Chronic alcoholics who substitute large amounts of alcohol for other dietary constituents are at risk for developing anemia. The causes of anemia in chronic alcoholics are multifactorial, including iron deficiency secondary to bleeding from episodic gastritis or other gastrointestinal sites, folate deficiency from inadequate diet or malabsorption, and deficiency of pyridoxine (vitamin B6) due to abnormal effects on its metabolism. Consequently, the bone marrow may demonstrate absent iron and mixtures of mega-loblastosis from folate deficiency and sideroblastosis from pyridoxine deficiency.

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