Effects of alcohol on some haematological parameters among alcohol consumers

Introduction

Heavy intake of alcohol is a leading cause of preventable mortality, second only to cigarette smoking in industrialized countries. Alcohol is implicated in greater than 40% of all fatal traffic accidents in 25% of all general hospital admissions, in liver and upper gastrointestinal cancers, suicides, sex crimes, industrial accidents, robbery, murder and foetal alcohol syndrome. In the context of promotion of disease or death, there is evidence to suggest that moderate alcohol intake reduces risks of coronary heart disease, the leading cause of death in most affluent societies. Therefore, it is important to establish the benefits and harmful effects of alcohol on specific cardiovascular disease outcomes (Oulett, 1979 cited in Akanni, 2010).

Acute and chronic alcohol abuses are common conditions in patients admitted to hospitals. Alcohol has widespread direct and indirect effects on the haematologic system which can obscure other disorders. Leukocyte, erythrocyte, and thrombocyte production and functions are affected directly. Liver damage secondary to alcohol abuse also affect red blood cells and the haemostatic mechanisms. Nutritional deficiencies are caused not only by poor dietary habits practiced by alcohol abusers, but by the effect of alcohol on the absorption, storage, and utilization of several vitamins (Herman, 2008). Over the past 20-30 years, the medical position on alcohol has become somewhat nuanced.

Investigation of large-scale observational cohorts have suggested that light to moderate drinking may be associated with decreased  mortality rates and with decreased risk of cardiovascular diseases (Lucas et al., 2005). The subject of alcohol and heart attacks is important because the major cause of death in many countries is cardiovascular disease. Besides, cardiovascular diseases, many of the pathophysiological effects of alcohol ingestion are related to the pathway of ethanol metabolism (Peter and Preedy, 2008). Findings that alcohol abuse results in diverse patterns of haematological effects and affects several cell lines. Alcohol suppresses platelet production and causes thrombocytopenia which results in platelet aggregation (Sellah and Bobzien, 2009).

However, some studies by Gronback et al., (2000); Fuchs, et al., (2005); Rimm et al., (2006), but not all have suggested that wine may provide additional benefits over and above the effects of alcohol, perhaps because of antioxidants or other types of effects of non-alcohol grape chemicals like resveratrol (Stervbo et al., 2007). Some investigators have been so intrigued by the possible benefits of low-dose alcohol that they have gone so far as to consider mechanisms by which alcohol can have salutary cardiovascular effects (Rimm et al., 2006)

These include increased levels of high density lipoprotein cholesterol and a decreased tendency to thrombosis. Combining these reported biological benefits with epidemiological findings, some medical organizations have stated that low level of alcohol consumption may be a legitimate “item of discussion between physicians and patients (Goldberg et al., 2001)

Unfortunately, alcohol abuse is known to have a wide array of adverse effects on the transport medium in the cardiovascular system, blood. The mechanisms by which it does so have not yet been established; but there is considerable evidence which reveals adverse effects on serum protein, blood cells and their progenitors in the bone marrow (Jaana, 2004).

The effect of alcohol on the haematopoietic system can be divided into direct and indirect effects. Direct effects are primarily seen in the bone marrow and involve the white cell, red cell and platelet lines. Indirect effects are secondary to metabolic or physiologic alterations resulting in liver disease and to nutritional abnormalities, such as folate deficiency (Herman, 2008)

Haematological abnormalities are frequently found in heavy drinking alcoholics but anaemia is generally a rare complication, when present, haemolysis is considered to be one of the most common causes. (Kristensson et al., 2008).

 Conceptual framework on alcohol

Alcohol is a sedative substance which changes the way we feel. Alcohol is colourless, characteristic odour and flammable. Alcohol as a substance does not contain any nutrient in the body (Hull and Stone, 2004). Alcohol is described as a drug. It is classed as a depressant, meaning that it slows down vital functions resulting in slurred speech, unsteady movement, disturbed perceptions and an inability to react quickly. It reduces an individual’s ability to think rationally and distorts his or her judgment.

