SHM Converge Scientific Abstract ePoster Gallery-Spur Cell Anemia: An Overlooked Cause of Anemia in Cirrhosis

Pdf Summary

Spur cell anemia is a rare but serious hemolytic anemia seen in patients with cirrhosis. The case described a 67-year-old woman with decompensated NASH cirrhosis, portal hypertensive enteropathy, and severe anemia (hemoglobin 5.8 g/dL) without overt bleeding. She had jaundice, abdominal distention, and edema. Laboratory findings showed elevated LDH, reticulocytosis, high indirect bilirubin, undetectable haptoglobin, and a negative direct antiglobulin test, supporting hemolysis rather than blood loss. Peripheral smear revealed numerous acanthocytes, or spur cells, which are the key diagnostic feature.<br /><br />Spur cells form because liver disease alters red blood cell membrane lipid composition, making cells more fragile and prone to splenic destruction. Clinically, the condition presents as refractory anemia with signs of hemolysis and abnormal smear findings. It is associated with advanced liver disease, including autoimmune hepatitis, Wilson disease, Zieve’s syndrome, and cirrhosis.<br /><br />The prognosis is poor: standard liver severity scores such as MELD-Na and Child-Turcotte-Pugh may underestimate short-term mortality. More than 5% spur cells on smear is associated with a median survival of only 1.9 months. Management focuses on supportive care with transfusions and temporary therapies such as pentoxifylline, cholestyramine, flunarizine, or prednisolone, though evidence is limited. The only curative treatment is liver transplantation, which can rapidly and completely resolve the anemia and is associated with excellent post-transplant outcomes.<br /><br />The key message is that spur cell anemia should be recognized early in cirrhotic patients with unexplained hemolytic anemia, since delayed transplant evaluation can worsen outcomes.

Asset Subtitle

Blake Bentley

Meta Tag

Author List Blake Bentley, Frank Ventura, William C. Lippert

Category Clinical Vignettes

Concept Spur Cell Anemia

Concept Acanthocyte

Concept Liver Transplantation

Concept Cirrhosis

Concept Hemolysis

Distinguished Non-Finalist

Presenter Organization Atrium Health Wake Forest Baptist, Department of Internal Medicine

Presenting Author Blake Bentley

Track Adult

Keywords

spur cell anemia

cirrhosis

hemolytic anemia

acanthocytes

acanthocytosis

liver transplantation

NASH cirrhosis

indirect bilirubin

haptoglobin

MELD-Na

Spur Cell Anemia

Acanthocyte

Liver Transplantation

Cirrhosis

Hemolysis