JAUNDICE, HYPERLIPEMIA AND HEMOLYTIC ANEMIA: A HERETOFORE UNRECOGNIZED SYNDROME ASSOCIATED WITH ALCOHOLIC FATTY LIVER AND CIRRHOSIS

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Abstract
Twenty patients were observed who exhibited an interesting group of manifestations previously unrecognized as a distinct syndrome with a predictable course. The essential clinical features are jaundice, hyperlipemia or hyper-cholesterolemia, and hemolytic anemia. The illness follows excessive drinking, and improves rapidly once the drinking stops, the hyper-bilirubinemla and hypercholesterolemia receding over a few weeks. Hemolysis is generally slight and of short duration. The anemia is mild or moderate and does not persist. Hepatic function is usually mildly disturbed and improves rapidly. The anatomic abnormality on liver biopsy is fatty infiltration and minimal to moderate portal cirrhosis. The patients were generally diagnostic problems until the syndrome was defined. Obstructive jaundice was often suspected initially, and one patient was explored surgically. The anemia was always recognized; however, hemolysis was usually not suspected. Repeated stool examinations for occult blood were made, with negative findings. In one instance the hemolytic anemia was extensively studied without recognition of the related alterations in blood lipids or in hepatic function. The mechanism of the hemolytic anemia is unknown; however, the hemolysis apparently is related to the hyperlipemia, and an abnormal lipid may be present.

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