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Spur cell anemia
Image of the Month Sanjiv Chopra, Section Editor
Question: A 49-year-old man presented with progressive jaundice and ascites. He denied a recent history of fevers, abdominal pain, confusion, weight loss, recent travel, blood transfusions, or intravenous drug use. He had been consuming two glasses of wine per day for several years. At physical examination, the sclera were icteric, Kayser–Fleischer rings were absent, and multiple spider angiomata were noted on the anterior chest wall. Cardiac examination revealed a grade III/VI systolic murmur with radiation to the axilla. Abdominal examination was notable for ascites and splenomegaly. The liver span was 7 cm.
Laboratory values were as follows: hematocrit, 22.5%, platelet count, 82,000; alanine aminotransferase, 70 IU/L; aspartate aminotransferase, 137 IU/L; total bilirubin, 16 mg/dL; indirect bilirubin, 12 mg/dL; lactate dehydrogenase, 453 IU/L; albumin, 3.4 g/dL; and prothrombin time, 18.6 seconds. The peripheral blood smear and abdominal magnetic resonance image are shown. What is the diagnosis? Look on page 673 for the answer. ANDREW T. MARSHALL, M.D. IRVING WAXMAN, M.D. Beth Israel Deaconess Medical Center Harvard Medical School Boston, Massachusetts
©1997 by the American Gastroenterological Association 0016-5085/97/$3.00 GASTROENTEROLOGY 1997;112:326
Question: A 49-year-old man presented with progressive jaundice and ascites. He denied a recent history of fevers, abdominal pain, confusion, weight loss, recent travel, blood transfusions, or intravenous drug use. He had been consuming two glasses of wine per day for several years. At physical examination, the sclera were icteric, Kayser–Fleischer rings were absent, and multiple spider angiomata were noted on the anterior chest wall. Cardiac examination revealed a grade III/VI systolic murmur with radiation to the axilla. Abdominal examination was notable for ascites and splenomegaly. The liver span was 7 cm.
Laboratory values were as follows: hematocrit, 22.5%, platelet count, 82,000; alanine aminotransferase, 70 IU/L; aspartate aminotransferase, 137 IU/L; total bilirubin, 16 mg/dL; indirect bilirubin, 12 mg/dL; lactate dehydrogenase, 453 IU/L; albumin, 3.4 g/dL; and prothrombin time, 18.6 seconds. The peripheral blood smear and abdominal magnetic resonance image are shown. What is the diagnosis? Look on page 673 for the answer. ANDREW T. MARSHALL, M.D. IRVING WAXMAN, M.D. Beth Israel Deaconess Medical Center Harvard Medical School Boston, Massachusetts
©1997 by the American Gastroenterological Association 0016-5085/97/$3.00 GASTROENTEROLOGY 1997;112:326