50 year old Black male with end stage renal disease requiring chronic dialysis, secondary hyperparathyroidism and anemia unresponsive to Epogen underwent a bone marrow examination for the evaluation of his anemia. His CBC included an H/H of 7.5/24, WBC of 6300/ul and a platelet count of 128,000/ul. The marrow aspirate was hypocellular with no spicules present. There were numerous large multinucleated cells with abundant granular cytoplasm, two of which are shown in this image.