Skill Checkup: A 72-Year-Old Woman With Myelodysplastic Syndrome Presents With Persistent Anemia and Fatigue

Emmanuel C. Besa, MD


April 08, 2022

The National Comprehensive Cancer Network guidelines advise that during MDS workup, cytogenetics, bone marrow aspiration with iron stain, and biopsy should be used to determine World Health Organization subtype, iron status, and the level of ring sideroblasts. For MDS to be classified as RARS, as in the present case, anemia should be present but with no blasts in the blood; for bone marrow, either ≥ 15% of erythroid precursors with ring sideroblasts must be identified, or if SF3B1 mutation is present, ≥ 5% ring sideroblasts.

The same guidelines also make recommendations for additional testing of symptomatic anemia with MDS. These include flow cytometry to evaluate for large granular lymphocyte and paroxysmal nocturnal hemoglobinuria clone. Human leukocyte antigen typing offers clinical value if the patient is a hematopoietic cell transplant candidate; because the patient in the present case is lower-risk, she likely is not at this juncture.


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