case_images: PMC9906038_01
case_images: a BM aspirate, Wright-Giemsa stain. Cytoplasmic vacuoles in erythroid and myeloid precursors. BM biopsy revealed hypercellular marrow (80-90%) with dysplastic features in the erythroid lineage. These changes included cytoplasmic vacuoles in erythroid and myeloid precursors. These findings pointed toward a diagnosis of MDS. b BM aspirate, Wright-Giemsa stain: Rare erythroid cells with nuclear budding BM biopsy additionally revealed rare erythroid cells also showing nuclear budding, which contributed to the possible diagnosis of MDS.
case_images: cro-2023-0016-0001-528899_f1.jpg
case_images: PMC9906038_01_cro-2023-0016-0001-528899_f1.jpg
case_images: F1
case_images: There were cytoplasmic vacuoles in erythroid and myeloid precursors with rare erythroid cells also showing nuclear budding, as seen in Figure 1a and b, respectively.
case_images: BM aspirate, iron stain. Ring sideroblasts. BM aspirate also revealed ring sideroblasts, which are not consistent with the diagnosis of MDS. This finding prompted the team to draw a copper level, as this finding can be seen in copper deficiency.
case_images: cro-2023-0016-0001-528899_f2.jpg
case_images: PMC9906038_01_cro-2023-0016-0001-528899_f2.jpg
case_images: F2
case_images: Additionally, ring sideroblasts were increased by 14%, as seen in Figure 2.