Peripheral blood smear shows Howell-Jolly bodies and acanthocytes. What is the most likely interpretation?

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Multiple Choice

Peripheral blood smear shows Howell-Jolly bodies and acanthocytes. What is the most likely interpretation?

The key idea is that red blood cell features on a smear can reflect spleen function. Howell-Jolly bodies are DNA remnants that the spleen normally filters out. When the spleen is absent or not working well—such as after splenectomy—these nuclear remnants remain in circulating RBCs. Acanthocytes, or spur cells, are also more likely when the spleen isn’t filtering abnormal cells properly. Put together, these two findings point to post-splenectomy changes or hyposplenia. Other conditions would present with different patterns: iron deficiency typically shows microcytosis and hypochromia without Howell-Jolly bodies; megaloblastic anemia shows macrocytosis with hypersegmented neutrophils and macro-ovalocytes; thrombocytopenia concerns platelets rather than RBC morphology.

The key idea is that red blood cell features on a smear can reflect spleen function. Howell-Jolly bodies are DNA remnants that the spleen normally filters out. When the spleen is absent or not working well—such as after splenectomy—these nuclear remnants remain in circulating RBCs. Acanthocytes, or spur cells, are also more likely when the spleen isn’t filtering abnormal cells properly. Put together, these two findings point to post-splenectomy changes or hyposplenia.

Other conditions would present with different patterns: iron deficiency typically shows microcytosis and hypochromia without Howell-Jolly bodies; megaloblastic anemia shows macrocytosis with hypersegmented neutrophils and macro-ovalocytes; thrombocytopenia concerns platelets rather than RBC morphology.

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