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Haematological Changes in Alcohol and Substance Use Dis- Orders- an Overview Raka Jain*, Aishwariya Brigit George and Shubham Narnoli

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Haematological Changes in Alcohol and Substance Use Dis- Orders- an Overview Raka Jain*, Aishwariya Brigit George and Shubham Narnoli ISSN: 2690-263X Jain et al. Int Arch Subst Abuse Rehabil 2020, 2:006 DOI: 10.23937/2690-263X/1710006 International Archives of Volume 2 | Issue 1 Open Access Substance Abuse and Rehabilitation MINI REVIEW Haematological Changes in Alcohol and Substance Use Dis- orders- An Overview Raka Jain*, Aishwariya Brigit George and Shubham Narnoli Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, India *Corresponding author: Dr. Raka Jain, Professor, Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi-110029, India, Tel: +91-11- Check for 26593595, Fax: +91-11-26588641 updates to the nervous system and internal organs. Moreover, Abstract illicit drug uses are commonly linked with aplastic anae- Alcohol and Substance use remains a worldwide social mia, bone marrow repression and variety of systemic problem. There is an increasing awareness that alcohol- ics and substance abusers do show some haematological disorders [3]. Hence, early diagnosis of these disorders abnormalities (e.g., hemoglobin, white blood cells count, and identification of the complications they result in is mean corpuscular volume, mean corpuscular haemoglobin important. Haematology is the branch of medicine that concentration, red blood cells count, hematocrit). Conse- deals with blood, blood-forming organs and blood dis- quences of these haematological abnormalities can result in serious medical complications. The aim of this paper is to orders. This article summarizes current information on present an overview of haematological changes in alcohol the haematological changes that are observed in dif- and substance use disorders. This may be beneficial for de- ferent substance use disorders and the utility of these fining the homeostasis condition of the body, which leads to changes in clinical assessment. indications for treatment approaches. Keywords Overview of Substances Alcohol, Substance use, Hematological changes Alcohol Alcohol is the most commonly used worldwide. Introduction Alcohol consumption is one of the leading causes of Substance use disorders cause tremendous burden death. Chronic alcohol intake can interfere with various to health care systems and society world-wide. As per physiological, biochemical and metabolic processes of the World Drug Report (2019) [1], about 35 million peo- the blood cells and affect multiple organ systems. Al- ple worldwide suffer from drug use disorders. Disorders cohol use, especially in heavy drinkers, can cause dif- due to illicit drug use accounted for 10.9% of the DALYs ferent metabolic derangements. Haematological ad- caused by mental and substance use disorders and al- verse effects of acute and chronic alcohol use result cohol use disorders accounted for 9.6% [2]. These drugs from both direct and indirect effects [4,5]. The direct can be consumed either by inhalation, injection, or by consequences include toxicity to the blood-forming or- ingestion. Alcohol and Substance use changes the body gans (viz. bone marrow); the blood cell precursors; and functions by influencing endogenous constituents of the mature Red Blood Cells (RBC’s), White Blood Cells the bodies [3]. These substances, when cross the blood- (WBC’s), and platelets, resulting in fewer than-normal brain barrier on ingestion, may affect the brain function or non-functional mature blood cells. either depress or stimulate its activity and temporarily Alcohol’s indirect effects include metabolic or phys- alter the chemical milieu of the brain. Long-term use iological alterations resulting in liver disease and nu- of these addictive substances leads to serious damage tritional deficiencies such as folate deficiencies that Citation: Jain R, George AB, Narnoli S (2020) Haematological Changes in Alcohol and Substance Use Disorders- An Overview. Int Arch Subst Abuse Rehabil 2:006. doi.org/10.23937/2690-263X/1710006 Accepted: August 29, 2020: Published: August 31, 2020 Copyright: © 2020 Jain R, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Jain et al. Int Arch Subst Abuse Rehabil 2020, 2:006 • Page 1 of 6 • DOI: 10.23937/2690-263X/1710006 ISSN: 2690-263X impair the production and function of various blood mal subjects [13]. Recently, a cross-sectional study has cells [4-6]. Folate deficiency also has an important role been published in which comparison of haematologi- in the pathogenesis and progression of alcohol-relat- cal parameters between alcoholics and non-alcoholics ed liver disease [7]. Moreover, Liver damage second- were