FBC abnormalities in liver disease
Last updated Nov. 3, 2025, 1:04 p.m. by ivo
Tags: FBC
- Pancytopenia
- Anaemia
- Neutropenia
- Thrombocytopenia – this can be moderate to severe, with platelet counts down to ~30 x 109/L
- Macrocytosis
- Target cells, stomatocytes, acanthocytes/Spur cells on blood film
- Elevated ferritin
- Elevated PT/INR and APTT
- Reduced fibrinogen
- Iron deficiency related to chronic variceal bleeding
There is no specific haematological management for the changes seen in chronic liver disease. The mainstay of management is optimisation of the underlying liver disease and reduction in any ongoing contributing factors (e.g. alcohol).
Whilst the neutropenia and thrombocytopenia can be marked in chronic liver disease, complications are uncommon. Generally, the risk of infection is not significantly increased until the neutrophil count is < 0.5 x 109/L. Generally, the risk of bleeding is not significantly increased until the platelet count is < 20 x 109/L. Most procedures can be performed with platelet counts > 50 x 109/L.
Variceal bleeding is thought to be mainly related to increased blood pressure through the portal system, rather than the thrombocytopenia or abnormal coagulation profile. In patients with full blood count abnormalities related to chronic liver disease, evaluation and follow-up by Hepatology is most appropriate.
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