blood Sickle Cell Disease Articles

Swee Lay Thein, Jo Howard
Oct 25, 2018
Evans M. Machogu, Roberto F. Machado
Oct 25, 2018
Andria L. Ford, Dustin K. Ragan, Slim Fellah, Michael M. Binkley, Melanie E. Fields, Kristin P. Guilliams, Hongyu An, Lori C. Jordan, Robert C. McKinstry, Jin-Moo Lee, Michael R. DeBaun
Oct 18, 2018
Xin Miao, Soyoung Choi, Benita Tamrazi, Yaqiong Chai, Chau Vu, Thomas D. Coates, John C. Wood
Oct 11, 2018
Santosh L. Saraf, Maya Viner, Ariel Rischall, Rasha Raslan, Binal N. Shah, Xu Zhang, Jin Han, Michel Gowhari, Shivi Jain, Robert E. Molokie, Roberto F. Machado, James P. Lash, Victor R. Gordeuk
Oct 11, 2018

ASH ® Image Bank


A 26-year-old AF male with sickle cell disease who presented to the ER complaining of abdominal pain. His CBC at that time showed a hemoglobin of 7.2g/dL, WBC of 11.2k/uL and a platelet count of 360k/uL. His peripheral smear is show. Sickle cells are readily identified (intermediate-sized arrow) throughout the smear. A RBC with a Howell-Jolly body (small arrow) is also noted. Multiple irregular inclusions (large arrow) are present in many of the other RBC. These iron-containing granules are Pappenheimer bodies. A Prussian Blue is needed to confirm the presence of non-heme iron in these granules. Also note on this smear increased polychromatophilic cells and target cells.


A 22-year-old male with sickle cell disease (SCD) presented to the emergency department with a chief complaint of acute left lower extremity pain and a non-productive cough. PA and lateral chest roentograms were obtained revealing biconcave vertebral defects or "fish mouth" vertebrae. Developing in greater than seventy percent of patients with SCD, the depicted vertebral changes result from infarction of the vertebral bodies and thinned trabeculae allowing hyperplastic marrow to expand into the central vertebral space (solid arrows, Panels A and B). Debate exists regarding appropriate terminology as "fish" or "fish mouth" vertebrae. Though the appearance of the intervertebral disks resembles a fish mouth, the biconcave vertebral bodies are strikingly similar to a salmon’s vertebrae (dashed arrow, Panel C*).


Numerous sickled RBC's are present (small arrows). A single nucleated RBC is noted (large arrow). Of note is the absence of polychromasia.


Peripheral smear from a patient with sickle cell disease illustrates the spectrum of RBC findings in this disorder including sickle cells, polychromatophilic RBCs, target cells, and Howell-Jolly bodies.


In addition to the RBC findings noted in Fig. 1, this image shows a nucleated RBC (arrow).


Crescent-shaped sickle cells are noted (double arrow). Several RBCs with Howell-Jolly bodies are also present. One has two such inclusions (single arrow).


The Pappenheimer bodies are shown at high magnification. The inclusion in the RBC at the top center of the image has the appearance of a Howell-Jolly body.


My Say

Sickle cell disease has come full circle

Swee Lay Thein, MB, BS, FRCP, FRCPath, DSc, FMedSci
Professor of Molecular Haematology / Consultant Haematologist
King's College London School of Medicine / King's College Hospital
London, UK

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Feature Editor: Dr. Swee Lay Thein