Presence of spur cells as a highly predictive factor of mortality in patients with cirrhosis

Alexopoulou, Alexandra; Vasilieva, Larisa; Kanellopoulou, Theoni; Pouriki, Sophia; Soultati, Aspasia; Dourakis, Spyridon P.

doi:10.1111/jgh.12473

Cited by 23 publications

(25 citation statements)

References 18 publications

(50 reference statements)

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“…A prospective study by Alexopoulou et al indicated that in patients with liver cirrhosis and spur cell anaemia, higher mortality has been reported compared with cirrhotic without spur cell anaemia. The study which included 116 patients with cirrhosis reported survival rates of 77%, 45% and 33%, in patients with spur cell anaemia, at 1-month, 2-month and 3-month follow-up, respectively 18. As life span of these patients is short, the question of long-term toxicity of steroids may not be of overwhelming concern.…”

Section: Discussionmentioning

confidence: 99%

High-dose steroids as a therapeutic option in the management of spur cell haemolytic anaemia

Karam¹,

Swiatkowski

Purohit

et al. 2018

BMJ Case Reports

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Spur cell haemolytic anaemia (SCA) is a form of anaemia that can be seen in patients with severely impaired liver function or advanced cirrhosis. It is associated with high mortality. The treatment options for SCA secondary to cirrhosis are limited. Our patient is a middle-aged man who developed SCA and was not a candidate for liver transplantation or splenectomy. High-dose steroids helped ameliorate haemolysis and improve anaemia and general condition of our patient.

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Section: Discussionmentioning

confidence: 99%

High-dose steroids as a therapeutic option in the management of spur cell haemolytic anaemia

Karam¹,

Swiatkowski

Purohit

et al. 2018

BMJ Case Reports

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“…Chronic hemolytic anemia with acanthocytosis is a severe manifestation of advanced cirrhosis with a poor prognosis . Reduced erythrocyte lifespan in this situation results from both dysregulated membrane lipids and oxidative damage.…”

Section: Discussionmentioning

confidence: 99%

“…Chronic hemolytic anemia with acanthocytosis is a severe manifestation of advanced cirrhosis with a poor prognosis. 2 Reduced erythrocyte lifespan in this situation results from both dysregulated membrane lipids and oxidative damage. Thus, there is a rationale to administrate vitamin E in order to improve red blood cell membrane alterations and to reduce hemolysis.…”

Section: Discussionmentioning

confidence: 99%

“…Anemia in patients with cirrhosis is a common finding, reported in approximately 50% of cases, and results from several causes including gastrointestinal bleeding, hypersplenism, as well as iron and folate deficiencies. In addition, chronic hemolysis aggravates anemia and participates in hyperbilirubinemia, with a negative impact on prognosis . Examination of blood smear in these patients may reveal populations of erythrocytes with abnormal shape, including echinocytes and acanthocytes .…”

Section: Introductionmentioning

confidence: 99%

“…In addition, chronic hemolysis aggravates anemia and participates in hyperbilirubinemia, with a negative impact on prognosis. 2 Examination of blood smear in these patients may reveal populations of erythrocytes with abnormal shape, including echinocytes and acanthocytes. 3 These red blood cells present both morphological and functional alterations.…”

Section: Introductionmentioning

confidence: 99%

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Effect of hydrosoluble vitamin E on erythrocyte membrane lipid composition in patients with advanced cirrhosis: An open‐label pilot trial

Restellini

Alaei

Matthes

et al. 2014

Hepatology Research

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Aim: Deficiency in vitamin E, a natural antioxidant, participates in abnormal erythrocyte membrane lipids, structural alterations and hemolysis in advanced cirrhosis. Poor absorption of fat-soluble vitamins limits full correction of deficiency with standard formulations in cirrhosis with cholestasis. The aim of the present study was to examine safety and effects of tocofersolan, a water-soluble derivative of vitamin E, on erythrocyte membrane lipids and anemia in patients with biopsy-proven advanced cirrhosis, vitamin E deficiency and hemolysis. Results: Abdominal pain occurred in one patient. Five patients received blood transfusions due to severe anemia. After 4 weeks, both Chol and Phosph decreased, but changes were not significant. Both plasma vitamin E (P < 0.05) and hemoglobin (P < 0.05) increased, together with a decrease in total (P < 0.05) and conjugated (P < 0.05) bilirubin. Conclusion:In patients with advanced cirrhosis, low vitamin E plasma levels and chronic anemia with hemolysis, oral tocofersolan was overall well tolerated, but did not affect erythrocyte membrane lipid composition.

