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Present
Status
Relationship
of Spiculed
to the
Red
VARIETY
OF
described
and
specific
well
cells
are
nently
defined
abnormal
triangular2
acterized
erythropoiesis,
by
fibrin
on
remains
during
foreign
a group
burr
of
cells,2’5
into
the
the
and
are
subject.
nizable
cell
cells,
and
Scanning
electron
a three
possible
to
cally
exposed
the
cells.
Submitted
July
accepted
February
Supported
in
29,
of
of
prototypes
provided
new
in a variety
abnormal
red
of normal
cells
the
recog-
to
define
or abnormal
contradictory
findings
Nomenclature
red
of
has
of
These
spiculed
A, or ten
200
a large
depth
of
features
cells
clearly
have
and
times
focus
and
made
it
unequivo-
echinocytes.
echinocyte
or crenated
red
at 37#{176}Cfor
plasma
incubated
Clinical
Pathology,
and
the
1971;
first
2, 1972.
part
by
designated
Recent
ob-
pathogenesis,
a resolution
view
of the
Calif.,
has
dimensional
Department
Francisco,
and
it
to compatible
From
San
microscope
and
prototype
vessel
There
to define
of apparently
In addition,
: acanthocytes
The
their
cells
cells.
Observations
two
and
paper
distortion
microscope.
delineate
have
char-
red
diseased
occurring
normal
discuss
on
variously
cells.’0
cells
present
artifactual
a number
spiculed
Microscope
light
presents
to
to reconcile
of these
scanning
of the
of the
to avoid
been
spiculed
well
prostheses.34
acanthroid
to which
purpose
morphologically,
Electron
The
the
Helmet’
been
of normal
microscope11’4
of
distortions
necessary
to attempt
have
or
promi-
leukemia.
now
to bisection
which
electron
It is the
types
on the origin
that
scanning
artifactual
the precautions
cells
drop
most
intracardiac
acanthocytes,79
interrelationship
of diseases
equally
red
cells,6
cells
Tear
: thalassemia
or injury
by
with
sickle
associated
have
coagulation
presented
spiculed
spur
with
servations
insights
intravascular
surfaces
due
been
conditions
preceding
anemia
as being
only
pathogenically.
been
and
has
associated
these,
in other
congenital
microangiopathic
been
Of
have
occur
projections
have
and
and
studies
spiny
cells
anemias.
they
both
of
experimental
strands
or
or more
etiologically,
although
cells
M. Bessis
one
morphologically
myelofibrosis,
Transformation:
spiculed
hemolytic
sharply
and
and
with
these
acquired
morphologically,
and
as
or
of
defined
with
walls
CELLS
some
congenital
are
by
RED
Their
Review
By G. Brecher
A
and
Discocyte-Echinocyte
A Critical
1-1._
Cells
institut
de
revision
USPHS
Grant
University
Pathologie
August
cell
of
California
Cellulaire,
30,
1971;
CA-08608,
and
is the normal
(Figs.
1-4).
red cell,
Addition
24 hr
Paris,
School
or
Medicine,
France.
second
revision
January
31,
1972;
by
INSERM
and
Association
Claude Bernard,
Paris, France.
C. Brecher,
M.D.: Professor
and Chairman,
Department
of California
School
of Medicine,
San Francisco,
Calif.
of Clinical
Pathology,
University
M. Bessis,
M.D.:
Professor
of
Medicine,
de
University
of
Paris;
Director
of
the
Institut
Pathologie
Cellulaire,
Paris,
France.
Blood,
Vol. 40, No. 3 (September),
1972
333
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334
BRECHER
Fig.
1. Echinocyte
stage
1, characterized
electron
micrograph
taken
at 30#{176}
angIe.
Fig.
2. Echlnocyte
stage
1, more
Fig.
3. Echinocyte
stage
by
obvious
irregularity
angulation
2, characterIzed
by
of edges.
of edge.
spicules
AND BESSIS
seen at 45#{176}.
Cell
in a still
Scanning
flat
cell,
seen
at 30#{176}.
Fig. 4. Echinocyte
stage
over the surface
of a round
3, characterIzed
cell.
by
spicules
uniformly
distributed
to 3.5 mM oleic acid or 0.3 mM lysolecithin
to fresh
plasma
has the same
effect. We shall refer to plasma
capable
of crenating
normal
red cells as echinocytogenic.
