Howell-Jolly Bodies

Created 17 January 2011.

Updated 16 January 2021 (incorporating Google Document of 6 March 2018 & updated to new format)

Last update 16 May 2024 (added a new case)

Meanwhile… down the microscope

Here’s something I saw down the microscope only the other day. Note the bizarre red cells (marked anisopoikilocytosis with macrocytes), the giant platelets, what *are* those white cells?....

And look at those red cells in the middle of the field

Howell-Jolly bodies are black circular inclusions seen in red cells (when using standard Lieshman staining). Named after William Henry Howell and Justin Marie Jolly they are nuclear remnants.

During normal erythropoesis (in the bone marrow) the red cell nucleus is expelled at the late erythroblast stage. Normally the nuclear expulsion is total, but in some cases a small portion of DNA remains. These are the Howell-Jolly bodies, and are then removed as the red cells pass through the spleen. Their presence in peripheral blood (in any significant number) is indicative of splenic inadequacy; either a damaged or absent spleen.

This is either primary (i.e. post splenectomy or traumatic splenic damage) or secondary to a range of conditions.

Interestingly the absence of Howell-Jolly bodies in health seems to be peculiar to humans. They are present (albeit in low numbers) in many other mammalian species; especially noticeable in cats and horses. 

Here’s one I saw in early 2024… with MCV 135 and folate <4.5 there’s Howell-Jolly bodies and right shifted (hypersegmented) neutrophils too.

Some More Expert Opinion…

My original blog entry

My original Google Document

https://www.gpnotebook.co.uk/simplepage.cfm?ID=-1825243106

https://stanfordmedicine25.stanford.edu/blog/archive/2016/Diagnose-the-cause-of-sepsis-from-one-cell-in-the-blood.html

http://www.eclinpath.com/hematology/morphologic-features/red-blood-cells/quick-guide/