{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T14:10:49Z","timestamp":1779199849070,"version":"3.51.4"},"reference-count":31,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"official grants"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CIMB"],"abstract":"<jats:p>Background and Aims: Anemia is seen in nearly &gt;70% of patients with cirrhosis and is often non-responsive to nutritional supplements; therefore, we assessed the erythropoiesis and associated alteration in bone marrow (BM). Methods: It is a cross-sectional study. Flow cytometry was performed to assess the hematopoietic stem cells (HSCs) and erythroid population of 60 patients with cirrhosis compared with patients with 7 non-cirrhotic portal fibrosis (NCPF) and 3 controls. Proteomics were performed of the pure CD71 erythroid population taken from patients with cirrhosis to decipher the internal abnormalities supported by validation experiments. Real Time PCR, colony assay and heme quantification, cytokine array, and ELISA were performed to assess erythropoietic stimulating agents (ESA), inflammatory cytokines, and growth factors as an external factor affecting erythropoiesis. Results: We found a decrease in intermediate erythroid progenitors [IEPs; CD71+ CD235a+], conversely early erythroid precursors [EEP; CD71+ CD235a\u2212] and late erythroid progenitors [LEP; CD71\u2212 CD235a+] were increased (p &lt; 0.05) in cirrhotic and NCPF as compared to control. However, unlike NCPF, cirrhosis exhibited decreased CD71+ transferrin receptor (TfR1) expression over erythroid cells and increased immature erythrocytes (p &lt; 0.05) in peripheral circulation. In vitro culture of erythroid precursors showed impaired differentiation and maturation that was confirmed by the reduced (p &lt; 0.05) number of erythroid colonies (BFU-E). Proteomics analysis showed downregulated proteins associated with hemoglobin synthesis, ROS detoxification, translation, and mitochondrial activity. Furthermore, we found an altered expression of genes related to erythropoiesis and hemoglobin synthesis and increase (p &lt; 0.05) in inflammatory cytokines such as IL-5, TRAIL-R2, TGF-\u03b1, and TGF-\u03b2 in BM. Conclusions: This study suggests that the dysregulated erythropoiesis observed in patients with cirrhosis having anemia is maintained despite adequate nutrition.<\/jats:p>","DOI":"10.3390\/cimb48050511","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T13:11:31Z","timestamp":1779196291000},"page":"511","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Imperfect Maturation of Erythroid Progenitors in Patients with Cirrhosis-Associated Anemia"],"prefix":"10.3390","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4265-4398","authenticated-orcid":false,"given":"Deepika","family":"Lal","sequence":"first","affiliation":[{"name":"Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi 110070, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaswinder Singh","family":"Maras","sequence":"additional","affiliation":[{"name":"Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi 110070, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rakhi","family":"Maiwall","sequence":"additional","affiliation":[{"name":"Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi 110070, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anupam","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi 110070, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5801-9458","authenticated-orcid":false,"given":"Chhagan","family":"Bihari","sequence":"additional","affiliation":[{"name":"Department of Pathology, Institute of Liver and Biliary Sciences, New Delhi 110070, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1111\/j.1478-3231.2006.01228.x","article-title":"Definition and management of anemia in patients infected with hepatitis C virus","volume":"26","author":"McHutchison","year":"2006","journal-title":"Liver Int."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1155\/2009\/591317","article-title":"Abnormal hematological indices in cirrhosis","volume":"23","author":"Qamar","year":"2009","journal-title":"Can. 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