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(A) Bone marrow aspirate smear demonstrates myeloid hyperplasia (elevated myeloid: erythroid ratio = 7.5: 1) (40x, Wright-Giemsa). (B) Neutrophil proliferation from myelocyte to segmented forms without dysplasia (50x, Wright-Giemsa).
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Toxic granulations were seen in neutrophils (Fig. 1A and B).
(A) Megakaryocytes appeared normal. (B) Only minor small/hypolobulation on a subset of cells (50x, Wright-Giemsa).
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The majority of megakaryocytes were normal in size and morphology, with only minor hypolobulation on a subset of cells (Fig. 2A and B).
(A) Markedly elevated myeloid: erythroid ratio with increased number of neutrophils, particularly mature segmented forms (40x, hematoxylin and eosin). (B) Myeloperoxidase immunohistochemistry stain demonstrates myeloid hyperplasia (20x, IHC stain).
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The bone marrow core biopsy was hypercellular for age, with a cellularity estimated at 75%-85% with neutrophilic proliferation and adequate megakaryocytes (Fig. 3A). Immunohistochemical staining performed on the core biopsy showed predominance of myeloperoxidase-positive myeloid cells, without any increase in cluster of differentiation-34 (CD34)-positive cells (Fig. 3B).
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