RBC INCLUSIONS

What are Howell-Jolly bodies?

A. Iron particles
B. Denatured hemoglobin
C. DNA remnants
D. RNA remnants

C. DNA remnants

Howell-Jolly bodies are usually found where inside the RBC?

A. Directly in the center
B. Eccentrically/off to the side
C. Outside the RBC
D. Inside the nucleus

B. Eccentrically/off to the side

How many Howell-Jolly bodies may commonly be seen in an RBC according to your notes?

A. 10–20
B. 5–10
C. 1–2
D. 50–100

C. 1–2

Which organ is especially important when thinking about Howell-Jolly bodies?

A. Kidney
B. Liver
C. Spleen
D. Pancreas

C. Spleen

Which of the following is associated with Howell-Jolly bodies?

²Splenectomy

²Thalassemia

²Hemolytic anemia

²Megaloblastic anemia

²Functional hyposplenia

What is the characteristic appearance of basophilic stippling?

A. Large purple circles
B. Tiny blue dots throughout the RBC
C. A ring around the RBC
D. A bull's-eye appearance

B. Tiny blue dots throughout the RBC

Basophilic stippling is associated with remnants of:

A. DNA only
B. Hemoglobin only
C. Ribosomes/RNA
D. Iron only

C. Ribosomes/RNA

The stipples in basophilic stippling are made of what

ribonucleoprotein and Mitochondrial remnants

Which condition is classically associated with basophilic stippling in your notes?

Lead intoxication

Thalassemia.

Heme synthesis problems

What is the easiest way to distinguish basophilic stippling from Howell-Jolly bodies?

Basophilic stippling = RNA/ribosomes; Howell-Jolly = DNA.

You see an RBC covered with many tiny blue dots. What RBC inclusion are you looking at?

A patient has lead intoxication. Which RBC inclusion would you expect to remember?

Basophilic stippling

What do siderotic granules represent?

A. DNA
B. RNA
C. Iron
D. Denatured hemoglobin

C. Iron

Where are siderotic granules commonly located?

A. RBC center only
B. RBC periphery
C. Outside the RBC
D. Inside the nucleus

B. RBC periphery

What color are siderotic granules described as in your notes?

A. Green
B. Yellow
C. Magenta
D. Black

C. Magenta

Clusters of siderotic granules are presumptive for:

A. DNA
B. Iron
C. RNA
D. Calcium

B. Iron

Which stain confirms that the granules contain iron?

A. Wright's stain
B. Prussian Blue
C. Gram stain
D. Methylene blue

B. Prussian Blue

If iron-containing granules are seen with Wright's stain, they are called:

A. Howell-Jolly bodies
B. Heinz bodies
C. Pappenheimer bodies
D. Cabot rings

C. Pappenheimer bodies

You see small irregular magenta granules near the edge of an RBC. What are you thinking about?

Siderotic granules

A stain is performed and confirms that the granules contain iron. Which stain was most likely used?

Prussian Blue

A blood smear is stained with Wright's stain and shows iron-containing granules. What are they called?

Pappenheimer bodies

What is the difference between "presumptive for iron" and "confirmed iron"?

Presumptive means suspected; Prussian Blue confirmation proves the granules contain iron.

Conditions Associated With Siderotic Granules

•Sideroblastic anemia

•Hemochromatosis or Hemosiderosis

•Hemoglobinopathies such as Sickle cell or Thalassemia

•Splenectomy

What are Heinz bodies made of?

A. DNA
B. RNA
C. Denatured/precipitated hemoglobin
D. Iron

C. Denatured/precipitated hemoglobin

What happens to the RBC when Heinz bodies form?

A. It becomes more flexible
B. It becomes rigid and the membrane can become distorted
C. It becomes a target cell
D. It loses its nucleus

B. It becomes rigid and the membrane can become distorted

Heinz bodies may NOT be visible with which stain?

A. Wright's stain
B. Crystal Violet
C. Brilliant Cresyl Blue
D. Both B and C

A. Wright's stain

Which stain may help visualize Heinz bodies?

A. Crystal Violet
B. Gram stain
C. Prussian Blue
D. Wright's stain only

C. Prussian Blue

Which RBC enzyme deficiency is associated with Heinz bodies?

A. Pyruvate kinase
B. G6PD
C. Lactate dehydrogenase
D. Hexokinase

B. G6PD

what •Conditions include in Heinz boodies

•alpha-Thalassemic syndromes

•Glucose-6-phosphate dehydrogenase (G6PD) deficiency

•Chemical insult to RBC

What is the characteristic appearance of a Cabot ring?

A. Bull's-eye
B. Figure 8 or necklace-like structure
C. Teardrop
D. Sickle

B. Figure 8 or necklace-like structure

Cabot rings are best described as:

A. RBC fragments
B. RBC inclusions
C. WBC granules
D. Platelet clumps

B. RBC inclusions

Which substance is found in Cabot rings according to your notes?

A. Arginine-rich histone
B. DNA only
C. Denatured hemoglobin
D. RNA only

A. Arginine-rich histone

Cabot rings contain which type of iron according to your notes?

A. Hemoglobin iron
B. Non-hemoglobin iron
C. Free plasma iron
D. Ferritin only

B. Non-hemoglobin iron

Which anemia is associated with Cabot rings?

A. Megaloblastic anemia
B. Iron deficiency anemia only
C. Hemolytic anemia only
D. Aplastic anemia only

A. Megaloblastic anemia

Which thalassemia association is listed in your notes?

A. Thalassemia trait
B. Homozygous thalassemia
C. Alpha-thalassemia only
D. Beta-thalassemia trait only

B. Homozygous thalassemia

Cabot rings may be seen in patients who are:

A. Pre-splenectomy
B. Postsplenectomy
C. Before birth
D. Never without a spleen

B. Postsplenectomy

What are the THREE conditions listed in your notes that are associated with Cabot rings?

Megaloblastic anemia, homozygous thalassemia, postsplenectomy