Shown here is a 400x magnification of a bone marrow of a patient with primary refractory anemia. The patient had normal serum levels of B12 and folate and an increased serum iron saturation. The previous slides demonstrated megaloblastic dyserythropoiesis, but there are other forms that are abnormal but not megaloblastic. The morphologic signs of dyserythropoiesis and ineffective erythropoiesis (failure of bone marrow with erythroid hyperplasia to deliver red cells to the peripheral blood) are multinucleated cells, karyorrhexis or fragmentation of the nucleus, abnormal mitoses, and nuclear budding. The chromatin may be decreased or increased and heavily clumped. The cytoplasm may be reduced, ragged, and crumpled, and it may contain vacuoles.
Course Section: 05. Nucleated Red Blood Cells
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