Pappenheimer bodies

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Pappenheimer bodies are abnormal basophilic granules of iron found inside red blood cells on routine blood stain.^[1] They are a type of inclusion body composed of ferritin aggregates, or mitochondria or phagosomes containing aggregated ferritin. They appear as dense, blue-purple granules within the red blood cell and there are usually only one or two, located in the cell periphery. They stain on a Romanowsky stain because clumps of ribosomes are co‐precipitated with the iron‐containing organelles.

A cell containing Pappenheimer bodies is a siderocyte. Reticulocytes often contain Pappenheimer bodies. They are mostly observed in diseases such as myelodysplastic syndrome (MDS), sideroblastic anemia, hemolytic anemia, lead poisoning and sickle cell disease. They can interfere with platelet counts when the analysis is performed by electro-optical counters.^[2]

Distinction with basophilic stippling

Pappenheimer bodies must be distinguished with other basophilic granules inside erythrocytes like the basophilic stippling. Contrary to the latter, they contain iron.^[3]

History

In 1945, Alwin Max Pappenheimer Jr. et al. described three patients whose red blood cells, after splenectomy, showed inclusions when stained with Giemsa stain or Wright's stain.^[4]

Diagnosis

Pappenheimer bodies are visible with a Wright and/or Giemsa stain. Confirmation of non-heme iron in the granules is made with a Perls' Prussian blue stain, and this atypical red blood cell is then known as a siderocyte.^[5] Only the finding of ring (or ringed) sideroblasts characterizes Sideroblastic anemia.

References

^ Sears DA, Udden MM (2004). "Pappenheimer bodies: a brief historical review". Am. J. Hematol. 75 (4): 249–50. doi:10.1002/ajh.20008. PMID 15054821.
^ "Definition: Pappenheimer bodies from Online Medical Dictionary". Retrieved 2008-03-23.
^ Greer, John P.; Arber, Daniel A.; List, Alan F.; Foerster, John (2014). Wintrobe's clinical hematology (Thirteenth ed.). Philadelphia. p. 8. ISBN 978-1451172683.{{cite book}}: CS1 maint: location missing publisher (link)
^ Pappenheimer, A. M.; Thompson, W. P.; Parker, D.; Smith, K. E. (1944). "Unidentified Inclusions within the Erythrocytes in Certain Gases of Febrile Anemia". Experimental Biology and Medicine. 56 (2): 145–148. doi:10.3181/00379727-56-14627P. S2CID 88228863.
^ "Medical Definition of SIDEROCYTE". www.merriam-webster.com. Retrieved 11 October 2020.

3. Lazarchick, J. "Pappenheimer Bodies." ASH Image Bank (2004); doi:10.1182/ashimagebank-2004-101168 (Retrieved from https://web.archive.org/web/20090106200424/http://ashimagebank.hematologylibrary.org/cgi/content/full/2004/0722/101168 on January 17, 2011.)^[1]

External links

Image from The New York Times

Blood film findings

Red blood cells

Size	Anisocytosis Macrocytosis Microcytosis
Shape	Poikilocytosis Membrane abnormalities Acanthocyte Codocyte Elliptocyte Hereditary elliptocytosis Spherocyte Hereditary spherocytosis Dacrocyte Echinocyte Schistocyte Degmacyte Sickle cell/drepanocyte Sickle cell disease Stomatocyte Hereditary stomatocytosis
Colour	Anisochromia Hypochromic anemia Polychromasia
Inclusion bodies	Developmental Howell–Jolly body Basophilic stippling Pappenheimer bodies Cabot rings Hemoglobin precipitation Heinz body
Other	Haemoconia Red cell agglutination Rouleaux

White blood cells

Lymphocytes	Reactive lymphocyte Smudge cell Russell bodies
Granulocytes	Hypersegmented neutrophil Arneth count Pelger–Huët anomaly Döhle bodies Toxic granulation Toxic vacuolation Critical green inclusion Alder–Reilly anomaly Jordans' anomaly Left shift
Other	Auer rod

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^ Sears DA, Udden MM (April 2004). "Pappenheimer bodies: a brief historical review". Am. J. Hematol. 75 (4): 249–50. doi:10.1002/ajh.20008. PMID 15054821.

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