Howell jolly body

The American William Howell and the Frenchman Justin Jolly were the first to describe the Howell-Jolly corpuscles named after them at the end of the late 19th and beginning of the 20th century respectively. However, it was only after the middle of the 20th century that the mechanisms of formation of the Howell-Jolly corpuscles could be understood and the corpuscles could be distinguished from basophilic puncta (Fakoya 2024 / Sears 2012).

The Howell-Jolly bodies are nuclear remnants in erythrocytes, so-called chromatin remnants, which typically occur in asplenia (Herold 2020).

Howell-Jolly bodies are nuclear fragments. They are medium-sized, cytoplasmic, round inclusions in erythrocytes and consist of DNA. They show the same staining properties as a nucleus. (Bain 2015).

Normally, they are removed from the spleen and do not appear in the peripheral blood. Only in the case of asplenia or a maturation or dysplasia disorder are they visible in the peripheral smear (Kasper 2015). Only in newborns do they represent a normal finding due to the functional immaturity of the spleen (Bain 2015).

If Howell-Jolly bodies are not found after a splenectomy, this is an indication of secondary spleens (Herold 2020).

• Howell- Jolly corpuscles are found in peripheral blood smears in patients with deficient spleen function or asplenia (Adekbenro 2024). They can also be found in:
• Post splenectomy
• Congenital asplenia
• Functional asplenia with sickle cell hemoglobinopathies
• sepsis
• alcoholism
• Lupus and other autoimmune diseases
• After bone marrow transplantation
• Bone marrow diseases such as myelodysplastic syndrome or malignant diseases with bone marrow infiltration
• Severe postpartum haemorrhage
• Herditary spherocytosis
• under chemotherapy
• Radiotherapy (Adekbenro 2024)
• Hemolytic or megaloblastic anemia
• Functional disorders of the spleen (Bain 2015)

Diseases that are only rarely associated with Howell-Jolly bodies include:

• Neoplastic diseases
• Certain gastrointestinal diseases such as coeliac disease, but also inflammatory bowel diseases
• High-dose corticosteroid therapy
• Splenic vascular thrombosis
• Post-methyldopa treatment
• Advanced amyloidosis (Adekbenro 2024)

Erythropoiesis is initiated by hematopoietic stem cells in the bone marrow and comprises the following stages of maturation:

• Proerythroblast
• Basophilic erythroblast
• Polychromatic erythroblast
• Orthochromatic erythroblast, also known as normoblast
• Reticulocyte

The reticulocyte finally loses its nucleus and enters the bloodstream. There it matures into a functional erythrocyte within 2 - 3 days. Defective erythrocytes or nuclear remnants are removed from the spleen by a process known as "pitting". During pitting, the red pulp of the spleen contains macrophages. These remove inclusions such as Howell-Jolly bodies from the erythrocytes without destroying the erythrocytes themselves. Pitting thus ensures that only mature, defect-free erythrocytes remain in the bloodstream (Adekbenro 2024).

Howell-Jolly bodies are found intraerythrocytically after a splenectomy, for example (Herold 2020).

• Sog. Howell-Jolly-like corpuscles in neutrophils (Rowe 2015)
• Basophilic spotting (Baum 2015)

1. Adekbenro O F, Amraei R (2024) Histology, Howell Jolly Bodies. StatPearls Treasure Island Bookshelf ID: NBK557489
2. Bain B J, Kreuzer K A (2015) The blood count: diagnostic methods and clinical interpretation. Walter de Gruyter Verlag Berlin / Boston 136
3. Baum H (2018) Basophilic spotting. Encyclopedia of Medical Laboratory Diagnostics. eMedipedia doi: https://www.springermedizin.de/emedpedia/detail/lexikon-der-medizinischen-laboratoriumsdiagnostik/basophile-tuepfelung?epediaDoi=10.1007%2F978-3-662-49054-9_494
4. Fakoya A O, Amraei R (2024) Histology, Howell Jolly Bodies. StatPearls Treasure Island. Bookshelf ID: NBK557489
5. Herold G et al (2020) Internal medicine. Herold Publishing House 32, 46, 135
6. Kasper D L, Fauci A S, Hauser S L, Longo D L, Jameson J L, Loscalzo J et al. (2015) Harrison's Principles of Internal Medicine. Mc Graw Hill Education 81e- 5
7. Rowe R G, Esrick E (2015) Howell- Jolly- like bodies in neutrophils. Blood. 125 (17) 2729 doi: 10.1182/blood-2015-02-626796
8. Sears D A, Udden M M (2012) Howell- Jolly bodies: a brief historiacal review. Am J Med Sci. 343 (5) 407 - 409