A syndrome that is characterized by acute metabolic condition that can occur during prolonged alcohol abuse. It was described initially in 1958 by Dr Leslie Zieve for patients with a combination of alcoholic liver disease Hemolytic Anemia and Hypertriglyceridemia. Zieve's syndrome exhibits liver and blood abnormalities caused by heavy alcohol consumption.
This is a condition associated with chronic alcoholism, frequently encountered in hospitalized alcoholics who have suddenly stopped alcohol. The underlying cause is liver delipidization and hemolytic anemia. This is distinct from alcoholic hepatitis which may be present simultaneously or develop later. The syndrome is defined by excessive blood lipoprotein, jaundice and abdominal pain.
Most common symptoms due to long-term history of chronic alcoholism include:
Vomiting after heavy drinking
Hepatomegaly, enlarged spleen, late cirrhosis
Skin and yellow sclera
Hemolytic Anemia, Hemoglobinuria (hemoglobin is excreted in urine) and Hemosiderin (insoluble form of storage iron complex) in urine.
Hepatic dysfunction, Jaundice, Hyperlipidemia and reversible hemolytic anemia after alcohol abuse are prominent symptoms.
Causes of Zieve's Syndrome
Zieve's syndrome is caused by alcoholism due to liver cell damage and various degrees of cholestasis thus causing cancer. Fatty liver production of free fatty acids into blood stream, increased triglycerides that causes hyperlipidemia and increased cholesterol and phospholipid deposition, and damaged red blood cells which become hard and brittle and blocked by splenic sinusoids. In addition, alcoholism induced pancreatitis and vitamin E deficiency is associated with hemolysis.
Diagnosis of Zieve's Syndrome
The diagnosis is based from objective information about alcoholism, and blood test for the abnormalities. It is based on history and the triple disease – jaundice, hemolytic anemia and hyperlipidaemia. For jaundice, moderate and direct bilirubin test is done. Hemolytic anemia is visible in hemoglobinuria and hemosiderin urine. There could be drop in hemoglobin, reticulocytes, bone marrow erythroblastic hyperplasia, and increased erythrocyte fragility and shortened life of red blood cells.
Hyperlipidemia is detected by increase in cholesterol, triglycerides and phospholipids. Diagnostic tests include hemoglobin, bone marrow examination, blood lipids including cholesterol, phospholipids, triglycerides, serum bilirubin, alkaline phosphatase, and liver function test and liver biopsy. Ultrasonography is done to reveal the syndrome. There could be rapid serum level rise after alcohol withdrawal in patients with denial of drinking.
Temperance for two to three weeks is essential for symptoms to disappear. A diet high in sugar-protein, vitamins and hepatoprotective drug is necessary. In addition to jaundice, treatment for high blood cholesterol and hemolytic anemia are essential. Basic therapy includes bed rest, adequate food intake, hydration and vitamin supplementation. The patient usually recovers from the symptoms very quickly, but the disease can recur if alcohol abuse persists.
Hemolytic anemia is a kind of anemia that occurs when there is high rate of destruction of RBC. Infections of Streptococcus or other conditions can lead the body to destroy its own RBC. Hemolytic anemia can enlarge the spleen that results in increased destruction of red blood cells (Hemolysis). Some complications of this Anemia:
Persons suffering hemolytic condition might experience severe fatigue, dizziness, shortness of breath and chest pain. A complete blood count can help in identifying hemolytic anemia. Hemolytic anemia is treated with lifestyle changes and medicines. In more severe cases blood transfusion and plasmapheresis might be resorted to.
Autoimmune Hemolytic Anemia : Warm antibody hemolytic anemia, one of the most common types afflicting women, results when the body produces auto antibodies that coat red blood cells which in turn are destroyed by the spleen, liver or bone marrow. Many of these patients also have leukemia, lupus, lymphoma or connective tissue disease. In cold antibody hemolytic anemia, the body targets red blood cells at or below normal body temperature - often to patients who have had pneumonia, mononucleosis or other acute infections. Exposure to cold temperatures can accelerate red blood cell destruction resulting in fatigue, discoloration of limbs and joint pains.
Sideroblastic Anemia: In this anemia, the body has sufficient iron but it fails to incorporate it into hemoglobin.
Platelets or thrombocytes are cell fragments found in the blood with an average life span of about 5- 9 days. Typically a healthy adult has about 150,000 to 450,000 platelets per micro liter of blood. Platelets are crucial for the clotting process since they are involved in hemostatis. If the platelet count is too high or low, it can be indicative of some disorders. Abnormally high platelet count can lead to myocardial infarction, pulmonary embolism or a stroke. Very low platelet count can lead to excessive bleeding. Low platelets can happen due to medications, leukemia, hemolytic anemia or chemotherapy. Abnormally high platelet count can be due to anemia, thrombocythemia or recent spleen removal.
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Bibliography / Reference
Collection of Pages - Last revised Date: October 21, 2019