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We encountered three families that showed NASH accumulation. In family #1, a 21-year-old son and 10-year-old daughter were diagnosed with nonalcoholic steatohepatitis (NASH). They shared two adiponectin-gene single nucleotide polymorphisms (SNP). In family #2, a 51-year-old mother and 27-year-old son were diagnosed with NASH and shared the SNPs of other genes. In family #3, a 66-year-old mother and 34-year-old son were diagnosed with NASH and shared the SNPs of other genes. SNP sites differed among the three families, suggesting that the genes associated with the occurrence of NASH might be different in each patient.

Spur cell anemia is an acquired hemolytic anemia, which may occur in patients with severe liver dysfunction, especially in those with alcoholic cirrhosis. Recently, non-alcoholic steatohepatitis (NASH) has been highlighted as one of the causes of chronic liver diseases, which could progress to cirrhosis. Histological features of NASH are indistinguishable from those of alcoholic hepatitis. We report on a cirrhotic NASH patient who developed progressive indirect dominant jaundice and intractable hemolytic anemia during his follow-up. This report shows the first case of a cirrhotic NASH patient who died as a result of spur cell anemia.