Hematology & immune disorders

Peripheral blood smear morphology


RBC inclusions

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Last staff update: 4 October 2023

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Cite this page: Zhao X. RBC inclusions. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/bonemarrowhowelljollybodies.html. Accessed June 16th, 2024.
Definition / general
Howell-Jolly bodies
  • Basophilic nuclear remnants, i.e. clusters of DNA in circulating erythrocytes as well as erythroid precursors
  • Named after William Henry Howell and Justin Marie Jolly (Am J Med Sci 2012;343:407)
Howell-Jolly bodies
  • Also called "micronucleated reticulocytes"
Howell-Jolly bodies
  • Circulating erythrocytes
  • Erythroid precursors in bone marrow
Howell-Jolly bodies
  • During maturation in bone marrow, erythrocytes normally expel their nuclei but sometimes a small portion of DNA remains
  • In healthy people, Howell-Jolly bodies are pitted out by spleen during erythrocyte circulation
  • Howell-Jolly bodies persist in those with functional hyposplenia or asplenia:
    • Autosplenectomy due to sickle cell anemia
    • Celiac disease (~10% have splenic atrophy)
    • Hereditary spherocytosis
    • Megaloblastic anemia
    • Myelodysplastic syndrome (MDS)
    • Radiation therapy
    • Severe hemolytic anemia
    • Splenectomy following trauma
Case reports
Howell-Jolly bodies
Howell-Jolly bodies
  • By itself, does not need to be treated
Microscopic (histologic) description
Howell-Jolly bodies
  • Peripheral blood smear preparation with standard Wright-Giemsa stain shows smooth, round basophilic (purple) particles in eosinophilic erythrocytes
  • Single Howell-Jolly bodies may be seen in megaloblastic anemia, hemolytic anemia, postsplenectomy
  • Multiple Howell-Jolly bodies in a single cell usually indicates megaloblastic anemia or other abnormal erythropoiesis
Peripheral smear images

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Inclusions of nuclear chromatin remnants

Electron microscopy description
  • EM confirms Howell-Jolly bodies are intracellular, located beneath red cell membrane, which have small circular membrane defect in their concavity beneath the membrane bulge (Arch Intern Med 1973;131:236)
Differential diagnosis
  • Basophilic stippling (punctate basophilia):
    • Irregular basophilic granules within erythrocytes, fine to coarse, deep blue with Wright stain, due to abnormal instability of RNA in young red cell
    • Fine stippling is associated with increased polychromatophilia, increased production of red cells
    • Coarse stippling is associated with lead poisoning, other diseases of impaired hemoglobin synthesis, megaloblastic anemia, other severe anemia
  • Howell-Jolly-like bodies:
    • Detached nuclear fragments in cytoplasm of neutrophils that resemble Howell-Jolly bodies
  • Malarial stippling:
    • Fine minute granules in enlarged erythrocytes that harbor Plasmodium vivax
    • With Wright stain, these "Sch├╝ffner granules" stain purplish red; may be so numerous that they hide the parasites
  • Pappenheimer bodies:
    • Iron containing granules of siderocytes which may stain with Wright stain
    • Usually few in number in a given red cell
    • Less commonly seen in peripheral blood except after splenectomy
  • Siderocytes:
    • Red cells with inorganic iron containing granules, as demonstrated by Prussian stain for iron
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