Hematological Clues to Alcohol Use Disorder: The Diagnostic Significance of Basophilic Stippling & Macrocytosis in Vitamin Deficiency-Related Anemia

AUD is a prevalent disease that impacts hundreds of millions of individuals worldwide. AUD remains underdiagnosed in clinical settings, with the main factor in this being related to non-disclosure of drinking habits. However, peripheral blood smears can provide hematological clues and diagnostic markers to prompt further investigation into AUD. Two findings in particular– basophilic stippling and macrocytosis– can serve as early markers of alcohol induced physiological dysfunction. This paper seeks to investigate the diagnostic value of these often-incidental findings, with a focus on their underlying systemic mechanisms and how this links to vitamin B12, folate, and B6 deficiencies that are common in AUD. Macrocytosis in the context of AUD can have causes that are megaloblastic and non-megaloblastic, with this distinction underscoring the different etiologies and pathologies of these conditions. Both can reveal underlying liver dysfunction and nutritional deficiencies like vitamin B12, and folate based on erythrocyte morphology. Basophilic stippling in the context of AUD can point towards toxin induced changes and disrupted RNA degradation from impaired erythropoiesis. This finding often reveals oxidative stress and deficiencies in vitamin B6. When macrocytosis and basophilic stippling are observed together, they can prompt further investigation into nutritional deficiencies and liver enzyme function. Through this, the proper identification of AUD can be established. Understanding the morphological distinctions can help aid in differential diagnosis of alcohol-induced anemias and nutritional deficiencies from other etiologies, thus helping with timely intervention for this common disease.