Name: Hasan Haboubi

Theme: Classification of Myelodysplastic syndromes

OPTION LIST

A	Refractory cytopenia with multilineage dysplasia	I	Myelodysplastic syndrome associated with isolated del(5q) chromosome abnormality (5q syndrome)
B	Refractory Anaemia	J	Chronic Myelomonocytic Anaemia
C	Aplastic Anaemia	K	Secondary Sideroblastic Anaemia
D	Refractory Anaemia with excess of Blasts II	L
E	Myelodysplastic syndrome,unclassifiable	M
F	Acute Myeloid Leukaemia	N
G	Refractory Anaemia with Ring Sideroblasts	O
H	Refractory Anaemia with excess of Blasts I	P

For each scenario below, choose the most appropriate answer from the list above. Each option may be used once, more than once or not at all.

1. A 65 year old patient presents with hepatosplenomegaly. He is mildly anaemic and thrombocytompenic. A blood monocyte count of 1.2 x 10⁹/l is observed. Bone marrow aspirate reveals ring sideroblasts at 15% of total blasts. Auer rods are observed.

2. An alcoholic presents to your clinic with anaemia. Sideroblasts are observed on morphological examination.

3. A 58 year old lady complains of lethargy and “easy bruising”. She presents with purpura. Her FBC reveals Hb 10.5g/dl; WBCs 2.3x10⁹/l and platelets 8x10⁹/l. Blood film reveals <1% Blasts, and marrow aspirate shows dysplasia and less than 5% blasts.

4. A 78 year old male patient with recurring infections of the face and maxillary sinuses associated with neutropenia. His bloods are: Hb 9.8 g/dl; WBC 1.3x10⁹/l; Neutrophils 0.3x10⁹/l; platelets 38x10⁹/l.The lab informs you that there are Blasts approximately compromise 17% of bone marrow aspirate.

5. You are called to A&E to see a 65 year old man. He is complaining of fever, shortness of breath, and has lost 5Kg in the last few months. His notes say he was previously diagnosed with “Refractory Anaemia with excess Blasts in Transformation” (RAEB-t). His blast cell count is approximately 30% of all nucleated cells.

ANSWERS

1. J

2. K

3. B

4. D

5. F