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A 58-year-old male presents for further evaluation of anemia. Physical examination reveals no lymphadenopathy or hepatosplenomegaly. Laboratory workup shows hemo globin 7. 7 g/dL. mean corpuscular volume 1 OLJ FL. leukocyte count 7.800/ .uL. and platelet count 760.000/,LLL. Ferritin level is elevated. Peripheral blood smear is shown below.
Bone marrow aspirate and Prussian blue iron stain of bone marrow aspirate are shown below.
What test(s) are considered appropriate for the evaluation of this case?
- Testing for JAK2 mutation
- Testing for BCR-ABL translocation
- Cytogenetics
- All of the above
- None of the above
Medicine
D. Peripheral smear reveals evidence of anisopoikilocytosis, platelets exhibiting different sizes and abnormal granulation, and a hypogranular neutrophil. Macrocytic anemia and increased number of ring sideroblasts in the bone marrow, evident with Prussian blue stain, are characteristic of refractory anemia with ring sideroblasts (RARS). Thrombocytosis is a rare feature of newly diagnosed myelodysplastic syndrome (MDS). It has been associated with 5q-syndrome, 3q syndrome, and cases otherwise meeting criteria for RARS. Ruling out an underlying myeloproliferative disorder (MPD) or chronic myeloid leukemia is also appropriate in the workup of this case (Luek Lymphoma. 2007;48(12):2375, Haematologica. 1999;84(8):690, Leuk Lymphoma. 2003;44(3):557).
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