Spur-Cell Anemia- A 31-year-old man with a history of cirrhosis, recurrent hepatic encephalopathy, and anemia presented to the emergency department with confusion...A peripheral-blood smear showed numerous acanthocytes (or spur cells), a finding consistent with spur-cell anemia, a form of hemolytic anemia that can occur in patients with decompensated cirrhosis. Spur cells acquire spiny projections on their surfaces as a result of altered lipid metabolism and an excess of cholesterol in patients with cirrhosis; these changes make the erythrocytes inflexible and prone to hemolysis. Acanthocytes are often confused with echinocytes (or burr cells), which have more regularly spaced spicules. Spur-cell anemia is associated with a poor prognosis and is definitively treated by liver transplantation; however, this patient was not considered to be a candidate for liver transplantation because of his ongoing use of alcohol. He remained encephalopathic, and his anemia did not resolve despite blood transfusions.... #NEJM #clinical #spurcell #anemia #peripheral #blood #smear
