Transfusion-refractory anaemia in liver cirrhosis

A 33-year-old-man with chronic alcoholism presented with anaemia. Investigations showed haemoglobin 7.5 g/dl (reticulocytes: 11.2%), leucocytes 4.7×109/l, platelets 61×109/l, direct bilirubin 221 (reference <6) μmol/l, aspartate transaminase 109 (reference 15–38) U/l, alanine transaminase 38 (reference 8–58) U/l, γ-glutamyltransferase 31 (reference 11–62) U/l, lactate dehydrogenase 319 (reference 118–221) U/l, haptoglobin <0.06 (reference 0.16–1.97) g/l, methaemalbumin 0.18 (reference <0.1) mg/dl and a negative direct antiglobulin test. The iron status, cholesterol and triglyceride profiles were unremarkable. On referral, physical examination showed pallor, jaundice, …