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Echinocytes
🩸 Echinocytes, also called burr cells, are red blood cells (RBCs) with abnormal membranes showing numerous, small, evenly spaced projections (spicules). 🔬 Under the microscope they have a crenated, thorny appearance, but the projections are regular and uniform (unlike acanthocytes).
Causes
- ⚠️ Uraemia: Seen in advanced kidney failure due to altered plasma composition and toxins affecting RBC membranes.
- 🧬 Pyruvate Kinase Deficiency: A hereditary enzyme defect disrupting RBC energy metabolism, causing burr cell formation.
- ⚡ Electrolyte Imbalances: Abnormal calcium/phosphate levels may distort RBC membranes.
- 🧪 Artifact: Poor smear technique, excess EDTA, or drying artefacts may mimic echinocytes → always repeat to confirm.
Differential Diagnosis
- Echinocytes may be mistaken for acanthocytes, but key differences are:
- 🔹 Echinocytes: Numerous, short, evenly spaced projections.
- 🔹 Acanthocytes: Fewer, irregular, spiky projections of varying length.
Clinical Significance
- 👩⚕️ The presence of echinocytes suggests renal disease, metabolic disorders, or enzyme deficiencies.
- ⚠️ Important clue in uremia (advanced CKD/ESRD) where they may coexist with anaemia of chronic disease.
- 🧾 Recognition helps distinguish true pathology from artefact to guide appropriate further testing.
References
- Hoffbrand AV, Moss PAH. Essential Haematology. 7th ed. Wiley-Blackwell; 2016.
- Rodak BF, Fritsma GA, Keohane EM. Hematology: Clinical Principles and Applications. 5th ed. Elsevier; 2016.
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