Peripheral blood #1: Peripheral blood smear at time of first bone marrow biopsy. There is red blood cell anisopoikilocytosis, and rare hypogranular neutrophils and neutrophils with pseudo-Pelger-Huet anomaly are seen. Occasional giant and hypogranular platelets are present.
Bone marrow aspirate #1: The bone marrow aspirate shows erythroid-predominant trilineage hematopoiesis with prominent megaloblastoid erythroid precursors. Blasts are mildly increased (4%), and plasma cells comprise 12% of cells.
Bone marrow aspirate #1: There is dyserythropoiesis with nuclear budding and karyorrhexis. An iron stain shows rare ring sideroblasts. Occasional myeloid cells appear hypogranular, and some megaloblastoid and pseudo-Pelger-Huet forms are also seen. Some megakaryocytes are small and hypolobated.
Bone marrow biopsy #1: The marrow is hypercellular (90% cellular). Many dysplastic megakaryocytes are present.
Bone marrow flow cytometry #1: There are approximately 6% CD34+ myeloblasts by flow cytometry.
Bone marrow immunohistochemistry #1: Plasma cells comprise 10-15% of cells in the biopsy and are lambda light chain-restricted.
Peripheral blood #2: Circulating blasts are present comprising 19% of cells. Many of the blasts contain cytoplasmic granules. Occasional dysplastic neutrophils are present.
Bone marrow aspirate #2: The bone marrow aspirate shows approximately 37% blasts similar to those seen in the peripheral blood. Dyserythropoiesis is present in the background.
Bone marrow aspirate #2: In addition to the blasts, there are dysplastic, hypogranular neutrophils and dysplastic megakaryocytes.
Bone marrow biopsy #2: The bone marrow appears hypercellular in small amount of marrow present.
Bone marrow flow cytometry #2: There are approximately 43% blasts. Although a small subset (8% of total events) have an immunophenotype similar to the blasts seen in the first bone marrow, the majority of the blasts are now CD34-, CD117+, CD13/CD33+, HLA-DR-, CD15+, CD64+, myeloperoxidase+, CD4+, and CD7+.