December 2021 (PDF for print)
Patient Demography: Male, 70’s, anemia
Diagnosis: Myelodysplastic Syndrome with Excess Blasts (MDS-EB-1)
Other Information: In peripheral blood - mature neutrophils (Band + Seg.) 60%, myelocytes 14%, blasts 2%, erythroblasts also present, blasts with high N/C ratio, delicate nuclear network structure and nucleoli. In addition, Pseudo-Pelger-Huët anomaly, neutrophil with hypogranularity, and giant platelets were also observed, but erythroblasts showed no megaloblastoid changes. In bone marrow aspirate - giant neutrophil with hypogranularity, binucleated erythroblasts, and micromegakaryocytes. We diagnosed MDS-EB-1 based on the percentage of blasts in the peripheral blood.
FBC results plus flagging/graphical indicators:
In addition to anemia and thrombocytopenia, the RDW-SD and RDW-CV were high, suggesting abnormalities in the size and morphology of erythrocytes. Raised Large Immature Cells (LIC), especially IMG and IMM, suggesting immature myeloid cells.
➡ 1. Not clearly separated, suggesting large platelets and schizocytes.
➡ 2. Neutrophil population.
➡ 3. Reduced optical absorbance, suggesting neutrophils with hypogranularity and/ or hyposegmentation.
➡ 4. Populations of large immature cells are seen across the IMG and IMM regions.
➡ 5. Population indicating the presence of erythroblasts.
➡ 6. Area suggesting the presence of giant platelets.
This clinical case is provided by Dr. Tohru Inaba, Dept. of Infection Control and Lab. Med., Kyoto Prefectural Univ. of Medicine.
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