Present Status of Spiculed Red Cells and Their Relationship to the Discocyte-Echinocyte Transformation: A Critical Review

Abstract

The literature on spiculed red cells, contains a redundant nomenclature and contradictory claims on the pathogenesis of the abnormal red cells. A resolution of these difficulties requires knowledge of the many conditions that induce crenation in normal and abnormal red cells because these artifacts have frequently been confused with spiculed cells in the patient’s circulation. The biconcave red cells (disocytes) can be transformed into crenated red cells (echinocytes) (1) by extrinsic factors (plasma incubated at 37°C for 24 hr, lysolecithin, high levels of fatty acid or physiologic levels of fatty acid in the presence of lysolecithin and many others); (2) by intrinsic factors, such as aging of red cells, which are probably related to depressed ATP; and (3) by washing in saline and the "glass effect" of observing cells between slide and cover slip. The extrinsically induced discocyte-echinocyte transformation is generally reversible by washing in fresh plasma, the intrinsically induced transformation is not. The discocyte-echinocyte transformation due to glass contact is prevented by observation between plastic cover slips. Echinocytes probably occur in various diseases, but such claims must be reevaluated because examination of fresh cells between plastic cover slips is necessary to exclude artifactual crenation during preparation of smears. Sphero-echinocytes and spherocytes may develop with higher concentration of echinocytogenic agents. The relationship of these cells to echinocytes, on one hand, and prelytic spheres, on the other, needs further clarification. The spiculed cells in the circulation of certain patients with liver disease are indistinguishable from the acanthocytes of abetalipoproteinemia. Acanthocytes can develop crenation superimposed on their own spicules and become acanthoechinocytes. It is suggested that the term burr cell for echinocyte and spur cells for the acanthocytes of liver disease be abandoned because they are redundant and do not allow for designation of the mixed forms of acantho-echinocytes which are of diagnostic importance. Speculations are presented on the pathogenesis of echinocyte formation and their importance for an understanding of the structure of the red cell membrane.

Atrazine‐induced alterations in rat erythrocyte membranes: Ameliorating effect of vitamin E

“…Different studies have suggested that morphological changes in erythrocytes are possibly due to oxidative stress induced by administration of pesticides [28,[36][37][38]. It has also been reported that changes in the membrane lipid composition might lead to morphological changes in blood cells in response to administration of various pesticides [39,40]. Diplock et al [41] have suggested that vitamin E is responsible for structurally stabilizing biomembranes due to the physico-chemical interactions between α-tochopherol and unsaturated fatty acids.…”

Observation of Echinocytosis in Eight Patients: a Phase Contrast and SEM Study

“…To the first type belong uraemic patients fed parenterally in whom severe hypophosphataemia developed (Lichtman et al, 1969;Jacob & Amsden, 197I), patients with congenital deficiency of pyruvate kinase (Oski et al, 1964) or patients with phosphoglycerate kinase deficiency. To the second type belong rare cases of heparinized patients on cardiac by-pass in whom fatty acids presumably accumulate in the plasma from which they are normally cleared instantaneously (Brecher & Bessis, 1972). Recently, Harlan et al (1976) described up to 90% of echinocytes in patients with extensive burns and implicated abnormally low phospholipids as the cause, although the exact mechanism has not been definitely established.…”

Effect of lipid A on the deformability, membrane rigidity and geometry of human adult red blood cells

“…Morphology of 80 resting RBCs was studied on video recordings for each sample at each lipid A concentration. Since echinocytes and spherocytes were the predominant shape changes, we used the criteria established by Brecher et al [17] for the characterization of discocytes, echinocytes (stage 1-3) and spheroechinocytes.…”