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Spur Cell Anemia Workup

  • Author: Christopher D Braden, DO; Chief Editor: Emmanuel C Besa, MD  more...
 
Updated: Dec 06, 2015
 

Approach Considerations

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.

Reticulocyte count

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).

Plasma lipids

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.

Blood typing

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.

Next

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.

Acanthocytes with target cells in a patient with a Acanthocytes with target cells in a patient with advanced liver disease.
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Contributor Information and Disclosures
Author

Christopher D Braden, DO Hematologist/Oncologist, Chancellor Center for Oncology at Deaconess Hospital

Disclosure: Nothing to disclose.

Coauthor(s)

Issam Makhoul, MD Associate Professor, Department of Medicine, Division of Hematology/Oncology, University of Arkansas for Medical Sciences

Issam Makhoul, MD is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology

Disclosure: Nothing to disclose.

Mansoor Javeed, MD, FACP Clinical Assistant Professor of Medicine, University of California, Davis, School of Medicine; Consultant, Sierra Hematology-Oncology Medical Center

Mansoor Javeed, MD, FACP is a member of the following medical societies: American College of Physicians, Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Emmanuel C Besa, MD Professor Emeritus, Department of Medicine, Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University

Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American Society of Clinical Oncology, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Hematology, New York Academy of Sciences

Disclosure: Nothing to disclose.

Acknowledgements

James O Ballard, MD Kienle Chair for Humane Medicine, Professor, Departments of Humanities, Medicine, and Pathology, Division of Hematology/Oncology, Milton S Hershey Medical Center, Pennsylvania State University College of Medicine

James O Ballard, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, and American Society of Hematology

Disclosure: Nothing to disclose.

Marcel E Conrad, MD (Retired) Distinguished Professor of Medicine, University of South Alabama

Marcel E Conrad, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for the Advancement of Science, American Association of Blood Banks, American Chemical Society, American College of Physicians, American Physiological Society, American Society for Clinical Investigation, American Society of Hematology, Association of American Physicians, Association of Military Surgeons of the US, International Society of Hematology, Society for Experimental Biology and Medicine, and Southwest Oncology Group

Disclosure: Nothing to disclose.

Koyamangalath Krishnan, MD, FRCP, FACP Paul Dishner Endowed Chair of Excellence in Medicine, Professor of Medicine and Chief of Hematology-Oncology, Program Director, Hematology-Oncology Fellowship, James H Quillen College of Medicine at East Tennessee State University

Koyamangalath Krishnan, MD, FRCP, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Society of Hematology, and Royal College of Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References
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Acanthocytes with target cells in a patient with advanced liver disease.
 
 
 
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