. Appearance: BackgroundNeuroacanthocytosis (NA) and Huntington's disease (HD) are neurodegenerative conditions that share clinical symptoms and imaging findings, despite their distinct genetic etiologies. . - may be an artifact due to specimen contamination (large numbers, evenly dispersed = crenated cells) - "true" burr cells - in small numbers! The spiculated appearance of RBCs can also result from an ethylene diamine tetra-acetic acid (EDTA) artifact after a delay of more than 6 hours between storage and smear preparation. . They have normal central pallor with the hemoglobin concentrated at the ends of the elongated cells. Often artifacts. FIGURE 11-1C Acanthocytes; two nucleated red blood . "Artifact" Mouth like slit pallor Hereditary Alcohol cirrhosis . A few spherocytes are also noted. Dysmorphic RBCs (e.g., sickle cells, target cells) have an altered form and are often a sign of an underlying condition. . Chapter 29. The ends of the cells are blunt and not sharp like sickle cells. Hereditary elliptocytosis (HE) refers to a group of inherited blood conditions where the red blood cells are abnormally shaped. They have no cytoplasm, and sometimes all that can be seen are smashed nuclei. June 2022; Frontiers in Neuroscience 16:913401; DOI: . Clinical relevance: usually an artifact with no pathological . A more common term for these cells is burr cells. Blood to be transfused). Hereditary stomatocytosis (HSt) is a rare disorder that presents with various degrees of hemolytic anemia and abnormal red blood cell (RBC) morphology. Echinocytes most frequently represent drying artifact, but are also seen with electrolyte derangements, renal disease, or secondary to snake envenomation. Giant platelets have a diameter greater than 7 microns (larger than a normal red blood cell). Echinocytes. This article was the first to call peculiarly shaped erythrocytes in the urine "acanthocytes," and it was the first to systematically study the sensitivity and specificity of acanthocyturia for the diagnosis of glomerular disease.1 In: Lichtman MA, Kipps TJ, Seligsohn U, Kaushansky K, Prchal JT. They can result from chemical contamination, high humidity or from the blood drying slowly. FIGURE 11-4A Spherocytes. Although acanthocytes (and sometimes echinocytes) are a pathologic finding, echinocytes (crenation) can be an artifact of excess EDTA, prolonged blood storage, or slow drying of smears . Although Burr cells may be associated with diseases, such as uremia or pyruvate kinase deficiency, crenated cells that may be confused with true Burr cells are frequent artifacts. Crenated cells, or red blood cells that mimic the appearance of burr cells, are frequent artifacts within blood smear tests. Large platelets can be seen when platelet turnover is increased (as in immune thrombocytopenic purpura). Acanthocytes, by contrast, have irregularly spaced thorn-like projections and little or no central pallor. (EDTA) artifact after a delay of more than 6 hours between storage and smear preparation. Acanthocytes, also called spur cells, are dense, shrunken, and irregularly shaped red blood cells. They can be an artifact from a change in pH during slow drying of blood film but are also associated with renal disease, lymphoma, chemotherapy (doxorubicin toxicosis) and snake envenomation. A rare ovalocyte/elliptocyte (less than 1%) may . Acanthocytes are rarely the dominant finding in a hemolytic patient, but may suggest pyruvate kinase deficiency (where they will be accompanied by irregularly contracted cells) or the McLeod phenotype. IDA HE Concentrated ends makes it longer . Finding is most likely an artifact caused by poor smear preparation . Therefore for accuracy, it is crucial . Macrocytic cells, target, acanthocytes (liver disease) Liver, alcoholism, hypothyroidism . 