This document provides information about Chronic Myelomonocytic Leukemia (CMML). It describes CMML as a clonal hematopoietic malignancy with features of both a myeloproliferative neoplasm and myelodysplastic syndrome. Key details include that CMML occurs mostly in elderly patients, presents with symptoms like fatigue, fever and bleeding, and involves blood and bone marrow abnormalities like monocytosis, dysgranulopoiesis, and less than 20% blasts. The document discusses diagnostic criteria, genetic abnormalities, prognosis, treatment and differential diagnosis of CMML.
Internal quality control (IQC) in coagulation labAnkit Raiyani
In the haematology laboratory it is essential to ensure that the right test is carried out on the right specimen and that the correct results are delivered to the appropriate recipient without delay.
Quality control (QC) is defined as measures that must be included during each assay run to verify that the test is working properly.
Internal quality control (IQC) is monitoring the haematology test procedures to ensure continual evaluation of the reliability of the daily work of the laboratory with validation of tests before reports are released
Internal quality control (IQC) in coagulation labAnkit Raiyani
In the haematology laboratory it is essential to ensure that the right test is carried out on the right specimen and that the correct results are delivered to the appropriate recipient without delay.
Quality control (QC) is defined as measures that must be included during each assay run to verify that the test is working properly.
Internal quality control (IQC) is monitoring the haematology test procedures to ensure continual evaluation of the reliability of the daily work of the laboratory with validation of tests before reports are released
ACUTE MYELOID LEUKEMIA is a neoplastic disease characterized by
infiltration of the blood,
bone marrow, and
proliferative, clonal undifferentiated cells of the hematopoietic system.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
2. Chronic myelomonocytic leukemia
(CMML)
Atypical chronic myeloid leukemia,
BCR-ABL1-negative (aCML)
Myelodysplastic/myeloproliferative
neoplasm with ring sideroblasts and
thrombocytosis (MDS/MPN-RS-T)
Myelodysplastic/myeloproliferative
neoplasm, unclassifiable
(MDS/MPN-U)
Adult MD/MP disorders
Cell of origin:
Hematopoietic stem cell
Invariably involves
blood and bone marrow
Occurs in elderly age
group
3. Chronic myelomonocytic leukemia
• Introduction: It is a clonal hematopoietic malignancy with features of
both a myeloproliferative neoplasm and a myelodysplastic syndrome
• Incidence: 0.4 cases per 100,000 population
• Age: Elderly (median age 65-75years)
• Male predominance (M:F ~2.5:1)
• Etiology: Primarily de novo
• Exposure to occupational and environmental carcinogens or ionizing irradiation
• Sites for extramedullary leukemic infiltration: spleen, liver, skin and
lymph nodes
6. Chronic myelomonocytic leukemia
Peripheral blood:
• RBC:
• Mild anemia
• Normocytic but sometimes macrocytic
• nRBCs: may be present
• Platelet:
• Variable in number
• Moderate thrombocytopenia
• Atypical and large platelets may be seen
7. Chronic myelomonocytic leukemia
• WBC:
• Increased/normal/decreased in number
• Monocyte count: always >10%
• Monocytosis (always >1 x 109/L)
• Monocyte morphology: mature but can exhibit unusual nuclear lobulation or
chromatin patterns and abnormal granulation (abnormal monocytes)
• Neutrophil precursors: <10%
• Dysgranulopoiesis: may be seen
• Eosinophil and basophil count: usually normal
• Blasts & promonocytes: <20%
8.
9. Chronic myelomonocytic leukemia
• Bone marrow aspirate:
• Usually hypercellular
• Increased M:E ratio
• Granulocytic and monocytic
proliferation
• Dysgranulopoiesis &
dysmegakaryopoiesis: ~80%
• Erythroid precursors: often
reduced in number
• Mild Dyserythropoiesis
• Blasts and promonocytes: <20%
• Bone marrow biopsy:
• Mild to moderate fibrosis
• Interstitial nodules composed of
mature plasmacytoid dendritic
cells (~20% cases)
10.
11.
12.
13. Nodules of mature plasmacytoid dendritic cells
The cells have round nuclei, finely dispersed chromatin,
inconspicuous nucleoli, and a rim of eosinophilic cytoplasm.
The cytoplasmic membrane is usually distinct with well-
defined cytoplasmic borders, imparting a cohesive appearance
to the infiltrating cells.
14. Chronic myelomonocytic leukemia
• < 2% blasts in the blood and
• < 5% in the bone marrowCMML-0
• 2-4% blasts in the blood and/or
• 5-9% blasts in the bone marrowCMML-1
• 5-19% blasts in the blood and/or
• 10-19% in the bone marrow and/or
• Presence of Auer rods
CMML-2
Based on percentage of blasts and promonocytes in the peripheral blood and bone marrow:
15. • Cytochemistry:
• Strongly recommended
• Alpha-naphthyl butyrate esterase
(ANBE) staining alone or in
combination with chloroacetate
esterase (CAE) staining
• ANBE: brown reaction product in
monocytes and it’s precursors
• CAE: granular bright blue reaction
product in cells of neutrophil
lineage
• More sensitive than IHC
Chronic myelomonocytic leukemia
16. • Immunophenotype:
• Blood and marrow cells usually express typical myelomonocytic antigens
(CD33 and CD13) and variably express CD14, CD68 and CD64
• Blood and marrow monocytes: aberrant phenotypes (decreased CD14
expression; overexpression of CD56; aberrant expression of CD2)
• Increased proportion of CD14+/CD16- monocytes
• Mature plasmacytoid dendritic cells: positive for CD123, CD4, CD43, CD45RA,
CD68
Chronic myelomonocytic leukemia
18. • Genetic profile: molecular and epigenetic abnormalities
Patnaik MM, Tefferi A. Cytogenetic and molecular
abnormalities in chronic myelomonocytic leukemia.
