Dyserythropoiesis: A morphology-based study on bone marrow specimens

Abstract

Background and Aims: Dyserythropoiesis is an altered state of erythropoiesis in bone marrow, classically seen in myelodysplastic syndrome (MDS) and congenital dyserythropoietic anemia. However, it can manifest in a variety of other disorders like stress erythropoiesis resulting from intense erythropoietic proliferative drive. We aim to quantify and study the light microscopic dyserythropoietic features in various reactive hematological and nonhematological disorders on bone marrow aspirates. Materials and Methods: Of a total of 150 bone marrow aspirate smears showing dyserythropoietic features, 132 smears met the adequacy criteria and were included. They were categorized into seven broad groups based on bone marrow diagnosis. The percentage of erythroid cells showing dyserythropoiesis on bone marrow aspirate, and the morphological features of dyserythropoiesis, including nuclear budding, multinuclearity, internuclear bridging, karyorrhexis, megaloblastosis, and cytoplasmic vacuoles, were scored semiquantitatively in each case. These features were compared between the above-mentioned groups. Results: Bone marrow diagnoses included erythroid hyperplasia, megaloblastic erythroid hyperplasia, reactive marrow, megakaryocytic thrombocytopenia, acute lymphoblastic leukemia in remission, hemophagocytic lymphohistiocytosis, and eosinophilia. The maximum dyserythropoietic changes were noted in erythroid and megaloblastic erythroid hyperplasia (75%–90%). Nuclear budding was the most frequent change seen through all groups, while cytoplasmic vacuoles followed by internuclear bridging were less frequently observed. Conclusions: Of all three hematopoietic lineages, erythroid series is the most prone to dysplasia. Erythroid hyperplasia, due to an increased erythropoietic drive, can show prominent dyserythropoietic changes on bone marrow aspirate and is indicative of reactive rather than neoplastic process. Therefore, the use of isolated dyserythropoiesis in diagnosing clonal disorders (MDS) warrants an extreme caution.