3. For example, red blood cells interacting with the glass of a microscope slide during a stained . (acanthocytes) may indicate: Abetalipoproteinemia Severe liver disease The presence of teardrop-shaped [ucsfbenioffchildrens.org] They may be artefactual - see Crenated cells - or pathological - see Burr cells above. Although acanthocytes (and sometimes echinocytes) are a pathologic finding, echinocytes (crenation) can be an artifact of excess EDTA, prolonged blood storage, or slow drying of smears . Acanthocytes, by contrast, have irregularly spaced thorn-like projections and little or no central pallor. Echinocytes are often considered artifact from the smear . Wright-Giemsa . May be an artifact, but also seen with circulating paraproteins. A few such cells are common. Erythrocytes are differentiated into eumorphic and dysmorphic erythrocytes and acanthocytes and their percentage determined. Acanthocytes are spiked red blood cells which will be destroyed from disease, neurological disorder, and different diseases. This topic discusses their mechanisms of formation and their usefulness in . eClinpath helped 1.2 million visitors last year from 220 countries find important information on animal health. microangiopathic hemolytic anemia, neonates (especially premature), artifact. Ruocco E, Brunetti G, Vecchio M Del, Ruocco V. The practical use of cytology for diagnosis in dermatology. Acanthocytes (o r spur cells) are spherical cells with blunt-tipped or club-shaped spicules of different lengths projecting from their surface at irregular intervals. . 343-346 Chorea is the most characteristic movement abnormality, primarily affecting the lower extremities. Echinocytes are abnormally shaped red blood cells. Smudge cells are formed from leukocytes, typically lymphocytes, that are fragile, and are destroyed or smudged in the physical process of making a smear. They may also be present in myeloproliferative neoplasms, myelodysplasia, and some congenital thrombocytopenia syndromes, including Bernard-Soulier . Acanthocytes (Spur Cells) . In order to better assess the quality of the urine sample, one counts squamous epithelial cells per HPF. Wright-Giemsa stain; magnification, 1000. Figure 4-12. Spur cells (acanthocytes): severe liver disease, abetalipoproteinemia, . Schistocytes (arrows) and acanthocytes (arrowheads), along with 2 Howell-Jolly bodies, which are circular, basophilic inclusions. Acanthocytes (spur or spiculated cells): irregular shaped cells with 5-10 spicules; may be present in the blood of people who have had their spleen removed (splenectomy) or with liver disease. Normal RBCs have a biconcave shape and contain hemoglobin but no nucleus or organelles. Regenerative anemia with spherocytes. JAVMA 2008; 232 (5):747-754. Red blood cells are then remodelled in circulation, resulting in an acanthocyte.1,3,4 Acanthocytes (or acantho-echinocytes) were first reported in healthy laboratory rabbits nearly 50 years ago [7] and have been observed anecdotally in companion . Increased MCH or MCHC is an artifact secondary to Heinz bodies, lipemia, or hemoglobinemia. Acanthocytes are red blood cells with irregular projections varying in width, length and number. Keratocytes usually have a pair of spicules and they are . Bain, B. Echinocytes can be distinguished from acanthocytes by the shape of the projections, which are smaller and more numerous than in acanthocytes and are evenly spaced. Spicules are uniform in shape with sharp or blunt tips, uniform in length, and evenly spaced around the periphery of the cell. Acanthocytes: 1-10: 11-30 >30: Burr cells 30%: Report if present: . Look alike: acanthocytes. Defects that cause an imbalance between the membrane cholesterol and lipid content affect the RBC's ability to deform resulting in more rigid plasma membrane. However, while echinocytes can be the result of artifact (crenation), acanthocytes In all peripheral blood films ( Figure ), a fraction of the red blood cells (RBC) exhibited membrane appendages that are characteristic for acanthocytes. FIGURE 11-1C Acanthocytes; two nucleated red blood cells in field. They have no cytoplasm, and sometimes all that can be seen are smashed nuclei. Color: Darker than surrounding . The patient had lip and tongue injuries and poor intake due to trouble orobuccolingual dyskinesias FIGURE 11-1B Acanthocytes. Echinocytes or burr cells are RBCs that have evenly-spaced thorny projections. It is thought to be a result of low . Echinocytes. FIGURE 11-1B Acanthocytes. Although burr cells may be associated with diseases, such as uremia or pyruvate kinase