Hemolytic Anemia in Liver Disease: A Case of Spur Cell Anemia

Spur cell anemia (SCA) is a rare but severe form of acquired hemolytic anemia seen in advanced cirrhosis and carries a poor prognosis in the absence of liver transplantation. We report the case of a middle-aged man with alcohol-related cirrhosis who developed profound anemia requiring recurrent transfusions. An extensive workup was performed to rule out other causes of anemia, including gastrointestinal bleeding, microangiopathic hemolytic anemia, and autoimmune hemolytic anemia. Peripheral smear confirmed the presence of acanthocytes, consistent with SCA. Given that he was not a transplant candidate, supportive transfusions were provided, but his condition deteriorated rapidly, and he died within one month of diagnosis. This case highlights the aggressive course of SCA in non-transplant candidates and underscores the need for further research into alternative therapies.