done. The findings indicated that mean RBC count, ary to alcohol abuse also impacts red blood cells and mean MCH, MCHC were normal among the non-alco- the hemostatic mechanisms. These direct and indirect holic group and decreased among moderate alcoholics effects of alcohol can result in serious medical compli- and more so with severe alcoholics and a similar type of cations among alcohol abusers. For instance, anaemia result was also seen with total count and platelet count resulting from diminished RBC production and impaired [14]. A study from Japan attempted to characterise the RBC metabolism and function causes fatigue, shortness change in the white blood cell counts with varying alco- of breath, light headedness, and even reduced mental hol consumption levels as it has been seen that lower capacity and abnormal heartbeats in alcoholics. It has number of white blood cells has been associated with been found that alcohol interferes with the produc- a decreased risk for chronic heart disease [15]. The tion and function of white blood cells. The number of common abnormalities that are associated with alco- WBC’s decreases (especially neutrophils) which increas- hol abuse with respect to duration of alcohol abuse and es the risk of serious infection. Also, the platelet (PLT) the quantity of alcohol consumed are anemia, leuko- production gets impaired resulting in interference with penia and thrombocytopenia [8]. Several studies have blood clotting. This may lead to symptoms ranging from tried to explain the mechanism through which alcohol nose bleeding to bleeding in the brain (i.e., hemorrhag- causes these changes in blood parameters. Anemia ic stroke). Finally, alcohol-induced abnormalities in the may be caused by a patient’s poor nutritional status plasma proteins, required for blood clotting can lead to coupled with poorer access to health care. This result- the formation of blood clots (i.e., thrombosis) [4]. Evi- ed in chronic infections causing anemia of chronic dis- dence is there to suggest that alcohol abuse can cause ease, through blood loss from gastrointestinal bleeds, bone marrow suppression, or ethanol has cytotoxic ef- through splenic sequestration and destruction of cells fects. These includes myelosuppression that is accom- in hyper-splenic from portal hypertension [16,17]. The panying with slight reduction in all blood cells, blood findings suggest that the development of megaloblastic loss from gastrointestinal tract, malnutrition etc [8]. haematopoiesis in alcoholics is due to the induction of Among the mechanisms explored for the effect of al- folate deficiency. Besides folate depletion, direct toxic cohol is the formation of adducts by acetaldehyde with effect of alcohol on erythroid precursors is reflected by cellular proteins [9]. These altered proteins have been the presence of normal plasma and erythrocyte folate postulated to evoke an immune reaction as evidenced levels in several patients with megaloblastic change. An- by the presence of IgM and IgG antibodies against them. other important effect of alcohol is in haematopoiesis in Studies suggest that consumption of alcohol causes the marrow. Ringed side oblasts are seen in the marrow changes of Complete Blood Counts (CBC). A study from and the marrow might be hypoplastic or even aplastic India shows significant reductions of haemoglobin, RBC, [18]. A finding that precedes anemia is macrocytosis, WBC, haematocrit and significant elevations in MCV and the mechanism of which is not known [19]. This result MCH among alcoholics [10]. Another study from, India, in cell sizes ranging from 100-110 falls this finding has to compared the changes in the complete blood count in be differentiated from megaloblastic anemia in which 30 young male subjects between 20-40 years of age cell sizes generally exceed that seen in alcohol use. The group who consumed two to three units of alcohol on a poor immunity to infections in alcohol dependent sub- daily basis with abstainers of the same age group [11]. jects may be the result of both the decrease in neutro- The findings suggest that drinking of alcohol even for a phil number as well as faulty functioning [20]. The de- short or moderate duration can affect various haema- creased counts may be caused due to marrow hypopla- tological parameters like platelet count and Mean Cor- sia or hypersplenism. The effects on the blood platelets puscular Volume (MCV). Furthermore, another study are similar with effect on both thrombocyte formation from North India examined the haematological profile as well as functioning. The platelet count rarely falls be- of alcohol dependent subjects [12]. The results showed low 10,000/mm3. Abstaining from alcohol results in a an increase in erythrocyte Mean Cell Volume (MCV),
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