Erythrocyte Disorders: Smear Case 3: Intracellular RBC Inclusions

G6PD deficiency

  • A ten-year-old boy came to a physician's attention because of recent jaundice and icteric sclerae.
  • The immediate laboratory work revealed: Hct 24%(normal 36%-47%), MCV 79.5 fl (normal 78-95fl),RDW 13%(normal 11.5-15.0%).
  • His blood smear findings are reflected in these photomicrographs. Note particularly the spherocytes in the upper picture. Some resemble a half-blister with the other half of the cell containing solidly-staining hemoglobin. These are called eccentrocytes.
  • When present, they should trigger a search for red cell hereditary G-6PD deficiency and the oxidant that triggered hemolysis.
  • These morphological findings are only clues; specific testing for G-6PD deficiency should be performed.
  • The blue arrows in the upper photomicrograph are directed toward solid-staining spherocytes in which the cell membrane is beaded by inclusions wrapped within the cell membrane, suggesting the remains of denatured hemoglobin.
  • Included on the smear is a target cell, several acanthocytes, a smudge cell, and a few schistocytes.
  • The lower photomicrograph is supravital staining of affected red blood cells, verifying the presence of Heinz bodies.
  • This disorder was first recognized during the Korean war in 10% of black American soldiers given the antimalarial drug primiquine.

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