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Red Cell Inclusion Bodies

 
 
 
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Overview

Red blood cell inclusion bodies are pieces of stainable material within red blood cells, mainly due to retained remnants of cellular components.
  • Common Red Cell Inclusions

  • Howell Jolly bodies - DNA fragmentsSeen post splenectomy and in functional hyposplenism
  • Basophilic stippling - RNA fragmentsSeen in haemoglobinopathies and heavy metal poisoning
  • Pappenheimer bodies - clumps of ferritinSeen post splenectomy, in sideroblastic anaemia and in lead poisoning
  • Cabot ring - strings of mitotic spindle remnantsSeen in megaloblastic anaemia, MDS and myelofibrosis
  • Heinz bodies - clumps of denatured haemoglobinSeen on supravital staining in oxidative haemolysis, e.g. G-6-PD deficiency
  • HbH bodies - clumps of haemoglobin H (four beta chains)Seen on supravital staining in HbH disease, i.e. alpha thalassaemia major

Howell Jolly Bodies

Howell Jolly bodies are basophilic inclusions within the cytoplasm, made up of DNA fragments.
  • Howell Jolly Bodies
  • Howell Jolly Bodies
     
Howell Jolly bodies are classically seen following splenectomy, though may also occur in patients with any cause of hyposplenism.
  • Causes of Howell Jolly Bodies

  • Post-splenectomy
  • Functional hyposplenism - sickle cell anaemia, liver cirrhosis, SLE, rheumatoid arteritis, coeliac disease, inflammatory bowel disease, splenic artery / vein thrombosis, amyloidosis, sarcoidosis 

Basophilic Stippling

Basophilic stippling is the presence of irregular basophilic granules, made up of RNA fragments.
  • Basophilic Stippling
  • Basophilic Stippling
     
  • Causes of Basophilic Stippling

  • Thalassaemia
  • Sideroblastic anaemia
  • Unstable haemoglobins
  • Myelodysplastic syndromes
  • Heavy metal poisoning - lead, arsenic, mercury

Pappenheimer Bodies

Pappenheimer bodies are basophilic inclusions seen in the periphery of red blood cells, made up of ferritin.
  • Pappenheimer Bodies
  • Pappenheimer Bodies
     
  • Causes of Pappenheimer Bodies

  • Post-splenectomy
  • Sideroblastic anaemia
  • Lead poisoning

Cabot Rings

A cabot ring is a basophilic loop seen within red blood cells, made up of mitotic spindle remnants.
  • Cabot Rings
  • Causes of Cabot Ring

  • Megaloblastic anaemia - B12 / folate deficiency, drugs
  • Myelodysplastic syndrome
  • Myelofibrosis
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