In anemia due to lead poisoning, bone marrow will characteristically show: (E. REPEAT 2007}
Ref: Harrison's Principles of Internal Medicine. 18th edition, Rage 49Explanation:DIAGNOSIS OF LEAD POISONINGFeatures in ChildrenAbdominal pain.Irritability.Lethargy.Anorexia.Anemia.Fanconi's syndrome.Pyuria.Azotemia.Epiphyseal plate "lead lines" on long bone X- rays.Convulsions, coma at higher levels.Neurodevelopmental delays.Features in AdultsSimilar symptoms as in children.Headaches.Arthralgia.Myalgias.Depression.Impaired short term memory.Loss of libido.Lead line at the gingiva-tooth border.Pallor.Wristdrop.Cognitive dysfunction (Decline in MMSE). Lab TestsNormocytic, normochromic anemia.Basophilic stippling.Elevated blood protoporphyrin level (free erythrocyte or zinc).Motor delays on nerve conduction.Erythroid cytologic alterations:o Anisocytosiso Poikilocytosiso Polychromasiao Basophilic stippling.Figure: Basophilic stippling {Black arrows)ALSO NOTERing SideroblastsErythroblasts with iron-loaded mitochondria.Prussian blue staining (Peris' reaction) reveals perinuclear ring of blue granules.Seen in sideroblastic anemia.Pugler Huet CellsInherited condition.Dumbbell shaped. Bilobed nuclei.Pseudo Pegler is seen in myeloid leukemia, myelodysplasia. ALL.Dwarf MegakaryocytesThey have scant cytoplasm with bilobed nucleus.Seen in CML.
Dwarf megakaryocyte
Ring sideroblasts
Pelger huet anomaly
Basophilic stippling
Anemia and RBC Disorders