcoholic cirrhosis patients.