I posted a poll on Twitter showing the peripheral smear below and asked what the most likely diagnosis was. The answer – which was the most popular choice – was cirrhosis.
The smear shows many acanthocytes (aka spur cells) and a target cell, classic for chronic liver disease. There are a few cells that look like more like burr cells, but the appearance of a spectrum between acanthocytes and burr cells is common in cirrhosis.
Chronic kidney disease is associated with the presence of burr cells (aka echinocytes). However, in contrast to liver disease, there are no acanthocytes or acanthocyte-burr cell hybrid forms.
