Gkamprela Eleana, Deutsch Melanie, Pectasides Dimitrios
Second Department of Internal Medicine, University of Athens, Hippokration General Hospital, Athens.
Ann Gastroenterol. 2017;30(4):405-413. doi: 10.20524/aog.2017.0152. Epub 2017 May 3.
Chronic liver disease is accompanied by multiple hematological abnormalities. Iron deficiency anemia is a frequent complication of advanced liver disease. The etiology is multifactorial, mostly due to chronic hemorrhage into the gastrointestinal tract. The diagnosis of iron deficiency anemia is very challenging, as simple laboratory methods, including serum iron, ferritin, transferrin saturation (Tsat), and mean corpuscular volume are affected by the liver disease itself or the cause of the disease, resulting in difficulty in the interpretation of the results. Several new parameters, such as red blood cell ferritin, serum transferrin receptor test and index, and hepcidin, have been studied for their utility in indicating true iron deficiency in combination with chronic liver disease. Once iron deficiency anemia is diagnosed, it should be treated with oral or parenteral iron as well as portal pressure reducing drugs. Blood transfusion is reserved for symptomatic anemia despite iron supplementation.
慢性肝病伴有多种血液学异常。缺铁性贫血是晚期肝病常见的并发症。其病因是多因素的，主要是由于胃肠道慢性出血。缺铁性贫血的诊断极具挑战性，因为包括血清铁、铁蛋白、转铁蛋白饱和度（Tsat）和平均红细胞体积在内的简单实验室检查方法会受到肝病本身或病因的影响，导致结果难以解读。已经对一些新参数进行了研究，如红细胞铁蛋白、血清转铁蛋白受体检测及指数和铁调素，以评估它们在结合慢性肝病时指示真正缺铁的效用。一旦诊断出缺铁性贫血，应使用口服或胃肠外铁剂以及降低门静脉压力药物进行治疗。尽管补充了铁剂，但有症状的贫血仍需输血治疗。
