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An Unusual Type of Spiculated Erythrocyte in Metastatic Liver Disease and Hemolytic Anemia: Report of a Case

[+] Article, Author, and Disclosure Information

Supported in part by grants AM 10550 and HE 00022, U.S. Public Health Service, Washington, D.C.; grant PRA 33, American Cancer Society, New York, N.Y.; and grant RR 36, National Institutes of Health Clinical Research Center, Bethesda, Md. The Scanning Electron Microscope was supported by Health Science Award F-304-FR 06115 to Washington University.

Dr. Keller is a recipient of U.S. Public Health Services Graduate Training Grant AM 05089, and Dr. Majerus is a Teaching and Research Scholar of the American College of Physicians, Philadelphia, Pa.

▸Requests for reprints should be addressed to Philip W. Majerus, M.D., Division of Hematology, 4550 Scott Ave., St. Louis, Mo. 63110

St. Louis, Missouri

Ann Intern Med. 1971;74(5):732-737. doi:10.7326/0003-4819-74-5-732
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A patient had hemolytic anemia associated with spiculated erythrocytes and massive hepatic metastases from rectal carcinoid. The patient's erythrocytes resembled acanthocytes found in abetalipoproteinemia when examined by scanning electron microscopy. The patient's erythrocytes contained normal quantities of cholesterol, and his serum did not transform normal erythrocytes into spiculated cells in vitro. Normal erythrocytes infused into the patient did not acquire the filtration properties of acanthocytes, yet their survival was shortened, suggesting that the mechanism of hemolysis was independent of acanthocyte formation. These findings are discussed in relation to the acanthocytes found in other liver diseases. The great variability in results obtained studying the mechanism of acanthocyte formation suggest that multiple factors may lead to their formation.





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