Howell-Jolly (HJ) bodies are nuclear fragments that are normally removed by the spleen. Hence, their presence is usually associated with hyposplenism or a previous splenectomy. They may also be seen in megaloblastic anemias, hemolytic anemias, thalassemia, alcoholism, and sickle cell anemia.
Appearance
Howell-Jolly bodies are densely staining round purple inclusions in the cytoplasm of a red blood cell, usually appearing singularly.
Lookalikes
Pappenheimer bodies are another type of basophilic inclusion. However, pappenheimer bodies are smaller than HJ bodies and usually appear in clusters.
Stain can precipitate on the slide. When this precipitate overlays a red blood cell, it can look like an inclusion. If stain precipitate is noted on the slide, try looking in a different area or remake the slide to check for inclusions. Precipitate is irregular in shape and will also appear outside the red blood cell.
Platelets can sometimes sit on top of a red blood cell, appearing as though they are an inclusion. However, these overlying platelets have a sort of “halo” around them. They can be easily compared to the other platelets in the smear for identification.
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