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Inflammation
Published in George Feuer, Felix A. de la Iglesia, Molecular Biochemistry of Human Disease, 2020
George Feuer, Felix A. de la Iglesia
In advanced lesions, the cell membrane shows diverse structural distortions. A variety of conditions modify the permeability of the cell membrane and influence membrane transport, including disorders of water and electrolyte movements and specific transport defects for various substrates. These membrane lesions can be congenital or acquired. Acquired lesions are often derived from toxic interactions. Aminoaciduria is associated with defects in amino acid transport by the proximal tubular cells in the kidney.71 Lead toxicity can cause membrane transport defects.152 The erythrocyte membrane, especially, is very sensitive and shows cation transport defects in many disease conditions, such as various types of hemolytic anemias (sickle cell anemia, congenital hemolytic anemia), malaria, heavy metal poisoning, and digitalis poisoning. In cystic fibrosis and in syndromes related to bums, uremia, or shock, abnormalities of red cell transport have also been observed. In alcoholics, the so-called Zieve syndrome, plasma and erythrocyte membrane abnormalities are caused by changes in osmotic fragility due to abnormalities of membrane lipids.271 Neoplasmic transformations and virus infections are associated with chronic modifications of the cell surface properties.60,492
Hemolytic Anemia Associated with Red Cell Membrane Defects
Published in Harold R. Schumacher, William A. Rock, Sanford A. Stass, Handbook of Hematologic Pathology, 2019
Zieves syndrome is an unusual and poorly understood condition occurring in patients with alcoholic liver disease. Spherocytes are present on blood smear examination. Hyperlipoproteinemia and jaundice are features of Zieve’s. Zieve’s must be distinguished from spur cell anemia (see below).
Zieve syndrome in acute alcoholic hepatitis
Published in Baylor University Medical Center Proceedings, 2020
Ted George Achufusi, Jasmine Sandhu, Japjot Chahal, Zachary Shepherd, Kanish Mirchia
Timely recognition of Zieve syndrome is crucial in avoiding unnecessary and potentially harmful treatment. Often, patients admitted with Zieve syndrome are incorrectly treated with corticosteroids. High bilirubin levels in the setting of hemolysis along with elevated scoring systems (Maddrey discriminant function) often lead clinicians to presume underlying alcoholic hepatitis. Data have shown that treating critically ill patients with steroids often leads to adverse outcomes along with an increased incidence of hospital-acquired infections.2,6 Other associations seen in Zieve syndrome, although less common, include acute renal failure and myalgias, commonly mistaken for polymyalgia rheumatica due to elevated plasma viscosity.7 Most documented cases have shown that patients often recover within 5 to 6 weeks following alcohol cessation. It is presumed that abstinence causes decreased serum lipid levels as a result of movement of lipids from plasma and liver to adipose tissue. The challenge for clinicians remains the timely recognition of Zieve syndrome in order to improve patient care and avoid unnecessary and costly treatment. This case illustrates the importance of considering Zieve syndrome in those who present with acute anemia in the setting of chronic liver disease.
Multifactorial jaundice and pigmented choledocholithiasis secondary to warm autoimmune hemolytic anemia and alcoholic cirrhosis
Published in Baylor University Medical Center Proceedings, 2022
Colten Watson, Mazen Hassan, Grant Breeland
This case raises the question of whether the two disease processes are linked. There are several case reports of Zieve syndrome4 addressing hemolytic anemia in alcoholic cirrhosis with prolonged abstention from alcohol, but no reports have presented definitive research on the mechanism involved or examined if there are multiple etiologies for the manifestation of autoimmune hemolytic anemia in the setting of cirrhosis.