Basophilic stippling Information and Courses from MediaLab, Inc.

The normal RBC count (4.84 x 1012/L) in this case, together with the decreased hemoglobin (8.4 g/dL) and MCV (59 fl) is an indicator of ineffective erythropoeisis that often points to thalassemia.The RBC morphology shows slight hypochromic microcytosis with codocytes, schizocytes, and basophilic stippling. Schizocytes form by several mechanisms, one being the removal of rbc inclusions.This patient's elevated bilirubin correlates with her presentation of sclera icterus; and her splenomegaly is consistent with increased rbc destruction.The Hb electrophoresis demonstrated a normal pattern, initially, but the unstable Hemoglobin H was revealed upon repeat electrophoresis with reduced incubation time. Hemoglobin H is the result of beta globin chain tetramer formation due to the insufficient supply of alpha globin chains in alpha thalassemia intermedia.People with Hemoglogin H disease (alpha thalassemia intermedia) usually have a normal life expectancy without treatment. However, hemolysis may lead to moderate anemia that may be treated with splenectomy.

In the center of this field is a red cell containing small blue granules throughout the cell. This is an example of fine basophilic stippling.

Coarse basophilic stippling is present in the cell in the center of this slide. The granules are larger and more prominent than those seen in fine stippling.

Fine basophilic stippling is associated with increased red cell production and is commonly seen when there is increased polychromatophilia. Coarse basophilic stippling is seen in megaloblastic anemia and other forms of severe anemias, lead poisoning, and thalassemia. Coarse basophilic stippling indicates impaired hemoglobin synthesis, probably due to the instability of RNA in the young cell.

Another example of coarse basophilic stippling is seen on this slide.

In contrast to the granular appearance of the basophilic stippling seen in the previous two slides, the polychromatophilic cell in the center of this slide is smooth in appearance and bluish-gray in color.

Jaundice was recognized in a day-old infant. Notice particularly the size variation (anisocytosis) of the erythrocytes on the infant's peripheral smear. What does this observation mean? Does it provide immediate information that might serve as guidance in expediting diagnosis and treatment? Note that normal-sized red blood cells, microcytes, microspherocytes, macrocytes, and nucleated red blood cells are all present. Red cell variations are expected findings in healthy neonates, but the variations here are exaggerated. Hyposplenic functional features may appear, including acanthocytes, spherocytes, and possibly Howell-Jolly bodies, especially if hemolysis is particularly vigorous. A high (3-7%) reticulocyte count is not unusual during the first three or four days after birth, however, the marrow in this jaundiced infant is proliferating vigorously in response to hemolysis. A call for more red cells is urgent. Immature red cells (in the form of nucleated red cells) and red cells with stippling of RNA (basophilic stippling) are readily identified. Red cell maturation sequence has not been totally processed in the marrow nor is all residual red cell debris removed by the spleen. In the lower photograph are reticulocytes stained by supravital stain (new methylene blue). Basophilic stippling (specks of RNA) stains with both supravital stains and with routine Wright-Giemsa stain.

Poikylocytosis that includes tear-drop shaped erythrocytes, schistocytes, and target cells is present in both the upper and lower photographs. In addition, macrocytes are present, two of which (one in each field) have coarse basophilic stippling. The stippling may represent abnormal hemoglobin synthesis. These stippled erythrocytes remain in circulation in the absence of pitting by a spleen.