Pleuripotent stem cells give rise to erythrocytes by the process of erythropoiesis.

The stem
cell looks like a small lymphocyte and lacks the functional capabilities of the erythrocyte. The
stem cells have the capacity of infinite division something the mature cells lack. Some of the
daughter cells arising from the stem cell acquire erythroid characters over generations and
time. Most of the erythroid cells in the bone marrow have a distinct morphology but
commitment to erythroid maturation is seen even in cells that have not acquired
morphological features distinctive of the erythroid lineage. These cells are recognized by the
type of colonies they form in vitro. Two such cells are recognized. Burst-forming unit
erythroid (BFU-E) arise from the stem cell and gives rise to colony-forming unit erythroid
(CFU-E). CFU-E gives rise to pronormoblast, the most immature of erythroid cells with a
distinct morphology (figure 1). BFU-E and CFU-E form a very small fraction of bone marrow
cells and are not important in diagnosis. Examination of Romanovsky stained (Giemsa,
Wright’s) bone marrow smears is central to the haematological diagnosis. Morphologically
five erythroid precursors are identifiable in the bone marrow stained with Romanovsky
stains. The five stages from the most immature to the most mature are the proerythroblast,
the basophilic normoblast (early erythroblast), polychromatophilic normoblast (intermediate
erythroblast), orthochromatophilic normoblast (late erythroblast) and reticulocyte (figure 1).
As the cell matures the following morphological changes take place

1. Cell becomes smaller

2. Nucleus becomes smaller, chromatin more clumped and the nucleoli disappear

3. Cytoplasm shrinks

4. The cytoplasmic basophilia decreases: Haemoglobin is a major constituent of the red

cell takes a pink to red colour on staining with Romanovsky stains. The machinery to
synthesize haemoglobin (ribosomes) must appear before haemoglobin. Ribosomes
make the cytoplasm basophilic (blue) because of their RNA content. As the
haemoglobin content approaches the desired levels the number of ribosomes decreases.
The cytoplasm of the maturing erythroid cell captures these changes and changes from
deep blue (mainly ribosomes) in basophilic normoblast to polychromatophilic
(ribosomes and haemoglobin) in polychromatophilic normoblast and resembling that
of a erythrocyte (mainly haemoglobin) in orthochromatophilic normoblast.

5. The earliest nucleated stages are least numerous and the later stages the most numerous