Decreased nuclear lobes in myelodysplasia (pseudo Pelger-Huet anomaly)

Peripheral blood smear from a patient with refractory anemia with excess blasts (RAEB) shows a neutrophil with a bilobed pseudo-Pelger-Huet (Pelgeroid) nucleus. The two lobes are connected by a thin strand (arrow) giving a "pince-nez" appearance. These nuclei look identical to the those seen in the inherited Pelger-Huet anomaly. This neutrophil also has markedly reduced granulation, a finding commonly seen in the myelodysplastic syndromes.