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The page below is a sample from the LabCE course Red Cell Disorders: Peripheral Blood Clues to Nonneoplastic Conditions. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Red Blood Cell Inclusions and Associated Conditions

InclusionImageAssociated Clinical ConditionsComments
Basophilic stippling
Coarse stippling seen in lead poisoning and thalassemia, sideroblastic anemia, megaloblastic anemia, alcoholism, congenital dyserythropoietic anemia, myelodysplasia, post treatment for iron deficiency anemia
Coarse basophilic stippling reflects abnormal hemoglobin synthesis and abnormal RNA degradation.
Fine diffuse stippling may be artifactual due to slow drying of the slide.
Pappenheimer bodies
Absent or atrophic spleen, hyposplenism, hemolytic anemia, sideroblastic anemia, megaloblastic anemia, thalassemia, congenital dyserythropoietic anemia, myelodysplastic syndromes
Inclusions may also be seen in nucleated red blood cells (nRBCs).
Heinz bodies
Hemolytic anemia due to unstable hemoglobins, exposure to oxidizing drugs, chemical poisoning, G-6PD deficiency
Supravital staining is required to see Heinz bodies.
Howell-Jolly bodyAbsent or atrophic spleen, hyposplenism, hemolytic anemia, megaloblastic anemia, alcoholism
May see more than one inclusion per cell in megaloblastic anemia.
Nucleated red blood cell
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.
Found in normal bone marrow, but increased numbers occur in dyserythropoiesis and iron overload; ringed sideroblasts (as seen in image on the left) observed in myelodysplastic syndromes, sideroblastic anemia
Seen in sideroblasts (normoblasts containing ferritin granules).