University of Virginia Health System

Heinz Body

Peripheral blood smear, Crystal Violet stain, 1000x

Definition:

Refractile red cell inclusions of variable size and usually eccentrically located and adhered to the red cell membrane. Seen only with supravital staining with crystal violet, brilliant cresyl blue or on a fresh, wet preparation of blood. Not seen on a Wright-Giemsa stain, but spherocytosis of varying degree, depending on the severity of the hemolysis, is usually present, and bite cells may be seen.

Pathobiology:

The inclusions are composed of denatured hemoglobin that occurs as a result of oxidative injury to the red cell. Oxidative injury to the red cell membrane also occurs.

Differential diagnosis:

• Red cell enzymopathies (usually a result of oxidant drug exposure or infection)
  • acute Heinz body hemolytic anemia, e.g. G-6PD deficiency
  • chronic nonspherocytic hemolytic anemia, e.g. pyruvate kinase deficiency
• Unstable hemoglobinopathies, e.g. Hb Gun-Hill
• Thalassemias

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