Zieve syndrome: An underdiagnosed clinical entity in alcoholic patients

Zieve syndrome (ZS) is an uncommon but reversible metabolic condition observed in individuals with chronic alcohol use, defined by the classic triad of jaundice, hyperlipidemia, and hemolytic anemia. This case series describes three patients with diverse clinical and laboratory profiles, including peripheral blood smear findings. The schistocyte count of ≥1% is generally indicative of hemolysis in ZS; only one patient in our series met this criterion. In the other two cases, hemolytic anemia was supported by elevated reticulocyte counts, the presence of nucleated red blood cells, and supportive biochemical markers. All cases were effectively treated through alcohol cessation and supportive management. The findings highlight the importance of clinical awareness to avoid misdiagnosis and promote timely, accurate treatment.