Burr cells, hemolytic anemia and cirrhosis

Anemia with spur cells: a red cell defect acquired in serum and modified in the circulation

“…Similarly, only the lipoprotein-rich portion of spur se-rum obtained by Sephadex column fractionation was able to induce spicules in normal cells (8). Grahn et al (5) found that those ammonium sulfate fractions of spur serum which were richest in albumin were best able to induce spicules. However, fractions richest in albumin are also richest in both alpha-and beta-lipoprotein.…”

“…Ghosts were prepared from red cells using the method of Dodge, Mitchell, and Hanahan (17), and their lipids were analyzed using the procedure outlined for intact red cells. Red cell filterability was determined according to Jandl, Simmons, and Castle (18), using 5 moval of extracellular Na and K by washing rapidly with isotonic MgCl2. Examination of serum.…”

“…Evidence for the acquired nature of this red cell morphologic abnormality has been obtained in vitro by several investigators (2,5,7), but has been denied by others (3,4,6). However, in two studies normal red cells transfused into patients with spur cells became morphologically similar to the recipients' own cells (2. 3).…”

“…Over the past 5 yr, a small number of patients have been reported with the syndrome of hemolytic anemia and red cells resembling acanthocytes in association with severe liver disease (2)(3)(4)(5)(6)(7)(8). The term "spur cell" has been applied to these bizarre red cells (2), and it serves both to describe their unusual thorny projections and to distinguish them from the morphologically similar but chemically dissimilar acanthocytes seen in patients with abetalipoproteinemia (9,10).…”

The Use of Fish Oil Lipid Emulsion in the Treatment of Intestinal Failure Associated Liver Disease (IFALD)

“…This resolved with discontinuation of the emulsion. Another possible explanation for the development of burr cell anemia is the association of preexisting liver disease and the presence of burr cells [130]. Another case report evaluating liver biopsy findings in 2 children treated with FO monotherapy failed to draw any meaningful conclusions due to the timing of the biopsies in relation to the start of treatment with FO [131].…”