Hematogones in copper deficiency

An increase in hematogones (lymphoid precursor cells) in the bone marrow aspirate smear is characteristic of copper deficiency and has been proposed to be helpful in distinguishing copper deficiency from myelodysplastic syndromes (MDS). The figure shows a bone marrow aspirate from a boy with leukopenia and macrocytic anemia. Copper deficiency was diagnosed and attributed to small bowel resection with enteral feedings that probably did not contain adequate copper supplementation. Dashed arrow: Hematogone. Arrow: Cytoplasmic vacuolization in a granulocytic precursor. Arrowhead: Cytoplasmic vacuolization in an erythroid precursor.