This document discusses various types of inclusion bodies that can occur within red blood cells, including Pappenheimer bodies, Howell-Jolly bodies, Heinz bodies, Cabot rings, and basophilic stippling. It provides details on the composition, appearance, causes, associated diseases, and diagnosis of each type of inclusion body. The document is presented by Group 6 to Miss Mehreen and serves to explain the different inclusion bodies that can be found in red blood cell analysis.

2. P R E S E N T E D B Y G R O U P 6
P R E S E N T E D T O M I S S M E H R E E N
Red blood cell inclusion

3. Introduction
 Inclusion bodies are those things that just appear in
cells and.. don’t really do anything. They’re just
included within the cell, for some purpose
 Typically, inclusion bodies are nuclear or
cytoplasmic aggregates of stainable substance,
usually proteins
 In RBC it is indication of some pathological
conditions

4. Introduction
 These bodies are never enclosed by a membrane and
serve as storage vessels.
 Glycogen, which is a polymer of glucose, is stored as
a reserve of carbohydrate and energy.
 it is useful to understand each inclusion body that
can occur within a red blood cell.

5. Contt…
 Following are the inclusion bodies with in RBC
 Howell-Jolly Body
 Heinz Body
 Pappenhemier Body
 Basophilic Stippling
 Cabot Ring

6. Pappenheimer Body
 Pappenheimer bodies are abnormal inclusions of
iron found inside RBC on a routine blood stain
 Formed by phagosomes that have engulfed excessive
amounts of iron
 Pappenheimer bodies are basophilic erythrocytic
inclusions usually Located at the periphery of the cell
 They appear as dense, blue-purple granules within
the red blood cell
 1 or 2 in number

7. Causes
 Pappenheimer bodies are most likely caused by
accelerated red cell division or impaired hemoglobin
synthesis

8. Lab diagnosis
 Can be visible with Wright or Giemsa stain
 Prussian blue is more useful for identification and
differentiation
 Cells containing Pappenheimer bodies can be confused
with late reticulocytes but it can not take prussian blue
stain
 They also stain with Romanowsky stains because of co-
precipitation of ribosomes
 Blood cell morphology
 Reticulocyte count
 MCV
 Blood film

9. Diseases Associated
 Splenectomy
 Hemolytic Anemia
 Sideroblastic Anemia
 Megaloblastic Anemia
 Hemoglobinopathies
 The exact cause of Pappenheimer bodies in these
diseases is unknown.

11. HOWELL-JOLLY BODIES
 DEFINITION:Histopathologic findings of basophilic
nuclear remenants in circulating erythrocytes
 TERMINOLOGY:Micronucleated Reticulocytes
 SIZE:1 micronmeter in diameter
 APPEARANCE:Small rounded,dense purple granules

12. Cont…
 COMPOSITION:
1. Deoxyribonucleic acid (DNA)
2. Nuclear remenants
 SITES:
1. Circulating erythrocytes
2. Erythroid precursors in bonemarrow
 ASSOCIATED WITH:Rapid or abnormal RBCs
formation

13. Contt…
 PATHOPHYSIOLOGY:
1. During Maturation in bonemarrow .Erythrocytes
normally expels nuclei
2. But sometimes small portion of DNA remains

15. contt…
 CONDITIONS:
1. Autospleenectomy due to sickle cell anemia
2. Hereditary spherocytosis
3. Megaloblastic anemia
4. Myelodysplastic syndrome .
5. Severe haemolytic anemia
6. Spleenectomy
 DIAGNOSIS:
1. Peripheral blood smear
2. Wright stain (methylene blue + eosine)
3. Remenants of nucleus (DNA) observes

16. Heinz Body
• H E I N Z B O D I E S A R E I N C L U S I O N S
W I T H I N R E D B L O O D C E L L S C O M P O S E D
O F D E N A T U R E D H E M O G L O B I N .
• H E I N Z B O D I E S A P P E A R A S S M A L L R O U N D
I N C L U S I O N S W I T H I N T H E R E D C E L L
B O D Y .

17. Contt…
 Heinz bodies are formed by damage and denaturing
to the hemoglobin component of red blood cells,
most commonly by oxidative stress, but also possibly
by genetic abnormalities in hemoglobin.
 Typically, during oxidative damage to hemoglobin,
an electron is transferred from the hemoglobin to
oxygen, resulting in the formation of a reactive
oxygen species (ROS). This ROS can lead to severe
damage within the cells, and can even cause lysis of
the entire cell.

18. Contt…
 The ROS denatures portions of the hemoglobin,
causing the to precipitate and produce Heinz Bodies,
which becomes an antigenic agent. Thus,
macrophages detect the antigen and remove the
damaged portions of the cell, its damaged membrane
and the denatured hemoglobin (now called the Heinz
Body).

20. Causes
 G6PD deficiency
 NADPH Deficiency
 Chronic Liver Disease
 Alpha Thalassemia
 Hyposplenism and Splenectomy

21. Cabot ring
 They are literally loop ,rings or figure 8 types
structure that are located with in the cytoplasm of
RBC.
 They are typically colored red purple under the
Wright stain
 They are quite rare
 They are simple microtubular remnants of mitotic
tubules that are involve in mitosis

22. DISEASES ASSOCIATED WITH CABOT RING
 MYELODYSPLASTIC SYNDROME
 MEGALOBLASTIC ANEMIA
 LEAD POISONING
 HEAVY METAL POISONING
 LIVER DISEASES

23. DIGNOSIS
 RARE CONDITION
 CHECK THE MORPHOLOGY OF RED BLOOD
CELL

25. Basophilic Stippling
 Basophilic stippling is also referred to
as punctuate *dots* basophilia
 Diseases Associated:
 can be divided into
 1 fine basophilic stippling
 polychromatophilia.
 2 coarse *rough* basophilic stippling.
 lead poisoning, and thalassemia
 impaired hemoglobin synthesis
 Stained by Wright stain