Merisa Klaharn M.D1., Tawatchai Pongpruttipan M.D1., Weerapat Owattanapanich M.D2., Sanya Sukpanichnant M.D1.
1Department of Pathology and 2Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Objective: Dyserythropoiesis-like post-mortem changes in erythroid precursors at autopsy can look similar to certain kinds of primary marrow diseases. This study is designed to evaluate nuclear changes in erythroid precursors in marrow aspirate smears and histologic sections at different intervals after taken out from the body (delayed ﬁ xation) simulating post-mortem changes.
Methods: Marrow aspirate and clotted marrow samples from patients were evaluated for the percentages of erythroid precursors with dyserythropoiesis-like nuclei immediately (0 hour) and at different intervals of the same sample in each case that was kept at room temperature – 1, 2, 4, 8, 12 and 24 hours. Signiﬁ cant hematologic changes were determined at 10% cut-off.
Results: Twenty cases were collected but only 13 cases had sufﬁ cient samples for evaluation. The patients’ ages were between 21 and 72 years (mean = 56.2 years). At 0 hour, dyserythropoietic nuclei were detected up to 6% of erythroid precursors. Dyserythropoiesis-like nuclei from marrow aspirate smears were counted as > 10% of erythroid precursors at 8 hours in 4 cases (30.8%), at 12 hours in 1 case (7.7%) and at 24 hours in 8 cases (61.5%) (Mean 12.8% at 12 hours; median 16% at 24 hours). Morphologic evaluation of dyserythropoiesis in histologic sections was inferior to marrow aspirate smears.
Conclusion: Dyserythropoiesis-like nuclear changes occur inevitably and the rate of signiﬁ cant changes at 10% cut-off from this study is at 8 hours. This phenomenon can interfere with the evaluation of erythroid changes concerning any disease related to dyserythropoiesis when delayed ﬁ xation or at autopsy.