A red cell exposed
to such plasma
transforms
within
minutes
into
an irregularly
contoured
disk (stage
1), a flat cell with
spicules
(stage
2), and
finally
into
an
ovoid
or
spherical
over
the surfaces
(stage
echinocytes,’3
or crenated
used
for
The
useful
tionally.
for
normal
area
echinocytes
1 and
of
volume,
biconcave
and
of
quantification
For example,
plasma,
stages
tween
both
identification
three
of
when
the
2. The
cell
of
spicules
and
in which
plasma
of echinocytes
probably
definite
spheres,
should,
echinocyte
experiments
echinocytogenic
preponderance
although
10-30
acanthocytes
stages
transformation
disks,
with
evenly
We suggest
that these
cells be
cells. The common
synonym,
burr
3).
proof
and
spiculed
occurs
of
identity
cells
therefore,
formation
distributed
designated
as
cell, has been
be avoided.
is occasionally
crenation
is induced
is suffidently
diluted
will
shift
without
of
from
change
these
is difficult
stage
in
parameters
to obtain.
intenwith
3 to
surface
beEchino-
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SPICULED
RED
cytes
produced
plasma.
When
echinocytes,
spicules,
light
by incubated
plasma
red cells
are exposed
are
them
are
to
readily
plasma
which
have
an increased
volume
produced
(Figs.
5-8).
These
may
microscope.
rtated
335
CELLS
To
distinguish
them
sphero-echinocytes.
the
other
proteinemia.’4
The
distributed
(Fig.
holic
has
over
the
red
9). Morphologically
cirrhosis
accompanied
been
suggested
morphologic
The
conditions
on the primary
red cells, such
for
distinction,
which
cell
five
to
surface.
identical
by
5-8. Sphero-echlnocyte
and progressing
ten
spicules
The
individual
acanthocytes
the
term
crenate
of
of
appears
normal
poikilo-echinocytes
and
to complete
liver
red
have
can
in the
and
desig-
is further
irregularly
knobby
in patients
The term
but
acid,
abetalipo-
length,
unnecessary
cells
have
acid
in congenital
spicules
disease,
both
we
varying
cells have been
found
hemolytic
anemia.8’10’120
spicules
of acanthocytes
as poikilocytes
or sickle
as acantho-echinocytes,
Fig.
spicules
have
fresh
oleic
less prominent
spheres
with
the
of oleic
spheres
and finally hemolysis
results.
of acanthocytes
are the red cells found
by
mM
echinocytes,
concentration
increased,
true
The prototype
cells
to discocytes
15-30
and progressively
be mistaken
for
from
When
reversed
with
ends
with
alcospur
cell
absence
of
confusing.
superimpose
crenation
(Fig. 10) and other
abnormally
shaped
cells. These
cells can then be designated
and
epherocytes,
spheres.
sickle-echinocytes.’2
characterized
by
shortened
a
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330
BRECHER
AND
BESSIS
&
0
Fig. 9. Acanthocytes
by a small
number
tributed
spicules,
knobby
ends.
Light
of
characterized
irregularly
disgenerally
with
Fig. 10. Acantho-echinocyte
defined
as an acanthocyte
with secondary
spicules
genic
superimposed
factor.
by
echinocyto-
Microscopy
Once the details
of echinocyte
and acanthocyte
morphology
as seen by the
SEM are appreciated,
the different
types of spiculed
cells can usually
be distinguished
in ordinary
smears
(Fig. 11). The typical
echinocytes
have a serrated
outline,
with small projections
more
or less evenly
spaced
over the circum-
Fig. 11. Acanthocytes
and hemolytic
anemia.
and
echinocytes
in smear
from
a patient
with
cirrhosis
Fig. 12. Echinocytes
and two
acantho-echinocytes.
Supravital
preparation
from a splenectomized
man. Lysolecithin
was added
to fresh blood to transform
discocytes
into echinocytes
and acanthocytes
into acantho-echinocytes.
Note
contrast
between
regularly
serrated
edges
of echinocytes
and few irregular
processes
of acanthocytes
some
of which
have developed
bifurcation
due to
superimposed
secondary
spicules.
From www.bloodjournal.org by guest on June 15, 2017. For personal use only.
