Anemia in cirrhosis: An underestimated entity

Table 1 Etiopathogenesis and prevalence of anemia in cirrhosis

Type of anemia	Etiology	Prevalence (%)	Ref.
Normocytic	Anemia of chronic disease	40-51.4	Singh et al[7], Özatli et al[56]
Microcytic	Acute blood loss (variceal hemorrhage)	5-15/yr; Increasing risk with severity of liver dysfunction and red wale marks on varices	Singh et al[7], European Association for the Study of the Liver[45]
	Portal hypertensive gastropathy	20-80	Gkamprela et al[37]
	Gastric antral vascular ectasia	4	Selinger and Ang[57]
	Peptic ulcer	35-53	Singh et al[7], Loperfido et al[58]
	Hemolytic anemia in patients on interferon and ribavirin	9-13	Gonzalez-Casas et al[3]
	Hemolytic anemia due to hypersplenism	24	Özatli et al[56]
Macrocytic anemia	Folic acid (Vit B9) deficiency	44	Herbert et al[59]
	Vit B12 (cyanocobalamin) deficiency	31.8 in PBC; 43 in NAFLD	Singh et al[7], Sharma and Jahnavi[60], Shizuma[61]

Vit: Vitamin; NAFLD: Nonalcoholic fatty liver disease.

Table 2 Ongoing trials on evaluation and management of anemia in cirrhosis

S No	Trial name	Clinical Trials.gov identifier	Aim	Ref.
1	Etiopathogenesis of anemia in chronic liver disease	NCT04622449	(1) To determine the prevalence of various etiologies of anemia in patients with liver disease; and (2) Association of liver disease severity as measured by MELD, MELD Na and CTP scores with severity of anemia	Premkumar[62]
2	Iron deficiency anemia in children with liver cirrhosis	NCT03482076	To determine prevalence of IDA in liver cirrhosis	Mohamed[63]
3	Lactoferrin in treatment of Fe deficiency anemia in cirrhosis	NCT04335058	(1) Correction of anemia (time frame: 1 mo): Number of participants achieving hemoglobin level > 12 g/dL iron deficiency anemia in patients with chronic liver disease of any etiology; and (2) Correction of anemia (time frame: 3 mo): Number of participants achieving hemoglobin level > 12 g/dL	Premkumar[64]

MELD: Model for end-stage liver disease; CTP: Child Turcotte Pugh score; IDA: Iron deficiency anemia.