2.6: Echinocytes (Burr Cells)

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Cell Description:

The red blood cell has multiple evenly distributed projections that are of equal length that cover the entire surface of the cell.¹ Cells usually have an area of central pallor.²

Cell Formation:

Commonly form due to a “glass effect” during peripheral blood smear preparation with glass slides. Glass slides can release basic substances that can induce echinocyte formation.³

Another cause of echinocyte formation is due to storage conditions. Echinocytes can naturally form in whole blood that has been stored at 4℃ after a few days (i.e. Blood to be transfused).³

The formation of echinocytes is a reversible process and can reform a natural discoid shape.³

Echinocytes are often considered artifact from the smear making process (drying or staining) and may not be reported, depending on individual laboratory protocol.

Associated Disease/Clinical States: ^1-3

Artifact

Post-transfusion

Burns

Liver Disease

Pyruvate Kinase (PK) Deficiency

Uremia

Microangiopathic Hemolytic Anemias (MAHAs)

References:

1. Ford J. Red blood cell morphology. Int J Lab Hematol [Internet]. 2013 Mar 9 [cited 2018 Jul 12];35(3):351–7. Available from: https://doi.org/10.1111/ijlh.12082

2. Rodak BF, Carr JH. Variations in shape and distribution of erythrocytes. In: Clinical hematology atlas. 5th ed. St. Louis, Missouri: Elsevier Inc.; 2017. p. 93-106.

3. Landis-Piwowar K, Landis J, Keila P. The complete blood count and peripheral blood smear evaluation. In: Clinical laboratory hematology. 3rd ed. New Jersey: Pearson; 2015. p. 154-77.