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ASH Image Bank (2004); doi:10.1182/ashimagebank-2004-100977
Copyright © 2004 by the American Society of Hematology.
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Atlas Image Set

Refractory Anemia with Ringed Sideroblasts (RARS)

John Lazarchick



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Figure 1. Red blood cells are macrocytic (MCV 104)and exhibit mild aniso- and poikilocytosis. Only a rare polychromatophilic cell is seen. A Pelger-Huet-like neutrophil is present.

 


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Figure 2. The Pelger-Huet morphology of the neutrophil is more apparent at higher magnification (100x).

 


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Figure 3. Cellular marrow with erythroid hyperplasia. The blast population is not increased. Minimal dysplastic changes are present inthe erythroid series.(10x)

 


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Figure 4. Marked erythroid hyperplasia is more evident at higher magnisfication. Binucleated erythroid precursors are present. Cytoplasm on many of the erythroid precursors has shaggy borders. Howell-Jolly bodies are also present. (20x)

 


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Figure 5. The marrow shows 60% cellularity due primarily to erythroid hyperplasia. Megakaryocytes show dysplastic changes. Clusters of immature myeloid precursors are also evident.

 


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Figure 6. Higher magnification of previous image shows the marked erythroid hyperplasia with marked increase in early to intermediate forms. Megakaryocytic dysplasia and clustering of immature myeloid precursors are evident.

 


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Figure 7. Low magnification view of the marrow aspirate shows marked increase in marrow iron.

 


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Figure 8. Late erythroid forms showing ringed siderobalsts are depicted.

 


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Figure 9. Both ringed sideroblasts and an iron-laden macrophage are show in this view.

 

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Related ASH-SAP Chapter:space logo
Chapter 9: Myelodysplastic syndrome and overlap syndromes

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Copyright © 2004 by the American Society of Hematology.