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Klinische Wochenschrift

, Volume 59, Issue 23, pp 1303–1312 | Cite as

Alkoholtoxische Veränderungen der Hämatopoiese

Eine prospektive Studie bei chronischen Alkoholikern
  • E. Heidemann
  • O. Nerke
  • H. D. Waller
Originalien

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.

Schlüsselwörter

Alkohol und Hämatopoiese Makrozytose Megaloblasten Sideroblasten Thrombozytopenie Plasmavakuolen Folsäure Ferritin 

Abkürzungen

MCV

Mittleres Erythrozytenvolumen

MCH

Hämoglobin/Erythrozyt

GOT

Glutamatoxalacetattransaminase

Gamma-GT

Gamma-Glutamyltranspeptidase

EBK

Totale Eisenbindungskapazität

Alcohol — induced changes in hemopoiesis

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.

Key words

Alcohol and hemopoiesis Macrocytosis Megaloblasts Sideroblasts Thrombocytopenia Vacuolization of hemopoietic precursors Folic acid Ferritin 

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Copyright information

© Springer-Verlag 1981

Authors and Affiliations

  • E. Heidemann
    • 1
  • O. Nerke
    • 1
  • H. D. Waller
    • 1
  1. 1.Abt. Innere Medizin IIMedizinische Universitätsklinik TübingenGermany

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