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The page below is a sample from the LabCE course Myelodysplastic Syndromes (MDS). Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Normal normoblast

Dysplastic Erythroid Cell Line (Dyserythropoiesis)

In normal bone marrow, the normoblasts show synchronous maturation between the nucleus and cytoplasm, as well as normal nuclear & cytoplasmic features (please refer to the image on the right). In MDS, this is not the case; dysplastic normoblasts may show:
  • Nuclear budding: the nucleus is not round and demonstrates buds
  • Inter-nuclear bridging: nuclear bridge between two normoblasts
  • Nuclear fragments: cytoplasmic pieces of nuclear fragments
  • Multi-nucleation: normoblasts with multiple nuclei
  • Megaloblastoid changes due asynchronous maturation between the nucleus and cytoplasm
  • Karyorrhexis: degenerating normoblasts
  • Ring sideroblasts: iron granules surrounding the nucleus in a ring form (see Prussian blue stain image below)
  • Cytoplasmic vacuolization: vacuoles present in the cellular cytoplasm
Examples of Dysplastic Erythroid Cells:
Normoblasts with inter-nuclear bridging
Normoblast with nuclear fragments
Prussian blue stain shows Ring Sideroblasts