Red blood cells

Red blood cell (RBC) inclusions which may be seen in the peripheral blood film in various conditions.

• The reticulocyte RNA and Heinz bodies are only demonstrated by supravital staining (e.g. with new methylene blue).
• Heinz bodies are oxidized denatured haemoglobin.
• Siderotic granules (Pappenheimer bodies) contain iron. They are purple on conventional staining but blue with Perls’ stain.
• The Howell–Jolly body is a DNA remnant.
• Basophilic stippling is denatured RNA.

RBC Inclusions

Normal peripheral blood smear

High power view of a normal peripheral blood smear. Several platelets (black arrows) and a normal lymphocyte (blue arrow) can also be seen. The red cells are of relatively uniform size and shape. The diameter of the normal red cell should approximate that of the nucleus of the small lymphocyte; central pallor (red arrow) should equal one-third of its diameter.

Macroovalocytes in vitamin B12 deficiency

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Peripheral smear shows marked macroovalocytosis in a patient with vitamin B12 deficiency. In this case teardrop cells are an advanced form of macroovalocytes.

Elliptical red cells in hereditary elliptocytosis

Peripheral blood smear from a patient with hereditary elliptocytosis shows multiple elliptocytes.

Schistocytes