What’s the Relationship Between Liver Cirrhosis and Anemia?

Cirrhosis is a condition where the liver is severely scarred. Because the liver plays a role in many important bodily functions, cirrhosis can lead to health conditions, including anemia.

Anemia involves having a low red blood cell count or low hemoglobin count. Because hemoglobin transports oxygen throughout your body, anemia can cause fatigue, weakness, and shortness of breath. This condition is common among people with cirrhosis.

Anemia can also worsen the condition of your liver, particularly when it’s left untreated. For this reason, it’s important that people with liver cirrhosis are tested for anemia and that they manage their anemia well.

Yes, anemia is common among people with liver diseases, including cirrhosis.

Studies estimate that between 66-75% of people with liver cirrhosis develop anemia at some point. It’s more common among liver disease patients with late-stage, severe cirrhosis.

Association between anemia and severity of cirrhosis

The more severe the cirrhosis is, the more likely you are to develop anemia.

The most common type of anemia is iron deficiency anemia (IDA). A recent study says that IDA has been observed in 22% of patients with compensated cirrhosis (earlier stages of cirrhosis). By contrast, IDA is found in 78% of those with decompensated cirrhosis (severe, late-stage liver disease).

A 2020 study found that anemia and systemic inflammation are strongly associated with severe liver complications. If you have both liver disease and anemia, you’re more likely to develop severe cirrhosis.

Anemia is associated with severe cirrhosis for two reasons: liver disease can lead to anemia, but anemia can also worsen the condition of your liver.

There are a number of reasons why liver disease may lead to anemia, according to a 2022 study .

The following issues in liver cirrhosis may cause anemia:

• Chronic inflammation. Liver disease is associated with chronic inflammation, which can cause normocytic normochromic anemia.
• Lower erythropoietin levels. The liver produces a hormone called erythropoietin, which stimulates the bone marrow to produce red blood cells. When the liver is damaged, it may produce less erythropoietin, leading to a decrease in red blood cell production.
• Blood loss. People with liver cirrhosis are more likely to develop varices, which are enlarged veins, in the esophagus and stomach. If the varices rupture, it can lead to severe blood loss, possibly causing anemia.
• Hypersplenism. Your spleen breaks down red blood cells. People with liver disease may develop hypersplenism (overactive spleen), which means that the spleen breaks down red blood cells far more quickly than they’re produced. This can cause anemia.
• Medication.Interferon and ribavirin are often used to treat liver disease, particularly hepatitis. Although these medications can be effective, both can lead to anemia.
• Malnutrition. Nutrients like iron, vitamin B12, and folate are important for red blood cell production. When your liver is compromised, it’s more difficult for your body to absorb nutrients from your food. This can lead to nutritional deficiencies, which can cause anemia.

It’s possible that more than one of these risk factors can play a role in developing anemia.

Although anybody with liver disease is at a higher risk for developing anemia, anemia is more common as liver disease progresses. End-stage liver disease, in particular, is strongly associated with anemia.

As a recent study points out, cirrhosis patients with anemia usually score higher on the model for end-stage liver disease (MELD) scale. MELD is a scoring system for assessing the severity of chronic liver disease.

People with anemia are also more likely to have lower albumin levels. Low albumin levels, or hypoalbuminemia, is an indicator of liver failure.

If you have both anemia and cirrhosis, you must be treated for both conditions. If you’ve had any issues with your liver and you experience the symptoms of anemia, ask a doctor to test your iron levels.

A recent study looked at people with both anemia and liver cirrhosis. It concluded that, if your anemia is treated successfully, you’re more likely to survive without needing a liver transplant.

Anemia treatment in cirrhosis can be treated with:

• iron supplements
• folic acid supplements
• vitamin B12 supplements or B12 injections
• eating a nutritious, balanced diet

In severe cases, you may be prescribed erythropoiesis-stimulating medication, which stimulates your bone marrow to produce more red blood cells. People with severe anemia may need a blood transfusion to increase their red blood cell count.

Anemia is common in people who have liver cirrhosis. In addition to the uncomfortable symptoms of anemia, the condition can cause additional complications in people with liver disease.

Research suggests that treating anemia can prevent further deterioration of the liver. If you have liver disease, it’s important to have your iron levels checked for anemia. Common anemia treatments include supplements, a nutritious diet, and prescription medications.

Last medically reviewed on April 13, 2023