Condensed Case

A 65-year-old recent retiree went to visit the nurse practitioner in her assisted living community. She complained of excessive fatigue, rapid heart rate, and bruising. A CBC and differential was performed and the results suggested a macrocytic anemia with a slightly decreased platelet count. No hypersegmented neutrophils were seen and no oval macrocytes were observed on the peripheral smear. What other testing is worth considering in this case?

Answer

Other causes for a nonmegaloblastic macrocytic anemia may be liver disease, reticulocytosis, or hypothyroid conditions. Each of these was ruled out on our patient, and she was referred for a hematology consult. A bone marrow and cytogenetic studies were ordered. The bone marrow showed a hypercellular marrow with slightly increased and dys-plastic megakaryocytes. Cytogenetic studies show a deleted 5q. This patient progressed well with transfusion support and as of this date has not shown a progression to acute leukemia.

Summary Points

• The myelodysplastic disorders (MDSs) are a group of clonal disorders characterized by refractory anemias and cytopenias of one or more cell lines.

• The bone marrow and peripheral smear will show dysplastic changes in white cells, red cells, and platelets over time.

• Dyserythropoietic changes include multinu-clear red cell precursors, bizarre nuclear

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