What Do I Do When Red Blood Cell Inclusions Have Been Miside…
What Do I Do When Red Blood Cell Inclusions Have Been Misidentified? A 36-year-old woman with chronic alcoholism, liver disease, and pneumonia was admitted to the hospital. Her admission was for treatment of the pneumonia. Routine CBCs including differential were ordered daily to monitor her WBC during treatment. During evaluation of her peripheral smear, a shift to the left was observed. This is a term used to describe the presence of younger white blood cells from the bone marrow in response to infection and inflammation. On the second day after admission, the patient’s smear was being examined on the evening shift by a new laboratory graduate. She noted red blood cell inclusions and identified them as Howell-Jolly bodies, but she felt insecure about the identity of the inclusion, and no one was available to observe the inclusion. After consulting with the lead technologist, they reviewed the smear together to try to identify which inclusion was present. The student preliminarily identified the inclusions as Howell-Jolly bodies, which are single inclusion, DNA in origin, and usually located in the periphery of the red blood cell. Basophilic stippling was another possibility, but stippling is RNA in origin and seen throughout the red blood cells; the new employee noted that the inclusion was located toward the periphery of the cell. The next possibility was Pappenheimer bodies, small inclusions that look like grape clusters. Pappenheimer bodies are usually iron deposits in the form of either ferritin or hemosiderin. What should/can be done to accurately report/confirm the RBCs’ inclusions?