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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_2768_Библиотеки_им_академика_М_И_Перельмана
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CHAPTER 12
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INCLUSIONS IN ERYTHROCYTES
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SECTION 3 Erythrocytes
HOWELL-JOLLY BODIES
A
FIGURE 12.1A Howell-Jolly bodies (arrows).
COLOR: Dark blue to purple
SHAPE: Round to oval
SIZE: 0.5 to 1.5 μm
NUMBER PER CELL: Usually 1; may be multiple
COMPOSITION: DNA (deoxyribonucleic acid)
ASSOCIATED WITH: Splenectomy, hyposplenism, megaloblastic anemia, hemolytic anemia
B
FIGURE 12.1B Howell-Jolly bodies (arrows) in a patient
with sickle cell anemia.
CHAPTER 12 Inclusions in Erythrocytes
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BASOPHILIC STIPPLING
109
A
FIGURE 12.2A Basophilic stippling (arrows).
COLOR: Dark blue to purple
SHAPE: Fine or coarse punctate granules
NUMBER PER CELL: Numerous with fairly even distribution
COMPOSITION: RNA (ribonucleic acid)
ASSOCIATED WITH: Lead intoxication, thalassemia, abnormal heme synthesis
B
FIGURE 12.2B Basophilic stippling (arrows).
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SECTION 3 Erythrocytes
PAPPENHEIMER BODIES
Siderotic Granules
A
FIGURE 12.3A Pappenheimer bodies (arrows) with
Wright stain.
C
B
FIGURE 12.3B Pappenheimer bodies (arrows) with Wright stain.
(Courtesy George Girgis [CLS] Indiana University Health.)
COLOR: Light blue
SHAPE: Fine irregular granules in clusters
NUMBER PER CELL: Usually one cluster; may be
multiples; often at periphery of cell
COMPOSITION: Iron
ASSOCIATED WITH: Splenectomy, hemolytic
anemia, sideroblastic anemia, megaloblastic anemia, hemoglobinopathies
FIGURE 12.3C Siderotic granules with iron stain.
CABOT RINGS
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CHAPTER 12 Inclusions in Erythrocytes
111
A
FIGURE 12.4A Cabot ring (arrow).
COLOR: Dark blue to purple
SHAPE: Loop, ring, or gure eight; may look like beads on a string
NUMBER PER CELL: 1 to 2
COMPOSITION: Thought to be remnants of mitotic spindle
ASSOCIATED WITH: Myelodysplastic syndrome, megaloblastic anemia
NOTE: This is a rare nding. May be confused with malaria (see Fig. 21.1A).
B
FIGURE 12.4B Cabot ring: gure eight (arrow).
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SECTION 3 Erythrocytes
INCLUSIONS WITH SUPRAVITAL STAIN
Stained with New Methylene Blue
A
FIGURE 12.5A Reticulocytes.
CELL: Anuclear immature erythrocyte
COMPOSITION: Precipitated RNA
NUMBER: Two or more per cell
COLOR: Dark blue
ASSOCIATED WITH: Immature erythrocyte
NOTE: Supravital stains are taken up by living cells.
B
FIGURE 12.5B Heinz bodies.
CELL: Mature erythrocyte
COMPOSITION: Denatured hemoglobin
NUMBER: Single or multiple, generally membrane bound
COLOR: Dark blue to purple
ASSOCIATED WITH: Unstable hemoglobin, some
hemoglobinopathies, some erythrocyte enzyme
deciencies (e.g., glucose-6-phosphate dehydrogenase)
FIGURE 12.5C Hemoglobin H. (From the American Society for Hematology slide bank.)
CELL: Mature erythrocyte
COMPOSITION: Hemoglobin β chain tetramers
NUMBER: Multiple evenly dispersed inclusions described as “golf balls” or “raspberries”
COLOR: Dark blue
C
CHAPTER 12 Inclusions in Erythrocytes
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TABLE 12.1
Staining Qualities of Erythrocyte Inclusion Bodies
New Methylene
Wright-
Inclusion Composition
Howell-Jolly body DNA
Basophilic stippling RNA
Pappenheimer body Iron
Reticulocyte RNA 0
Cabot ring Remnant of mitotic spindle
Heinz body Unstable hemoglobin 0
Hemoglobin H
+, Positive; 0, negative. DNA, Deoxyribonucleic acid; NA, not applicable; RNA, ribonucleic acid.
β chain
Giemsa stain
+ +
+ +
+ + +
+ +
0
Blue (or other
supravital stain)
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Prussian
Blue (iron)
0
0
+
+
+
0
0
0
0
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CHAPTER 13
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DISEASES AFFECTING
ERYTHROCYTES
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SECTION 3 Erythrocytes
MICROCYTIC HYPOCHROMIC
IRON DEFICIENCY ANEMIA
A
FIGURE 13.1A Severe iron deciency anemia
(peripheral blood [PB] ×500).
FIGURE 13.1C Iron deciency anemia (bone marrow
[BM] ×1000; showing shaggy cytoplasm).
Peripheral Blood: Erythrocytes are hypochromic
and microcytic; large variation in size; possible
thrombocytosis
B
FIGURE 13.1B Iron deciency anemia (PB ×1000).
D
FIGURE 13.1D Prussian blue dye on bone marrow
aspirate smears (500 ×). Normal iron stores indicated at arrows (left). Absence of iron stores (right).
(From Keohane E.A., Smith L., Walenga J. (Eds.)
(2016). Rodak’s hematology: clinical principles and
applications. (5th ed.). St. Louis: Saunders Elsevier.)
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