What is Zieve’s syndrome?

Zieve’s syndrome:

It is a unique form of hemolytic anaemia (with spur cells and acanthocytes) which can occur in patients with severe alcoholic hepatitis. 

Clinical features: 

A combination of a tetrad (4):

  • Alcoholic hepatitis
  • Hemolytic anaemia (with spur cells and acanthocytes)
  • Jaundice
  • Hyperlipidemia


There is no specific treatment for Zieve's syndrome but supportive therapy is indicated which includes 
  • Correction of clotting abnormalities
  • Treatment of hemolysis
  • Treating alcohol withdrawal
  • Preventing further alcohol intake
  • Adequate nutrition


  • Step Up to MRCP Review Notes for P1 & P2 by Dr Khaled El Magraby 1st Edition; page: 801
  • Harrison’s Principles of Internal Medicine 2 volumes 19th Edition; page: 2059

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