The amount of alcohol consumed determines the type of effect. Most people drink for the depressant effect, such as a glass/bottle of beer or glass of wine taken to “loosen up.” But if a person consumes more than the body can handle, they then experience alcohol’s depressant effect. They will feel “stupid” or lose coordination and control (Edwards, 2004).

Alcohol overdose causes even more severe depressant effects (inability to feel pain, toxicity where the body vomits the poison, and finally unconsciousness or, worse, coma or death from severe toxic overdose). These reactions depend on how much is consumed and how quickly. There are different kinds of alcohol. Ethyl alcohol (ethanol) is the only alcohol used in beverages and is produced by the fermentation of grains and fruits. Fermenting is a chemical process whereby yeast acts upon certain ingredients in the food, creating alcohol (Gmei, 2003).

History of alcohol

The word alcohol appears as a term for a very fine powder in the 16^th century. It was borrowed from French which took it from medical Latin. The word alcohol was originally used for the very powder produced by the sublimation of the mineral stibnite to form antimony sulphide (Sb₂S_3­­­) hence the essence of “spirit” of the substance which was used as antiseptics, eyeliner and cosmetic (Majerza and Natkaniel, 2006)

In 1657, Willian Johnson used the word to refer to any fluid obtained by distillation, including alcohol or wine; the distilled essence of wine. The alcohol become restricted to “spirit or wine” (the chemical known to as ethanol) in the 18^th century and was extended to the class of substance so called “alcohol” in the modern chemistry after 1850. The first alcohol (today known as ethyl alcohol) was discovered by the tenth century Persian Alchemist al-Razi.

Types of alcohol

Alcohol beverages have been a popular drinking medium for celebrations and parties. According to Hull and Stone (2004), alcohol beverages are usually classified into two main categories;

• Fermented or undistilled alcohol.
• Distilled alcohol beverages

Fermented or undistilled alcohol

Fermented and undistilled alcoholic beverages include beer, palm wine, sake and wine. Beer is one of the oldest forms of fermented alcoholic beverages. There are many sub-types of beer which according to Rimm et al., (2006) are;

1. Wheat beer: Wheat beer is the type of bear produced by mixing a large proportion of wheat when compared to the malted barley content. This type of beer has its origin in Austria and Germany.
2. Palm wine: Palm wine is a type of alcoholic beverage consumed in Asia and Africa. Palm wine is produced from the sap of the palm tree and raffia palm.
3. Sake: Sake is a fermented alcoholic beverage made in Japan by fermenting rice at a controlled temperature.
4. Wine: Wine is a type of alcoholic beverage that is made from fermented grapes. During the fermentation process, yeast absorbs the sugar in the grape juice and converts it into alcohol. It contains 8 – 20% of alcohol by volume (ABV).

Distilled alcohol beverages

Distilled alcohol beverages include gin, whiskey and brandy.

1. Gin: Gin is a spirit which derives its predominant flavour from juniper berries (Juniperus communis). From its earliest origins in the Middle Ages, gin has evolved over the course of a millennium from a herbal medicine to an object of commerce in the spirits industry. Gin was developed on the basis of the older Jenever, and became widely popular in Great Britain when William of Orange, leader of the Dutch Republic, occupied the British thrones with his wife Mary. Today, the gin category is one of the most popular and widely distributed range of spirits, and is represented by products of various origins, styles, and flavour profiles that all revolve around juniper as a common ingredient (Gmei, 2003).
2. Whiskey: Whiskey is a type of distilled alcoholic beverage that is made by forming a combination of different grains including barley, rye, corn and wheat. Whiskey contents of 40 – 50% alcohol by volume (ABV).
3. Brandy: Brandy is a type of distilled alcoholic beverage that is made by distilling wine. It has an alcoholic content that ranges between 30% and 60%.

