Pappenheimer bodies are abnormal basophilic granules of

iron Iron () is a chemical element with symbol Fe (from la, ferrum) and atomic number 26. It is a metal that belongs to the first transition series and group 8 of the periodic table. It is, by mass, the most common element on Earth, right in f ...

found inside

red blood cell Red blood cells (RBCs), also referred to as red cells, red blood corpuscles (in humans or other animals not having nucleus in red blood cells), haematids, erythroid cells or erythrocytes (from Greek ''erythros'' for "red" and ''kytos'' for "holl ...

s on routine blood stain. They are a type of

inclusion body Inclusion bodies are aggregates of specific types of protein found in neurons, a number of tissue cells including red blood cells, bacteria, viruses, and plants. Inclusion bodies of aggregations of multiple proteins are also found in muscle cells ...

composed of

ferritin Ferritin is a universal intracellular protein that stores iron and releases it in a controlled fashion. The protein is produced by almost all living organisms, including archaea, bacteria, algae, higher plants, and animals. It is the primary ' ...

aggregates, or

mitochondria A mitochondrion (; ) is an organelle found in the Cell (biology), cells of most Eukaryotes, such as animals, plants and Fungus, fungi. Mitochondria have a double lipid bilayer, membrane structure and use aerobic respiration to generate adenosi ...

phagosome In cell biology, a phagosome is a vesicle formed around a particle engulfed by a phagocyte via phagocytosis. Professional phagocytes include macrophages, neutrophils, and dendritic cells (DCs). A phagosome is formed by the fusion of the cell mem ...

s 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 Romanowsky staining, also known as Romanowsky–Giemsa staining, is a prototypical staining technique that was the forerunner of several distinct but similar stains widely used in hematology (the study of blood) and cytopathology (the study of di ...

because clumps of

ribosome Ribosomes ( ) are macromolecular machines, found within all cells, that perform biological protein synthesis (mRNA translation). Ribosomes link amino acids together in the order specified by the codons of messenger RNA (mRNA) molecules to ...

s 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 Sideroblastic anemia, or sideroachrestic anemia, is a form of anemia in which the bone marrow produces ringed sideroblasts rather than healthy red blood cells (erythrocytes). In sideroblastic anemia, the body has iron available but cannot incorpora ...

hemolytic anemia Hemolytic anemia or haemolytic anaemia is a form of anemia due to hemolysis, the abnormal breakdown of red blood cells (RBCs), either in the blood vessels (intravascular hemolysis) or elsewhere in the human body (extravascular). This most commonly ...

lead poisoning Lead poisoning, also known as plumbism and saturnism, is a type of metal poisoning caused by lead in the body. The brain is the most sensitive. Symptoms may include abdominal pain, constipation, headaches, irritability, memory problems, inferti ...

and

sickle cell disease Sickle cell disease (SCD) is a group of blood disorders typically inherited from a person's parents. The most common type is known as sickle cell anaemia. It results in an abnormality in the oxygen-carrying protein haemoglobin found in red blo ...

. They can interfere with platelet counts when the analysis is performed by electro-optical counters.

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.

History

In 1945,

Alwin Max Pappenheimer Jr. Alwin Max Pappenheimer Jr. (November 25, 1908 – March 21, 1995) was an American biochemist and immunologist. Pappenheimer was noted for his advances in the field of bacterial toxins and in particular for isolation and analysis of the diphth ...

''et al.'' described three patients whose red blood cells, after splenectomy, showed inclusions when stained with

Giemsa stain Giemsa stain (), named after German chemist and bacteriologist Gustav Giemsa, is a nucleic acid stain used in cytogenetics and for the histopathological diagnosis of malaria and other parasites. Uses It is specific for the phosphate groups of ...

Wright's stain Wright's stain is a hematologic stain that facilitates the differentiation of blood cell types. It is classically a mixture of eosin (red) and methylene blue dyes. It is used primarily to stain peripheral blood smears, urine samples, and bone marr ...

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 In histology, histopathology, and clinical pathology, Perls Prussian blue is a commonly used method to detect the presence of iron in tissue or cell samples. Perls Prussian Blue derives its name from the German pathologist Max Perls (1843–1881 ...

stain, and this atypical red blood cell is then known as a ''siderocyte''. Only the finding of ring (or ringed) sideroblasts characterizes

Sideroblastic anemia Sideroblastic anemia, or sideroachrestic anemia, is a form of anemia in which the bone marrow produces ringed sideroblasts rather than healthy red blood cells (erythrocytes). In sideroblastic anemia, the body has iron available but cannot incorpora ...

References

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

External links

Abnormal clinical and laboratory findings for RBCs {{pathology-stub