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Updated: Mar 30, 2026

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Reticulum vs Inclusions: A Learning Experience in Haemoglobin H Disease.

Hanaganahalli B Sridevi1, Anupama Hegde2, Prashantha Balanthimogru3

  • 1Assistant Professor, Department of Pathology, Kasturba Medical College Manipal University , Mangalore, Karnataka, India .

Journal of Clinical and Diagnostic Research : JCDR
|November 12, 2015
PubMed
Summary

Haemoglobin H disease, a form of alpha-thalassaemia, can be misdiagnosed. HbH inclusions were mistaken for reticulocyte reticulum, highlighting the need for accurate diagnostic methods.

Keywords:
Brilliant cresyl blueGranulofilamentous reticulumHbH inclusionsHigh performance liquid chromatography

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Area of Science:

  • Hematology
  • Genetics
  • Red blood cell disorders

Background:

  • Haemoglobin H (HbH) disease, a variant of alpha-thalassaemia, is defined by HbH inclusions in erythrocytes.
  • Diagnosis typically involves identifying these inclusions via specific staining techniques.

Observation:

  • A 31-year-old male presented with insidious anemia and splenomegaly.
  • Peripheral smear showed microcytic hypochromic anemia with spherocytes and polychromasia.
  • HbH inclusions were initially misidentified as reticulocyte reticulum on vital stain, leading to an erroneously high reticulocyte count.

Findings:

  • Accurate identification of HbH inclusions is crucial for diagnosing Haemoglobin H disease.
  • High-performance liquid chromatography (HPLC) confirmed the presence of HbH inclusions.
  • Distinguishing HbH inclusions from reticulocyte reticulum is essential for correct diagnosis.

Implications:

  • Misinterpretation of HbH inclusions can lead to diagnostic errors and delayed treatment.
  • This case underscores the importance of careful microscopic examination and advanced diagnostic tools.
  • Accurate diagnosis of alpha-thalassaemia variants ensures appropriate patient management and genetic counseling.