Rapid reversion of spur cell anemia after liver transplantation

Spur cell anemia (SCA) is a form of hemolytic anemia historically associated with alcoholic liver cirrhosis. The name of the disease comes from the spike-like projections on the erythrocyte membrane. These are due to a disorder in the cholesterol metabolism causing increased cholesterol to protein and cholesterol to phospholipid ratios in the red cell membrane, making the cells more prone to trapping and destruction by the spleen [1]. One of the first cases of SCA associated to post-alcoholic liver cirrhosis was reported in the New England Journal of Medicine in 1964 [2]. Several investigators have reported the association between alcoholism and SCA, but recent reports demonstrated that the entity might be present in liver disease regardless of etiology. It was reported that the comparison of spur cell rate in patients with alcoholic cirrhosis versus remaining etiologies did not exhibit any difference [3]. The presence of SCA in liver cirrhosis has been associated with advanced disease and poor prognosis [4]. Spur-cell morphological abnormality is reversible in a non-cirrhotic microenvironment and it vanishes after liver transplantation [5]. In the following case report we discuss the history of a patient diagnosed with SCA who, after liver transplantation, promptly resolved the disease.