Hemolytic Anemia in Cirrhosis: A Case of Spur-Cell Anemia

Abstract

Anemia is a common complication of cirrhosis; therefore, its evaluation must be thorough and tailored to a patient's history. In this case, a 67-year-old woman with metabolic dysfunction–associated cirrhosis presented with transfusion-refractory hemolytic anemia. The differential diagnosis for hemolytic anemia associated with liver disease includes autoimmune hepatitis, Wilson disease, Zieve syndrome, and spur-cell anemia. Spur-cell anemia should be considered in all hemolytic anemias with a peripheral blood smear revealing the presence of 5% spur cells or greater, with prompt referral for liver transplant evaluation because of its median survival of 1.9 months.