Spur cells (an extreme form of acanthocyte seen in severe liver disease)

These images are two regions from the same blood smear of the same patient, an individual with cirrhosis due to excess alcohol. Both show representative areas of the smear with spur cells (an extreme form of acanthocytes seen in severe liver disease). White blood cells are present for size comparison.

Acanthocytes form when alterations in lipid metabolism affect the red blood cell membrane. These cells are sometimes confused with burr cells (echinocytes), which are seen in liver disease or uremia. The main difference between these cell types is that acanthocytes have more uneven, irregular projections, whereas burr cells tend to have smaller, more regular projections.