Complete blood count results could indicate disease severity in patients with Wilson disease (WD), according to a study recently published in Digestive Diseases.

“Anemia was common in WD patients and was associated with greater disease severity, a higher risk of hepatic complications, and a faster progression,” the authors wrote.

This retrospective cohort study included 288 patients previously diagnosed with WD. The researchers obtained medical records from 2016 to 2020 and analyzed the association between subnormal hemoglobin levels and disease severity related to liver dysfunction, complications, and overall progression of WD.

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Of all participants, the majority (83.33%) did not have anemia, while the remaining 48 did present with low hemoglobin and/or red blood cell count values.

Interestingly, individuals with anemia also had increased levels of bilirubin, liver enzymes such as alanine transaminase, type IV collagen, and hyaluronic acid, as well as prolonged prothrombin time and, subsequently, a high international normalized ratio. On the other hand, blood levels of albumin, total cholesterol, and high density lipoprotein cholesterol were all diminished when compared to normal reference values. A multivariate linear regression yielded these results with statistical significance.

Moreover, a multivariate logistic regression revealed that anemia served as a risk factor for developing 2 different manifestations of portal hypertension: gastric varices and ascites. These results were also statistically significant.

Finally, anemia was an independent risk factor for predicted mortality due to cirrhosis since it correlated with higher scores on the Child-Pugh classification based on a a fully adjusted Cox regression.

These findings yield valuable information regarding disease severity, liver function, and even cirrhosis-associated mortality in patients with WD. The presence of anemia provides an important insight after obtaining results from a simple laboratory test like complete blood count, translating into a potential timely identification of disease progression and hence, adjustment of management in patients with WD.


Wang SQ, Zhan YQ, Hu X, et al. Anemia is associated with disease severity, hepatic complications, and progression of Wilson disease: a retrospective cohort study. Dig Dis. Published online April 5, 2023. doi:10.1159/000530473