Lab CE Course - Erythrocyte Inclusions

Reticulocytes

slightly larger (10 microns) than the mature erythrocyte, appear blue-gray on the Wright- or Wright-Giemsa-stained smear and are referred to as polychromatophilic red cells

Cabot Ring

thin, red-violet-staining strands in the shape of rings, figure eights, or shapes of the letter B on Wright-stained, in megaloblastic anemia, lead poisoning, severe anemia, leukemia, myelodysplastic syndromes, and other cases of dyserythropoiesis

Pappenheimer body

Variable in size and aggregated near cell periphery

Thalassemia and lead poisoning

probably observe coarse basophilic stippling on a Wright-stained peripheral blood smear

Howell-Jolly Body

DNA, nuclear remnants/aggregates of chromosomes that have separated from the mitotic spindle, usually 1 on RBC

Howell-Jolly Body in nucleated red cell

nuclear remnants, they may also be present in the cytoplasm of nucleated red cells

Polychromatophilic RBCs

How would you classify these cells

Ringed sideroblast

If five or more siderotic granules form a ring around at least half the periphery of the nucleus of a nucleated red blood cell, the cell is referred to as

Megaloblastic anemia, lead poisoning

In which of the following conditions might Cabot rings be observed in erythrocytes on a Wright-stained peripheral blood smear

20-60%

of red cell precursors seen in bone marrow slides normally contain siderotic iron granules visible with Prussian blue stain

Siderotic granules

NOT all are visible on Wright-stained smears as Pappenheimer bodies

Ringed sideroblast

NOT present in normal bone marrow and would be associated with a disease or disorder

Basophilic stippling

Relatively evenly distributed coarse granules throughout the cell

Howell-Jolly body

Round and smooth and usually one per erythrocyte

Heinz bodies

Supravital stain; are clumps of precipitated hemoglobin

True

The cell that is indicated by the arrow in this Prussian-blue stained bone marrow smear is a ringed sideroblast

True

The inclusions that are indicated by the arrows on this Wright-Giemsa stained peripheral blood smear are most likely Pappenheimer bodies

polychromatophilic RBCs

This image represents a field of red blood cells (RBCs) that were stained using the supravital stain New Methylene Blue. How would these cells appear if they were viewed on a Wright-stained smear

None

What abnormality is present in this slide

Howell-Jolly Bodies

Which of the following inclusions are composed of DNA

Howell-Jolly and Pappenheimer bodies

Which of the following inclusions may be observed on a Wright-stained peripheral blood smear if a patient has had a splenectomy

Prussian blue stain: Pappenheimer bodies stain blue but Howell-Jolly bodies do not stain blue

Which of these methods could be used to differentiate between Howell-Jolly bodies and Pappenheimer bodies and what results would be noted

lead poisoning

associated with coarse basophilic stippling

Polychromatophilic RBCs

blue-gray appearance when compared to the other RBCs, often larger than mature RBCs, either lack central pallor or have diminished central pallor

Siderocyte

cell may or may not have been visible on a Wright-stained

Reticulum visible with a supravital stain, such as new methylene blue Contains some organelles used for hemoglobin production

characterize a reticulocyte

DNA

composition of Howell-Jolly bodies

aggregates of ribosomes

composition of the granules associated with basophilic stippling

Hyposplenism, Megaloblastic anemia

conditions you expect to find Howell-Jolly bodies

Basophilic stippling

dark-blue or blue-purple granules predominantly RNA, may indicate impaired Hgb synthesis, probably due to the RNA instability, coarse in sideroblastic anemias, lead poisoning, myelodysplasias, and thalassemias

Halo around the platelet

distinguishing characteristic of platelet on RBC

One

how many Howell-Jolly bodies are usually seen within a given erythrocyte

Sideroblast

immature erythrocyte containing siderotic granules

Sideroblast

indicated by the red arrow, is a nucleated red cell containing siderotic granules

Pappenheimer bodies

mature and immature RBCs, Wright-stain, confirmed with Prussian blue, small dark purple granular bodies varying size, clusters in groups of two, three, or more near cell edge, degenerating cellular remnants containing iron, accelerated red cell division or impaired hemoglobin synthesis, sideroblastic anemia, thalassemia, postsplenectomy

Siderocyte

mature erythrocyte containing siderotic granules

erythrocyte inclusions

may indicate the presence of disease