Page 110 - Haematologica Atlas of Hematologic Cytology

AB
CD
Figure . Refractory cytopenia of childhood (R ). (A) Peripheral blood (PB) smear from a 7-year-old boy pre- senting with severe pancytopenia. Marked anisopoikilocytosis of red cells with macrocytes, stomatocytes, a tear cell, polychromatic cells. (B) Bone marrow smear showing, at low magnification, hypocellularity, lymphocytes, granulocytic cells at different maturation stages, rare erythroid precursors. (C) Higher magnification reveals hypogranular neutrophils and increased eosinophils. (D) Hypogranular, vacuolated micromegakaryocytes. Blasts were less than 5% of bone marrow cells. Bone marrow biopsy showed a marked decrease in cellularity, some micromegakaryocytes, and rare islands of erythroid precursors, confirming the diagnosis of RCC. Cytogenetics demonstrated an acquired monosomy 7. RCC is a provisional MDS entity characterized by less than 5% blasts in the bone marrow and less than 2% blasts in the peripheral blood, and dysplastic changes in at least two myeloid cell lineages or in at least 10% of cells of one lineage. It is the most common subtype of MDS in childhood. Since in most cases of RCC bone marrow is hypocellular, a trephine biopsy is essential for the differential diagnosis from other bone marrow failure disorders.
97