The cell indicated by the arrow is an E4 with three nuclei. It was observed in the bone marrow of a patient with myelomonocytic leukemia. The presence of multinucleated NRBCs, like this one, in the bone marrow is the hallmark of Di Guglielmo's syndrome. However, the syndrome is usually transitory and is a phase of a white cell leukemia. It is highly abnormal to have different sized nuclei in the same cell. In fact, it is rare to see even one binucleated red blood cell in a normal marrow.
Course Section: 05. Nucleated Red Blood Cells
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