| Session: Myelodysplastic / myeloproliferative disease |
| Case number: 126 |
Submitter(s): Yaneth R. Orduz.
Clinical history
This is a 66 years old man with macrocytic anemia since November 2004. Ferritina and B12 normal. In Jun/2006 a control shows thrombocytosis (639.000).
June 23/2006: WBC: 7920 N: 56% L: 34% M: 3% Eo: 5% Bas: 2% Hb: 10.2 Hcto: 30.3. Platelets. 639.000
No previuos malignancies or chemotherapy.
Since Sept/2006 his medication is Erythropoietin 30.000 U /week.
Jan/2007 WBC: 7030 N: 49.2% L: 38.2% M: 5.5% Eo: 5.5% Bas: 1.7% Hb: 10 Hcto: 31 Platelets: 592.000.
Details of gross/microscopic pathology:
Agost/2006 We recieved a iliac crest bone marrow biopsy that was fixed in formalin. This biopsy was hypercellular (90%) with erythroid predominance, increase of its precursors as well as in the bone marrow aspirate. The CD34 was less than 5% of the nucleated cells of the bone marrow.
His bone marrow aspirate did not show important displasia (more than 20%) in any of the three lineages. The Fe coloration on the bone marrow smear shows that almost all of the erythroid precursors were ringed sideroblasts.
Immunophenotype (flow cytometry/immunohistochemistry):
There was no increased of CD34 and CD117 positive precursors. There was a predominance of the erythropoiesis with small decrease odf the granulopoiesis.
Cytogenetics:
46 XY.
Molecular analysis:
Not done yet.
Interesting feature(s) of submitted case:
Few cases have been studied for JAK2 V617F mutation and recent publications show that there is a common association so they could be more a Myeloproliferative disorder than a Myelodysplastic even the presence of ringed sideroblasts?
Proposed diagnosis:
Refractory anemia with ringed sideroblasts and thrombocytosis.
Panel diagnosis:
MDS/MPD, unclassifiable
Comments:
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