Morphology: marrow cellularity seems markedly increased. myelopoiesis is hyperplastic, with normal maturation.On image DSCN 5925 one possibly hypersegmented neutrophil is seen. On 2 low power images several morphologically normal megakaryocytes can be recognized. Erythropoiesis seems very active and megaloblastic maturation can be suspected. The peripheral blood smear macrocytic as well. There is no increase in blasts and no unequivocal signs of myelodysplasia are seen.  
Summary: Makrocytic maturation of Erythropoiesis and reactive hyperlasia of myelo- and megakaryopoiesis.  
The following additional interpretation is needed to enable an interpretation of these findings: do you have any explanation for the elevated bilirubin? Chronic liver dissease can be a cause of macrocytic anemia. As you correctly stated hypersegmented neutrophils, do you have any indication for vit B12 deficiency? A combination chronic liver disease and vit B12 deficiency is a possibility as well.  
Could you please provide a few additional high power images depicting samples of all three cell lines and more clinical data,perhaps explaning the elevated bilirubin levels (how is the proportion between directly and indirectly reacting bilirubin?)

Agree with all Nina's comments. High power picture(s) showing the cytologic characteristics of erythropoiesis is badly needed. B12, folate, iron, and peripheral blood film review are needed too.  
 
Ineffective erythropoiesis and intramedullary apoptosis may on their own cause increased indirect bilirubin in pernicious anemia patients. Additionally, pernicious anemia itself increases the frequency of gallbladder stones. Should a patient with pernicious anemia develop upper-abdominal pain or other symptoms, a high index of suspicion for gallstone-related disease should be maintained. Biliary obstruction obviously may thus cause also direct bilirubin to raise.  

Thank you Dr. Hurwitz and Dr. Orazi for your educative comments.  
I think image DSCN5934 shows hig power view of some nucleated rbc precursors. Do you think they show some megaloblastic change?  
His bilirubin today was 8.8 mg/dl, direct fraction - 6.6 mg/dl, liver enzymes - normal, Australia antigen: negative.

The association of macrocytic anemia and hyperleukocytosis is not usual.  
In Biermer disease with such a profound anemia leukocytosis is normal or low;  
As Nina said, we need some more informations to understand this case :  
- What is the clinical history ? fever, intestinal pain, length of evolution etc..  
- What is the biological background ? reticulocyte count, vit B12 and folates, inflammatory signs etc..  
- It is necessary to perform a Perls staining on the bone marrow sample in order to verify ring sideroblasts

There are megaloblastic changes in both erythro and granulopoiesis so B12 and/or folic acid deficiency is the first thing that should be investigated. Some kind of toxic exposure should also be looked for - what does the patient work with, did he take any new medication? He has also increased WBC - maybe leukocyte alkaline score would be of help?  

There is some additional information I received fron Dr.Sachin, the patient did not respond to B12/Folic acid treatment. there was a minimal plearal effusion, PCR for Tb is negative. In this case we certainly need more high power images from all cell lines, and an iron stain for ringsideroblasts is mandatory. In view of the anemia being refractory to B12/folic acid, Anjas question regarding the patients occupation becomes even more relevant. I hope you will be able to provide mmore clinical information