SPICULED
RED CELLS
of
ference
length
Wet
side
the
red
cells,
and thickness
preparations
views,
the
are
337
and
while
acanthocytes
projecting
have
the
hence
the
biconcave
three
stages
of echinocytes
also most
readily
distinguished
Particular
present
in
difficulties
arise
a preparation.
It
lysolecithin
deliberately
out
(Fig.
Some
12).
spicules,
The
greatest
are
plasmas
may
to
of conditions
spicules
distinguished
wet
from
the
seen
SEM
can
plasma
with
to have
during
crenate
the
of
are
phase
micro-
and stand
echinocytes
into
bifurcation
of
in
their
which
acanthocytes.
fresh
red
of the
fallacies,
induce
in
any
containing
experiments
with
an inherent
capacity
To avoid
such
which
seen
images.
patients
to
be
acanthocytes
add
preparations
encountered
from
capacity
to
into acantho-echinocytes
have been
transformed
be
varying
from
and
helpful
of
or cup-shaped
cells”
in wet preparations.
echinocytes
be
may
are
the
acquire
readily
both
then
to examine
plasma
be mistaken
for
or acanthocytes.
variety
when
may
are transformed
all other
cells
difficulties
a few
the red cel! surface.
that red cells can
transformation.
Spherical
from biconcave
disks
be predicted
exposed
may then
echinocytes
shape
acantho-echinocytes
would
as
cells
the
and
The acanthocytes
prominently
because
scope.
have
irregularly
from
obvious
advantage
red
Any
cells,
and
stored
this
effect
patient’s
plasma
to induce
a detailed
knowledge
of
echinocyte
transformation
becomes
crucial.
Discocyte-Echinocyte
Transformation
in
Physiologic
and
Saline
the
“Glass
Effect”
Ponder
non
of
have
provided
appreciated
Washing
to crenate
plasma
sequent
crenation
to
only
After
out
by
on
a thin
by
slips,
the
are
ently
close
needed
test
cells
to produce
tube
through
*Discocytes
is
the
seen
with
to have
glass
crenation
insufficient,
wall
exposed
or
as
using
to
an
can
objective
hypertonic
just
maintained
be
solutions
red
by
long
become
cell
subfresh
of
surface
of plasma
of
5%
for
of 10%-20%
if the maintenance
which
in saline.
depend
biconcave
glass
cells.
verified
than
entirely
cover
slip. If thrice
washed
between
two plastic
cover
of
washed
with
the
their
ratio
less
described
glass
and
are observed
of plasma
are needed
In contrast,
percentage
findings
a high
of thrice
on
in tonicity.*
coating
washes
certainly
addition
expected
layer
phenome-
investigators
change
crenated.
high
the
of red cells between
or Hank’s
solution
contact
when
are
a relatively
Furchgott,24
any
few
a protective
fact that three
cells
plasma
of the
yet
without
discocytes,
would
be
on the observation
red cells in saline
red
place
washes,
to
descriptions
lysis,2123
removing
by the
This
be reconstituted
pointed
take
two
necessary.
depended
detailed
and
of red
echinocytes
is
shape
can
i%-io%
of
saline
biconcave
cells.
of
only
reversal
plasma
As
that
and
sphering
probably
acts by
This
is suggested
100%
remains,
studies
preceding
in saline
red cells.
the
from
could
extensive
as
crenation
to
Exposure
observation
working
flattened
echinocytes
become
shrunken
echinocytes.
In both cases
the
tonic
solution,
discocytes
become
cup-shaped,
before
they
Echinocytes
in hypotonic
solutions
become
sphero-echinocytes
shape.
red
Appar-
cell
surfaces
to the
glass
of
the
distance.
discocytes
volume
is decreased.
become
swollen
and spheres.52
red
Only
is
in a
cells
when
(leptocytes),
In hypospherocytes.
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338
BRECHER
cells are
between
washed
plastic
12 or more
surfaces
and
Although
fresh
plasma
between
glass
and cover
or
in
thin
portions
plasmas
the
cytes
between
the
in
mum
and
that
result
even
of the red cell
slips.
The
alter
the
may
observation
in a test
population.
cells
from
becoming
will frequently
form
after
in
the
a few
test
importance
but
of red
or, so to speak,
in the
or
echinocytes
at the edge
In
become
of these
appearance
tube
minutes.
tube,
BESSIS
some
echino-
observations
cells
very
by
lies
even
process
mini-
of observ-
them.
