Poikilocytosis and Burr cells

[markjeep51]

I have CLL, the slow moving type since 2013; am 68 yrs old. My blood work is not that much out of the normal range and I feel fine. Had my standard checkup last week with a new oncologist who order a standard CBC plus a couple of other new blood tests; testing for the existance of poikilocytosis cells and burr cells. The results of both blood tests came back as 1+. As I understand it, this means that 25% of my red blood cells are abnormal in size per the poikilocytosis test and 25% of my red blood cells have spikes on them per the burr test. How concerned should I be ? Should these parameters be monitored more often and on a periodically basis to track any negative trending ? Don't know what these tests imply or suggest.

[cllady01 Former Volunteer]

Anemia (low RBCs) comes in many forms. The tests are looking at the RBCs and seeking to determine the cause (which would be other than your CLL) of any size/shape that is abnormal for those particular cells. There are several anemias possible that are not caused by CLL, and the Dr. is trying to discern what is causing your condition.

Sorry, it is not possible to give you a definitive answer in regard to followup or what the results suggest in your specific situation. Please do check with your Dr. to save yourself any worry/stress that will have your questions running round and round in your mind and not let you rest.

Your Dr. should be forthcoming with what the finding means. There may be other tests needed to get to the cause. And there may need to be time for the situation to develop more before there is anything else done. If your Dr. hasn't shared with you what has been found (if there is a finding already) you might want to call and ask the questions of him---should and will there be closer followup because of these findings.

Please do keep us updated on any progress you make in getting information and know that we welcome your sharing. We support and educate each other. The waiting can be maddening when we have no information, and we deserve to know what is going on in our bodies, is that can be known. We seek to be partners with our Drs. in our journeys with CLL.

[markjeep51 in reply to cllady01]

Great reply. Thanks. For the past year, my HCT blood level was a bit high and my MCHC is a bit low, while at the same time, my RBC and my HGB blood counts are all well within normal range. About a year ago, I looked into what HCT and MCHC blood tests were all about and concluded that I might have a slight anemia issue. So as a result, I started taking an iron supplement twice a week; specifically Iron Protein Succinylate at 300mg, which does not cause constipation. But doing such apparently did not have any effect on my HCT and MCHC blood counts. So something strange is going on in my body. I will do as you suggest and pressure my oncologist/hemotologist to pursue this condition further. Once again, thank you very much for your advice. Mark

[cllady01 Former Volunteer]

Also, Mark-- I found this for the Burr cells:

en.wikipedia.org/wiki/Echin...

[Dyverg in reply to cllady01]

I found the first link says its temporarily unavailable.

[cllady01 Former Volunteer in reply to Dyverg]

I just tried it and got the same result you did--so, I am deleting the link. (will see if I can find the site again).

[morepork]

Hi Mark.

I have Spur cells in my RBC's, they are spiky a bit like Burr cells if I understand it correctly. BUT I don 't have any form of anemia at all. RBC and Hb normal. However I am told that they can occur in other "haematological conditions " so I've decided not to worry about them.

[Jm954 Administrator]

Hi Mark,

Some of these parameters are reported by the analyser and not from microscopy. Both burr cells and poikilocytes are often seen if the sample is a bit old when it's analysed. You said you had a new oncologist, do you know if your sample had to travel further to the lab? The other problem that can occur is that the sample might sit in the lab for many hours before it's analysed, especially if there had been a machine breakdown that needed to be sorted.

Regarding your MCHC, that value is a measure of haemoglobin concentration in each red cell and that can be low or high if the analyser isn't quite set up correctly. It would be very unusual to have a normal MCH (27-32) and low MCHC (less than 34). If your MCV is normal (80-100) please don't take iron because, as you have seen, it has no effect and can be toxic to your liver. Sometimes, people have a red cell count and MCV at the upper end of normal and that leads to the HCT being just over the upper limit but these values can be different lab to lab.

In essence, please don't take the iron and don't worry about any of your red cell results, I think they are probably just down to the lab and not you.

Jackie

[markjeep51 in reply to Jm954]

Good write-up. Thanks for the advice, Mark