Myelodysplastic syndrome. (Bone marrow aspirate, 100 × Myelodysplastic syndrome. (Bone marrow aspirate, 100 ×.) Note increased number of erythroid cells with basophilic cytoplasm. Many of these red blood cell precursors have a "tapioca pudding"-like appearance consistent with dyssynchrony between nuclear and cytoplasmic maturation in the erythroid series. These findings alone in the red blood cell line would be consistent with a megaloblastic picture. The finding of dysmorphic changes in the granulocyte maturation or megakaryocyte maturation helps establish the diagnosis of myelodysplastic syndrome. (Used, with permission, from L Damon.) Source: Blood Disorders, Current Medical Diagnosis & Treatment 2017 Citation: Papadakis MA, McPhee SJ, Rabow MW. Current Medical Diagnosis & Treatment 2017; 2016 Available at: https://accessmedicine.mhmedical.com/DownloadImage.aspx?image=/data/books/1843/cmdt17_ch13_ef027.png&sec=135709029&BookID=1843&ChapterSecID=135708533&imagename= Accessed: October 16, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved