Zieve’s Syndrome: A review

Anandhi Sathyakumar1*, Roselin2, Stella Towncent3, P. Jose Lincy4

1Nursing Director, Kauvery Hospital, Chennai, Tamilnadu, India

2Deputy Nursing Superintendent, Kauvery Hospital, Chennai, Tamilnadu, India

3,4Nurse Educator, Kauvery Hospital, Chennai, Tamilnadu, India

*Correspondence: M: +91-9790861662; Email ID:nursingdirector.kch@kauveryhospital.com

Background

Zieve’s syndrome discovered by Dr. Leslie Zieve in 1958, presents as a triad of hemolytic anemia, jaundice, and transient hyperlipidemia that develops secondary to alcohol-induced liver injury. Anemia is a common finding in alcoholic liver disease and can be explained by nutritional deficits, medullary alcohol toxicity, chronic inflammation, hypersplenism, or hemolysis in the context of Zieve’s syndrome. Probably due to its transient nature, hyperlipidemia is not apparent at the time of diagnosis in some patients. Abstention from alcohol and supportive management are the basis of its treatment.

Pathogenesis

The pathogenesis of Zieve’s syndrome remains poorly understood. Some research suggests that changes to the membrane of red blood cells are due to vitamin E and polyunsaturated fatty acid deficiency. Additionally, alcohol breaks down in the liver into a chemical called acetaldehyde, which may inhibit red blood cell enzymes and make them more susceptible to injury. Additionally, Hyperlipidemia due to fat molecules migrate from liver towards bloodstream.

Risk factors

Male and female who consumes alcohol in a daily basis are highly prone to be affected.

Clinical manifestation

Zieve’s syndrome is characterized by hyperlipidemia, jaundice and hemolytic anemia. The initial symptoms include

Jaundice often shows up;

Hemolytic anemia might cause;

Acute pancreatitis, are associated with;

  • Sudden and severe pain in left upper quadrant of abdomen
  • Fever
  • Jaundice
  • Diarrhea

Diagnosis

The diagnosis has been established through the detailed history from the families and patient, through physical assessment, reviewing the symptoms or characteristics of Zieves triad. The most evident indicator include blood investigations such as bilirubin, alkaline phosphatase, gamma-glutamyl, lactate dehydrogenase, reticulocytes (immature red blood cells). In rare situations Bone marrow biopsy is done to confirm the illness.

Treatment

Zieve’s syndrome is primarily treated by completely stopping alcohol consumption. In known case of alcohol addiction, Alcohol anonymous and supportive therapy are advised to prevent alcohol withdrawal syndrome. Dr. Zieve first noticed that people had spontaneous resolution of their symptoms when they quit alcohol. Repeated blood transfusions are done to help increase red blood cell count. Plasmapheresis is a procedure that involves removing plasma from your blood may be considered, if the patient has a high chance of intracerebral hemorrhage and a history of pancreatitis.

Prevention

The prevention is only evident if the patient completely stops consuming alcohol contents in any forms. It usually improves once quit drinking alcohol. Continuing to drink may lead to the risk of severe liver disease which can be life threatening.

Complication

The potential complication of Zieves syndrome is Cirrhosis of liver which leads to Hepatic failure.

Reference

  • Abughanimeh O, et al. (2019). Zieve’s syndrome: An under-reported cause of anemia in alcoholics.
  • Gosal K, et al. (2021). Underrecognized Zieve’s syndrome, a case report.
  • Patel R, et al. (2023). Alcoholic liver disease.
  • Reyes JVM, et al. (2022). Zieve syndrome: A clinical triad, or perchance a quartet?
  • Ribeiro R, et al. (2024). Zieve’s Syndrome: An underdiagnosed cause of non-immune hemolytic anemia.
  • Zalavadiya R, et al. (2024). An unusual case of Zieve’s syndrome in a 36-year-old male with latent autoimmune diabetes of adult and disseminated intravascular coagulation.

Ms. Anandhi Sathiyakumar
Nursing Director

Ms. Roseline
Deputy Nursing Superintendent

Ms. Stella Towncent
Clinical Nurse Educator

Ms. P. Jose Lincy
Clinical Nurse Educator

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