A Clue in the Blood Smear

A 31-year-old man presents with confusion and Severe Anemia. Lab tests suggest hemolysis. What does the peripheral blood smear reveal about the underlying cause?

Decompensated cirrhosis


A 31-year-old man presented to the emergency department with confusion. He was found to be anemic with a hemoglobin level of 6.7 g per deciliter. Additional laboratory tests revealed an elevated indirect bilirubin level, an elevated lactate dehydrogenase level, and undetectable haptoglobin. A peripheral-blood smear was performed. With what underlying disease process is this form of anemia most closely associated?

What is the most likely diagnosis?

Decompensated cirrhosis
Myelodysplastic syndrome
Iron deficiency
End-stage renal disease
Vitamin B12 deficiency

Acanthocytes, Decompensated cirrhosis, Hemolytic Anemia, Hepatic encephalopathy, Spur-cell anemia

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