A 25-year-old woman of African descent has chronic hemolytic anemia. Blood smear shows target cells, irreversibly sickled cells, and Howell-Jolly bodies. The Howell-Jolly bodies indicate:

• A Iron deficiency from chronic hemolysis
• B Vitamin B12 deficiency complicating sickle cell disease
• C Intravascular hemolysis with hemoglobin precipitation
• D Functional asplenia from repeated splenic infarctions ✓

Explanation

Howell-Jolly bodies are nuclear remnants normally removed by the spleen. In sickle cell disease, repeated vaso-occlusive episodes cause progressive splenic infarction and autosplenectomy, resulting in functional asplenia. The inability to remove Howell-Jolly bodies from RBCs is a reliable indicator of this. This also explains the increased susceptibility to encapsulated organisms.

Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.