Refractory cytopenia with multilineage dysplasia (RCMD). Bone marrow aspirate smear (Wright-Giemsa stain). This composite illustrates typical fields from the bone marrow aspirate. In the photograph on the left side, the arrows point to dyspoietic erythroid precursors, with abnormally shaped nuclei. In the photograph on the right, an abnormal neutrophil with a hypolobated nucleus is seen at the arrow, and an abnormal megakaryocyte is also present (double arrow). More than 30% of the erythroid precursors and over one-half of the megakaryocytes in the specimen were dysplastic. Relatively few (~10%) of the neutrophils show abnormalities. Note that there is no increase in the number of blasts, which totaled 3% in a 500-cell differential performed on the aspirate smear.