Spur cell anemia related to alcoholic liver cirrhosis managed without liver transplantation: a case report and literatur
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CASE REPORT
Spur cell anemia related to alcoholic liver cirrhosis managed without liver transplantation: a case report and literature review Takao Miwa1 · Yuichiro Hatano2 · Takahiro Kochi1 · Masashi Aiba1 · Katsuhisa Toda1 · Hideko Goto3 · Noriaki Nakamura1 · Naoki Katsumura1 · Kenji Imai4 · Masahito Shimizu4 Received: 19 November 2019 / Accepted: 20 May 2020 © Japanese Society of Gastroenterology 2020
Abstract Spur cell anemia is an acquired hemolytic anemia associated with liver cirrhosis and is characterized by the presence of increased large red blood cells, which are covered with spike-like projections that vary in width, length, and distribution. A 26-year-old man was referred to our hospital presenting with jaundice, lower limb edema, and dyspnea. The patient was subsequently diagnosed with spur cell anemia related to alcoholic liver cirrhosis. Spur cell anemia is an independent predictor of mortality in liver cirrhosis and has been associated with extremely poor prognosis. The most effective treatment for spur cell anemia is liver transplantation. As seen in the literature, the treatment of spur cell anemia without liver transplantation is quite challenging. This report highlights the importance of management and treatment strategies, including control of fluid retention, blood transfusion, plasma diafiltration, and administration of diuretics. Our treatment strategies might be useful in patients who are not candidate of liver transplantation or patients waiting for liver transplantation. Keywords Alcoholic liver cirrhosis · Case report · Liver cirrhosis · Plasma diafiltration · Spur cell anemia
Introduction Anemia of diverse etiology is commonly seen in patients with liver cirrhosis. Causes of anemia related to liver cirrhosis are complex and multifactorial. Gastrointestinal hemorrhage secondary to the formation of esophageal and gastric varices, thrombocytopenia, and coagulation disorders are some of the major and life-threatening causes of anemia in liver cirrhosis [1, 2]. In addition, in patients with cirrhosis, portal hypertension gastropathy and gastric vascular ectasia are common causes of chronic anemia [3]. Gastrointestinal hemorrhage may also lead to iron-deficiency anemia in cirrhosis [4]. Hemolysis secondary to splenomegaly, caused by * Takao Miwa [email protected] 1
Department of Gastroenterology, Chuno Kosei Hospital, 5‑1 Wakusadori, Seki, Gifu 501‑3802, Japan
2
Department of Tumor Pathology, Gifu University Graduate School of Medicine, Gifu, Japan
3
Department of Hematology, Chuno Kosei Hospital, Gifu, Japan
4
Department of Gastroenterology, Gifu University Graduate School of Medicine, Gifu, Japan
portal hypertension, may lead to increased plasma volume, macrocytosis, and megaloblastic anemia [5]. In addition, autoimmune hemolytic anemia associated with autoimmune hepatitis [6], Wilson’s disease with increased non-ceruloplasmin-bound copper released from impaired hepatocytes [7], Zieve’s syndrome [8], and spur cell anemia (SCA) [9] are all causes of hemolytic an
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