Which laboratory pattern most strongly supports alcoholic liver disease as the cause of anemia in these results?

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Alcohol-related liver disease shows a liver injury pattern on tests, and that pattern most clearly points to alcohol as the cause when evaluating anemia. The strongest signal is a combination of elevated GGT alongside elevated transaminases, with bilirubin also raised. GGT rises with alcohol exposure and is a sensitive marker of alcohol-related effects on the liver. When transaminases are elevated, especially with an AST:ALT ratio that can be greater than one, it indicates hepatocellular injury. A raised bilirubin suggests some impairment of the liver’s ability to process and excrete bile pigments. Seeing all three together forms a lab fingerprint that aligns with alcohol-induced liver injury contributing to the patient’s anemia, whether through chronic liver disease–related mechanisms or associated nutritional and hematologic effects.

Patterns such as low bilirubin with normal GGT argue against active alcohol-induced liver injury; ferritin can be nonspecifically elevated with alcohol use; and normal liver enzymes with normal bilirubin do not support active alcoholic liver disease as the cause of anemia.