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: a nuclear bridge between two normoblasts
- Nuclear fragments: cytoplasmic pieces of nuclear fragments
- Multi-nucleation: normoblasts with multiple nuclei
- Megaloblastoid changes due to 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
