Skip to main content
SpringerLink
Log in

Alkoholtoxische Veränderungen der Hämatopoiese

Alcohol — induced changes in hemopoiesis

Eine prospektive Studie bei chronischen Alkoholikern

  • Originalien
  • Published:
Klinische Wochenschrift Aims and scope Submit manuscript

Summary

In a prospective trial with 120 chronic alcoholics (July, 1978 to January, 1980) on admission the following haematological values significantly different from those of the normal population were found: elevated erythrocyte mean corpuscular volume (64%), increased mean corpuscular hemoglobin (32%), thrombocytopenia (48%), increased percentage of bone marrow sideroblasts (35%), decreased percentage of sideroblasts (37%), megaloblastic bone marrow changes (55%) including nuclear abnormalities (32%), and vacuolization in red cell (20%) and white cell (16%) precursors. These changes were independent of liver cirrhosis with hypersplenism (increased mean corpuscular volume in 52% of the patients who did not have liver cirrhosis, increased mean corpuscular volume in 76% of the patients who were cirrhotic but not suffering from major bleeding). Platelets returned to normal values within 6 days of discontinuation of alcohol ingestion. In respect to iron metabolism we found the following changes: decreased serum iron concentration (32%), increased iron concentration (42%), increased total iron binding capacity (54%), increased ferritin (41%), decreased transferrin (20%).

In contrast to data from the Anglo-American literature, serum folate concentrations were mostly normal in our patients (87%). This may be due to different eating and drinking habits. The percentage of bone marrow sideroblasts was also lower in our patients than those described in the literature mentioned above. The changes in maturation are likely to be caused partially by a toxic effect of alcohol on nuclear metabolism of bone marrow cells.

Zusammenfassung

Bei 120 chronischen Alkoholikern wurden in einer prospektiven Studie von Juli 1978 bis Januar 1980 am Aufnahmetag folgende Veränderungen des Blutes und blutbildenden Systems beobachtet: Erhöhung des mittleren Erythrozytenvolumens (MCV) (64%) und des MCH (32%), Thrombozytopenie (48%), Erhöhung des Sideroblastenanteiles im Knochenmark (35%), Erniedrigung der Sideroblasten (37%), megaloblastäre Veränderungen (55%) mit Kernanomalien (32%), sowie Plasmavakuolen in den Vorläuferzellen der Erythropoiese (20%) und Granulopoiese (16%). Diese Veränderungen traten unabhängig vom Vorliegen einer Leberzirrhose mit Hypersplenie-Syndrom auf (MCV in 52% ohne Leberzirrhose und in 76% mit Leberzirrhose ohne Blutung erhöht). Bei Alkoholkarenz stiegen die Thrombozytenzahlen innerhalb von 6 Tagen wieder an. Das Serumeisen war in 32% erniedrigt und in 42% erhöht, die totale Eisenbindungskapazität in 54% und das Ferritin in 41% vermehrt und das Transferrin in 20% vermindert.

Im Gegensatz zu den Angaben im angelsächsichen Schrifttum lag die Folsäure im Serum bei der Mehrzahl unserer Patienten im Normbereich (87%), wahrscheinlich wegen unterschiedlicher Trink- und Eßgewohnheiten. Der Sideroblastenanteil im Knochenmark war ebenfalls im Mittel niedriger. Die Reifungsstörungen sind wahrscheinlich z.T. Folge eines toxischen Einflusses von Alkohol auf den Nukleinsäurestoffwechsel der Knochenmarkzellen.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

MCV:

Mittleres Erythrozytenvolumen

MCH:

Hämoglobin/Erythrozyt

GOT:

Glutamatoxalacetattransaminase

Gamma-GT:

Gamma-Glutamyltranspeptidase

EBK:

Totale Eisenbindungskapazität

Literatur

  1. Ali MAM, Brain MC (1974) Ethanol inhibition of hemoglobin synthesis: in vitro evidence for a haem correctable defect in normal subjects and in alcoholics. Br J Haematol 28:311

    Google Scholar 

  2. D'Amaro J (1978) HLA polymorphisms in the Netherlands. A study in population-and immunogenetics. Kompenaer, Oegstgeest, P 50

    Google Scholar 

  3. Atkinson JP, Sullivan TJ, Kelly JP, Parker CW (1977) Stimulation by alcohol of cyclic AMP metabolism in human leucocytes: possible role of cyclic AMP in the antiinflammatory effects of ethanol. J Clin Invest 60:284–294

    Google Scholar 

  4. Bertino JR, Ward J, Sartorelli AC, Silber R (1965) An effect of ethanol on folate metabolism. J Clin Invest 44:1028

    Google Scholar 

  5. Bock HE, Karges O, Löhr GW, Waller HD (1958) Fermenteigenschaften roter Blutzellen bei Lebererkrankungen. Klin Wochenschr 36:56–60

    Google Scholar 

  6. Brayton RG, Stokes PE, Schwartz MS, Louria DB (1970) Effect of alcohol and various diseases on leucocyte mobilisation, phagocytosis and intracellular bacterial killing. N Engl J Med 282:123–128

    Google Scholar 

  7. Charlton RW, Jacobs P, Stefel H (1964) Effect of alcohol on iron absorption. Br Med J 2:1427–1429

    Google Scholar 

  8. Colman N, Herbert V (1980) Hematologic complications of alcoholism: overview. Semin Hematol 17:164–176

    Google Scholar 

  9. Conrad ME, Barton JC (1980) Anemia and iron kinetics in alcoholism. Semin Hematol 17:149–163

    Google Scholar 

  10. Cooper RA (1980) Hemolytic syndromes and red cell membrane abnormalities in liver disease. Semin Hematol 17:103–112

    Google Scholar 

  11. Cowan DH (1973) Thrombokinetic studies in alcohol-related thrombocytopenia. J Lab Clin Med 81:64–76

    Google Scholar 

  12. Cowan DH (1980) Effect of alcoholism on hemostasis. Semin Hematol 17:137–147

    Google Scholar 

  13. DeMeo AN, Anderson BR (1972) Defective chemotaxis associated with a serum inhibitor in cirrhotic patients. N Engl J Med 286:735–740