Kinds of alcohol

There are different kinds of alcohol. We have methanol, ethanol, propan-1-ol, propan-2-ol, etc., but ethyl alcohol (ethanol) is the only alcohol used in beverages.

Names of alcohol, chemical formula and their structure

Alcohol content of different brands of alcohol

(Source: Foundation for a Drug-Free World, 2006)

How alcohol affects the body

Alcohol is absorbed into the bloodstream via small blood vessels in the walls of the stomach and small intestine. Within minutes of drinking alcohol, it travels from the stomach to the brain, where it quickly produces its effects, slowing the action of nerve cells. Approximately 20% of alcohol is absorbed through the stomach. Most of the remaining 80% is absorbed through the small intestine.

Alcohol is also carried by the bloodstream to the liver, which eliminates the alcohol from the blood through a process called “metabolizing,” where it is converted to a nontoxic substance. The liver can only metabolize a certain amount at a time, leaving the excess circulating throughout the body. Thus the intensity of the effect on the body is directly related to the amount consumed. When the amount of alcohol in the blood exceeds a certain level, the respiratory (breathing) system slows down markedly, and can cause a coma or death, because oxygen no longer reaches the brain. (Bruun, 2005).

Health effects of excessive alcohol intake

Drinking too much alcohol in a single occasion or over time can take a series toll (damage) on human health. Ferrer (2008) stated that alcohol can affect some parts of the body such as;

1. Brain: Alcohol interferes with the brain’s communication pathways, and can affect the way the brain looks and works. These disruptions can change mood and behaviour, and make it harder to think clearly and move with coordination.
2. Heart: Drinking a lot over a long time or too much on a single occasion can damage the heart, causing problems including, cardiomyopathy (stretching and drooping of heart muscle), arrhythmias (irregular heart beat), stroke and high blood pressure .Research also shows that drinking moderate amounts of alcohol may protect healthy adults from developing coronary heart disease (Ferrer, 2008).
3. Liver: Heavy drinking takes a toll (damage) on the liver, and can lead to a variety of problems and liver inflammations including steatosis or fatty liver, alcoholic hepatitis, fibrosis and cirrhosis
4. Cancer: Drinking too much alcohol can increase your risk of developing certain cancers, including cancers of the mouth, oesophagus, throat, liver and breast.
5. Pancreas: Alcohol causes the pancreas to produce toxic substances that can eventually lead to pancreatitis, a dangerous inflammation and swelling of the blood vessels in the pancreas that prevents proper digestion.
6. Immune system: Drinking too much can weaken your immune system, making your body a much easier target for disease.  Chronic drinkers are more liable to contract diseases like pneumonia and tuberculosis than people who do not drink too much.  Drinking a lot on a single occasion slows your body’s ability to ward off infections – even up to 24 hours after getting drunk (Ferrer, 2008).

Social effects of excessive alcohol intake

Excessive alcohol intake carries with it a host of social problems. Both the drinker and the family unit are affected. Numerous marriages have been broken by the effect of alcohol, both emotionally and financially.  In most cases heavy alcohol drinkers are saddle with emotional issues such as guilt, depression, and relationship problems are often found in children of alcoholics (Klingemann and Gmei, 2001).

Communities suffer the cost of alcohol abuse. An enormous amount of money is lost each year in the workplace because of alcohol. Insurance costs, decreased productivity, workplace injuries, and work-related grievances are just a few of many problems associated with alcohol. Alcohol is also a leading factor in motor vehicle accidents and injuries. Alcohol-related vehicular accidents are especially prevalent among teenagers and young adults, for whom they are the leading cause of accidental death. Fires, drowning, and suicides are also frequently associated with alcohol (Gmei and Rehm, 2003).

Health benefits of alcohol intake

According to the Dietary Guidelines for Americans, “moderate alcohol consumption is defined as having up to one drink per day for women and up to two drinks per day for men. This definition is referring to the amount consumed on any single day and is not intended as an average over several days.” Moderate intake of alcohol when one is of the legal drinking age can benefit health (Edward, 2004).

