Pappenheimer bodies in a patient with long-term alcohol use and post-splenectomy

This figure shows the blood smear from a patient who had long-term alcohol use and malnutrition and had undergone splenectomy years before for splenic rupture that was a complication of gastric surgery. Pappenheimer bodies are seen in approximately 20% of RBCs. Following B vitamin administration, improved nutrition, and alcohol avoidance, Pappenheimer bodies decreased to <10% of RBCs.

Pappenheimer bodies represent iron-containing granules inside RBCs. Mature RBCs containing Pappenheimer bodies are called siderocytes; nucleated RBC precursors containing iron are called sideroblasts. These cells can be identified with special stains for iron (Prussian blue, Perls). Siderocytes are more prominent in asplenic individuals.

• (A) Wright-Giemsa stain
• (B) Perls stain for iron