Spur cell anemia related to alcoholic liver cirrhosis managed without liver transplantation: a case report and literature review

Miwa, Takao; Hatano, Yuichiro; Kochi, Takeshi; Aiba, Masashi; Toda, Katsuhisa; Goto, Hideko; Nakamura, Noriaki; Katsumura, Naoki; Imai, Kenji; Shimizu, Masahito

doi:10.1007/s12328-020-01142-3

Cited by 12 publications

(7 citation statements)

References 46 publications

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“…Remarkably, patients with alcohol-related cirrhosis have higher incidence of anemia compared with HBV-related cirrhosis, with an incidence of anemia 80.7-65.8% in our study population. Possible explanations are as following: rstly, bone marrow toxicity of alcohol could be an important reason for the development of anemia [15], secondly, hemolytic anemia were shown in patients with alcohol-related cirrhosis as previous described through altering the structure and metabolic pathways of red-blood cell membrane, moreover, malnutrition is common in patients with alcohol-related cirrhosis as chronic alcohol consumption may lead to micronutrient de ciencies [18], in addition, spur cell anemia caused by alcohol-related cirrhosis have also been reported by previous studies [19,20].…”

Section: Discussionmentioning

confidence: 83%

Prognostic Relevance of Anemia In Hospitalized Patients With Cirrhosis:A Multicenter Cohort Study

Ren

Deng

et al. 2021

Preprint

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Background and Aims: Anemia is common in cirrhosis and closely related with adverse outcome in cirrhotic patients, but their clinical features and the effect of variations in hemoglobin levels on mortality or time of death have not yet fully elucidated. As we performed this prospective, multi-center, cohort study to further determine these points.Methods: We retrospectively collected data from the Chinese AcuTe on CHronic LIver FailurE (CATCH-LIFE) study, a prospective multi-center cohort study of patients with chronic liver disease and acute exacerbation conducted by the Chinese Chronic Liver Failure (CLIF) Consortium, which is composed of 15 tertiary hospitals in hepatitis-B-virus high endemic area. Patients were consisted of two prospective multi-center cohorts from the CLIF Consortium between January 2015 to December 2016 and July 2018 to January 2019.We conducted data analysis on prevalence of anemia and clinical characteristics among these patients and further determine the relationship between anemia and prognosis.Results: Among 1979 hospitalized patients with cirrhosis,1389(70.2%) were combine with anemia, a patient has an 6.8% lower risk of death on 90-day mortality and 5.7% lower risk of death on 1-year mortality with a 10g/L decrease in hemoglobin at any level throughout the entire range. Patients with severe anemia have significant higher risk [HR=1.649(1.100,2.473), p=0.016] of 90-day mortality and [HR=1.610(1.159,2.238), p=0.005] of 1-year mortality comparedto those without anemia.Conclusions: Anemia is common in cirrhosis and strongly associated with increased mortality after acute decompensation (AD)/acute liver injury (ALI). Severe anemia is an independent risk factor for poor 90-day and 1-year prognosis in cirrhosis with AD/ALI.

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Section: Discussionmentioning

confidence: 83%

Prognostic Relevance of Anemia In Hospitalized Patients With Cirrhosis:A Multicenter Cohort Study

Ren

Deng

et al. 2021

Preprint

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“…The prevalence of SCA in literature is ill-defined 5 and the exact pathophysiology is still unclear; however, abnormal lipoprotein metabolism 6 is thought to play a key role. These patients tend to have decreased serum lipoprotein-a, apo-AI, apo-AII, HDL3, and reduced lecithin cholesterol acyltransferase activity 7 .…”

Section: Discussionmentioning

confidence: 99%

“…SCA is an independent predictor of mortality in end- stage liver disease with median survival ranging from a few days to less than 6 months 5 . The most effective treatment is orthotopic liver transplantation.…”

