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From question on page 1302

The peripheral blood smear revealed numerous deformed red blood cells with thorny projections, consistent with spur cells. The increased free cholesterol/phospholipid molar ratio in the erythrocyte membrane was also noted. Magnetic resonance imaging demonstrated diffuse hypointensity of the liver, suggesting heavy iron loading. Spur cell anaemia of alcoholic cirrhosis was diagnosed.

Spur cell anaemia (acanthocytosis), a rare acquired haemolytic anaemia observed mainly in the end stages of alcoholic cirrhosis, is characterised by an increased ratio of free cholesterol to phospholipid in the erythrocyte membranes that results in multispiculated erythrocytes (acanthocytes). These acanthocytes undergo rapid splenic destruction and consequently have a shortened survival. Recent studies have indicated that alcoholic iron overload may be associated with spur cell anaemia rather than hereditary haemochromatosis. Patients usually need frequent blood transfusions and the prognosis is extremely poor. Liver transplantation, which improves hepatic function and resolves spur cell anaemia, has been the most effective treatment. Our patient did not choose liver transplantation. She had a poor response to conservative treatment with multiple blood transfusions and died of liver failure seven months later.

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