Discocyte-Ech
The
inocyte
simplest
Transformation
way
at 37#{176}Cfor
24
dilution
with
plasma.25
the
normal
echinocytogenic
mm
30
stroys
the
tion
of an
ability
factor
We
The
the
fatty
but
might
at a slow
of plasma
is not
rate
and
changed
which
who
this
drawn
i.e.,
the
tinued
red
rapidly
sible
and
mm
of
mm
30
only
cooling
rule
bypass,
slowed
Discocyte-Echinocyte
long
in
on
been
known
It is less
incubated
The
chylomicrons
was
levels
because
cells
lose
37#{176}C.However,
evident
by
levels
was
LPL,
from
con-
of 1.6
to
fatty
Crenation
acids
of
clear
in vitro.
Pos-
2.0
mEq
Ullyot3#{176}in surgical
of albumen
and
simul-
acids.
Aged
appreciated
content
hr.
in volunteers
of blood
observed
low
fatty
acid
24
LPL. Blood
activity
of
cells supervened.
in vivo because
incubation
been
in
to esterify
(LPL)
can
become
studied
the conditions
acids
reached
plasma
involved
fatty
at 37#{176}Cfor
fatty
red
fresh
echinocytogenic
enzyme
from
of
observed
deincubaechino-
is known
to release
continued
in
red
the
which
hyperlipemia
to transformation
3 to 4 days
in whole
at
and
the
alimentary
of free
generally
to 56#{176}Cfor
normal
that
incubation
recently
possibly
that
after
proven
subsequent
have
by
acquires
subsequent
it has become
heparin
known
at 37#{176}C.The
crenation
plasma
plasma
of lipoproteinlipase
in vitro.
Dc Vries29
Transformation
blood.
blood
and
clearance
form
rouleaux
secondary
Echinocytes
form
within
hr
Free
accumulate
cardiac
on
taneous
acids
routinely
to this
patients
It has
fatty
fresh
lysolecithin.28
by
produced
plasma.
however,
not
to produce
injection
of
and incubated
of the
exceptions
in banked
He
an
production
clearing
approximately
cells is not,
in
occurs.
then
received
within
15
the
normal
quantitated
on
transferase
Plasma
containing
large
amounts
echinocytogenic
on brief
incubation
under
of
be lysolecithin26
significantly
be
which
echinocytogenic
factor.2627
acids or lysolecithin
makes
suggested
plasma
can
para-hydroxymercurobenzoate,
lecithin-cholesterol-acyl
cholesterol
by
Heating
inhibitor,
is to incubate
factor
mechanism
is enzymatic.
have
in incubated
production
plasma
echinocytogenic
enzyme
does not destroy
of oleic, other
echinocytogenic.
its
echinocytogenic
The
of plasma
to become
echinocytogenic
24 hr. Heating
to 56#{176}Cof plasma
37#{176}Cfor
at
cytogenic
Addition
hr.
factor
addition
or
in Plasma
of producing
plasmas
24
red
discocytes
cover
we
for
crenation
in part
preparation
remain
glass
preparation
ing
supravital
will
realization
will
only
protects
fresh
slips,
echinocytes
of
cells
times
then
AND
Red
their
Cells
ability
that
to
this
sediment
is due
normally
to
failure
of discocytes
to echinocytes.
blood
kept
at 4#{176}C,3’and within
while
the
supernatant
plasma
to
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SPICULED
RED CELLS
339
becomes
echinocytogenic
kept at 4#{176}C
for days
after
24
or even weeks
sequently,
that
quite
it appears
apart
from
any
changes
produced
and of the aging
aging
hr at 37#{176}C,plasma
only rarely
becomes
of red
plasma
cells
changes.
by incubated
effect
as due
promotes
It may
or altered
to intrinsic
separated
from
echinocytogenic.
echinocyte
be
useful
plasma
factors,
blood
Con-
transformation
to think
as due
possibly
of
the
to extrinsic
reduced
shape
factors,
adenosine
triphosphate.3235
Reversibility
of Echinocytes
Echinocytes
produced
readily
reversed
to
bumen
in buffered
pounds
and
saline
conditions
pyrrolidone,
by
certain
the
disc
Echinocytes
may
of
may
be
recipients
of transfused
The
and
neuronal
liver
is high
it has
been
which
may
hemolytic
anemia
is not
Moreover,
when
normal
hemolytic
anemia,
they
function.
