PAPPENHEIMER BODIES (SIDEROTIC GRANULES)

DESCRIPTION
Pappenheimer bodies (siderotic granules) are small, irregular magenta inclusions seen along the periphery of red
cells. They usually appear in clusters, as if they have been gently placed on the red cell membrane. Their presence on a Wrights
or a supravital stained peripheral smear is presumptive evidence for the presence of iron. However, the Prussian blue stain is the
confirmatory test for determining the presence of these inclusions. These bodies/granules in RBCs are nonheme iron, resulting
from an excess of available iron throughout the body. Even though Pappenheimer bodies and siderotic granules are the same
inclusion, they are designated differently depending on the stain used.
The inclusions are termed Pappenheimer bodies, when seen in a Wrightstained smear and siderotic granules
when seen in Prussian blue or other kinds of iron stain. The explanation for the difference in terminology is that Romanowsky
stains visualize Pappenheimer bodies by staining the protein matrix of the granule, whereas Prussian blue stain is
responsible for staining the iron portion of the granule.
Once the presence of siderotic granules has been confirmed by iron stains, the cells in which they are found are termed
siderocytes. Siderocytes containing a nucleus are described as sideroblasts and are commonly seen in sideroblastic anemias.
Sideroblasts exhibiting numerous siderotic granules found within the mitochondria forming a ring around at least one-third of the
nucleus, are labeled as pathologic ringed sideroblasts.
CLINICAL SIGNIFICANCE
Siderocytes are seen in any condition in which there is iron overloading such as hemochromatosis or hemosiderosis.
They may also be seen in the hemoglobinopathies (e.g., sickle cell anemia and thalassemia) and in patients following
splenectomy.
REFERENCES
Bull B.S., Herrmann P.C. (2010). Chapter 29. Morphology of the Erythron. In J.T. Prchal, K. Kaushansky, M.A. Lichtman, T.J. Kipps, U.
Seligsohn (Eds),Williams Hematology, 8e. Retrieved October 11, 2013 from http://www.accessmedicine.com/content.aspx?
aID=6119772.
Harmening, D. (2009). Clinical hematology and fundamentals of hemostasis (5th ed.). Philadelphia, PA: F. A. Davis Co..

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18 VALDEZ, DENNIS BRYAN A.

BMLS III-A