A 49-year-old man presents with jaundice, nausea, and vomiting. He has a history of chronic alcoholism, and is currently drinking over one bottle of red wine a day. On physical examination, he is jaundiced and pale with a large tender liver. Laboratory data include hemoglobin of 9 g/dL, WBC of 4200/mL, and platelet count of 80,000/mL. His liver enzymes and bilirubin are also elevated. Ultrasound of the abdomen reveals liver enlargement with no bile duct obstruction, a normal size spleen, and no ascites. Which of the following is the most likely toxic effect of alcohol on the bone marrow?
High-Yield Explanation
Alcohol is directly toxic to dividing and maturing cells, but may also affect neutrophil function. The hematologic effects of alcohol may be direct or indirect, via diet, infection, liver disease, and GI disease. The resulting hematologic abnormalities may be profound.