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Hemolysis in Acute Alcoholic Hepatitis: Zieve's Syndrome.

Shukla S, Sitrin M - ACG Case Rep J (2015)

Bottom Line: The patient was diagnosed with Zieve's syndrome and managed with supportive measures.Zieve's syndrome has been described in literature, mostly in non-English language case studies, but is largely under-recognized and under-reported.Diagnosis should be made quickly to avoid unnecessary invasive diagnostic interventions.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, University of Buffalo, Buffalo, NY.

ABSTRACT
A 45-year-old man presented with acute alcoholic hepatitis, jaundice, and anemia on admission. There was no history of bleeding or any evidence of gastrointestinal blood loss. Lab studies revealed hemolysis as the cause of anemia. The patient was diagnosed with Zieve's syndrome and managed with supportive measures. He recovered well and was discharged to a detoxification unit in a stable condition. Zieve's syndrome has been described in literature, mostly in non-English language case studies, but is largely under-recognized and under-reported. Diagnosis should be made quickly to avoid unnecessary invasive diagnostic interventions.

No MeSH data available.


Related in: MedlinePlus

Peripheral smear from patient showing schistocytes and spur cells.
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Figure 1: Peripheral smear from patient showing schistocytes and spur cells.

Mentions: Physical examination was remarkable for scleral icterus, conjunctival pallor, and a dry oral mucosa. Laboratory tests showed hemoglobin 6.5 g/dL, hematocrit 19%, mean corpuscular volume 115 fL, red cell distribution width 17%, total bilirubin 16 mg/dL, direct bilirubin 6.3 mg/dL, alkaline phosphatase 97 U/L, aspartate aminotransferase 47 U/L, alanine aminotransferase 23 U/L, lactate dehydrogenase 326 U/L, albumin 3.5, and an international normalized ratio of 1:1. The patient's peripheral smear showed polychromasia, macrocytosis, tear drop cells, ovalocytes, spur cells, and schistocytes (Figure 1). A stool occult blood test was negative. Upper endoscopy was normal with no varices. Additional laboratory tests were consistent with hemolytic anemia, including reticulocytosis (12%), elevated LDH level, and an undetectable haptoglobin level. The patient was diagnosed with Zieve's syndrome, and was provided supportive management with intravenous hydration, supplementation of thiamine and folate, and management of alcohol withdrawal. He recovered rapidly during his short stay. His bilirubin trended down within a few days and hemoglobin remained stable 2 weeks after initial transfusion at 9.7 g/dL. He was discharged to a detoxification unit in a stable condition.


Hemolysis in Acute Alcoholic Hepatitis: Zieve's Syndrome.

Shukla S, Sitrin M - ACG Case Rep J (2015)

Peripheral smear from patient showing schistocytes and spur cells.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4508957&req=5

Figure 1: Peripheral smear from patient showing schistocytes and spur cells.
Mentions: Physical examination was remarkable for scleral icterus, conjunctival pallor, and a dry oral mucosa. Laboratory tests showed hemoglobin 6.5 g/dL, hematocrit 19%, mean corpuscular volume 115 fL, red cell distribution width 17%, total bilirubin 16 mg/dL, direct bilirubin 6.3 mg/dL, alkaline phosphatase 97 U/L, aspartate aminotransferase 47 U/L, alanine aminotransferase 23 U/L, lactate dehydrogenase 326 U/L, albumin 3.5, and an international normalized ratio of 1:1. The patient's peripheral smear showed polychromasia, macrocytosis, tear drop cells, ovalocytes, spur cells, and schistocytes (Figure 1). A stool occult blood test was negative. Upper endoscopy was normal with no varices. Additional laboratory tests were consistent with hemolytic anemia, including reticulocytosis (12%), elevated LDH level, and an undetectable haptoglobin level. The patient was diagnosed with Zieve's syndrome, and was provided supportive management with intravenous hydration, supplementation of thiamine and folate, and management of alcohol withdrawal. He recovered rapidly during his short stay. His bilirubin trended down within a few days and hemoglobin remained stable 2 weeks after initial transfusion at 9.7 g/dL. He was discharged to a detoxification unit in a stable condition.

Bottom Line: The patient was diagnosed with Zieve's syndrome and managed with supportive measures.Zieve's syndrome has been described in literature, mostly in non-English language case studies, but is largely under-recognized and under-reported.Diagnosis should be made quickly to avoid unnecessary invasive diagnostic interventions.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, University of Buffalo, Buffalo, NY.

ABSTRACT
A 45-year-old man presented with acute alcoholic hepatitis, jaundice, and anemia on admission. There was no history of bleeding or any evidence of gastrointestinal blood loss. Lab studies revealed hemolysis as the cause of anemia. The patient was diagnosed with Zieve's syndrome and managed with supportive measures. He recovered well and was discharged to a detoxification unit in a stable condition. Zieve's syndrome has been described in literature, mostly in non-English language case studies, but is largely under-recognized and under-reported. Diagnosis should be made quickly to avoid unnecessary invasive diagnostic interventions.

No MeSH data available.


Related in: MedlinePlus