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A 47-year-old female was evaluated for easy bruising, menorrhagia, and anemia. The CBC revealed: WBC 1.4/µL, Hgb 8.8 g/dL and platelets 15,000/µL. Family history was negative for hematologic diseases and the physical examination was unremarkable. Bone marrow aspiration was hypercellular with prominent dyserythropoesis, dysmegakaryopoesis and dysgranulopoesis with less than 5% blasts. The chromosomal complement was 46,XX. The diagnosis of myelodysplasia was established and treatment was started with danazol, 200 mg twice daily and prednisone 1 mg/kg. The counts normalized except for the hemoglobin which remained at 10 g/dL. Follow up bone marrow revealed more prominent dyserythropoesis with striking karyorrhexis which is shown above in a Wright-Giemsa stained bone marrow aspirate.
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