Pappenheimer bodies
Pappenheimer bodies are abnormal granules of iron found inside red blood cells on routine blood stain.[1] They are a type of inclusion body formed by phagosomes that have engulfed excessive amounts of iron. 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 are seen in diseases such as sideroblastic anemia, hemolytic anemia, and sickle cell disease. They can interfere with platelet counts when the analysis is performed by electro-optical counters.[2]
In 1945, Pappenheimer 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 [2].
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 [3] and later splenectomized
adults [4]. He coined the term ‘‘siderocyte’’ for
these red cells with Prussian blue-staining inclusions
[3]. Otto and Rezek described red cell inclusions in a
splenectomized patient and concluded that they were
Bartonella organisms [5], but Pappenheimer et al. reviewed
material from their patient and found that the
granules stained for iron [1]. Case found siderocytes
in stored blood [6] but was not convinced that these inclusions
were the same as described by Pappenheimer
[1]. 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’’ [7]. 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 [1,3,6]. Dacie and
Doniach argued that siderocyte iron was iron not
used for hemoglobin synthesis [2], and Douglas and
Dacie, noting a high percentage of marrow sideroblasts,
felt that the granule formation was a normal
process
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.[3]
References
- ↑ 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.
- ↑ "Definition: Pappenheimer bodies from Online Medical Dictionary". Retrieved 2008-03-23.
3. Lazarchick, J. "Pappenheimer Bodies." ASH Image Bank (2004); doi:10.1182/ashimagebank-2004-101168 (Retrieved from http://ashimagebank.hematologylibrary.org/cgi/content/full/2004/0722/101168 on January 17, 2011.) [1]
External links
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