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.