Hematologic and oncologic implications of alcoholism

Alcohol-induced thrombocytopenia: Current review

Thrombocytopenia is a decrease in the platelet count below 150,000 in a microliter of blood, i.e., below the lower limit of the reference range, which is 150,000-400,000/μL. The phenomenon of thrombocytopenia related to heavy drinking began to arouse interest in the 1960s and 1970s. It was initially described in case reports and clinical studies on small groups. In the following years, the phenomenon itself and the significance of alcohol-induced thrombocytopenia was studied. Many methodological difficulties inhibiting objective conclusions from research were encountered. Model pathological mechanisms of alcohol thrombocytopenia and the effects of alcohol on the structure and function of platelets were described. Furthermore, the phenomenon of rapid normalization of the number of platelets in people who stopped drinking was described. Relationships between alcohol use, its intensity and occurrence, and intensity of thrombocytopenia have been demonstrated. Predictive platelet counts for alcohol withdrawal syndrome complications have been proven and calculated. The risk of occurrence of withdrawal seizures or delirium tremens in alcohol withdrawal syndrome increases significantly when the platelet count is less than 119,000/μL. The knowledge of the nature of the phenomenon of alcohol-induced thrombocytopenia in a clinical environment allows decisions that are more rational. The attention of clinicians should be drawn to the importance of results of blood tests routinely collected on admission.

Anemia in patients with traumatic spinal cord injury

Anemia is often a complication following spinal cord injury which interferes with the patient's rehabilitation. Hematological profiles of 65 male patients with traumatic spinal cord injury revealed a 52.3% incidence of mild anemia. The age, duration or level of injury had no correlation with the incidence and type of anemia. The anemia was normocytic-normochromic in 32%, normocytic mild hypochromic in 56%, and microcytic hypochromic in 12% of the patients. Factors in pathogenesis included decubitus ulcers, urinary tract infections, acute and chronic blood loss, and folic acid deficiency due to psychosocial maladjustment, alcohol and/or drug abuse. Often, multiple factors were operative in changing proportions. The success of management depends on a careful assessment of causes and removal of inciting factors. The most common type of anemia was that due to chronic disorder, associated with either decubitus ulcers and/or urinary tract infections. Since this type of anemia mimics iron deficiency in presentation it should be differentiated from the latter by evaluation of iron status. Normal hemoglobin levels can be attained only after the chronic disorder is eliminated. Unpredictable fluctuations of hemoglobin level secondary to changes in plasma volume due to autonomic hyperreflexia are common in SCI patients, and should be taken into account for diagnosis and follow-up in therapy.

Haematological changes and state of hydration during delirium tremens and related clinical states

In order to obtain some information about the state of hydration and possible haematological changes in patients with delirium tremens (grade 3) and related clinical states (grade 2) various clinico-chemical variables were measured at the time of admission and repeatedly until clinical recovery from the psychotic state. In grade 3 patients plasma protein concentration, blood haemoglobin concentration, blood haematocrit and erythrocyte count decreased between admission and recovery probably reflecting a slight haemodilution. The changes were all within the normal range for the variables and there was thus no indication of hypo- or hypervolemia. Delirium tremens patients without concomitant somatic diseases should not be routinely treated with intravenous fluid therapy. In grade 2 patients no statistically significant changes occurred in the above mentioned variables. In the grade 3 patients there was a dramatic (100%) increase in plasma iron concentration between admission and the subsequent morning and this was probably related to the elimination of ethanol from the body. In grade 2 patients, where the initial blood alcohol concentration was lower than in grade 3 patients, no change in plasma iron concentration occurred. A statistically significant increase in reticulocyte count between admission and recovery in both grade 3 and grade 2 patients probably reflected the recovery of haemopoietic tissue from the insult of the preceding ethanol intoxication. The same may be true for the prevailing anisocytosis, whereas the trend towards leucocytosis may be due to unspecific stress during the ethanol withdrawal reaction. The rapid changes in some of the clinico-chemical variables stress the importance of initiating investigational procedures immediately at the hour of admission.

Medical consequences of alcohol abuse

It is important for the primary care physician to be aware of the early physical effects of alcohol abuse on various body systems so that the alcoholic can be recognized and treated at the earliest possible time. There are many conditions which should alert the examiner to possible alcoholism.