The Cabot Ring at Different Stages of Erythropoiesis in the Bone Marrow in a Leukemic Patient

Cabot rings are red cell inclusions and may be looped or eight-shaped.They are seen in pernicious anemia and other severe anemias, leukemias, and lead poisoning.They may be remnants of the mitotic spindle and are associated with adherent granular material containing arginine-rich histone and nonhemoglobin iron.Some authors suggested that they originate from spindle material that was mishandled during abnormal mitosis.Although it is usually seen in mature erythrocytes in peripheral blood, it has also been defined in lateintermediate bone marrow megaloblasts [1,2].Here, we present a case diagnosed with acute myeloid leukemia (AML) in which a Cabot ring was observed in the different stages of erythropoiesis in bone marrow aspiration (BMA).In a fifty-three-year-old male patient diagnosed with AML with myelodysplasia-related cytogenetic abnormalities according to the 5 th edition of the World Health Organization, megaloblastic changes and a Cabot ring in the several stages of erythroblasts and erythrocytes was observed in BMA (Figure-1) [3].There was no Cabot ring appearance in the previous bone marrow samples (during diagnosis and after remission-induction). His folic acid level was detected <2.2 ng/Ml (3.1-20.5)and he had previously received cytarabine-based induction and three cycles of consolidation therapy.The Cabot ring was thought to be related to these factors.The widespread presence of a Cabot ring in different stages of erythropoiesis has not been previously described.