Table 6: Red Blood Cell Inclusions Review

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Table 6: Red Blood Cell Inclusions Review

InclusionImageDescriptionAssociated Diseases and Conditions
Basophilic stippling
  • Coarse basophilic stippling reflects abnormal hemoglobin synthesis and abnormal RNA degradation.
  • Fine diffuse stippling may be artifactual due to slow drying of the slide.
  • Lead poisoning
  • Thalassemia
  • Sideroblastic anemia
  • Megaloblastic anemia
  • Alcoholism
  • Congenital dyserythropoietic anemia
  • Myelodysplasia
  • Post-treatment for iron deficiency anemia
Pappenheimer bodies
  • Hemosiderin-containing granules
  • Inclusions may also be seen in nucleated red blood cells (nRBCs).
  • Sideroblastic anemia
  • Hemolytic anemia
  • Megaloblastic anemia
  • Thalassemia
  • Congenital dyserythropoietic anemia
  • Myelodysplastic syndromes
  • Absent or atrophic spleen
  • Hyposplenism
Heinz bodies
  • Precipitated, denatured hemoglobin attached to or protruding through cellular membrane.
  • Supravital staining is required to visually see Heinz bodies.
  • Hemolytic anemia due to unstable hemoglobins
  • G6PD deficiency
  • Exposure to oxidizing drugs
  • Chemical poisoning
Howell-Jolly bodies
  • Residual nuclear DNA
  • May see more than one inclusion per cell in megaloblastic anemia.
  • Megaloblastic anemia
  • Hemolytic anemia
  • Alcoholism
  • Absent or atrophic spleen
  • Hyposplenism
Siderosomes
  • Found in normal bone marrow
  • Seen in sideroblasts (normoblasts containing ferritin granules).
  • Image displays ringed sideroblasts. The iron-staining particles surrounding the nucleus of red blood cells create ringed sideroblasts. Iron has accumulated in the mitochondria of erythroblasts; the mitochondria are located close to the nucleus, giving the ringed appearance.
  • Dyserythropoiesis
  • Iron overload
  • Myelodysplastic syndromes
  • Sideroblastic anemia
Nucleated red blood cells (nRBCs)
  • Immature RBCs may appear in the peripheral blood in moderate and severe anemias.
  • Typically circulating nucleated RBCs are at the orthochromic stage of maturation, as shown in the image to the left.
  • Moderate to severe anemia
  • Increased bone marrow response