The stippling is due to precipitation of ribosomal material. Ribosomal material is usually low in circulating red blood cells but may accumulate in a number of pathologic processes.
The appearance of basophilic stippling depends on:
(1) the amount of ribosomal material present
(2) the presence of abnormal ribosomal material
(3) the stain used (Wright-Giemsa is relatively insensitive compared to supravital stains or dark-field microscopy)
(4) how the smear is handled
The stippling may be described as fine or coarse. Coarse stippling is potentially significant.
Basophilic stippling can be seen with:
(1) lead poisoning
(2) other causes of sideroblastic anemia
(3) thalassemia and other hemoglobinopathies
(4) hereditary red cell enzyme deficiencies such as pyrimidine-5'-nucleotidase deficiency
(5) following splenectomy
(6) with myelodysplasia (which may overlap with sideroblastic anemia)
