SHM Converge Scientific Abstract ePoster Gallery-Cirrhosis Spurs the Crisis; A Red Cell Breakdown

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Spur cell anemia (SCA) is an important cause of hemolytic anemia in patients with liver cirrhosis. This case describes a 23-year-old man with alcohol use disorder who presented with jaundice, ascites, edema, and early satiety. He had severe macrocytic anemia with elevated reticulocytes, low haptoglobin, indirect hyperbilirubinemia, and increased LDH. Imaging showed cirrhosis and ascites, and peripheral smear confirmed spur cells (acanthocytes), supporting the diagnosis of spur cell anemia.<br /><br />The pathophysiology is related to advanced liver disease causing abnormal lipid metabolism in red blood cell membranes. Reduced lecithin-cholesterol acyltransferase activity leads to altered membrane phospholipid composition, producing irregular membrane projections. These spur-shaped cells are then trapped and destroyed in the spleen, resulting in hemolysis. Because the underlying membrane defect persists, transfusions do not effectively correct the anemia. In cirrhosis, anemia can also be multifactorial, with contributions from gastrointestinal bleeding, bone marrow suppression, malnutrition, malabsorption, coagulopathy, and anemia of chronic disease.<br /><br />Management is limited. Liver transplantation is the only known curative treatment for SCA associated with cirrhosis. For patients who are not transplant candidates, steroids have been used in some cases, although evidence is limited and complications such as infection may require discontinuation, as in this patient. Overall, recognizing spur cell anemia is crucial because it signals severe liver dysfunction and carries a poor prognosis.

Asset Subtitle

Abiola A. Adebayo

Meta Tag

Author List Abiola A. Adebayo, Kristin Swedish, Lemchukwu Amaeshi

Category Clinical Vignettes

Concept Spur Cell Anemia

Concept Cirrhosis

Concept Liver Transplantation

Concept Spur Cell

Concept Red Blood Cell Membrane Lipid Abnormality

Distinguished Non-Finalist

Presenter Organization Montefiore Medical Center, Wakefield Campus

Presenting Author Abiola A. Adebayo

Track Adult

Keywords

spur cell anemia

hemolytic anemia

liver cirrhosis

acanthocytes

alcohol use disorder

macrocytic anemia

hyperbilirubinemia

reticulocytosis

liver transplantation

splenic hemolysis

Spur Cell Anemia

Cirrhosis

Liver Transplantation

Spur Cell

Red Blood Cell Membrane Lipid Abnormality