Rare cause of non-immune hemolytic anemia in end-stage liver disease

Spur cells are reportedly linked to advanced end-stage liver diseases and may lead to accelerated hemolysis. In this case report, we discuss one of these rare instances when a 45-year-old female with decompensated cirrhosis was admitted for severe anemia. Extensive workup revealed non-immune hemolysis secondary to spur cell formation. Orthotopic liver transplantation remains the only treatment of choice for reversal of spur cell anemia. Alternatively, multidrug therapy has also been explored, including usage of bile acid sequestrants; however, success is rare.