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A 78-year-old female presents for further evaluation of anemia. Physical examination reveals no lymphadenopathy or organomegaly. Laboratory evaluation shows hemo-globin of 8.2 g/dl. mean corpuscular volume of 1 06 fl. leukocyte count of 6.700/f.l.l. and platelet count of 5 62 .000/ f.l.l. Peripheral smear is shown below.
Bone marrow aspiration and biopsy were obtained and revealed hypercellulari ty and no increased ri ng sideroblasts. Bone marrow aspirate is shown below.
What is the most likely diagnosis?
- Myeloproliferative neoplasm
- Refractory anemia with ring sideroblasts with thrombocytosis (RARS-T)
- Iron-deficiency anemia
- Sq- syndrome
- Vitamin B12 deficiency
Medicine
D. The clinical case describes an elderly female presenting with moderate macrocytic anemia, thrombocytosis, and preserved leukocyte counts. Peripheral blood smear reveals evidence of anisopoikilocytosis. As demonstrated in the images of the bone marrow aspirate and biopsy, there is erythroid lineage dysplasia with nuclear budding and the characteristic hypolobated micromegakary-ocytes characteristic of Sq- syndrome. This syndrome classically presents with female predominance, macrocytic anemia, thrombocytosis, preserved neutrophil count, increased number of hypolobated micromegakaryocytes, and low risk of progression to acute leukemia (Leukemia. 20 10;24(7): 1 283).
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