Page 495 - Clinical Hematology_ Theory _ Procedures ( PDFDrive )

CHAPTER 24 ■ Myelodysplastic Syndromes and Myelodysplastic/Myeloproliferative Neoplasms 479

TABLE 24.3 Fourth Edition (2003) WHO Criteria MDSs

MDS Subtype Peripheral Blood Bone Marrow

Refractory anemia (RA)* Anemia Unilineage dysplasia ≥10% in one myeloid line

<1% blasts <5% blasts

<15% ring sideroblasts

Refractory anemia with ring Anemia Erythroid dysplasia only ≥15% ring sideroblasts

sideroblasts (RARS)

No blasts <5% blasts

Refractory cytopenias with Cytopenias Dysplasia in ≥10% of cells in two myeloid cell lines

multilineage dysplasia (RCMD)

No or rare blasts No Auer rods

<1 × 10 /L monocytes <5% blasts in marrow
9

No Auer rods No Auer rods

±15% ring sideroblasts

Refractory anemia with excess Cytopenias Unilineage or multilineage dysplasia

blasts type 1 (RAEB-1)

<5% blasts 5%–9% blasts

No Auer rods No Auer rods

<1 × 10 /L monocytes
9

Refractory anemia with excess Cytopenias Unilineage or multilineage dysplasia

blasts type 2 (RAEB-2)

<5%–19% blasts 10%–19% blasts

Auer rods ± <1 × 10 /L monocytes Auer rods ±
9
MDS associated with isolated Anemia <5% blasts

del (5q)

Normal or elevated platelet count Anemia, hypolobulated megakaryocytic anemia

isolated 5q31 chromosome deletion

<1% blasts

Childhood MDS, including Pancytopenia <5% marrow red blood cell blasts

refractory cytopenia of childhood

(provisional)

Usually hypocellular marrow

MDS, unclassi able (MDS-U) Cytopenias Does not t other categories

≤1% blasts Dysplasia and <5% blasts

If no dysplasia, MDS-associated karyotype

*This category is refractory cytopenias with unilineage dysplasia (RCUD) refractory anemia. The category includes refractory anemia, refractory neutropenia,
and refractory thrombocytopenia.

MDS, myelodysplastic syndrome.

Platelet Abnorm alities bulge o the cell e br ne, h s been observe . Incre se

T e eg k ryocyte popul tion y be ecre se , nor l, or nu bers o these typic l pl telets c n be observe in the

incre se . Micro eg k ryocytes, ononucle r eg k ryo- jority o p tients with MDS. Nor l pl telet orphol-

cytes, ultiple s ll sep r te nuclei, n gi nt gr nules c n ogy y be observe in p tients with RARS. T e nu ber

be seen in the peripher l bloo . L rge biz rre pl telets re o typic l pl telets is neg tively correl te with the periph-

requent f n ing in the peripher l bloo . A istinct sub- er l pl telet counts in MDS. T e typic l pl telets ost likely

popul tion o pl telets in MDS, which by ph se-contr st re ect tur tion isturb nces o eg k ryocytopoiesis.

icroscopic ex in tion see to h ve b lloon-sh pe Unless ssoci te with recent cytotoxic ther py, n incre se