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

Yuya Nakagami, Kaori Uchino, Hiroaki Okada, Kojiro Suzuki, Megumi Enomoto, Shohei Mizuno, Hidesuke Yamamoto, Ichiro Hanamura, Takayuki Nakayama, Hiroya Tani, Akiyoshi Takami

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


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.

Original languageEnglish
Pages (from-to)544-552
Number of pages9
JournalInternational Journal of Hematology
Issue number4
StatePublished - 1 Oct 2020
Externally publishedYes


  • Functional hyposplenism
  • Howell−Jolly body
  • Peripheral blood smear


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