What are the pathognomonic peripheral smear findings for Glucose-6-Phosphate Dehydrogenase (G6P) deficiency?

The pathognomonic peripheral smear findings for Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency are Heinz bodies and bite cells.

Heinz bodies are formed when hemoglobin is denatured due to oxidative stress, which occurs in individuals with G6PD deficiency when they are exposed to certain triggers like infections, certain foods (such as fava beans), or oxidative medications. These abnormal structures can be visualized in the red blood cells during a peripheral blood smear.

Bite cells, also known as degmacytes, arise as a result of splenic macrophages removing the Heinz bodies from the red blood cells. The removal process gives the cell a characteristic “bite” appearance. The presence of both Heinz bodies and bite cells is indicative of oxidative damage in the context of G6PD deficiency and serves as a key diagnostic feature.

Other options do not relate to G6PD deficiency. Smudge cells are typically associated with chronic lymphocytic leukemia. Auer rods are found in acute myeloid leukemia, while Reed Sternberg cells are classic for Hodgkin lymphoma. Thus, recognizing Heinz bodies and bite cells is crucial when evaluating potential G6PD deficiency in patients with hemolytic anemia.