Basophilic stippling

Q: Basophilic stippling can be seen in all of the following EXCEPT? - select one

A) Hb C / Hb SC disease

B) Thalassemia

C) Alcohol abuse

D) Lead poisoning

E) Hereditary pyrimidine 5'-nucleotidase deficiency

Answer: A

The objective of this question is to continue to emphasize the basic teachings learned in early medical school to apply at the bedside later as a clinician! The slide-preparation training in early lab classes in med school remains highly relevant in practice later on.

Basophilic stippling refers to blue granules of various sizes dispersed throughout the RBC cytoplasm. They are actually precipitated ribosomes. They can be seen in thalassemia, excess alcohol use, lead and heavy metal poisoning, and in hereditary pyrimidine 5'-nucleotidase deficiency.

Hb C disease or Hb SC disease usually has hemoglobin crystals, especially if the blood sample has become dehydrated before the peripheral smear is made. The crystals are usually hexagonal or rhomboid in shape.

#hematology

#pathology

References:

1. Munoz J, Guo Y. Basophilic stippling: a lead to the diagnosis. Blood. 2011 Nov 17;118(20):5370. doi: 10.1182/blood-2010-12-320911. Erratum in: Blood. 2014 Jan 9;123(2):302. PMID: 22204026.

2. Cheson BD, Rom WN, Webber RC. Basophilic stippling of red blood cells: a nonspecific finding of multiple etiology. Am J Ind Med. 1984;5(4):327-34. doi: 10.1002/ajim.4700050409. PMID: 6202140.