Page 97 - Haematologica Atlas of Hematologic Cytology

CHAPTER 12 - Myelodysplastic syndromes
AB
CD
Figure Dyserythropoiesis Bone marrow smears (A) Perls’ staining shows ring sideroblasts with 5 or or more po- sitive granules disposed in in in a a ring surrounding one-third or or more of of the the circumference of of the the nucleus Siderocytes are also evident In normal erythroblasts Perls’ stain may reveal type 1 sideroblasts with few (<5) siderotic granules granules and occasionally type 2 sideroblasts with 5 or or more siderotic granules granules sometimes coarse scattered within the the the cytoplasm Whereas the the the other morphological abnormalities of erythroid cells are commonly observed in in many hematologic hematologic as as as well as as as non-hematologic disorders and have a a a a a a a a a a a low diagnostic power ring sideroblasts are considered highly specific dysplastic changes Trephine biopsy sections should not be used for the assessment of sideroblast iron iron since decalcification removes storage iron iron Perls’ staining can also be applied to to films that have previously been stained with May Grünwald Giemsa even after years of storage (B) Whereas Perls’ stain stain shows hemosiderin or clustered ferritin ferritin molecules molecules immunocytochemical techniques may reveal also ferritin ferritin molecules molecules scattered within the the cytoplasm In dysplastic erythroblasts even negative for Perls’ stain the the amount of of H isofer- ritin is greatly increased Immuno-alkaline phosphatase technique using a a a a a a a a a monoclonal antibody specific for the H subunit of ferritin (C) Dysplastic erythroblasts may be positive for periodic acid Schiff (PAS) stain with glycogen accumulation confined to proerythroblasts or present in in erythroblasts erythroblasts at at at at all maturation stages PAS positivity is more frequent in in in erythroblasts showing marked morphological abnormalities and shows a a a a a a a a a diffuse pattern in in in late erythroblasts erythroblasts erythroblasts and a a a a a a a a a a a a granular pattern in early erythroblasts erythroblasts erythroblasts (D) Dysplastic erythroblasts erythroblasts erythroblasts show abnormal strong paranuclear reactivity for acid phosphatase 84