Spur cells and spur cell anemia in hospitalized patients with advanced liver disease: Incidence and correlation with disease severity and survival

Vassiliadis, Themistoklis; Mpoumponaris, Alexander; Vakalopoulou, Sofia; Γιουλεμέ, Όλγα; Gkissakis, Dimitrios; Grammatikos, Nikolaos; Soufleris, Konstantinos; Kakafika, Anna I.; Τζιόμαλος, Κωνσταντίνος; Patsiaoura, Kalliopi; Papanikolaou, Vasilis K.; Evgenidis, Nikolaos

doi:10.1111/j.1872-034x.2009.00590.x

Cited by 33 publications

(45 citation statements)

References 41 publications

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“…SCA is an insufficiently studied entity and its clinical importance has not been documented. There have been a few reports on survival for several decades . A recent study about survival in patients with SCA included only nine patients with spur cell rate higher or equal to 5% .…”

Section: Discussionmentioning

confidence: 99%

“…There have been a few reports on survival for several decades . A recent study about survival in patients with SCA included only nine patients with spur cell rate higher or equal to 5% . In addition, in the same study, the exact impact of SCA as an independent risk factor of survival was not determined since no further statistical analysis was used.…”

Section: Discussionmentioning

confidence: 99%

“…Spur‐cell morphological abnormality is reversible in a non‐cirrhotic microenvironment and is resolved after liver transplantation . The presence of SCA in liver cirrhosis has been associated with advanced disease and poor prognosis . Nevertheless, the exact impact of the presence of SCA on mortality is poorly documented.…”

Section: Introductionmentioning

confidence: 99%

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

Alexopoulou

Vasilieva

Kanellopoulou

et al. 2014

J of Gastro and Hepatol

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Alexopoulou

Vasilieva

Kanellopoulou

et al. 2014

J of Gastro and Hepatol

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“…1 Spur cells, the extreme form of acanthocytes, have a unique morphology with multiple thornlike projections that vary in length and width. 2 These projections are thought to form because of a decreased ratio of phospholipids to cholesterol in red blood cell membranes. 3,4 Spur cell anemia should be suspected in patients with a known history of severe liver disease who present with hemolytic anemia, jaundice, and encephalopathy.…”

mentioning

confidence: 99%

“…3,4 Spur cell anemia should be suspected in patients with a known history of severe liver disease who present with hemolytic anemia, jaundice, and encephalopathy. 2 Patients with spur cell anemia may develop disseminated intravascular coagulation and liver failure; for this reason, the prognosis is poor. 5,6 Orthotopic liver transplantation (OLT) has been shown to reverse spur cell anemia in adult patients with end-stage liver disease.…”

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confidence: 99%

Spur cell anemia as a cause of unconjugated hyperbilirubinemia after liver transplantation and its resolution after retransplantation

et al. 2011

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TO THE EDITORS:Spur cell anemia is a type of hemolytic anemia that can develop in patients with advanced liver disease (especially alcoholic cirrhosis). 1 Spur cells, the extreme form of acanthocytes, have a unique morphology with multiple thornlike projections that vary in length and width. 2 These projections are thought to form because of a decreased ratio of phospholipids to cholesterol in red blood cell membranes. 3,4 Spur cell anemia should be suspected in patients with a known history of severe liver disease who present with hemolytic anemia, jaundice, and encephalopathy. 2 Patients with spur cell anemia may develop disseminated intravascular coagulation and liver failure; for this reason, the prognosis is poor. 5,6 Orthotopic liver transplantation (OLT) has been shown to reverse spur cell anemia in adult patients with end-stage liver disease. 7,8 We present the first pediatric case of spur cell anemia in a patient with chronic liver disease after OLT for biliary atresia. We also report for the first time the resolution of spur cell anemia after liver retransplantation.A 17-year-old Caucasian female who had previously undergone OLT for biliary atresia, presented with jaundice and unconjugated hyperbilirubinemia. Her previous medical history was significant for a Kasai procedure at 2.5 months of age and for liver transplantation at 2 years of age. She did very well for 15 years after OLT and was receiving immunosuppression with tacrolimus. At 17 years of age, she presented with abdominal pain localized to the right upper quadrant with radiation to her back, chest tightness, a dry cough, and shortness of breath. A chest X-ray and a computed tomography scan identified massive right-side pleural effusion with almost complete collapse of the right lung and moderate left effusion. Chest tube placement improved the pleural effusion. Her effusion was exudative. An extensive workup was negative for malignancies (including posttransplant lymphoproliferative disease), pulmonary embolisms, and any active infections. Three months later, she presented with fatigue and jaundice. Her labs revealed the following: hemoglobin level, 5.7 mg/dL (low); platelet count, 156,000/mL (low); mean corpuscular volume, 118 fL (high); total bilirubin level, 21.8 mg/dL (high); indirect bilirubin level, 17.9 mg/dL (high); Coombs test, negative; haptoglobin level, <20 mg/dL (low); reticulocyte count, 9.5% (high); creatinine level, 0.6 mg/dL (normal); alkaline phosphatase level, 266 U/L; aspartate aminotransferase level, 102 U/L (high); alanine aminotransferase level, 48 U/L (high); lactate dehydrogenase level, 566 U/L (high); alpha-fetoprotein level, 2.4 ng/mL (normal); tacrolimus level, 6.2 ng/mL (normal); cholesterol level, 317 mg/dL (high); international normalized ratio, 1.5 (high); and aminotransferase levels were normal. Upper endoscopy and colonoscopy were performed, and the findings were normal. Liver biopsy showed advanced fibrosis (stage 3), chronic hepatitis (grade 2), and extramedullary hematopoiesis with no evidence of rejecti...

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Spur cell anemia in the setting of progressive liver allograft failure

et al. 2016

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Spur cells and spur cell anemia in hospitalized patients with advanced liver disease: Incidence and correlation with disease severity and survival

Abstract: Presence of spur cells in patients with advanced cirrhosis is not always accompanied by spur cell anemia. The presence of 5% spur cells or more and/or hemolytic anemia is associated with poor prognosis and these patients might have to be given priority for liver transplantation.

Cited by 33 publications

References 41 publications

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

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

Spur cell anemia as a cause of unconjugated hyperbilirubinemia after liver transplantation and its resolution after retransplantation

Spur cell anemia in the setting of progressive liver allograft failure

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