Anemia associated with alcoholism has numerous causes, most common being megaloblastic anemia and acquired sideroblastic anemia (SA). The bone marrow aspirate (BMA) and bone marrow iron (BMIr) findings and their correlation with peripheral blood smear (PBS) have not been extensively described in literature. We aim to study the spectrum of hematological abnormalities in chronic alcoholics. Complete blood count (CBC), PBS, BMA and BMIr of 71 chronic alcoholics were studied retrospectively over a period of 3 years. The slides were reviewed by 2 pathologists. The clinical history, CBC, PBS, BMA and BMIr findings were recorded. Out of 71 patients, 68 (95.77%) had anaemia. Red cell morphology varied from normocytic-normochromic, microcytic-hypochromic, macrocytic, to dimorphic anaemia. Principal findings seen on BMA were erythroid hyperplasia and megaloblastic maturation. BMIr was available in 41 patients; iron stores were decreased in 2 (4.88%), normal in 14 (34.15%), increased in 25 (60.97%). Seven (17.07%) cases showed presence of ring sideroblasts. Chronic alcoholics show a variety of abnormalities in BMA, which closely mimic many haematological disorders. A history of alcoholism should always be taken in these circumstances. SA should be ruled out in all chronic alcoholics with anaemia not responding to vitamin B12/folic acid, even with macrocytic picture on PBS.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Peripheral blood smear
Bone marrow aspiration
Bone marrow iron
Mean corpuscular volume
Mean corpuscular hemoglobin
Mean corpuscular hemoglobin concentration
Complete blood count
Eichner ER, Hillman RS (1971) The evolution of anemia in alcoholic patients. Am J Med 50(2):218–232
Lindenbaum J, Roman MJ (1980) Nutritional anemia in alcoholism. Am J Clin Nutr 33(12):2727–2735
Mason DY, Emerson PM (1973) Primary acquired sideroblastic anemia: response to treatment with pyridoxal-5-phosphate. Br Med J 1(5850):389–390
http://health.gov/dietaryguidelines/2015/guidelines/appendix-9/. Accessed 22 Aug 2019
World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. WHO/NMH/NHD/MNM/11.1. http://www.who.int/vmnis/indicators/haemoglobin.pdf. Accessed 22 Aug 2019
Erkurt MA, Kaya E, Berber I, Koroglu M, Kuku I (2012) Thrombocytopenia in adults: review article. J Hematol 1(2–3):44–53
Narang NC, Kotru M, Rao K, Sikka M (2016) Megaloblastic anemia with ring sideroblast is not always myelodysplastic syndrome. Turk J Haematol 33(4):358–359
Cowan DH, John DH (1971) Thrombocytopenia of severe alcoholism. Ann Intern Med 74(1):37–43
Latvala J, Parkkila S, Niemelä O (2004) Excess alcohol consumption is common in patients with cytopenia: studies in blood and bone marrow cells. Alcohol Clin Exp Res 28(4):619–624
Alcindor T, Bridges KR (2002) Sideroblastic anemias. Br J Haematol 116:733–743
Cazzola M, Invernizzi R (2011) Ring sideroblasts and sideroblastic anemias. Haematologica 96(6):789–792
Conflict of interest
The authors declare that there are no conflicts of interest.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Mangla, G., Garg, N., Bansal, D. et al. Peripheral Blood and Bone Marrow Findings in Chronic Alcoholics with Special Reference to Acquired Sideroblastic Anemia. Indian J Hematol Blood Transfus 36, 559–564 (2020). https://doi.org/10.1007/s12288-019-01188-5
- Chronic alcoholics
- Ring sideroblasts
- Peripheral blood smear
- Bone marrow aspirate
- Acquired sideroblastic anemia
- Bone marrow iron