Haematological disorders in liver disease

The liver plays a central role in haemopoiesis and synthesis of coagulation proteins; liver disease is associated with a broad range of haematological abnormalities. Anaemia arises through multiple mechanisms, haem metabolism is disturbed, and liver disease causes alterations in red cell lipid metabolism. Defects of platelet number and function arise due to the effects of liver disease, immune mechanisms and hypersplenism. Coagulation disturbances are due to impaired vitamin K metabolism, defective synthesis of coagulation factors and regulatory proteins, impaired clearance of activated coagulation factors and increased fibrinolysis. Treatment, including blood component therapy, is discussed. Recent data indicate an emerging role for disturbances in Epo, cytokines (TNF, IL-6) and thrombopoietin in causing haematological changes in liver disease.