A 40 year old male had undergone splenectomy 20 years ago. Peripheral blood smear examination would show the presence of –
## **Core Concept**
The question tests the understanding of the consequences of splenectomy on the peripheral blood smear. The spleen plays a crucial role in filtering the blood, storing red blood cells, and removing old, damaged red blood cells and other foreign particles. After splenectomy, certain changes occur in the blood due to the absence of these splenic functions.
## **Why the Correct Answer is Right**
The correct answer, Howell-Jordan bodies, are inclusions within red blood cells that represent remnants of nuclear material. Normally, the spleen would remove these inclusions from the circulation. In the absence of the spleen, such as after splenectomy, these inclusions can persist within the red blood cells, making their presence a characteristic finding in the peripheral blood smear of asplenic patients.
## **Why Each Wrong Option is Incorrect**
- **Option A:** Target cells are seen in conditions like hemoglobinopathies (e.g., thalassemia, sickle cell disease) and are not directly related to the absence of the spleen.
- **Option B:** Heinz bodies are inclusions within red blood cells composed of denatured hemoglobin. While they can be seen in various conditions, their presence is not specifically indicative of asplenia; rather, they are more related to oxidative stress.
- **Option D:** Schistocytes are fragmented red blood cells often seen in conditions causing mechanical damage to red cells, such as microangiopathic hemolytic anemia, and are not a direct consequence of splenectomy.
## **Clinical Pearl / High-Yield Fact**
A key clinical pearl is that patients who have undergone splenectomy are at increased risk of infections, particularly those caused by encapsulated bacteria. The presence of Howell-Jordan bodies in a peripheral blood smear is a helpful diagnostic clue in patients with a history of splenectomy.
## **Correct Answer:** . Howell-Jordan bodies.