Section: Discussionmentioning

confidence: 99%

An Unusual Case of Hemolytic Anemia Reversed with Liver Transplantation

Katiyar¹,

Dadlani²,

Vohra³

et al. 2022

IJHOSCR

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Spur cell anemia is acquired hemolytic anemia seen in patients with advanced liver disease, particularly in the setting of alcoholism, and warrants urgent liver transplant evaluation. We describe the case of a 58-year-old female with alcoholic cirrhosis who presented with worsening liver disease, profound anemia poorly responsive to blood transfusions, and multiple spur cells on the peripheral smear. She underwent a liver transplant, which led to the resolution of hematologic abnormalities and the need for transfusions. Our case highlights the significance of spur cell anemia as a harbinger of poor prognosis in patients with advanced liver disease and its reversibility with liver transplantation.

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“…Spur cell anemia shows the presence of increased numbers of large RBCs with spike-like projections. It has been observed in alcohol-induced liver cirrhosis [50], and it occurs in about 3% of alcoholics with advanced liver disease [15]. The distortion in RBC shape is caused by excess amounts of cholesterol incorporated into the cell membrane of RBCs, which greatly increases the surface area of these cells without corresponding increase in cell volume.…”

Section: The Erythrocyte Contextmentioning

confidence: 99%

“…These cells are prematurely eliminated by splenic macrophages, leading to a low count of normal/functional RBCs [15]. Spur cell anemia in ALD patients needs to be carefully managed to prevent organ failure, and the patients are required to abstain from alcohol to prevent progression to liver cirrhosis [50]. ALD patients may also develop stomatocyte hemolysis, wherein RBCs with defective cell membranes develop stoma-like shape (RBCs called as stomatocytes), and these are trapped and destroyed in the spleen.…”

Section: The Erythrocyte Contextmentioning

confidence: 99%

Iron and iron-related proteins in alcohol consumers: cellular and clinical aspects

2022

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Alcohol-associated liver disease (ALD) is one of the most common chronic liver diseases. Its pathological spectrum includes the overlapping stages of hepatic steatosis/steatohepatitis that can progress to liver fibrosis and cirrhosis; both are risk factors for hepatocellular carcinoma. Moreover, ALD diagnosis and management pose several challenges. The early pathological stages are reversible by alcohol abstinence, but these early stages are often asymptomatic, and currently, there is no specific laboratory biomarker or diagnostic test that can confirm ALD etiology. Alcohol consumers frequently show dysregulation of iron and iron-related proteins. Examination of iron-related parameters in this group may aid in early disease diagnosis and better prognosis and management. For this, a coherent overview of the status of iron and iron-related proteins in alcohol consumers is essential. Therefore, here, we collated and reviewed the alcohol-induced alterations in iron and iron-related proteins. Reported observations include unaltered, increased, or decreased levels of hemoglobin and serum iron, increments in intestinal iron absorption (facilitated via upregulations of duodenal divalent metal transporter-1 and ferroportin), serum ferritin and carbohydrate-deficient transferrin, decrements in serum hepcidin, decreased or unaltered levels of transferrin, increased or unaltered levels of transferrin saturation, and unaltered levels of soluble transferrin receptor. Laboratory values of iron and iron-related proteins in alcohol consumers are provided for reference. The causes and mechanisms underlying these alcohol-induced alterations in iron parameters and anemia in ALD are explained. Notably, alcohol consumption by hemochromatosis (iron overload) patients worsens disease severity due to the synergistic effects of excess iron and alcohol.

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Spur cell anemia related to alcoholic liver cirrhosis managed without liver transplantation: a case report and literature review

Cited by 12 publications

References 46 publications

Prognostic Relevance of Anemia In Hospitalized Patients With Cirrhosis:A Multicenter Cohort Study

Prognostic Relevance of Anemia In Hospitalized Patients With Cirrhosis:A Multicenter Cohort Study

An Unusual Case of Hemolytic Anemia Reversed with Liver Transplantation

Iron and iron-related proteins in alcohol consumers: cellular and clinical aspects

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