PERIPHERAL BLOOD/BONE MARROW EXAMINATION:
Red blood cell morphology showed slight anisocytosis, slight poikilocytosis, with occasional teardrop and fragmented forms (Image 01 and Image 02). White blood cell morphology demonstrated mature neutrophils with slight toxic granulation and occasional cytoplasmic vacuoles. A bone marrow aspirate was performed. The aspirate smear was adequate with few cellular spicules present (Image 03). No core biopsy was done.
MICROSCOPIC DESCRIPTION OF MARROW ASPIRATE:
| Cell Type | Value | Mean | Age - Normal Range |
|---|---|---|---|
| Blasts | 1.7% | 0.4% | na |
| Promyelocyte | 10.3% | 1.6% | na |
| Myelocyte | 3.0% | 3.5% | na |
| Metamyelocyte | 5.0% | na | na |
| Band | 6.3% | 8.3% | na |
| Segmented Neutrophil | 13.3% | 8.1% | 3.7 - 11.5 |
| Eosinophil myelo/meta | 0.3% | 3.9% | na |
| Eosinophil Band | 2.0% | na | na |
| Eosinophil Seg. | 0% | na | na |
| Basophil | 0% | 0.1% | na |
| Monocytes | 3.3% | 5.0% | na |
| Pronormoblasts | 4.7% | 0.3% | na |
| Normoblasts | 30.3% | 18.4% | 12.9 - 13.9 |
| Lymphocytes | 19.7% | 51.0% | na |
| Plasma Cells | 0% | na | na |
| Myeloid/Erythroid Ratio | 1.3 | na | 1.7 - 2.6 |
The marrow aspirate demonstrated trilieage hematopoesis with a decreased myoloid to erythroid ratio (1.3:1). Pronormoblasts frequently contained cytoplasmic vacuoles (Image 04, Image 05 and Image 06). Maturing erythroid precursors occasionally demonstrated frayed or vacuolated cytoplasm (Image 04). Prussian Blue stain revealed occasional ringed sideroblasts (Image 07). Myoloid maturation was complete and mildly megaloblastoid withoccasional cytoplasmic vacuolization. Megakaryocytes were present and unremarkable.
