PMC3118059_01
(a) Pancytopenia peripheral smear. (b, c) Pelger-Heut anamoly. Peripheral smear. (d) Hypocellular marrow-cell block preparation H and E, 10x
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F1
Pancytopenia [Figure 1a] was persistent on every visit and the peripheral smear showed normocytic and macrocytic RBCs, leukopenia, hypogranular and pseudo Pelger-Huet neutrophils [Figure 1b and 1c], which were characteristic with relative lymphocytosis and no blasts in the peripheral smear; the platelet count was reduced. The bone marrow aspiration smears and cell block preparation showed severe hypocellularity (<20% for his age) [Figure 1d].
(a) Dyserythropoiesis with multinucleation in BMA. (b) Binucleated form. (c) Dysmegakaryopoiesis-cell block H and E, 40x. (d) dysmegakaryopoiesis BMA
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F2
Sparse erythroid cells with dyserythropoiesis [Figure 2a and 2b], minimal dysmyelopoietic (hypogranular and hyposegmented myeloid cells - 10%) and dysmegakaryopoietic (hypolobated and micromegakaryocytes [Figure 2c and 2d] features were evident with blasts <5% and absence of fibrosis in biopsy sections.
(a) Lymphoid infiltrate in BMA. (b) Lymphoid infiltrate in BMB (H and E, 40x)
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F3
On follow-up within few months, because of persistent pancytopenia, the patient was subjected for repeat bone marrow study, where the smear and section showed cellular marrow with diffuse infiltrate of mature lymphocytes (60%) [Figure 3a and b] with no evidence of improved hematopoiesis.