Dyserythropoiesis

FIGURE 18–1A Oval macrocytes (PB ×1000).

FIGURE 18–1B Dimorphic erythrocyte population (PB ×500).

FIGURE 18–1C Nucleated erythrocyte with abnormal nuclear shape (PB ×1000).

Evidence of dyserythropoiesis (Figure 18-1, A-I) may include any or all of the following: oval macrocytes, hypochromic microcytes, dimorphic erythrocyte population, erythrocyte precursors with more than one nucleus, abnormal nuclear shapes, nuclear bridging, uneven cytoplasmic staining, and/or ringed sideroblasts.

FIGURE 18–1D Erythrocyte precursor with partial loss of nucleus (PB ×1000).

FIGURE 18–1E Erythrocyte precursor with abnormal nuclear shape (bilobed, with one nucleus in mitosis, demonstrating asynchrony; BM ×1000).

FIGURE 18–1F Erythrocyte precursor with three uneven nuclei (BM ×1000).

FIGURE 18–1G Erythrocyte precursor with nuclear bridging (BM ×1000).

FIGURE 18–1H Erythrocyte precursors with uneven cytoplasmic staining (BM ×1000).

FIGURE 18–1I Ringed sideroblasts (iron stain, BM ×1000). Ringed sideroblasts are precursor RBCs containing at least five iron granules that circle at least one third of the nucleus.

Dysmyelopoiesis

FIGURE 18–2A Abnormal granulation, agranular segmented neutrophil.

FIGURE 18–2B Abnormal nuclear shapes, neutrophil with circular (donut) nucleus.

FIGURE 18–2C Abnormal nuclear shapes, neutrophil with hypersegmented nucleus; also exhibits hypogranulation.

Normal neutrophil for comparison.

Evidence of dysmyelopoiesis (Figure 18-2, A-E) may include any or all of the following: abnormal granulation, abnormal nuclear shapes, persistent basophilic cytoplasm, and/or uneven cytoplasmic staining and pseudo-Pelger-Hüet cells (see Figure 14-1).

FIGURE 18–2D Persistent basophilic cytoplasm.

FIGURE 18–2E Uneven cytoplasmic staining with uneven granulation. This characteristic does not necessarily imply malignancy, but is often found in MDS.

Dysmegakaryopoiesis

FIGURE 18–3A Giant platelet.

FIGURE 18–3B Platelet with hypogranulation.

FIGURE 18–3C Platelet with hypergranulation.

FIGURE 18–3D Giant platelet.

FIGURE 18–3E Circulating micromegakaryocyte. Hypogranular pseudo-Pelger-Hüet cell at arrow.

FIGURE 18–3F Large mononuclear megakaryocyte (BM ×1000).

FIGURE 18–3G Abnormal nuclear shape, uneven number of nuclei (BM ×1000).

FIGURE 18–3H Abnormal nuclear shapes, separate nuclei (BM, original magnification ×1000).

Evidence of dysmegakaryopoiesis (Figure 18-3, A-H) may include any or all of the following: giant platelets, platelets with abnormal granulation, circulating micromegakaryocytes, large mononuclear megakaryocytes, and abnormal nuclear shapes.

All photomicrographs are ×1000 original magnification with Wright-Giemsa staining unless stated otherwise.