Other health benefits of alcohol intake according to Edward (2004) are;

1. It can lower your risk of cardiovascular disease: The School of Public Health at Harvard University in 1998 found that “moderate amounts of alcohol raise levels of high-density lipoprotein, HDL, or ‘good’ cholesterol and higher HDL levels are associated with greater protection against heart disease. Moderate alcohol consumption has also been linked with beneficial changes ranging from better sensitivity to insulin to improvements in factors that influence blood clotting….Such changes would tend to prevent the formation of small blood clots that can block arteries in the heart, neck, and brain, the ultimate cause of many heart attacks and the most common kind of stroke.” This finding is applicable to both men and women who have not been previously diagnosed with any type of cardiovascular disease.
2. It can reduce the risk of gallstones: Drinking two units of alcohol per day can reduce the risk of gallstones by one-third, according to researchers at the University of East Anglia. The study found that those who reported consuming two UK units of alcohol per day had a one-third reduction in their risk of developing gallstones. “Researchers emphasized that their findings show the benefits of moderate alcohol intake but stress that excessive alcohol intake can cause health problems,” according to the study (Edward, 2004).
3. Lowers the chance of diabetes: Results of a Dutch study showed that healthy adults who drink one to two glasses per day have a decreased chance of developing type-2 diabetes, in comparison to those who do not drink at all. “The results of the investigation show that moderate alcohol consumption can play a part in a healthy lifestyle to help reduce the risk of developing diabetes type-2 (Edward, 2004).
4. It helps prevent against the common cold: The Department of Psychology at Carnegie Mellon University found that while susceptibility to the common cold was increased by smoking, moderate alcohol consumption led to a decrease in common cold cases for non-smokers. This study was conducted in 1993 with 391 adults. In 2002, according to the New York Times, Spanish researchers found that by drinking eight to 14 glasses of wine per week, particularly red wine, one could see a 60-percent reduction in the risk of developing a cold. The scientists suspected that this had something to do with the antioxidant properties of wine (Edward, 2004).

Haematological parameters

Packed cell volume (PCV) or hematocrit (HCT)

The hematocrit (Ht or HCT, British English spelling haematocrit), also known as packed cell volume (PCV) or erythrocyte volume fraction (EVF), is the volume percentage (%) of red blood cells in blood. It is normally 45% for men and 40% for women (Purves et al., 2004).

It is considered as part of a person’s complete blood count results along with haemoglobin concentration, white blood cell count, and platelet count. In mammals, hematocrit is in dependent of body size.

The packed cell volume (PCV) can be determined by centrifuging heparinized blood in a capillary tube (also known as a microhematocrit tube) at 10,000 RPM for five minutes. This separates the blood into layers. The volume of packed red blood cells divided by the total volume of the blood sample gives the PCV, because a tube is used, this can be calculated by measuring the lengths of the layers with hematocrit reader (Purves et al., 2004).

White blood cell (WBC) and differential cell count

Definition

White blood cells are a heterogeneous group of nucleated cells that can be found in circulation for at least a period of their life. Their normal concentration in blood varies between 4000 and 10,000 per micro liters. They play a most important role in phagocytosis and immunity and therefore in defense against infection. WBC are classified into granulocytes, lymphocytes, and monocytes. Granulocytes owe their name to the presence of distinct cytoplasmic granulation. Three varieties are recognized: neutrophils (or polymorphonuclear granulocytes), eosinophils, and basophils (Cline and Huttle, 2004).

Normal value of some haematological parameters

Values for haematological parameters are affected by factors such as age, sex, ethnic background, social, nutritional and environmental factor.

(Source: Fl-Hazmi, 2001)

Total White Cell Count

3.5 – 11 x 10⁹

Differential White Cell Count

Source: FlHazmi (2001).

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