Case Report

An Unusual Case of Hemolytic Anemia Reversed with Liver Transplantation


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

1. Qamar AA, Grace ND. Abnormal hematological indices in cirrhosis. Can J Gastroenterol. 2009;23(6):441-445.
2. Smith JA, Lonergan ET, Sterling K. Spur-Cell Anemia: Hemolytic Anemia with Red Cells Resembling Acanthocytes in Alcoholic Cirrhosis. N Engl J Med. 1964;271:396-8.
3. Vassiliadis T, Mpoumponaris A, Vakalopoulou S, et al. Spur cells and spur cell anemia in hospitalized patients with advanced liver disease: Incidence and correlation with disease severity and survival. Hepatol Res. 2010;40(2):161-170.
4. Shah R, Patel A, John S. Spur cell anemia in end-stage liver disease: a zebra!, Am J Emerg Med. 2014;32(8):944e3-4.
5. Miwa T, Hatano Y, Kochi T, et al. Spur cell anemia related to alcoholic liver cirrhosis managed without liver transplantation: a case report and literature review. Clin J Gastroenterol. 2020;13(5):882-890.
6. Marks PW. Hematologic manifestations of liver disease. Semin Hematol. 2013;50(3):216-21.
7. Cooper RA. Anemia with spur cells: a red cell defect acquired in serum and modified in the circulation. J Clin Invest. 1969;48(10):1820-31.
8. Haruta I, Hashimoto E, Kabutake A, et al. Spur cell anemia associated with a cirrhotic non-alcoholic steatohepatitis patient. Hepatol Res. 2007;37(6):482-5.
9. Sousa JM, Giraldez A, De Blas JM, et al. Spur cell anaemia in hepatic cirrhosis: incidence, prognosis and reversibility after liver transplantation. J Hepatol. 2002;36(1):64-64.
10. Miki K, Maruki T, Imashuku S. Plasmapheresis for Spur cell anemia in a patient with alcoholic liver cirrhosis. Case Rep Hematol. 2018;2018:9513946.
11. Aihara K, Azuma H, Ikeda Y, et al. Successful combination therapy—flunarizine, pentoxifylline, and cholestyramine—for spur cell anemia. Int J Hematol. 2001;73(3):351–5
12. Takemoto Y, Yamamoto H, Tanabe J, et al. Plasmapheresis for spur cell anemia. Kawasaki Disease. 1984;10(4):229–235.
13. Scott CK, Persico FJ, Carpenter K, et al. The effects on flunarizine, a new calcium antagonist, on human red blood cells in vitro. Angiology. 1980;31(5):320-330.
14. Nishio T, Toshima Y, Matsuno Y. Effects of pentoxifylline on cell shape, ATP content and deformability in rabbit erythrocytes under hyperosmolar conditions. Int J Biochem. 1982;14(10):915-20.
15. Angelin B, Björkhem I, Einarsson K, et al. Cholestyramine treatment reduces postprandial but not fasting serum bile acid levels in humans. Gastroenterology. 1982;83(5):1097-101.
16. Karam D, Swiatkowski S, Purohit P, et al. High-dose steroids as a therapeutic option in the management of spur cell haemolytic anaemia. BMJ Case Rep. 2018;2018:bcr2017223281.
IssueVol 16, No 2 (2022) QRcode
SectionCase Report(s)
Spur cell anemia; Alcoholic cirrhosis; Liver transplant; Zieve's disease; Plasmapheresis

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Katiyar V, Dadlani A, Vohra I, Cisak K, Barve A. An Unusual Case of Hemolytic Anemia Reversed with Liver Transplantation. Int J Hematol Oncol Stem Cell Res. 2022;16(2):128-130.