Refractory anemia with ringed sideroblasts, peripheral blood. There is a double population of normochromic and hypochromic red blood cells with marked variation in size and shape of the cells, including some macrocytes. The anemia is familial (X-chromosome linked) in this case; the patient has two maternal uncles with the same disorder.

 

Myelodysplasia, bone marrow aspirate. There are intense red cell dyspoietic nuclear changes in the pronormoblast and all its progeny. A dividing cell is also seen.

 

Myelodysplasia, Prussian blue stained bone marrow aspirate. This stain for iron is intensely positive. The dark granules are in storage cells.

 

Myelodysplasia, 5q- syndrome, bone marrow biopsy from an adult female. This disorder is characterized by the presence of an increased number of non-lobulated megakaryocytes.

 

Ringed sideroblasts in myelodysplasia, bone marrow, Prussian blue stain. Iron deposition in the mitochondria ringing the nucleus creates the ringed sideroblast morphology.