A 60-year-old patient visited his general practitioner because of fatigue and unexplained bruising. Physical examination revealed a frail, thin, pale man with widespread bruising. A CBC was ordered and revealed abnormal granularity of platelets and leukocytes. Red cells appeared dimorphic. Bone marrow analysis showed 20% ringed sideroblasts with dysplastic changes in RBC and WBC precursors. No cytogenetic abnormalities were detected. Based on this information, what is a probable diagnosis?

Question

Quizplus · Accepted Answer

The patient’s clinical findings, CBC results, and bone marrow analysis are consistent with myelodysplastic syndrome, a group of disorders characterized by ineffective blood cell production and a risk of transformation to acute leukemia. The abnormal granularity of platelets and leukocytes, dimorphic red cells, and ringed sideroblasts with dysplasia strongly suggest this diagnosis. Chronic lymphocytic leukemia would not present with the same degree of cytopenias and dysplasia seen in this patient. Myeloproliferative syndrome may present similarly to myelodysplastic syndrome but would have evidence of increased blood cell production rather than the cytopenias seen in this patient. Acute leukemia would have a higher percentage of blasts in the bone marrow and characteristic cytogenetic abnormalities.

A 60-Year-Old Patient Visited His General Practitioner Because of Fatigue