From the Research
Burr cells are seen in various conditions, including uremia, pyruvate kinase deficiency, liver disease, hypophosphatemia, and microangiopathic hemolytic anemias, as well as in patients taking certain medications such as aspirin, heparin, and some chemotherapeutic agents 1. These abnormally shaped red blood cells have spiny projections on their surface and can be an indicator of underlying kidney disease, especially if the patient shows other signs of renal dysfunction such as elevated creatinine or blood urea nitrogen levels. Some key conditions associated with burr cells include:
- Uremia (kidney failure)
- Pyruvate kinase deficiency, a congenital hemolytic anemia 2, 3, 1
- Liver disease, particularly cirrhosis
- Hypophosphatemia
- Microangiopathic hemolytic anemias Certain medications can also cause burr cell formation, including:
- Aspirin
- Heparin
- Some chemotherapeutic agents It is essential to investigate for underlying kidney disease if burr cells are present in a blood smear, especially if the patient shows other signs of renal dysfunction 1. The formation of these spiny projections occurs due to changes in the lipid composition of the red cell membrane, affecting its flexibility and potentially shortening the lifespan of affected cells, which can contribute to anemia in these conditions. In clinical practice, the presence of burr cells should prompt a thorough evaluation of the patient's medical history, physical examination, and laboratory tests to determine the underlying cause and guide appropriate management 4.