The
“Burr”
the
into
cells
stomach,
and
low
of
anions
under
have
been
and
heart
are
com-
polyvinyl
pH.
According
and
to
cup
appropriate
not
shapes
mixtures
usually
with
present
to revert
not
in
the
allows
circulation
transfused
in the
by
which
blood
may
become
in the circulation.
seen
in the
reversible
adenosine
in banked
to discocytes
are
to circulate
blood
of
and
the
recipient.
In Vivo
acanthocytes
they
have
have
without
been
studied
and
liver
cirrhosis
found
in a familial
reported
that
that
associated
cells
have
with
are
are
it
in
The
appears
with
occur
uremia,
original
of acanthovariable
in
and
a reduced
by
the
filtrability
spleen
in
vivo,
in abetalipoproteinemia.
into
interfere
echinocytes
have
with
neonatal
recognizable
for traumatic
percentage
removed
survival,
Thus
found
disease.5
The
no
in splenectomy,
transfused
which
with
removed
acanthocytosis
a shortened
hemolytic
disorder
in severe
acanthocytes
they
extensively
with
abetalipoproteinemia,39
transplantation.42
very low
suggest
most
been
anemia,40’41
and in patients
whom
the spleen
had been
acanthocytes.2#{176}
does
not necessarily
condition
cells
is known
but
in
transform
acanthocytes
red
on incubation
incidental
to kidney
in abetalipoproteinemia,
cirrhosis.
Although
Other
phenergan,36’37
with
is high
cells
with
hemolytic
disorder,
in
or
rupture
plasma.
normal
a number
echinocytes
addition,
degeneration,
cytes
of
abetalipoproteinemia
disease
Al-
are
percentage
in which
In
hematologic
are
plasma.
interconvertible,
Echinocytes
yet appear
Echinocytes
conditions
anemia.710’1420
plasmas
normal
fresh
compounds,
by
aging
their
red
congenital
are
by
because
when
Acanthocytes
other
echinocytogenic
in
for
echinocytes
be reversible
ATP.3235
plasma,
inferred
even
substituted
are
in fresh
irreversible
bulk
cations
by
shape.
but
regeneration
be
revert
of
or
resuspension
produced
produced
plasma,
This
can
cells
produced
washes
by
a host
crenated
restoring
saline
which
gelatine,
Deuticke,38
fresh
by
discocytes
patients
with
although
they
that
their
report
and
always
the bizarre
shape
normal
survival
in vivo
bleeding
cirrhosis
do not
peptic
depicts
are
less
ulcer,
well
defined.
carcinoma
a variety
of
and
of
of
spic-
From www.bloodjournal.org by guest on June 15, 2017. For personal use only.
340
BRECHER
uled
cells
anemia.3’4
and
with
of
then
which
work
about
to avoid
that
fresh
blood
should
adequate
be
that
circulation.
prepared
Examination
immediately
crenated
in others
cells in half a dozen
prepared
at the same
Schwartz
is not
and
echmnocytes
found
echinocytes
have
for
the
been
in
versible
by
Pathogenesis
on
was
and
patients
become
an
cirrhosis
that
surface
by Keller
et al.,2#{176}
it has
the
plasma
formation
ever,
according
are
spicules
after
of Grahn
red
patients
their
of
and
cells
have
own
in
not
vivo.
of a smear.5
studied
high
fatty
aware
plasma
This
to uremia,
and
except
by Ullyot3#{176} in
acids
and re-
membrane
critical
attempts
some
changes
of red
that
red
associated
days
in the
recently
denied
acanthocytes
can
incubation
is in keeping
50%
induce
24
cells
repetition
and
of these
to elucidate
connected
in incubated
or
transform
though
echinocytes
experiments
the
in the
pathogenesis
inferences
with
even
red
plasma
on
cell
was
How-
observations
can
morphology
acanthocyte
speculative
mm,
transhr.
rather
than
pronounced
prior
patients
for 15
acanthocytes
re-
by others,
for
with
of cirrhotic
be
into
abetaliporeflect-
as
though
may
recipients
in both
presumably
Moreover,
some,
with
acanthocytes
cells
transfused
several
on
on incubation
anemia
nor
echinocyte
of any
by
and
This
echinocytes
hemolytic
Again,
clearly
sequential
pictures’8
echmnocytes
which
develop
progressively
more
of about
Nevertheless,
Crenation
claimed
cirrhosis
at 1 hr,
of
are
after
to acanthocytes
published
knowledge
structural
permissible.
into
neither
disease
acanthocytes.’847
of observation.
circulation.
newer
indicated.
