Burr Cells (Echinocytes)

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The page below is a sample from the LabCE course Red Blood Cell (RBC) Morphology. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Burr Cells (Echinocytes)

Echinocyte comes from the Greek word meaning "sea urchin," which relates to its shell-like appearance. Echinocytes, more commonly referred to as Burr cells, are reversible, meaning that this alteration can be the result of the cell's environment, the pH of the medium (including the glass slides on which blood smears are made), the metabolic state of the cell, and the use of some chemical substances. Several echinocytes can be seen in the top image; three of them are indicated by the arrows. Notice that the projections are rounded and evenly spaced around the cells and the cells have central pallor. Acanthocytes, by contrast, have irregularly spaced thorn-like projections and little or no central pallor.

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 erythrocytes are most commonly caused by excess EDTA (underfilled collection tube) but may also be caused by (a) slow drying, (b) drying in a humid environment, or (c) an alkaline pH from glass slides. When crenation is an artifact, most cells on the slide will exhibit this characteristic. True Burr cells are less numerous. Corrective actions include making a new smear or re-collecting the sample, if possible. The bottom image contains crenated cells that were the result of an underfilled EDTA collection tube. These should not be reported.

A smear exhibiting artifact, crenated cells. It is important to note that these are NOT Burr cells; they are artifact, crenated cells most likely from an excess of EDTA in the tube. Burr cells should not be reported.