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Potential role of Howell−Jolly bodies in identifying functional hyposplenism: a prospective single-institute study

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Abstract

Although patients with cancer and immunosuppression are at a risk of functional hyposplenism, how to detect it promptly remains unclear. Since hyposplenism allows erythrocytes with nuclear remnants (Howell−Jolly bodies [HJBs]) to appear in the peripheral blood, HJB detection by a routine microscopic examination may help identify patients with functional hyposplenism. This prospective study was thus performed to determine the underlying diseases in patients who presented with HJBs. Of 100 consecutive patients presenting with HJBs, 73 had a history of splenectomy. The remaining 27 had hematologic cancer (n = 6, 22%), non-hematologic cancer (n = 8, 30%), hepatic disorders (n = 4, 15%), premature neonates (n = 3, 11%), hemolytic anemia (n = 2, 7%), autoimmune disorders (n = 2, 7%) and miscellaneous diseases (n = 2, 7%), and their prior treatments included chemotherapy (n = 8, 30%), steroids (n = 7, 26%) and molecular-targeted therapy (n = 3, 11%). Among the 27 patients, 22 had computed tomography scans available: 3 (14%) had underlying diseases in the spleen, and the remaining 19 (86%) were all found to have a decreased splenic volume, including 11 (50%) with more than 50% of the ideal value. The present findings suggest that HJB detection identifies patients with potentially functional hyposplenism who should receive appropriate interventional treatment, such as vaccination and prophylactic antibiotics.

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Acknowledgements

We thank all of the members of Department of Clinical Laboratory, Aichi Medical University Hospital for performing routine microscopic examinations and all of the medical staff of Aichi Medical University Hospital who provided valuable assistance in caring for the patients in this study.

Funding

This study was supported by Grants from the Ministry of Education, Culture, Sports and Technology of Japan (#18K08343), the Ministry of Health, Labour and Welfare of Japan, and Sysmex Corporation. The funders played no role in the study design, data collection and analysis, the decision to publish or the preparation of the manuscript.

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Authors and Affiliations

  1. Department of Internal Medicine, Division of Hematology, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, 480-1195, Japan

    Yuya Nakagami, Kaori Uchino, Shohei Mizuno, Hidesuke Yamamoto, Ichiro Hanamura, Takayuki Nakayama & Akiyoshi Takami

  2. Department of Clinical Laboratory, Aichi Medical University Hospital, Nagakute, Aichi, Japan

    Yuya Nakagami, Megumi Enomoto, Takayuki Nakayama & Hiroya Tani

  3. Hematopoietic Cell Transplantation Center, Aichi Medical University Hospital, Nagakute, Aichi, Japan

    Kaori Uchino, Shohei Mizuno, Hidesuke Yamamoto, Ichiro Hanamura & Akiyoshi Takami

  4. Department of Radiology, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan

    Hiroaki Okada & Kojiro Suzuki

Authors
  1. Yuya Nakagami
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  11. Akiyoshi Takami
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Contributions

AT designed the study and acquired funding. YN collected data in cooperation with ME under the supervision of TN and HT HO and KS evaluated computed tomography scans of the spleen. SM, HY and IH were involved in the management of patients. AT and YN performed the statistical analysis and wrote the paper.

Corresponding author

Correspondence to Akiyoshi Takami.

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Conflict of interest

The authors declare no conflicts of interest in association with the present study.

Explanation of novelty

We capitalized on the fact that Howell-Jolly bodies (HJBs) can be detected by routine clinical microscopy due to hyposplenism, as discovered by Dr. Dameshek, the founder of Blood, when 100 consecutive HJB-positive patients were analyzed, all of whom had underlying splenic diseases or a reduced splenic volume suggestive of functional hyposplenism, except for splenectomized cases. This study is this first to show that the HJB detection can easily and promptly screen patients with potential functional hyposplenism at risk of serious infections, and its usefulness should be recognized again.

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Nakagami, Y., Uchino, K., Okada, H. et al. Potential role of Howell−Jolly bodies in identifying functional hyposplenism: a prospective single-institute study. Int J Hematol 112, 544–552 (2020). https://doi.org/10.1007/s12185-020-02925-7

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  • DOI: https://doi.org/10.1007/s12185-020-02925-7

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