In addition to the non-specific phenomenon of dyserythro-poiesis described above, there is a group of disorders of variable severity with recessive inheritance, known as congenital dyserythropoietic anaemias (CDA). They are characterized by chronic anaemia with a relatively low reticulocyte count, jaundice and haemosiderosis. Peripheral blood films show anisocytosis, poikilocytosis and irregularly crenated and contracted cells. The marrow shows one of three patterns:
Type I. Megaloblastic changes, macrocytosis, internuclear chromatin bridges, but binuclearity not prominent; proerythroblasts and basophilic erythroblasts especially affected (Figure 13.5). Type II. Binuclearity, especially of late erythroblasts, multinucle-arity, pluripolar mitoses, karyorrhexis (Figure 13.6).
Type III. Multinuclearity with up to 12 nuclei, gigantoblasts, macrocytosis (Figure 13.7).
There is an overlap between types I and II and there are variants of each type. There are also a number of reports of congenital ineffective erythropoiesis, which do not fit into any of the three categories given.
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