Case Report
The Diagnosis Is in the Smear: A Case and Review of Spur Cell Anemia in Cirrhosis
Table 1
Laboratory data from admission.
| | Complete blood count | | WBC (4.0–10.5 103/μL) | 9.4 | | Hgb (11.1–14.6 g/dL) | 7.4 | | Hct (33.2–43.4%) | 22.1 | | MCV (80–100 fL) | 109.4 | | Plt (140–400 103/μL) | 51 |
| | Serum chemistries | | Sodium (135–146 mmol/L) | 131 | | Potassium (3.5–5.5 mmol/L) | 5.0 | | Chloride (98–110 mmol/L) | 101 | | Bicarbonate (19–34 mmol/L) | 20 | | BUN (6–20 mg/dL) | 16 | | Creatinine (0.4–1.1 mg/dL) | 0.58 | | Total bilirubin (0–1.2 mg/dL) | 15.4 | | Direct bilirubin (0.0–0.3 mg/dL) | 6.2 | | Total protein (6.1–8.1 g/dL) | 4.5 | | Albumin (3.5–5.2 g/dL) | 2.3 | | AST (10–40 U/L) | 48 | | ALT (0–33 U/L) | 33 | | Alkaline phosphatase (35–130 U/L) | 118 |
| | Anemia workup | | Vitamin B12 (232–1,245 pg/mL) | 1,925 | | Folate (>7.3 ng/mL) | 11.1 | | Iron (37–145 mcg/dL) | 148 | | TIBC (200–400 mcg/dL) | 220 | | Ferritin (13–150 mg/mL) | 203 | | %transferrin sat. (14–50%) | 67.3 | | Reticulocyte% | 16.1 | | LDH (135–214 U/L) | 263 | | Indirect bilirubin (calculated) | 9.2 | | Haptoglobin (30–200 mg/dL) | <10 |
| | PNH with FLAER (GPI-linked CD59) negative | | Direct Coombs | Negative |
| | Coagulation studies | | PTT (23.4–36.0 sec) | 46.1 | | PT (12.0–14.5 sec) | 28.5 | | INR (0.88–1.12) | 2.7 | | Fibrinogen (164–498 mg/dL) | 206 |
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Note that iron studies were obtained after transfusion.
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