deficiency, crenated cells, that may be confused with true burr cells/echinocytes, are frequent artifacts. They can form when RBC membranes contain excess cholesterol compared to phospholipids. Artifact, renal failure, post transfusion, phosphate deficiency, burns: Elliptocyte: . It is usually an artifact due to slow drying of the blood film. Drepanocytes are often seen in normal blood of deer and goats. They may be seen with storage artifact, liver and kidney diseases, and pyruvate kinase deficiency. FIGURE 11-4B Spherocytes. They are characterized by the following: 3-20 spicules with narrow bases that are distributed unevenly spicules are sharp or knobby microcytes The spikes on. Echinocytosis is a reversible condition of red blood cells that is often merely an artifact produced by EDTA, which is used as an anticoagulant in sampled blood. Some red blood cell (RBC) disorders affect the shape of the cells by altering the plasma membrane composition or the ratio of plasma membrane to intracellular volume. Albumin anemia artifact Ascaris lumbricoides bacteria basophil Basophilic Stippling bilirubin Blood Agar blood smear Candida Candida Albicans CBC Chocolate Agar CML E. histolytica EDTA Ferritin fibrinogen granular cast Haemophilus influenzae Hemoglobin hemolysis Hemolytic Anemia Hepatitis Howell-Jolly bodies lactose MCV monocyte Neutrophil . Acanthocytes are also seen in renal failure, liver cirrhosis, microangiopathic hemolytic anemia, and as an artifact in blood stored in EDTA. Commonly observed in pig blood but can be seen in any species. Color: Darker than surrounding red blood cells. Acanthocytes are irregularly spiculated cells (spicules are irregular in size, . Eliptocytes. Echinocyte (from the Greek word echinos, meaning 'hedgehog' or 'sea urchin'), in human biology and medicine, refers to a form of red blood cell that has an abnormal cell membrane characterized by many small, evenly spaced thorny projections. Use of cytology as a diagnostic method in veterinary practice and assessment of communication between veterinary practitioners and veterinary clinical pathologists. Smudge cells, or basket cells, are remnants of leukocytes. They are also called " spur cells " or "spike cells", because they resemble spurs on cowboy boots. Uremia, pyruvate kinase deficiency, microangiopathic hemolytic anemia, neonates (especially premature), artifact. !, irregularly sized, unevenly spaced spicules. Dr. Vaibhav Mathur. Morphology: red blood cells with small, regular spicules projecting from the cell surface. Bull BS, Herrmann PC. Symptoms vary from very mild to severe and can include fatigue, shortness of breath, gallstones, and yellowing of the skin and eyes (jaundice). Acanthocytes are frequently associated with hemangiosarcoma in the liver. Chorea-acanthocytosis is an autosomal recessive disorder characterized by progressive hyperkinetic movements (orofacial dyskinesias, limb chorea, dystonia, motor and phonic tics), acanthocytosis, and the absence of any lipid abnormality. . [patient.info] . The formation of echinocytes is a reversible process and can reform a natural discoid shape. Schistocytes. MAHA DIC HUS TTP . ACANTHOCYTES (SPUR CELLS) Acanthocytes are irregular, spiculated erythrocytes with few, unevenly distributed surface projections of variable length and . Pancyopenia low of everything Dimorphic with normo normo and macro normo (100x). Drepanocytes (Sickle cell) These cells are crescent shaped with pointed ends. Number of Acanthocytes should be significant at least 3% shown in repeated slides. The key to differentiating crenated cells from true burr cells is the frequency with which crenated cells appear in the sample. It is important to differentiate acanthocytes from echinocytes, which have smaller and more uniform projections and present in patients with end-stage renal disease, liver disease, pyruvate kinase deficiency, etc. They are crenated (notched) and resemble a hedgehog or sea urchin rather than the pale-centered biconcave disks that are characteristic of normal red blood cells. Echinocytes (diff from acanthocytes ) - AKA Burr cells - May be an artifact , regular and pointed - Associated with liver disease, uremia, and