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An 84-year-old man was found to have macrocytic anemia with a hemoglobin concentration of 85 g/L and mean corpuscular volume of 127.0 fl. The white blood cell count was 3.6×10/L and the platelet count 134×10/L. The peripheral blood smear showed macroovalocytes and hypersegmented neutrophils. The bone marrow aspiration revealed normoblastic erythroid hyperplasia, Howell-Jolly bodies in normoblasts and giant metamyelocytes. In those normoblasts at each maturation stage, cytoplasmic bridges were noted at a high frequency (Picture 1A: normoblasts with HowellJolly body and cytoplasmic bridge. 1B: giant metamyelocyte. 1C and 1D: normoblasts with cytoplasmic bridge). Megaloblasts were rarely observed. The plasma vitamin B12 level was 62 pmol/L (reference range, 172-676) and folate 43 nmol/L (8-29). The anti-intrinsic factor and gastric parietal cell antibodies were both positive. Vitamin B 12 injection was started with a brisk increase in the reticulocyte count. Megaloblastosis resulting from “nuclear-cytoplasmic asynchrony” is the morphologic hallmark of pernicious anemia (PA) and a sign of ineffective erythropoiesis. In the present

Non-Megaloblastic Pernicious Anemia with Normoblasts Possessing Cytoplasmic Bridge