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Predictors of mortality and outcomes of liver transplant in spur cell hemolytic anemia

et al. 2021

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Spur cell hemolytic anemia (SCHA) is a rare, acquired, nonimmune hemolytic anemia of decompensated cirrhosis. Data describing prognostic impact, outcomes of liver transplant, and clinical hematologic characteristics of SCHA are absent or limited. We performed a multicenter, 24-year observational cohort study of patients with SCHA, retrospectively analyzing hepatic and hematologic parameters, independent predictors of mortality, and long-term outcomes of liver transplant. Sixty-nine patients with SCHA met eligibility for inclusion. The median (interquartile range) age was 53 (42-59) years; 46.4% were female, and 11 (15.9%) received liver transplant. Thirty-nine patients (56.5%) were red blood celltransfusion-dependent. All 11 patients undergoing transplant had rapid and complete resolution of SCHA, with improvement in median hematocrit from 22.1% to 34.6% post-transplant (p = .001) and excellent post-transplant outcomes. In multivariable logistic models adjusting for age, sex, etiology of cirrhosis, active/recent variceal bleeding, and Child-Turcotte-Pugh score, transfusion dependence had an odds ratio (OR) for 90-day mortality of 9.14 (95% CI, 2.46-34.00) and reduced pre-transfusion hematocrit had an OR of 4.73 (95% CI, 1.42-15.82) per 6% decrease; increased red cell transfusion requirement, reduced hemoglobin, increased lactate dehydrogenase, and increased indirect bilirubin were also independently predictive of higher 90-day mortality. Model for endstage liver disease (MELD)-Na and Child-Turcotte-Pugh scores consistently significantly underestimated 90-day mortality, with standardized mortality ratios (SMRs) >1 across all scores/classes [MELD-Na 20-29, SMR 2.42 (1.18-4.44); Child-Turcotte-Pugh class B, SMR 4.46 (1.64-9.90)]. In conclusion, SCHA is associated with substantial excess mortality than predicted by MELD-Na or Child-Turcotte-Pugh scores and uniformly resolves with liver transplant, without recurrence. Multiple parameters of hemolytic anemia severity independently predict higher 90-day mortality. | INTRODUCTIONSpur cell hemolytic anemia (SCHA) is a rare, acquired, nonimmune hemolytic anemia occurring in patients with cirrhosis. 1 It is characterized by the presence of spur cells (acanthocytes), abnormal red cells with spiculated projections that decrease the fluidity of the red cell membrane, 2 in the setting of a clinically significant hemolytic anemia.These red cell changes are thought to be driven by abnormalities in hepatic lipid metabolism in patients with cirrhosis, resulting in perturbed red cell membrane lipid cholesterol balance. 3,4 This alteration to the red cell membrane results in reduced membrane fluidity and susceptibility to hemolysis.Data describing the hepatic and hematologic characteristics of SCHA, as well as its prognosis and treatment, are scarce. There are no consensus diagnostic criteria for SCHA, and its prevalence and incidence are unclear. The limited published data suggests that patients with end-stage liver disease and SCHA may have higher model for end-stage liver disease ...

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Presence of spur cells as a highly predictive factor of mortality in patients with cirrhosis

Abstract: The presence of spur-cell anemia is not uncommon in cirrhosis and seems to be strongly associated with mortality. SCA can be used in combination with MELD as an additional predictor of early mortality.

Cited by 23 publications

References 18 publications

High-dose steroids as a therapeutic option in the management of spur cell haemolytic anaemia

High-dose steroids as a therapeutic option in the management of spur cell haemolytic anaemia

Effect of hydrosoluble vitamin E on erythrocyte membrane lipid composition in patients with advanced cirrhosis: An open‐label pilot trial

Predictors of mortality and outcomes of liver transplant in spur cell hemolytic anemia

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