Alcohol poisoning. Marrow cells of a patient with chronic and acute alcoholism. Note dyserythropoiesis. Small erythroblasts with scant cytoplasm. Large orthochromatic erythroblast with lobulated nucleus. Three large erythroblasts (one proerythroblast and two basophilic erythroblasts) with vacuoles characteristic (but not specific for) of acute alcoholism. The vacuoles usually occur in early erythroid cells as seen here and very occasionally in myeloid cells. They may be observed after abstinence for about 3 to 14 days, suggesting the vacuoles persist that long despite cell division and maturation. The vacuoles often appear to overlie the nucleus as well as the cytoplasm, but in electron micrographic studies, they form from endocytotic vesicles and are localized only to the cytoplasm.
Arsenic poisoning. Marrow cells of patient with severe arsenic intoxication. Note severe dyserythropoiesis with megaloblastic features. Erythroblasts are mildly increased in size with bizarre nuclear abnormalities including multilobulated nuclei, open chromatin pattern simulating megaloblastic appearance. Note two very coarsely stippled erythroblasts.
Arsenic Intoxication. Marrow Films. (A)Erythroblasts with nuclear fragmentation and nuclear remnants in cytoplasm. (B)Large erythroblasts with nuclear lobulation and with chromatin patterns similar to that seen in megaloblastic anemia. The dyserythropoiesis of arsenic poisoning mimics that seen in megaloblastic anemia and has morphologic features similar to erythropoiesis in myelodysplastic syndrome.
Congenital dyserythropoietic anemia, type I. Note nuclear bridging in erythroblasts. Dyserythropoietic features also include wide variation in erythroblast size. Note three very small cells in upper center of field.
Congenital dyserythropoietic anemia, type I. Note erythroblast with double nucleus. Large (giant) erythroblasts.
Congenital dyserythropoietic anemia, type II. Hereditary Erythroblastic Multinuclearity associated with a Positive Acidified Serum test (HEMPAS). Multinucleated erythroblasts. Note binucleate erythroblast and one cell with five nuclei. This variant of congenital dyserythropoietic anemia has erythroblasts with two to seven nuclei.
Congenital dyserythropoietic anemia, Type II. Marrow films. (A and B) Note large and multinucleated erythroblasts characteristic of this disorder. (A) Four nuclei in erythroblast. (B) Two and six nuclei in erythroblasts. In later cell, a seventh nuclear remnant is present.