other disorders *regular and blunted Elliptocytes - AKA pencil cells, cigar cells - Associated with hereditary elliptocytosis, iron deficiency anemia and other disorders Acanthocytes are irregularly spiculated cells (spicules are irregular in size, . eds . may be an artifact - something caused during sample preparation . Acanthocytes should be distinguished from Echinocytes (burr cells). Recall that phase-contrast microscopy is especially helpful in detecting acanthocytesRBCs that develop arm-like projections (or "blebs") after passing through the glomerular basement membrane (GBM) and then being exposed to the osmotic challenges of the . Shape: Round; no central pallor zone . Acanthocytes are spheroidal dense cells with multiple unevenly distributed spikes of varying length. If cholesterol and phospholipids are increased to a similar degree, codocyte formation is more likely than acanthocyte formation (Cooper et al., 1972 ). Acanthocyte formation occurs as a result of either hereditary or acquired membrane defects. Echinocytosis is a reversible condition of red blood cells that is often merely an artifact produced by EDTA, which is used as an anticoagulant in sampled blood. FIGURE 11-1A Acanthocytes. Acanthocytes, by contrast, have irregularly spaced thorn-like projections and little or no central pallor. Acanthocytes (or acantho-echinocytes) were first reported in healthy laboratory rabbits nearly 50 years ago [7] and have been observed anecdotally in companion . There are a few acanthocyte like cells. If the number of acanthocytes are numerous, we should think of abetalipoproteinemia. Canine blood. 37) The alkalin hemoglobin electrophoresis pattern that is shown on the right includes controls . Anisocytosis is due to macrocytic cells and spherocytes . . Usually, the presence of acanthocytes can help narrow the differential diagnosis of a familial choreiform disorder, as the diagnosis of NA syndrome is supported by the presence of acanthocytes in . Acanthocytes, a subset of dysmorphic RBCs, are the hallmark of glomerular bleeding. Morphology of the Erythron. Albumin anemia artifact Ascaris lumbricoides bacteria basophil Basophilic Stippling bilirubin Blood Agar blood smear Candida Candida Albicans CBC Chocolate Agar CML E. histolytica EDTA Ferritin fibrinogen granular cast Haemophilus influenzae Hemoglobin hemolysis Hemolytic Anemia Hepatitis Howell-Jolly bodies lactose MCV monocyte Neutrophil . Therefore for accuracy, it is crucial to ensure that the peripheral blood smear is fresh when read. . Diagnosis from the Blood Smear, New Eng J Med 2005 353:498-507. Acanthocytes are more commonly observed in patients . Echinocytes type when exposure to anticoagulants and as artifacts from some staining techniques. Another cause of echinocyte formation is due to storage conditions. Thirty years ago, in 1991, Kidney International published a seminal article by Hans Khler, Eveline Wandel, and Bernd Brunck of the University of Mainz, Germany. When remodeled by the spleen in liver disease patients, acanthocytes develop more blunt spicules and become relatively more spherocytic; these are known as spheroacanthocytes or 'spur cells.' The membrane of red blood cells (RBCs) can undergo a variety of changes leading to morphologic alterations in these cells. Burr cells are commonly observed as an artifact of peripheral smear preparation. For the purpose of avoiding false positives, due to experimental artifacts or echinocytes, it is suggested that the limit to be considered pathologic should be more than 3% crenated forms, and repeated sampling is required. Echinocytes can naturally form in whole blood that has been stored at 4 after a few days (i.e. . Like burr cells, acanthocytes are spiculated from the changes in the lipid layers. It must be emphasized, however, that TC may be an artifact of blood film preparation due to slow air drying or over anticoagulation of blood sample. Smudge cells are formed from leukocytes, typically lymphocytes, that are fragile, and are destroyed or smudged in the physical process of making a smear. If you enjoy the site, please support our mission and consider a small gift to help us keep pace with its rapid growth.