Table of Contents Author Guidelines Submit a Manuscript
Canadian Journal of Gastroenterology
Volume 14, Issue 5, Pages 445-447
Brief Communication

Primary Biliary Cirrhosis and Hemolytic Anemia Confusing Serum Bilirubin Levels

M Brackstone and Cameron N Ghent

Liver Diseases and Transplantation, University of Western Ontario, London, Ontario, Canada

Received 30 May 1998; Revised 29 December 1998

Copyright © 2000 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Hemolysis is observed in more than 50% of patients with cirrhosis. However, there has been little documention of the association of primary biliary cirrhosis with autoimmune hemolytic anemia. Two cases, found within a single practice, of primary biliary cirrhosis coexisting with autoimmune hemolysis and a third case coexisting with hereditary spherocytosis are presented. Anemia in such patients is commonly attributed to chronic disease, and hyperbilirubinemia is attributed to primary biliary cirrhosis. These patients were considered for liver transplantation until the diagnosis of a comorbid hemolytic process was established. This association may be more prevalent than previously recognized. A diagnosis of comorbid hemolysis must always be considered in context with anemia and serum bilirubin levels that rise out of proportion to the severity of the primary biliary cirrhosis.