PMC8175405_01
A, B, and C: (A) blood smear showing anisopoikilocytosis and one morphologically unremarkable neutrophil; B and C: bone marrow biopsy showing a erythroid predominance associated with dysmegakaryopoiesis, the latter better appreciated at higher magnification (C).
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A repeated BM examination two months later, showed normal for age BM cellularity (30%), 2% blasts and significant (>10%) dysplastic changes in the megakaryocytic series (Fig. 1).
A, B, and C: (A) blood smear showing red blood cells with anisopoikilocytosis and neutrophilic leukocytosis with dysplastic neutrophils displaying a combination of hyposegmented nuclei (i.e. pseudo-Pelger-Huet anomaly) and abnormal nuclear hypersegmentation, in addition to 10% immature granulocytic forms (note one blast and one myelocyte); B, bone marrow aspirate showing myeloid predominance with dysgranulopoiesis. The marrow is markedly hypercellular (90%) due to a granulocytic proliferation. Presence of dysmegakaryopoiesis can be appreciated in the corresponding biopsy (C).
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The neutrophilic granulocytes showed severe dysplasia (Fig. 2). A third BM examination was performed that showed a hypercellular BM (90% cellularity) with a marked neutrophilic proliferation characterized by dysgranulopoiesis (>10%) and dysmegakaryopoiesis (>10%) (Fig. 2).