From the Guidelines
Basophilic granules in red blood cells (RBCs) are a significant indicator of abnormal erythropoiesis, suggesting the presence of residual ribosomal RNA, and their presence should prompt further investigation for underlying hematological disorders. The presence of these granules, which stain blue with basic dyes, is not normal in mature RBCs as ribosomes are typically eliminated during normal red cell maturation 1. Some key points to consider about basophilic granules in RBCs include:
- They serve as markers for certain hematological conditions, such as lead poisoning, where lead inhibits the enzyme pyrimidine 5'-nucleotidase, preventing RNA degradation.
- Basophilic stippling is commonly observed in hemoglobinopathies like thalassemia, sideroblastic anemia, and other conditions with dyserythropoiesis.
- The size and distribution of basophilic granules can vary, with coarse stippling often associated with more severe pathology than fine stippling.
- When observed during blood smear examination, these granules should prompt further investigation for underlying disorders affecting red cell production or maturation, as seen in myelodysplastic syndromes (MDS) 1. In the context of MDS, the presence of basophilic granules in RBCs may indicate dyserythropoiesis, which is a common feature of these disorders, and may require treatment with erythropoiesis-stimulating agents (ESAs) or other therapies, as outlined in the ESMO clinical practice guidelines for diagnosis, treatment, and follow-up of MDS 1.
From the Research
Basophilic Granules in RBC
- Basophilic stippling of red blood cells (BSC) is a nonspecific finding that can be seen in various conditions, including lead intoxication, malignant, rheumatologic, hematologic, cardiovascular, and other diseases 2.
- BSC are inclusions of aggregated ribosomes found only in red blood cells and may be confused with siderotic (iron) granules, Heinz Bodies, or reticulocytes 2.
- The presence of BSC is not specific to any particular disease and can be found in a small percentage of normal people, emphasizing that BSC is a nonspecific finding 2.
Iron Overload and Chelation Therapy
- Transfusional iron overload is a major concern in patients with transfusion-dependent thalassemia, and iron chelation therapy is necessary to prevent complications 3, 4, 5, 6.
- Iron accumulates in the liver, heart, and endocrine organs, leading to various complications, and chelation therapy removes accumulated iron and detoxifies iron 3, 4, 5, 6.
- Several iron chelators are available, including deferoxamine, deferiprone, and deferasirox, which can be used as monotherapy or in combination to tailor chelation to individual patient needs 3, 4, 5, 6.