    Google Scholar 

  14. Eichner ER (1973) The hematologic disorders of alcoholism Am J Med 54:621–630

    Google Scholar 

  15. Eichner ER (1973) The hematologic disorders of alcoholism. Am J Med 54:621–630

    Google Scholar 

  16. Eichner ER (1980) Anemia associated with alcohol ingestion or liver disease. Sci Pract Clin Med 6:39–42

    Google Scholar 

  17. Eichner ER, Hillman RS (1971) The evolution of anemia in alcoholic patients. Am J Med 50:218–232

    Google Scholar 

  18. Gerchow J, Schrappe O (1980) Alkoholverträglichkeitsgrenzen. In: Deutsche Hauptstelle gegen die Suchtgefahren e.V. (Hrsg) Alkoholismus, S 12–13

  19. Haselager EM, Vreeken J (1977) Rebound thrombocytosis after alcohol abuse: a possible factor in the pathogenesis of thromboembolic disease. Lancet 1:774–775

    Google Scholar 

  20. Haut MH, Cowan DH (1974) The effect of ethanol on hemostatic properties of human platelets. Am J Med 56:22–33

    Google Scholar 

  21. Herbert V, Zalusky R, Davidson CS (1963) Correlation of folate deficiency with alcoholism and associated macrocytosis, anemia, and liver disease. Ann Intern Med 58:977–988

    Google Scholar 

  22. Hines JD (1969) Reversible megaloblastic and sideroblastic marrow abnormalities in alcoholic patients. Br J Haematol 16:87–101

    Google Scholar 

  23. Hines JD, Cowan DH (1970) Studies on the pathogenesis of alcohol-induced sideroblastic bone-marrow abnormalities. N Engl J Med 283:441–446

    Google Scholar 

  24. Hourihane DOB, Weir DG (1970) Suppression of erythropoiesis by alcohol. Br Med J 1:86–89

    Google Scholar 

  25. Jarrold T, Will JJ, Davies AR (1967) Bone marrow erythroid morpholgy in alcoholic patients. Am J Clin Nutr 20:716–722

    Google Scholar 

  26. Lindenbaum J (1980) Folate and vitamin B12 deficiencies in alcoholism. Semin Hematol 17:119–129

    Google Scholar 

  27. Lindenbaum J, Hargrove RL (1968) Thrombocytopenia in alcoholics. Ann Intern Med 68:526–532

    Google Scholar 

  28. Liu YK (1980) Effects of alcohol on granulocytes and lymphocytes. Semin Hematol 17:130–136

    Google Scholar 

  29. McCurdy PR, Pierce LE, Rath CE (1962) Abnormal bone marrow morphology in acute alcoholism. N Engl J Med 266:505–507

    Google Scholar 

  30. McFarland W, Libre EP (1963) Abnormal leucocyte response in alcoholism. Ann Intern Med 59:865–877

    Google Scholar 

  31. Myrhed M, Berglund L, Böttiger LE (1977) Alcohol consumption and hematology. Acta Med Scand 202:11–15

    Google Scholar 

  32. Pearson ES Hartley HO (1966) Biometrika tables for statisticians, vol. I. University Press, Cambridge, pp 128–135

    Google Scholar 

  33. Pierce I, McGuffin RG, Hillman RS (1976) Clinical studies in alcoholic sideroblastosis. Arch Inn Med 136:283–289

    Google Scholar 

  34. Post RM, Desforges JF (1968) Thrombocytopenic effect of ethanol infusion. Blood 31:344–347

    Google Scholar 

  35. Straub PW (1975) Alkoholwirkungen auf das Blut. Schweiz Med Wochenschr 105:1072–1077

    Google Scholar 

  36. Sullivan LW, Herbert V (1964) Suppression of hematopoiesis by ethanol. J Clin Invest 43:2048–2062

    Google Scholar 

  37. Tisman G, Herbert V (1973) In vitro myelosuppression and immunosuppression by ethanol. J Clin Invest 52:1410–1414

    Google Scholar 

  38. Waller HD, Benöhr HChr (1978) Störungen der Hämatopoiese bei Alkoholismus. Klin Wochenschr 56:259–265

    Google Scholar 

  39. Waller HD, Nerke O, Heidemann E (1979) Alkoholtoxische Störungen der Hämatopoese. Diagnostik 12:111–114

    Google Scholar 

  40. Wintrobe MM, Shumacher HB (1933) Occurence of macrocytic anemia in association with disorders of the liver. Bull John Hopkins Hosp 52:387–407

    Google Scholar 

  41. Wu A, Chanarin I, Levi AJ (1974) Macrocytosis of chronic alcoholism. Lancet 1:829–831

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Abt. Innere Medizin II, Medizinische Universitätsklinik Tübingen, Germany

    E. Heidemann, O. Nerke & H. D. Waller

Authors
  1. E. Heidemann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. O. Nerke
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H. D. Waller
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Heidemann, E., Nerke, O. & Waller, H.D. Alkoholtoxische Veränderungen der Hämatopoiese. Klin Wochenschr 59, 1303–1312 (1981). https://doi.org/10.1007/BF01711180

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01711180

Key words

Schlüsselwörter

Search

Navigation