We are
cytes
hr
of
been
cells
present
24
et al.’#{176}
that
normal
present
fashion.
irreversible,
presented
that acanthocytes
an excess
of cholesterol,
with
red
to the
acanthocytes
area
of patients
of normal
liver
acanthocytes
increased
viewed
were
same
deficiency43’44
are
tempting
to speculate
constituents.
Normal
Evidence
has been
and cirrhosis
contain
proteinemia
part
to
in the
they
are
observed
In addition
recently
slips
present
even when
on occasion,
kinase
due
suggests
cover
already
they
bypass
certainly
recommenda-
plastic
in vivo.
general
Dacie2
Cells
it was
plasma
ing
cardiac
no
while
none
handled
in the
in pyruvate
how
blood.
formation
in only
occur
In
almost
plasma
abnormalities,
the result
of altered
with
made
were
of
of
plasma.
of Spiculed
circulation.4#{176}
not
to occur
abetalipoproteinemia
Because
cells
occasionally
do
the
between
slip preparations
and ostensibly
deficiency.45
crenation
fresh
crenated
them
patients
vivo
the
shown
kinase
heparinized
whom
but
smears
appreciated
of
echinocyte
immediately
cover
time
that
phosphoglycerate
of
in
some
examination
fully
of stained
smears
is less reliable,
from
free flowing
blood.
We have,
Motto
to suggest
been
smears,
by
echinocytes
A critical
not
BESSIS
microangiopathic
acanthocytes
withdrawal
knowledge
examined
assurance
it had
after
in blood
Present
of
recently.’8
since
in
with
occurrence
induced
crenation
them.
identified
equated
reasserted
be
artifactual
how
to give
can
later
been
The
been
particularly
crenation
tion
those
have
others.
has
is indicated,
warned
cells
by
uremia
commonly
resemble
burr
echmnocytes
with
patients
the
some
Since
AND
crenation
found
light
appears
of
the
the
in
echino-
biochemical
may
associated
be
From www.bloodjournal.org by guest on June 15, 2017. For personal use only.
SPICULED
with
RED CELLS
a significant
although
plasma
plasma
fatty
acids
fatty
the
cell
or
in red
associated
by
and
cell
loss
be
brought
to
a number
plasma.
Preliminary
red
have
pyruvate
kinase
of
cells
restores
and
reflect
yet
and
of
Prenant5’
They
which
in turn
pipette
and
spicules
during
red
of
the
and
however,
membrane
which
glass
effect,
Although
once
the
studies
of
the
models
of the
earlier
on
will
the
of
spicules
is some
the
discocyte-echinocyte
equilibrium
red
cell
may
Furchsolution,
of a glass
The
individual
cell
The
surface
experi-
at random
sites
reversal
a locus
reform.
be
may
by
It
differentiation
has been
speculative,
of
seems
the
as a result
removed.
they
of
the
Bessis
approach
of spicules
loss
effect
Hank’s
subsequently
occurrence
the
of
glass
pipette.
of
crenated
that
made
on
the
structural
the protective
protein
coating
concepts
presented
here
are
be
aged
membrane.
that
the spicules
appear
once
formed
leaves
on
which
for
of the
also
of
crenate
withdrawal
there
accounts
structure
that
adenosine
cells
stiffening
cell
a microdrop
to be
reversible
with
crenated
again
on identical
sites
of the red
cycles
of crenation
and reversal.
at
that
red
or
altera-
suggest
observations
in
oil,
a
and
the
acid
or
is evidence
with
of
fatty
is not
may
washings
cell
possibility
that a spicule
vulnerability
likely,
to saline
silicone
a disk
reappeared
again
and
as many
as 40 consecutive
increased
cell
by
to
deficiency
for
with
crena-
is known
cells
laboratory
associated
confirmed
is surrounded
revert
cells
red
ATP.49#{176} There
a red
of
cell
sites
changes
of red
that
red
echinocytes
reversible
volume.
