Refractory cytopenia with multilineage dysplasia (RCMD). Bone marrow biopsy (H & E stain). The biopsy demonstrates erythroid hyperplasia. Immature erythroid precursors (arrows) have round to oval vesicular nuclei, a prominent, comma-shaped nucleolus that often is close to the nuclear membrane, and a rim of amphophilic cytoplasm. Erythroid precursors that are more mature (double arrows) have homogenous, darkly-stained nuclei.