Pappenheimer bodies

Pappenheimer bodies (Peripheral Blood / May-Grünwald Giemsa and Prussian blue stain)

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 post-splenectomy states & 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, the American Pathologist, Alwin Max Pappenheimer, (1878–1955) et al. described three patients whose red blood cells, after splenectomy, showed inclusions when stained with Giemsa or Wright stain [1]. They described these bodies as red–purple, usually coccoid, and adjacent to the cell membrane, and they demonstrated that the cells stained for iron with Prussian blue stain. They distinguished them from basophilic stippling, Howell-Jolly bodies, and overlying platelets but discussed in detail the possibility that they were Bartonella microorganisms. They considered infection also because their first two patients had prolonged, ultimately fatal, febrile illnesses and because they cultured organisms from the spleen of the third. However, the organisms did not stain for iron, and they were unable to induce illness or red cell inclusions in splenectomized animals. They concluded that the inclusions were not microorganisms. This was confirmed by Dacie and Doniach. Several other investigators had described siderotic granules in erythrocytes prior to Pappenheimer’s report. Gruneberg found Prussian blue-positive inclusions in red cells of human fetuses and later splenectomized adults . He coined the term ‘‘siderocyte’’ for these red cells with Prussian blue-staining inclusions. Otto and Rezek described red cell inclusions in a splenectomized patient and concluded that they were Bartonella organisms, but Pappenheimer et al. reviewed material from their patient and found that the granules stained for iron. Case found siderocytes in stored blood but was not convinced that these inclusions were the same as described by Pappenheimer. None of these authors, except Pappenheimer et al., identified the inclusions on Wright or Giemsa stained blood smears. This then was the original observation justifying the eponym. Two years later, McFadzean and Davis, though protesting that they had ‘‘no desire to add yet another eponym to medical literature,’’ referred to the inclusions as ‘‘Pappenheimer bodies’’ . They also identified the bodies in nucleated red cells of post-splenectomy patients, both in bone marrow and blood, and noted that the number of siderocytes in the blood increased markedly after splenectomy while the number of marrow nucleated red cells containing inclusions did not. In these early studies authors speculated whether siderotic granules arose from a precursor of hemoglobin or a breakdown product and whether siderocytes were young or old erythrocytes . Dacie and Doniach argued that siderocyte iron was iron not used for hemoglobin synthesis, and Douglas and Dacie, noting a high percentage of marrow sideroblasts, felt that the granule formation was a normal process

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 is then known as siderocytes. Only the finding of ring (or ringed) sideroblasts characterizes Sideroblastic anemia.

References

  1. ↑ 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.
  2. ↑ "Definition: Pappenheimer bodies from Online Medical Dictionary". Retrieved 2008-03-23.
  3. ↑ Canada, editors, John P. Greer, MD, Professor, Departments of Medicine and Pediatrics, Divisions of Hermatology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee ; Daniel A. Arber, MD, Professor and Vice Chair, Department of Pathology, Stanford University, Director of Anatomic and Clinical Pathology Services, Stanford University Medical Center, Stanford, California ; Bertil Glader, MD, Professor, Departments of Pediatrics and Pathology, Stanford University Medical Center, Stanford, California, Lucile Packard Children's Hospital, Palo Alto, California ; Alan F. List, MD, Senior Member, Department of Malignant Hematology, President and CEO, Moffit Cancer Center, Tampa Florida ; Robert T. Means Jr., MD, PhD, Professor of Internal Medicine, Executive Dean, University of Kentucky College of Medicine, Lexington, Kentucky ; Frixos Paraskevas, MD, Professor of Internal Medicine and Immunology (Retired), University of Mantioba Medical School, Associate Member, Institute of Cell Biology-Cancer Care, Mantioba, Winnipeg, Mantioba, Canada ; George M. Rodgers, MD, Professor of Medicine and Pathology, University of Utah School of Medicine, Health Sciences Center, Medical Director, Coagulation Laboratory, ARUB Laboratories, Salt Lake City, Utah ; Editor Emeritus, John Foerster, MD, FRCPC, Professor and Physician Emertius, Winnipeg, (2014). Wintrobe's clinical hematology (Thirteenth edition. ed.). p. 8. ISBN 1451172680.

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]


  1. ↑ 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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