Hypervolemic Anemia in Cirrhosis.

Anemia is usually considered to exist when there is a reduction of hemoglobin, red blood cells or both, per unit volume of blood. This concept is valid in most types of anemia. There is an apparent tendency on the part of the body to compensate for a reduction in circulating red cell mass by an increase in plasma with resultant more or less normal blood volume for the individual (1). We have found this to be true even with the profound reduction of red blood cell mass occurring in cases of aplastic anemia of unknown etiology. There are, however, certain exceptions wherein gross alterations in total blood volume may mask the true hematological state. Reduction in total blood volume in spite of increase in plasma volume has been reported in pernicious anemia during relapse (2-4). Conversely, a significant increase in total blood volume with a relatively greater increase in plasma volume than in circulating red cell mass may, when only routine blood counts are done, suggest a more severe grade of anemia than actually exists. Such cases might be expected to respond poorly to hematinic agents. The following data suggest that the anemia occurring in cirrhosis of the liver is of this character.