Peripheral blood smear demonstrates pancytopenia; red blood cells show significant anisopoikilocytosis with occasional red cell fragments and abnormal appearing circulating nucleated red blood cells (inset)
Core biopsy demonstrates mild hypercellularity for age (approximately 50%).
Cellular bone marrow aspirate smear with increased blasts.
Cellular marrow aspirate smears show a predominance of erythroid precursors (A) and marked dyserythropoiesis with prominent megaloblastoid maturation (B), terminal dyspoiesis including nuclear budding (C) and nuclear dyskaryorrhexis (D).
Megakaryocytes included many relatively small, hypobated forms (A, C), as well as some with multiple, discrete nuclei and/or internuclear bridging (B,D).
Iron stain performed on the marrow aspirate smear demonstrated increased numbers of ringed sideroblasts.
Bone marrow aspirate flow cytometric immunophenotypic analysis demonstrated a prominent CD34 positive blast population.
Marker analysis demonstrates CD45 (dim) and CD13+33 expression within the blast subset.
CD34 Immunohistochemical stain performed on the bone marrow core biopsy highlights many blasts.
Marrow aspirate classical cytogenetic analysis demonstrated a complex karyotype.