PB and BM features of VEXAS. All patients studied had (A) macrocytic anemia demonstrated by RBCs greater in size than the nuclei of small lymphocytes. (B) Circulating hyposegmented pelgeroid neutrophils and (C) vacuolated neutrophils are common. Bone BM aspirates show striking vacuolization of (D) myeloid and erythroid precursors including (E) blasts, (F) erythroid pronormoblasts, (G) monoblasts, (H-I) promyelocytes, (J) myelocytes, (K) eosinophilic myelocytes, (L) promonocytes, and less commonly (M) megakaryocytes. (N) Core biopsies typically demonstrate hypercellular BM with myeloid hyperplasia (hematoxylin and eosin (H&E) stain; original magnification ×200). (A-M) Wright-Giemsa stained smears; original magnification ×1000.