The Hematologist

September-October 2019, Volume 16, Issue 5

Spur Cell Anemia

William Shomali, MD Postdoctoral Fellow, Division of Hematology
Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA
Sebastian Fernandez-Pol, MD, PhD Clinical Assistant Professor, Department of Pathology
Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA
Jason Gotlib, MD, MS Professor of Medicine
Stanford University School of Medicine, Stanford, CA

Published on: July 24, 2019

A 42-year-old white man presented with jaundice and generalized edema. He had been diagnosed with alcoholic cirrhosis four months prior. Laboratory evaluation is summarized in the Table. Abdominal ultrasound revealed a nodular liver and splenomegaly of 15.6 cm in craniocaudal dimension. Peripheral blood smear (panel A) revealed spur cells (acanthocytes, arrows). Hospital course was complicated by hematemesis and acute kidney injury requiring dialysis.

TestResultReference Range
Hemoglobin8.8 g/dL14-17 g/dL
Mean cell volume100 fL81-96 fL
Platelet count119 × 109/L150-425 × 109/L
White cell count11.4 × 109/L4.5-11 × 109/L
Reticulocytes5%0.4-1.9%
Vitamin B12> 1,500 pg/mL225-914 pg/mL
Folate12.4 ng/mL≥ 5.9 ng/mL
Ferritin955 ng/mL22-350 ng/mL
Creatinine0.75 mg/dL0.4-1.3 mg/dL
Blood urea nitrogen17 mg/dL6-26 mg/dL
Total/direct bilirubin14.2/5.6 mg/dL0.2-1.3/0-0.3 mg/dL
International normalized ration (INR)3.460.9-1.1
Fibrinogen69 mg/dL200-400 mg/dL
Haptoglobin< 30 mg/dL44-215 mg/dL
Direct antiglobulin (Coombs) testNegativeNegative
A peripheral blood smear before treatment with magnification x600

Peripheral blood smear before treatment (magnification x600)

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