Alcohol and the Hematologic System

Abstract

The hematologic disorders associated with alcoholism present some of the most challenging (and often confusing) problems in differential diagnosis to the internist and hematologist. Abnormalities involving red cells, white cells, and platelets often occur together but may have differing etiologies. The simultaneous, sometimes synergistic and sometimes opposing effects of acute and chronic ethanol intoxication, liver disease, multiple nutritional deficiencies, infections, and other associated disease states are often difficult to disentangle. The problem is compounded because the alcoholic patient admitted to the hospital is not in a steady state. During the first days or weeks in the hospital, the effects of alcohol on circulating blood cells rapidly recede, liver dysfunction often improves, nutritional depletion states are corrected, and infections are treated. The time at which hematologic observations are made thus becomes crucial: profound thrombocytopenia, for example, may be followed in a few days by striking thrombocytosis; megaloblastic and sideroblastic marrow abnormalities rapidly disappear; an elevated serum iron level during intoxication may be replaced by hypoferremia within 24 to 48 hr of abstinence; and brisk reticulocytosis may quickly succeed reticulocytopenia. The physician unaware of these potential developments will indeed often find the alcoholic patient hematologically baffling.