This is the bone marrow of a 53-year-old alcoholic with anemia (hemoglobin 9.8 gm/100 ml). The bone marrow revealed erythroid hyperplasia with megaloblastoid changes. The abnormal changes in the NRBCs included slightly larger than normal cells with more abundant cytoplasm and heavier nuclear chromatin than normal. There was a shift to younger forms in the granulocytic series. His serum B12 and folate levels were within normal limits. A diagnosis of refractory anemia was made. He failed to respond to pyridoxine treatment. Three years later he developed acute undifferentiated leukemia.
Course Section: 05. Nucleated Red Blood Cells
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