Clinical Pathology: General Principles, Hematology & Coagulation, Immunology & Histocompatibility, Urinalysis, Body Fluids, Clinical Microscopy, Genetic Testing


A 78-year-old woman presents to her physician with increasing fatigue. A complete blood cell count is ordered and is notable for pancytopenia. The peripheral smear is shown in Figure 1. In response to these findings, a bone marrow biopsy is performed, and the aspirate smear is shown in Figure 2. Use this scenario to answer the following three questions.

Which one of the following combinations of factors is most important in predicting the prognosis in this patient?

• Myelodysplastic syndrome (MDS) is a clonal hematopoietic stem cell disorder.

• MDS is characterized by cytopenias and dysplasia in one or more bone marrow lineages.

• Prognosis in MDS is determined by the International Prognostic Scoring System (IPSS) score, which incorporates bone marrow blast percentage, karyotype, and number of cytopenias. Age can be added to the IPSS score to predict survival, with age over 60 years being a poor prognostic factor.

• Good prognostic karyotypes in MDS are normal karyotype, –Y, del(5q), and del(20q).

• Poor prognostic karyotypes in MDS are chromosome 7 anomalies and complex karyotypes (≥3 abnormalities).

• Intermediate prognostic karyotypes in MDS are any other abnormalities not classified as good or poor risk.

• Patients with MDS have a high risk for progression to acute myeloid leukemia (AML) with rising blast counts.

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