PMC9938677_01
Images of Patient's Bone Marrow Biopsy. Images of the Wright's stain bone marrow aspirate smears show the typical abnormalities seen in Pearson's syndrome characterized by cytoplasmic vacuolization and megaloblastoid changes of erythroid precursors (A, B) and frequent basophilic stippling and abnormal hemoglobinization of orthochromatic normoblasts (C, D). Prussian blue iron stain highlights increased storage iron with ringed sideroblasts (E), also typically present in this subtype of congenital sideroblastic anemia. Image F shows an H&E section of the core biopsy with slightly decreased marrow cellularity, which can progress to aplastic anemia, a late complication of this disease.
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FIG1
Bone marrow biopsy revealed ringed sideroblasts, cytoplasmic vacuolization, dysmyelopoiesis, dyserythropoiesis, and 60% cellularity (normal range: 50%-70%), concerning mitochondrial diseases like Pearson syndrome (Figure 1).