and basophilic stippling were seen occasionally.
In the presented patient reticulocyte and normoblast
counts were low, which is consistent with Kell isoimmunization, whereas maternal antibody levels were unexpectedly very high.
A bone marrow biopsy report revealed diffuse infiltration of Langerhans cells with vesicular nuclear chromatin, irregular nuclear contours, pale cytoplasm with phagocytosed normoblasts
, and mature erythrocytes.
falciparum cases and only 20 (2.8%) cases showed normoblasts
indicating erythroid hyperplasia/ stimulation.
Peripheral smear revealed a widespread schistocytes, dacrocytes, spherocytes, normoblasts
Peripheral blood smear showed microcytic, hypochromic red blood corpuscles with immature white blood cells (WBCs; myleocytes, metamyleocytes, and bandforms) and normoblasts
Phagocytic vesicles contained red blood cells and normoblasts
, neutrophils and platelets.
Bone marrow aspiration showed hypercellularity, with 45% myeloblasts, 15% promyelocytes, 7% myelocytes, 4% metamyelocytes, 1% eosinophils, 2% neutrophils, 15% lymphocytes, and 11% normoblasts
. Wright staining of a bone marrow smear showed large (2-4 [micro]m) round-to-oval, hyaline-structured eosinophilic granules (pseudo Chediak-Higashi [PCH] granules) within 15% of the blast cells, promyelocytes, and myelocytes (Figure).
Megakaryocytes and normoblasts
are derived from a common committed progenitor cell, the CFU-GEMM (colony-forming unit, granulocytic, erythroid, myelomonocytic).
Routine full blood counts showed that, on average, the SCD patients had a normocytic, normochromic anaemia with a high white cell count, the latter usually indicative of excess normoblasts
in the peripheral blood.
These give rise to precursors that are microscopically recognisable as normoblasts
comprising the red cells series that include erythroid islands (Fig.
Macroscopic and microscopic evaluation of the placenta was aided by filling out a checklist with (a) macroscopic parameters: insertion and length of the cord, number of vessels in the cord, placental weight, presence of hematoma on the maternal surface, coloration of fetal surface, placental thicknesses, maternal infarction, insertion and color of fetal membranes and number of cotyledons; (b) microscopic parameters: changes of decidual vessels, location of fibrinoid depositions, location of placental hematoma, location and age of thrombus, number of villi vessels, presence of normoblasts
and necrosis in the villi.
A complete blood cell count showed a leukocyte count of 6,110/[micro]L (4% bands, 77% segmented neutrophils, 7% lymphocytes, 6% normoblasts
, and 3% myelocytes), hemoglobin level of 11.5 g/dL, and platelet count of 3,000/[micro]L.
Compared with simple [beta]-heterozygotes, co-inheritance of triplicated or quadruplicated [alpha]-globin genes in [beta]-heterozygotes often leads to more significant anemia, splenomegaly, more pronounced red cell abnormalities, the presence of circulating normoblasts
, higher hemoglobin F concentrations, and even the presence of inclusion bodies in erythroblasts (3,4).
Erythropoietic (Congenital) Porphyria: A Rare Abnormality of the Normoblasts
. Blood, 10(3):416-428.