A 69-year-old man was found to have pancytopenia. His hemoglobin level was 118 g/L with a normal mean corpuscular volume, white cell count 3.4 × 109/L, neutrophil count 1.7 × 109/L and platelet count 83 × 109/L. Blood smear showed dysplastic neutrophils, and the bone marrow aspirate confirmed myelodysplastic syndrome with 8% blasts (RAEB-1). He had trilineage dysplastic changes with prominent micromegakaryocytes and dyserythropoiesis. The nuclei of one of these dysplastic, polychromatic normoblasts took on the form of a snowman and is shown in the figure. Cytogenetic analysis revealed complex karyotype with rearrangements of chromosomes 7, 12, and 20, resulting in a partial deletion of 20q.FIG1
Jiri Pavlu and Nicki Panoskaltsis, Imperial College LondonMany Blood Work images are provided by the ASH IMAGE BANK, a reference and teaching tool that is continually updated with new atlas images and images of case studies. For more information or to contribute to the Image Bank, visit www.ashimagebank.org.
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