Difference Between Basophilic Stippling and Pappenheimer Bodies

The key difference between basophilic stippling and pappenheimer bodies is that the granules in basophilic stippling do not contain iron while pappenheimer bodies contain iron and they stain with Prussian blue.

Erythrocyte inclusions are a result of different types of anaemia and other conditions. Basophilic stippling and pappenheimer bodies are two examples of several clinically significant erythrocyte inclusions. Basophilic stippling is the presence of numerous basophilic granules in the cytoplasm of erythrocytes. Pappenheimer bodies are also erythrocyte granules containing irons.

CONTENTS

1. Overview and Key Difference
2. What is Basophilic Stippling 
3. What are Pappenheimer Bodies
4. Similarities Between Basophilic Stippling and Pappenheimer Bodies
5. Side by Side Comparison – Basophilic Stippling vs Pappenheimer Bodies in Tabular Form
6. Summary

What is Basophilic Stippling?

Basophilic stippling is the presence of numerous basophilic granules in the cytoplasm of erythrocytes. It is also known as punctate basophilia. It is a frequent manifestation of hematologic disease in the peripheral blood. In fact, it is a result of the disturbed erythrocyte formation process or disturbed erythropoiesis and erythrocyte maturation.  The basophilic granules are RNA residues that contain aggregates of ribosomes, degenerating mitochondria and siderosomes. However, unlike pappenheimer bodies, granules do not contain iron. Hence, they are negative with Perls’ acid ferrocyanide stain for iron.

In lead poisoning, basophilic stippling can be seen. In lead poisoning, RNase or ribonuclease do not degrade ribosomes. Hence, incomplete or failure of ribosomal degradation leads to precipitation of ribosomes or ribosomal remnants in circulating erythrocytes, causing basophilic stippling. Apart from lead, basophilic stippling can be an indicator of various heavy metal toxicities. Moreover, basophilic stippling is associated with Thalassemia, Hemolytic anaemia, megaloblastic anaemia, myelodysplastic syndrome.

What are Pappenheimer Bodies?

Pappenheimer bodies are a type of erythrocyte inclusions that contain iron. They are small debris or iron-containing granules that are normally destroyed before erythrocytes enter the peripheral circulation in a healthy person with a normal spleen. Therefore, pappenheimer bodies are seen in patients who don’t have a spleen (post-splenectomy),. Moreover, pappenheimer bodies can be found in patients having sideroblastic anaemia, myelodysplastic syndrome (MDS), congenital dyserythropoietic anaemia and thalassemia.

Prussian blue (iron stain) can confirm the presence of pappenheimer bodies in our peripheral blood smear. They appear as small blue granular and irregularly shaped inclusions.  Wright-Giemsa stained blood smear also can show pappenheimer bodies.

What are the Similarities Between Basophilic Stippling and Pappenheimer Bodies?

• Erythrocytes contain basophilic granules in both basophilic stippling and pappenheimer bodies.
• Both are erythrocyte inclusions.
• These aggregates precipitate in the cytoplasm of erythrocytes.
• Both can be examined in peripheral blood smears.
• Lead poisoning and thalassemia are common reasons for both inclusions.

What is the Difference Between Basophilic Stippling and Pappenheimer Bodies?

Basophilic stippling is the presence of numerous basophilic granules throughout the cytoplasm of erythrocytes in a peripheral blood smear. Pappenheimer bodies, on the other hand, are abnormal basophilic granules of iron found inside red blood cells. Basophilic granules in basophilic stippling do not contain iron while pappenheimer bodies contain iron. So, this is the key difference between basophilic stippling and pappenheimer bodies.

Basophilic stippling shows negative results for Perls’ acid ferrocyanide stain test, while pappenheimer bodies show positive results. Erythrocyte inclusions of basophilic stippling are aggregates of ribosomes and fragments of ribosomal RNA/ribonuclear proteins while pappenheimer bodies are ferritin aggregates, or mitochondria or phagosomes containing aggregated ferritin. Thus, this is also a difference between basophilic stippling and pappenheimer bodies.

The below infographic summarizes the differences between basophilic stippling and pappenheimer bodies.

Summary – Basophilic Stippling vs Pappenheimer Bodies

Basophilic stippling is the presence of numerous basophilic granules distributed through the cytoplasm of erythrocytes. These granules are basically aggregates of ribosomes and fragments of ribosomal RNA/ribonuclear proteins. On the other hand, pappenheimer bodies are basophilic granules that contain iron. They are mainly ferritin aggregates, or mitochondria or phagosomes containing aggregated ferritin. The key difference between basophilic stippling and pappenheimer bodies is that basophilic granules formed in basophilic stippling do not contain iron while pappenheimer bodies contain iron.

Reference:

1. Sanchez, John, and David Lynch. “Histology, Basophilic Stippling”. Ncbi.Nlm.Nih.Gov, 2020, Available here.
2. “Pappenheimer Bodies”. En.Wikipedia.Org, 2020, Available here.

Image Courtesy:

1. “Basophilic stippling 2” By Prof. Erhabor Osaro – Own work (CC BY-SA 4.0) via Commons Wikimedia

2. “Pappenheimer bodies smear 2015-08-31” By Paulo Henrique Orlandi Mourao – Own work (CC BY-SA 4.0) via Commons Wikimedia