The Acanthocyte in Cirrhosis with Hemolytic Anemia

Abstract

A 44-year-old white male with cirrhosis and hemolytic anemia is described who, several months prior to his death, was found to have marked acanthocytosis. Wet preparations and time-lapse cinematography demonstrated the acantho-cytic cells were rather rigid and nonpliable. A variety of agents could rapidly remove the spiny projections on these cells; however, only albumin was able to return them to a biconcave form with normal rouleaux formation. Numerous special studies failed to reveal any abnormality of these cells except their shape. The patient''s Cr51-labeled red cells demonstrated a markedly shortened survival in the patient as well as in a normal compatible recipient, with significant splenic sequestration in both. The patient''s cells did survive normally, however, when transfused into a compatible splenectomized recipient. The shortened survival of the acanthocyte may relate to simple trapping in the cords of Billroth due to the rigid, nonpliable shape. The acanthocyte of severe cirrhosis appears to be metabolically normal and very different in character than the acanthocyte associated with a-beta-lipoproteinemia. Its appearance is probably an ominous prognostic sign.