Spur Cell Anemia Workup
- Author: Christopher D Braden, DO; Chief Editor: Emmanuel C Besa, MD more...
Complete blood count
Test findings reveal variable degrees of anemia, with the hematocrit commonly between 15% and 20%. White blood cell and platelet counts may be normal; however, due to the severe and advanced liver disease, they are decreased in most cases.
An increase in the reticulocyte count depends on the degree of the anemia, but it is usually greater than 5%. In certain cases, the reticulocyte count may be decreased as a result of concomitant folate deficiency.
Liver function tests
Hyperbilirubinemia, predominantly indirect bilirubin, is present, and its increase parallels the hemolysis. Synthetic liver function is decreased, as evidenced by low levels of albumin and fibrinogen and prolongation of the prothrombin time (PT) and activated partial thromboplastin time (aPTT).
This study is helpful in screening suspected cases of abetalipoproteinemia. Serum cholesterol, phospholipid, and triglyceride levels are very low. Lipoprotein electrophoresis reveals the absence of beta-lipoproteins.
Kell antisera react poorly with red blood cells, white blood cells, or both in the McLeod phenotype.
Serum creatine kinase
In McLeod syndrome, the creatine kinase levels are increased.
Intestinal biopsy in abetalipoproteinemia
This procedure reveals the presence of fat droplets within the mucosal cells.
Peripheral Blood Film
This study is the mainstay for the diagnosis of spur cell anemia. It reveals the presence of red blood cells with thornlike surface projections, which are variable in size.
Characteristically, a high percentage of acanthocytes is present, equal to or greater than 20% of the erythrocytes observed. In cases of liver disease, target cells also may be seen (see the image below), particularly if obstructive jaundice is present.
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