What Are Heinz Bodies?

An Indicator of Red Blood Cell Damage

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Heinz bodies are small spots in red blood cells that are a sign of certain types of red blood cell damage. They can be observed when a sample of the damaged red blood cells is prepared with special stains and viewed with a microscope.

Heinz bodies can form because of oxidative damage, which occurs due to certain medical conditions, and sometimes because of exposure to toxins and medications. With Heinz body anemia you can have symptoms of anemia (low red blood cell number or function), as well as effects that may be associated with the cause.

Heinz bodies, also called Heinz-Ehrlich bodies, were named after the physician (Robert Heinz) who discovered them in the late 1800s. 

Lab professional looking at blood smear under microscope may find Heinz bodies

 Portra / Getty

What Are Heinz Bodies?

Heinz bodies look like small dark spots inside red blood cells. They form when hemoglobin molecules in the red blood cells break down due to oxidative damage. Hemoglobin is a red blood cell protein that binds to and carries oxygen to cells throughout the body.

Some conditions are known to cause hemoglobin to break down, forming Heinz bodies.

Significance

Heinz bodies are not a disease. Their presence is a diagnostic finding that signals a problem affecting hemoglobin and red blood cells.

Effects of Heinz Bodies

Heinz bodies can make the red blood cells fragile and prone to breaking down (hemolysis). This is the main reason that symptoms develop.

Complications associated with Heinz bodies include:

  • Heinz body anemia: Red blood cells that contain Heinz bodies cannot adequately carry oxygen. This causes anemia, a condition in which the body does not have enough healthy red blood cells. Symptoms of Heinz body anemia are the same as symptoms of most types of anemia and include low energy, dizziness, headaches, pale skin, irritability, rapid pulse, and shortness of breath.
  • Hemolytic anemia: Red blood cells that contain Heinz bodies tend to be broken down by the spleen. This process is hemolytic anemia—the breakdown of red blood cells. Hemolytic anemia causes severe symptoms of anemia, as well as possible fever, jaundice (yellowish discoloration of the skin and whites of the eyes), and brownish urine. It may also lead to organ failure.
  • Enlargement of the spleen: This condition can cause abdominal discomfort and diminished function of the spleen, and it can make the spleen susceptible to rupture.
  • Liver damage: Sometimes, the hemolytic anemia associated with Heinz bodies can cause liver damage and liver enlargement.

If you have Heinz bodies, you may also have other symptoms associated with its cause. For example, if it's triggered by an infection, you can also develop other complications of the infection.

Conditions Associated With Heinz Bodies

There are several different situations that can cause Heinz bodies to form. Certain blood disorders make the hemoglobin susceptible to breaking down, and some health issues may trigger Heinz body formation, even if a person does not have a predisposition to hemoglobin breakdown. 

Causes of Heinz bodies include:

  • Glucose 6 phosphate dehydrogenase (G6PD) deficiency: This hereditary condition is a lack of the G6PD enzyme, which helps metabolize certain substances, including sulfa drugs and fava beans. When a person is exposed to these substances, toxins cause hemoglobin and red blood cells to break down, leading to severe health problems.
  • Thalassemia: This hereditary condition is a defect in the hemoglobin molecule. It can be associated with hemoglobin breakdown and the presence of Heinz bodies, sometimes without any specific trigger.
  • Hemoglobin defects: Any condition associated with a defect in hemoglobin or a susceptibility to hemoglobin breaking down can lead to Heinz body formation.

Additionally, Heinz bodies can develop due to certain situations that may damage hemoglobin, even in people who do not have an underlying blood disorder. In these situations, all of the complications, including Heinz body anemia, can develop.

Situations that can cause Heinz bodies:

  • Chemical exposure, including dyes used for medical diagnostic tests
  • Medications such as phenazopyridine hydrochloride (used to treat urinary tract infections) or medications used for treating leprosy (an infection caused by a slow-growing bacteria)
  • Mineral deficiency
  • Infections

Recap

Certain triggers can cause anyone to develop Heinz bodies, but people who have blood disorders are more susceptible to this reaction.

Diagnosis

Heinz bodies are observed with a microscopic examination of a peripheral blood smear. To show Heinz bodies, a blood sample must be prepared and stained with methylene blue stain. This dye turns the denatured hemoglobin blue, making the Heinz bodies stand out with a darker appearance than the rest of the red blood cell.

This is not a standard test, but your healthcare provider will order it for you if you have signs and risk factors of Heinz body anemia. You can have more than one Heinz body in a red blood cell. With the special stain, they can appear bluish, and they appear near the outer portion of the red blood cells.

Heinz bodies can occur in humans, but they can also occur in some animals, and they may also be indicative of health issues that affect animals, such as toxin ingestion.

