Pathology: spur cell anemia

With end-stage liver disease and the finding of many spur
cells on peripheral smear, the etiology of a non-immune
hemolytic anemia is likely spur cell anemia. Changes in the lipid
composition of the red cell membranes are found in end-stage
liver disease.  These changes are associated with development
of spur cells and decreased red cell survival, resulting in
hemolytic anemia.

These patients are poorly responsive to RBC transfusions, as even transfused cells undergo membrane changes when circulating through the liver, and are thus subject to decreased survival. Spur cell anemia often reverses following liver transplantation but there is no other particular treatment.

As with other hemolytic disorders, supplementation with folic acid may be beneficial, given at 5 mg daily.

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