RBC inclusions

Question 1

Also known as punctate, characterized by irregular, dark blue to purple granules evenly distributed within an RBC

Answer 1

Basophilic stippling

Question 2

Content found in basophilic stippling

Answer 2

Aggregated RNA

Question 3

Stains used to visualize basophilic stippling

Answer 3

Wright stain (deep blue to purple), supravital stain

Question 4

Associated with lead poisoning (plumbism/saturnism), arsenic poisoning, pyrimidine-5’-nucleotidase deficiency, anemias with impaired hemoglobin synthesis (thalassemia), refractory anemias, alcoholism, megaloblastic anemias

Answer 4

Basophillic stippling

Question 5

Type of stippling observed in plumbism, disorders with impaired hemoglobin synthesis, megaloblastic anemia, and severe anemia.

Answer 5

Coarse stippling

Question 6

Characterized by dark blue irregular granules in Prussian blue iron staining and pale blue clusters in Wright staining

Answer 6

Siderotic granules (Pappenheimer bodies)

Question 7

Content of siderotic granules

Answer 7

Intracytoplasmic collections of iron

Question 8

Stains used to visualize siderotic granules

Answer 8

Perl’s reagent through Prussian blue reaction

Question 9

Conditions associated with siderotic granules

Answer 9

Sideroblastic anemias (dimorphic peripheral blood picture), thalassemia, hemochromatosis or hemosiderosis

Question 10

Stains to visualize Pappenheimer bodies

Answer 10

New Methylene Blue, Wright stain

Question 11

Howell-Jolly bodies: typical size, shape, and color

Answer 11

<1 μm, round, blue to purple

Question 12

Composition of Howell-Jolly bodies

Answer 12

Nuclear chromatin (DNA)

Question 13

Stains for Howell-Jolly bodies

Answer 13

Wright stain, New Methylene Blue, Feulgen reaction

Question 14

Conditions associated with Howell-Jolly bodies

Answer 14

Megaloblastic anemias, after splenectomy, thalassemia

Question 15

Cabot rings: appearance and composition

Answer 15

Threadlike purple-blue loops or rings, remnants of the mitotic spindle

Question 16

Stains for Cabot rings

Answer 16

Wright stain, Supravital stain

Question 17

Conditions associated with Cabot rings

Answer 17

Megaloblastic anemias, refractory anemia, lead poisoning

Question 18

Positive Feulgen reaction indicate in RBC inclusion?

Answer 18

Presence of DNA (Histochemical stain reaction for DNA)

Howell-Jolly bodies

Question 19

Location and appearance of Heinz bodies in RBCs

Answer 19

Eccentric, large, round, blue to purple materials along the inner RBC membrane

Question 20

Composition of Heinz bodies

Answer 20

Denatured and precipitated hemoglobin

Question 21

Stains used to visualize Heinz bodies

Answer 21

Supravital stains (e.g., BCB, NMB, Methyl violet, Crystal violet)

Question 22

Why are Heinz bodies not visible on Wright stain?

Answer 22

They can dissolve during the staining process

Question 23

Conditions associated with Heinz bodies

Answer 23

G-6-PD deficiency, drug-induced hemolytic anemias (DIHA), unstable hemoglobin disease

Question 24

Examples of unstable hemoglobin variants associated with Heinz bodies

Answer 24

Hb Köln, Hb Casper/Southampton, Hb Genova, Hb Gun Hill, Hb M-Saskatoon, Hb Bristol, Hb Torino, Hb Seattle

Question 25

Favism: related condition and population susceptibility

Answer 25

Sensitivity to fava beans; occurs mainly in people of Mediterranean origin and in the Chinese with G-6-PD deficiency

Question 26

Result of favism in G-6-PD deficiency

Answer 26

Severe hemolytic episode

Question 27

Small, multiple, evenly distributed granular greenish-blue bodies in RBCs

Answer 27

Hb H inclusion bodies

Question 28

Composition of Hb H inclusion bodies

Answer 28

Precipitated Hb H (4 β-globin chains, denatured β-globin chains)

Question 29

Stains for visualizing Hb H inclusion bodies

Answer 29

Supravital stains (e.g., BCB, NMB)

Question 30

Appearance of RBCs with Hb H inclusion bodies

Answer 30

Pitted golf ball appearance

Question 31

Condition associated with Hb H inclusion bodies

Answer 31

Hb H Disease (a subtype of alpha thalassemia)

Question 32

Examples of protozoan parasites found in RBCs

Answer 32

Malaria, Babesia spp.

Question 33

Associated feature of malaria-infected RBCs

Answer 33

Schuffner’s dots (eosinophilic stippling)

Question 34

Stains used for protozoan parasites in RBCs

Answer 34

Wright stain, Giemsa stain

Question 35

Grades for polychromatophilia, helmet cells, dacryocytes, acanthocytes, schistocytes, and spherocytes

Answer 35

1+ = 1 to 5 per field, 2+ = 6 to 10 per field, 3+ = greater than 10 per field

Question 36

Grades for poikilocytosis, ovalocytes, elliptocytes, burr cells, bizarre-shaped RBCs, target cells, and stomatocytes

Answer 36

1+ = 3 to 10 per field, 2+ = 11 to 20 per field, 3+ = greater than 20 per field

Question 37

Another name for rouleaux

Answer 37

Pseudoagglutination

Question 38

Appearance of rouleaux under the microscope

Answer 38

Stacks of coins

Question 39

Cause of rouleaux formation

Answer 39

Serum protein abnormality (increased globulin or fibrinogen)

Question 40

Condition where rouleaux is commonly observed

Answer 40

Multiple Myeloma (Plasma cell myeloma)

Question 41

Why should the thick part of the blood film be avoided for rouleaux observation?

Answer 41

Red blood cells overlap in the thick part, causing misinterpretation

Question 42

Grades for rouleaux formation

Answer 42

1+ = aggregates of 3 to 4 RBCs, 2+ = aggregates of 5 to 10 RBCs, 3+ = many aggregates with few free RBCs

Question 43

Effect of heavier cells on ESR

Answer 43

Faster fall in ESR

Question 44

How should sickle cells, basophilic stippling, Pappenheimer bodies, and Howell-Jolly bodies be graded?

Answer 44

Positive only

Question 45

Normal appearance or slight variation in erythrocytes: erythrocyte morphology grading

Answer 45

0

Question 46

Few abnormal erythrocytes: erythrocyte morphology grading

Answer 46

1+

Question 47

Moderately increased abnormal erythrocytes: erythrocyte morphology grading

Answer 47

2+

Question 48

Many abnormal erythrocytes in each microscopic field: erythrocyte morphology grading

Answer 48

3+

Question 49

Marked increase in abnormal erythrocytes throughout each microscopic field: erythrocyte morphology grading

Answer 49

4+