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Diagnostic Tests: Burr Cells
Overview — What Burr Cells Are
Burr cells, also known as echinocytes, are red blood cells that display numerous short, blunt, and regularly spaced spicules on their surface. Their uniform projections give them a spiky appearance, but unlike spur cells, these projections are consistent and evenly distributed. Burr cells typically reflect alterations in the red cell membrane caused by metabolic abnormalities.
Conditions Associated With Burr Cells
Burr cells appear most commonly in systemic diseases that affect the biochemical environment or membrane composition of red blood cells. They are classically associated with:
While some burr cells may arise from artifact during slide preparation, their presence in an appropriate clinical scenario strongly supports renal or hepatic pathology.
Differentiating Burr Cells From Spur Cells
It is important to distinguish burr cells (echinocytes) from spur cells (acanthocytes) because they indicate different underlying conditions.
Overview — What Burr Cells Are
Burr cells, also known as echinocytes, are red blood cells that display numerous short, blunt, and regularly spaced spicules on their surface. Their uniform projections give them a spiky appearance, but unlike spur cells, these projections are consistent and evenly distributed. Burr cells typically reflect alterations in the red cell membrane caused by metabolic abnormalities.
Conditions Associated With Burr Cells
Burr cells appear most commonly in systemic diseases that affect the biochemical environment or membrane composition of red blood cells. They are classically associated with:
- End-stage renal disease (ESRD)
Uremic toxins disrupt red cell membranes, producing echinocyte formation. - Liver disease
Changes in plasma lipid composition and membrane stability can lead to burr cell development.
While some burr cells may arise from artifact during slide preparation, their presence in an appropriate clinical scenario strongly supports renal or hepatic pathology.
Differentiating Burr Cells From Spur Cells
It is important to distinguish burr cells (echinocytes) from spur cells (acanthocytes) because they indicate different underlying conditions.
- Burr cells (echinocytes):
- Many short, uniform, regularly spaced spicules
- Associated with ESRD and liver disease
- Spur cells (acanthocytes):
- Few, irregular, unevenly spaced spicules
- Seen in severe liver disease, some hereditary spherocytosis, and myelodysplastic syndromes
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