Zieve's syndrome (ZS), which consists of transient haemolytic anaemia, jaundice, 
hyperlipoproteinaemia, and alcohol-induced liver disease, was studied in male 
patients during the acute (n = 20) and the remittent (n = 10) phase. Chronic 
alcoholics (n = 10) without haemolysis and healthy male persons (n = 10) served 
as controls. Erythrocytes were separated into old and young cells by means of 
density-layer centrifugation. Those fractions which contained older red cells 
disclosed a pyruvate-kinase instability which resulted in impaired metabolism. 
Changes in membrane lipid composition as indicated by increased cholesterol and 
polyunsaturated fatty acids (PUFA) were also detected in patients during the 
acute phase of ZS. Alcohol-induced red-cell vitamin-E deficiency with a decrease 
in PUFA levels may provoke an oxidation of reduced red-cell glutathione which in 
turn results in the enzyme instability. This study lends further support to the 
hypothesis that the putative role of the red-cell metabolic injury in the origin 
of haemolysis in ZS cannot be envisaged without introducing membrane-linked and 
extracellular cofactors.