ISSUE05

ISSUE

September
2020

This issue

Last Month’sSlides
August 2020 SlideSummaries
Slide 1
Generally normal film – all 5 normal
WBC cell types make it a goodtraining slide

Slide 2
Generally normal film – someplatelet aggregates

Slide 3Generally normal blood film, mildbasophilia

Slide 4Lymphocytosis with large granularlymphocytes and some atypicallymphocytes in a 19- year old male.
Glandular fever screening
recommended

Slide 5
Basophilia, myelocytes andoccasional blast. Possible
myeloproliferative disorder

Slide 6
Patient in intensive careLeukoerythroblastic blood film.
Thrombocytopaenia, anisocytosis,schistocytes, polychromasia andthe occasional spherocyte.
Basophilic RBC inclusions

Last Month’s Slides P.1
Monthly Case study P.1
Red Cell morphology P.2-3
Monthly Quiz P.2
Morphology Posters P.3

Monthly Digital Case study
August 2020 Slide 6
Presentation
Female (65 years old)
In Intensive Care Unit

FBC Results
WBCRBC
HGB
HCT
MCV
MCH
MCHC
PLT

14.8 (10^3/mm3)3.06 (10^6/mm3)91(g/L)27.5(%)
90 (fL)29.9 (pg)33.3 (g/dL)
57 (10^3/mm3)

Neutrophils
53.0%
Lymphocytes
17.4%
Monocytes
6.1%
Metamyelocytes 12.2%
Myelocytes
8.7%
Promyelocytes 0.9%
Blasts
1.7%

NRBCs 20/100WBCs

Slide review
Leucoerythroblstic blood film with an occasional blast.
Neutrophils are generally left shifted but without
toxic granulation.
The red cells show a variety of dyscrasia. Schistocytes
and the occasional spherocyte indicative of haemolysis.
Basophilic stippling and the occasional Howell-JollyBody.
The blood film confirms the thrombocytopaenia

Diagnosis
No clinical details however, given the patient’s location and in theabsence of any other clinical details, the blood film is suggestive ofSepsis with potential haemolysis, possible DIC.

Red Cell
Inclusions inPeripheral Blood

Monthly Morphology
QuizCan you identify thisAn overview of laboratory
findings

cell?:
Introduction

Red blood cells or Erythrocytes, are the most common cell type. Themorphology of a normal red cell is a bio-concave disc, lacking a nucleus
or organelles, with a central area of pallor. In general, red cells viewed under amicroscope will have a fairly uniform variation in size, shape and colour. Avariation in any of these features could indicate an abnormal red cellmorphology.
Red cell inclusions may arise in various sources. The correct identificationof these inclusions is extremely important for providing information
on metabolic, physiological and also pathogenic conditions which may
be effecting the patient.
The most commonly seen red cell inclusions are:

What does this Indicate?

Last month’s cells:

Basophilic Stippling​
Basophilic stippling, or punctate basophilia, appears in red cells as blue, fairly
evenly spread fine dots throughout the cytoplasm of the cell. The stippling can be
described as “fine” or “coarse”.
The stippling is due to spontaneous aggregation of ribosomal RNA in thecytoplasm of red cells. These aggregates then stain and are visible when using
routine haematology stains.
Basophilic stippling commonly arises due to one of two pathological processes:
Dyserythropoietic states- infiltrated Bone marrow, Haemoglobinopathy,
Pathways of RNA breakdown are impaired- due to poisoning by heavy metals,
classically lead or arsenic, or pyrimidine 5’ nuclease deficiency.

Howell-Jolly bodies

The blood film shows a red
cell with a Cabot ring and a
Howell-Jolly bodyIn this case, the patient wasdisplaying a myelodysplastic
picture with abnormalities
in all cell lines andcirculating
micromegakaryocytes.
For more on red cell
inclusions, see the main
article.

Identified by small blue/purple fragments which
are generally rounded in shape. Howell-jolly bodies
are usually single and centrally placed within the redcell with a relatively large size compared to otherinclusions. The colour and position reflects their origin
as non-functional nucleus fragments which have
Remained in the cell when it left the bone marrow.
The presence of these inclusions is commonly
associated with the absence of the spleen
or if the function of the spleen is impaired.in casessuch as coeliac disease, bone marrow transplant or pregnancy.

Pappenheimer Bodies
Pappenheimer bodies are basophilic iron-containing granules. Non-nucleated redcells containing pappenheimer bodies are known as siderocytes. These inclusions
occur because of aggregates of iron from the cytoplasm, or within themitochondria. A nucleated cell with the same inclusion is known as a sideroblast.
Pappenheimer bodies differ from basophilic stippling in that they
are a denser blue and the granules are courser and there are usuallyless of them and they are usually seen at the edge of the cell(see over for illustration).

Red Cell
Inclusions in
Peripheral BloodContinued from page 2…
Staining with Prussian blue will confirm the presence of siderocytes with a blue reaction,
if in sufficient amounts.
The presence of siderocytes may be connected to haemolytic anaemia- increased ironturnover can lead to siderocyte formation, or abnormal haem synthesis, where ironaccumulates in the RBC if haemoglobin production is hindered.

Heinz Bodies
Heinz bodies appear as small, round inclusions within the red cell, but are not visible
when using Romanowski dyes. They are visualised more clearly with the use ofsupravital staining such as methylene blue.

Other NewsQSP 2.0
Available now!
Options for a single
operator or site
license which allows
up to 10 concurrent
users

Bibliography
QSP August 2020
Hoffbrand’s Essential
Haematology 7th edition
Wiley Blackwell

Their presence on a blood film indicates oxidative damage to the haemoglobin
component molecules, often through oxidant damage by administered drugs.
Conditions associated with Heinz bodies include alpha-thalassaemia or haemolytic
anaemia and G6PD deficiency. Heinz bodies can also be present in chronic liver disease.

Editorial TeamConclusion

Kelly Duffy
Mandy Campbell
Shubham Rastogi

In conclusion, red cell inclusions are nuclear or
cytoplasmic aggregates which can be stained.
The presence of these inclusion bodies is almost
always indicative of some pathologicalabnormality and is therefore crucial that thecorrect identification.

Morphology Posters – Free of charge
HORIBA
Medicalhaveproduced
twoposters; Haematopoiesis, anillustrated chart of cell development, andMorphological abnormalities of red bloodcells.
These are available Free of Charge as highresolution PDF files for printing locally –they look particularly good in A2 size.
If you would like to receive the files, pleasecontact
International
MarketingCommunications atwebmaster.med@horiba.com

About us
HORIBA UK Limited
Kyoto Close
Moulton Park
Northampton, UKNN3 6FL
HORIBA MedicalParc Euromédecine,
390 Rue du Caducée,
34790, France
www.horiba.com/medical