Key Takeaways

Patients with cirrhosis may develop several hematological abnormalities, including leukopenia, anemia, thrombocytopenia and coagulopathy.

Anemia is present in the majority of patients with cirrhosis and is multifactorial.

One rare cause of anemia in this patient population is spur cell anemia, a non-immune hemolytic anemia associated with the presence of increased spur cells (acanthocytes) on the peripheral smear.

Consider the diagnosis of spur cell anemia in a patient with cirrhosis (typically alcoholic, advanced and progressive) and increasing red cell transfusion needs. Diagnosis confirmed by the presence of >5%-20% spur cells on the peripheral smear.

Treatment is supportive.

The prognosis is very poor, typically measured in months.

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