Incubation
shape.33’3#{176} The
constitution
that
of
that
of aged
acids,
the
receptor
plasma
in our
are
due
recently
have
accumulation
aging
kinase
of the
found
ments
do not preclude
on the first occasion
more
cells
with
to
different
crenation
of cellular
aspect
have
the
calcium34
have
gott.24
by
of
phosphoglycerate
levels
another
about
experiments
increased
membrane.
The crenation
known
a slightly
increased
the ATP
and
discoid
and
of reduced
ATP
is
fatty
It is known
equilibrate
In contrast,
and
membrane
normal.
and
reversibility
may
thus
speculate
due
crenated
sometimes
because
Albumen
of ATP
labeled
was
lysolecithin
metabolism..M
with
fresh
plasma
can
both
and
concentration
minutes.48
red
lysolecithin
tions
acid
acids
and
Jysolecithin
is well documented.
One
albumen
of
in lysolecithin
fatty
within
both
tion
increase
the
membrane
341
red
of the
suggest
value
in
that
building
membrane.
SUMMARY
The
literature
on
contradictory
these
crenation
cells
(echinocytes)
lysolecithmn,
the
presence
as
aging
(1)
high
of
of
red
red
cells,
contains
pathogenesis
with
cells
by
levels
spiculed
(disocytes)
extrinsic
cells
acid
lysolecithin
and
many
cells,
are
probably
which
of
cells
abnormal
the many
because
(plasma
or
related
cells.
circulation.
into
incubated
(2)
levels
by
intrinsic
to depressed
and
A resolution
conditions
these
artifacts
physiologic
others);
nomenclature
red
in the patient’s
can be transformed
factors
of fatty
a redundant
of the
requires
knowledge
and abnormal
red
been confused
biconcave
red
hr,
the
on
difficulties
in normal
of
quently
The
spiculed
claims
that
have
induce
fre-
crenated
red
at
37#{176}Cfor
of
fatty
factors,
ATP;
24
acid
in
such
and
(3)
From www.bloodjournal.org by guest on June 15, 2017. For personal use only.
342
BRECHER
by
washing
and
cover
in
saline
slip.
is generally
by
is not.
is prevented
occur
in
The
and
and
prelytic
spiculed
cells
develop
for
the
and
do
not
are
The
Speculations
their
importance
for
are
may
on
the
of
disease
designation
further
own
burr
echinocytes,
for
be abandoned
of
the
with
liver
and
become
echinocyte
forms
disease
are
Acanthocytes
because
mixed
on
clarification.
spicules
cell
to
concentration
to
of abetalipoproteinemia.
term
glass
is necessary
higher
cells
patients
to
slips.
Echinocytes
be reevaluated
be-
with
needs
of certain
the
induced
due
cover
slips
of smears.
these
slide
intrinsically
cover
must
develop
on their
that
between
transformation
the
plastic
claims
other,
circulation
cells
transformation
relationship
acanthocytes
of liver
allow
plasma,
between
but such
superimposed
of diagnostic
fresh
spherocytes
It is suggested
acanthocytes
which
the
observing
cells between
plastic
during
preparation
in the
crenation
echinocytes.
in
spheres,
from
of
discocyte-echinocyte
discocyte-echinocyte
agents.
indistinguishable
can
washing
of fresh
crenation
echinocytogenic
hand,
effect”
induced
The
Sphero-echinocytes
one
“glass
by observation
various
diseases,
cause
examination
exclude
artifactual
of
the
extrinsically
reversible
transformation
contact
probably
and
The
AND BESSIS
they
of
acantho-
and
are
spur
cells
redundant
acantho-echinocytes
importance.
presented
on the
for an understanding
pathogenesis
of the
of echinocyte
structure
of the
formation
red cell
and
mem-
brane.
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43.
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From www.bloodjournal.org by guest on June 15, 2017. For personal use only.
1972 40: 333-344
Present Status of Spiculed Red Cells and Their Relationship to the
Discocyte-Echinocyte Transformation: A Critical Review
G. Brecher and M. Bessis
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