Lab Med Online.  2016 Jan;6(1):41-44. 10.3343/lmo.2016.6.1.41.

A Case of Myelodysplastic Syndrome Characterized by Hemolytic Anemia at Presentation

• Kim YK

• KMID: 2312291
• DOI: http://doi.org/10.3343/lmo.2016.6.1.41

Abstract

A man aged 78 yr with no history of chemotherapy or toxic exposure presented with a history of dyspnea and intermittent red urine for 3 months and several years, respectively. Hematologic data at admission were as follows: hemoglobin, 65 g/L; white blood cell count, 4.05x109/L; platelet count, 96x109/L; and reticulocyte count, 10.9%. A peripheral blood smear revealed polychromasia, nucleated red blood cells, and neutrophils with a non-lobulated nucleus. The bone marrow was hypercellular and exhibited an increase in erythroid precursors with trilineage dysplasia and our findings were suggestive of refractory cytopenia with multilineage dysplasia (RCMD). Karyotype of bone marrow cells was as follows: 45,XY,der(9;17)(p10;q10),add(18)(q11.2)[10]/45,idem,del(3)(q21)[10]. Other laboratory findings showed decreased serum haptoglobin, increased lactate dehydrogenase, and increased indirect bilirubin levels. Moreover, results of the direct/indirect antiglobulin test (Coombs' test) and paroxysmal nocturnal hemoglobinuria analysis with CD55, CD59, fluorescent aerolysin (FLAER), and CD24 were negative. Cold agglutinin and Donath-Landsteiner antibodies were not detected. This is a case of myelodysplastic syndrome (MDS) associated with hemolytic anemia and complex chromosomal abnormalities at presentation.

Keyword

Hemolytic anemia; Myelodysplastic syndrome; Refractory cytopenia with multilineage dysplasia

MeSH Terms

Anemia, Hemolytic*
Antibodies
Bilirubin
Bone Marrow
Bone Marrow Cells
Chromosome Aberrations
Coombs Test
Drug Therapy
Dyspnea
Erythrocytes
Haptoglobins
Hemoglobinuria, Paroxysmal
Karyotype
L-Lactate Dehydrogenase
Leukocyte Count
Myelodysplastic Syndromes*
Neutrophils
Platelet Count
Reticulocyte Count
Antibodies
Bilirubin
Haptoglobins
L-Lactate Dehydrogenase

Figure

• 

  Fig. 1 (A and B) Peripheral blood smear showing neutrophils with a non-lobulated nucleus, poikilocytosis of red blood cells, and polychromasia. (C) Bone marrow biopsy showing hypercellularity and hypolobulated megakaryocyte. (D and E) Bone marrow smear showing dyserythropoiesis and dysplastic megakaryocytes.

• 

  Fig. 2 G-banded karyogram of bone marrow cells. (A) A derivative chromosome composed of the short arm of chromosome 9 and the long arm of chromosome 17. Additional material of unknown origin is attached at band 18q11.2. (B) Deletion of the long arm of chromosome 3.

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