Dyserythropoiesis DysE

Morphological bone marrow DysE may include the presence of ringed sideroblasts, multinuclear fragments, bizarre nuclear shapes, internuclear bridging, mitosis, abnormal intensity of the chromatin or fine chromatin with asynchronous cytoplasm, and abnormal cytoplasmic features (intense basophilia, Howell-Jolly bodies, ghosted cytoplasm). Marked macrocytosis (at least 100 fmoles/L), basophilic stippling, anisocytosis, and poikilocy-tosis may be observed in the peripheral blood. Quantitative changes include the presence of ringed sideroblasts (exceeding 15 percent of all nucleated erythroid cells) and a number of megaloblastic erythroid precursors.

Normal marrow can have occasional erythroblasts, typically with fewer than five granules. Pathologic sideroblasts have five or more granules and are termed ringed sideroblasts if the granules cover more than one-third of the nuclear rim (Plate 14-22). Ringed sideroblasts and increased iron stores can be found in any of the MDS, but they are characteristic of RARS.

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