Red Cell Inclusion Bodies
February 15th, 2021
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 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.
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.
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.
Causes of Cabot Ring
- Megaloblastic anaemia - B12 / folate deficiency, drugs
- Myelodysplastic syndrome
- Myelofibrosis
Test Yourself
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- What condition is the most likely cause of the following red cell inclusions?
Feedback:
- Basophilic stippling refers to the presence of irregular basophilic granules in red cells, which contain RNA fragments. These are often seen in thalassaemia and with unstable haemoglobins.
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Next up: Nucleated Red Cells
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