Other tests that you might have include:

  • Complete blood count (CBC): This is a common blood test that includes several different measurements, such as a red blood cell count, hemoglobin, and hematocrit (the percentage of your blood that is red blood cells by volume). Sometimes red blood cell count, hemoglobin, and hematocrit are lower than standard values with Heinz body anemia.
  • Bilirubin level: This component can be released into the blood due to red blood cell breakdown or liver damage, and it can be measured with a blood test.
  • Urinalysis (urine test): When a person has hemolysis, a urine sample may appear obviously red or brownish, or the sample may show red blood cells or bilirubin when examined with a microscope. 

Peripheral Blood Smear

Heinz bodies will not be apparent with the standard Wright stain of a peripheral blood smear. But the standard test may show bite cells or Howell-Jolly bodies, which are:

  • Bite cells: Red blood cells can look like they’ve had a bite taken from them after Heinz bodies form. This occurs when cells in the spleen act on the abnormal red cells.
  • Howell-Jolly bodies: These are the remnants of nuclei in the red blood cells. They are often present when the spleen is not functioning well or if the spleen has been removed. Other conditions that can cause the formation of Howell-Jolly bodies include sepsis (a severe whole-body reaction to a blood infection), heart disease, autoimmune diseases, and more.

Treatment

If your doctor identifies Heinz bodies in your blood, you may need treatment to manage anemia or other problems associated with your condition. Sometimes stopping the cause, such as the use of a medication, can resolve the problem as your own body replaces the damaged hemoglobin and red blood cells.

If you develop symptoms, you will need treatment with medical interventions, such as oxygen supplementation or blood transfusion.

You may also need treatment to manage the underlying condition. 

Summary

Heinz bodies are structures that are formed from the breakdown of hemoglobin in red blood cells. They occur due to oxidative damage from toxins, medications, or as a result of underlying G6PD deficiency or thalassemia.

Heinz bodies can cause red blood cells to break down, a condition described as Heinz body anemia. This causes low energy, dizziness, and other symptoms of anemia, and it can also cause jaundice and an enlarged spleen.

There is no specific treatment for Heinz bodies, but the cause can be treated, and sometimes treatment with blood transfusions and oxygen are needed while the body replenishes red blood cells.

A Word From Verywell 

If you have been told that you have Heinz bodies, you could have damage to your red blood cells. It is important that you understand the symptoms that can develop in association with Heinz bodies and that you tell your healthcare provider if you begin to develop any effects so they can treat you effectively.

When you recover, you can discuss a plan with your medical team for staying healthy and avoiding blood problems in the future.

Frequently Asked Questions

  • Are Heinz bodies visible in Wright stain?

    No, Heinz bodies cannot be seen with a standard Wright stain, which is what is typically used to examine blood smears. If the blood sample is prepared with methylene blue dye, Heinz bodies will show up as blue or violet against the rest of the red blood cell.

  • Do Heinz bodies resolve on their own?

    No, Heinz bodies don’t resolve. They are structures inside red blood cells that form when hemoglobin molecules are damaged by oxidation. They can cause red blood cell hemolysis (breakdown).

    But if the cause is not extensive, a person will be able to naturally replace the red blood cells with new cells that do not have Heinz bodies. 

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Schalcher TR, Borges RS, Coleman MD, et al. Clinical oxidative stress during leprosy multidrug therapy: impact of dapsone oxidation. PLoS One. 2014;9(1):e85712. doi:10.1371/journal.pone.0085712

  2. Hagag AA, Badraia IM, Elfarargy MS, Abd Elmageed MM, Abo-Ali EA. Study of glucose-6-phosphate dehydrogenase deficiency: 5 years retrospective Egyptian study. Endocr Metab Immune Disord Drug Targets. 2018;18(2):155-162. doi:10.2174/1871530317666171003160350

  3. Sagar CS, Kumar R, Sharma DC, Kishor P. DNA damage: beta zero versus beta plus thalassemia. Ann Hum Biol. 2015;42(6):585-8. doi:10.3109/03014460.2014.990921

  4. Mehler K, Oberthuer A, Weisshaar G, Valter M, Vierzig A, Eifinger F. Hemolytic anemia and methemoglobinemia in a preterm baby as a complication of antenatal intraamnial injection of toluidine blue. Klin Padiatr. 2013;225(5):263-5. doi:10.1055/s-0033-1333756

  5. Beri D, Singh M, Rodriguez M, Yazdanbakhsh K, Lobo CA. Sickle cell anemia and Babesia infection. Pathogens. 2021;10(11):1435. doi:10.3390/pathogens10111435

  6. Spada E, Perego R, Baggiani L, Proverbio D. Haematological and morphological evaluation of feline whole blood units collected for transfusion purposes. J Feline Med Surg. 2019;21(8):732-740. doi:10.1177/1098612X18798841

  7. Nakagami Y, Uchino K, Okada H, Suzuki K, et al. Potential role of Howell-Jolly bodies in identifying functional hyposplenism: a prospective single-institute study. Int J Hematol. 2020 Oct;112(4):544-552. doi:10.1007/s12185-020-02925-7

By Heidi Moawad, MD
Heidi Moawad is a neurologist and expert in the field of brain health and neurological disorders. Dr. Moawad regularly writes and edits health and career content for medical books and publications.