Blood Cancer J. 2016 Feb 5;6:e393.
19. • Prognosis and predictive factors:
• Survival times range from 1 month to >100 months
• Median survival time: 20-40 months
• 15-30% cases progress to AML
• Prognostic factors: serum LDH level, splenomegaly, anaemia,
thrombocytopenia and lymphocytosis
• %age of blasts in blood and BM: most important factor determining survival
Chronic myelomonocytic leukemia
20. Differential diagnosis of CMML
CMML CML-CP Myeloid neoplasms with
PDGFRB rearrangement
WBC Variable; Monocytosis,
may have left shifted
neutrophilia
Increased; Left shifted
neutrophilia with peaks in
%age of myelocytes and
segmented
neutrophils
Increased; may have left
shifted neutrophilia,
monocytosis, eosinophilia
Blood immature
granulocytes
Usually <10% >10% <10%
Blood monocytes Always >1x103/μL Variable, <1x103/μL Often <1x103/μL
Blood eosinophils Not increased Increased Increased
Blood basophils Not increased Increased Increased
Blood blasts <20% Usually <2% <20%
Granulocytic dysplasia Present Absent Absent
Pseudo-gaucher cells Absent Present Usually absent
BCR-ABL1 fusion gene Absent Present (90-95%) Absent
22. • Introduction: It is a leukemic disorder with myelodysplastic and
myeloproliferative features present at the time of initial diagnosis
• Incidence: unknown
• ~1-2 aCML cases per 100 cases of BCR-ABL1-positive CML
• Age: Elderly (median age 70-80years)
• Male predominance (M:F ~2.5:1)
• Sites for extramedullary leukemic infiltration: spleen and liver
• C/F: Fatigue, bleeding, hepatosplenomegaly
Atypical chronic myeloid leukemia, BCR-ABL 1-negative
23.
24. Atypical chronic myeloid leukemia, BCR-ABL 1-negative
Peripheral blood:
• RBC:
• Moderate anemia
• Anisopoikilocytosis
• Dyserythropoiesis may be seen
• Platelets:
• Usually decreased in number
• WBC:
• Increased in number (always >13 x 109/L)
• Neutrophil precursors: >10%
• Monocyte count: may be increased
(<10%)
• Blasts: <5%
• Dysgranulopoiesis: prominent
• Hypersegmentation with abnormally
clumped nuclear chromatin or bizarrely
segmented nuclei, abnormal cytoplasmic
granularity (usually hypogranular) and
multiple nuclear projections
• Basophil count: usually normal
25.
26. Atypical chronic myeloid leukemia, BCR-ABL 1-negative
• Bone marrow aspirate:
• Usually hypercellular
• Increased M:E ratio
• Granulocytic proliferation
• Dysgranulopoiesis: prominent
• Erythroid precursors: usually decreased in number
• Dyserythropoiesis: seen in 40% cases
• Megakaryocytes: Usually normal/increased in number
• Dysmegakaryopoiesis: often present
• Blasts: <20%
• Bone marrow biopsy:
• Mild fibrosis
27.
28. • Cytochemistry and immunophenotype:
• No specific cytochemical abnormalities or immunophenotypic characteristics
• Genetic profile:
• ~80% show karyotypic abnormalities
• Most common abnormalities: +8 and del(20q)
• Abnormalities of chromosomes 13, 14, 17, 19 and 12 are also frequent
• SETBP1 and ETNK1 mutations: present in one-third cases
• CSF3R mutation: present in <10% cases
Atypical chronic myeloid leukemia, BCR-ABL 1-negative
29. • Prognosis and predictive factors:
• Poor prognosis
• Median survival time: 14-29 months
• Adverse prognostic factors: age >65 years, female gender, WBC count >50 x 109/L,
thrombocytopenia and haemoglobin level <10 g/dl
• ~30-40% cases evolves to AML
Atypical chronic myeloid leukemia, BCR-ABL 1-negative
32. • Introduction: It is a definitive entity in the 2016 WHO classification
• Age: Elderly (median age 72-75years)
• Slight female predominance
• Sites for extramedullary involvement: spleen and liver
• C/F: Fatigue, splenomegaly (~40%), hepatomegaly, thrombotic events
(2% to 20%)
Myelodysplastic/myeloproliferative neoplasm
with ring sideroblasts and thrombocytosis
33.
34. Myelodysplastic/myeloproliferative neoplasm
with ring sideroblasts and thrombocytosis
Peripheral blood:
• RBC:
• Anemia
• Normochromic macrocytic or
normocytic
• Often dimorphic blood picture
• Anisocytosis
• WBC count and DLC:
• Usually normal
• Neutrophils may show mild
dysgranulopoiesis
• Blasts: absent/rare (<1%)
• Platelets:
• Persistant thrombocytosis (>450 x 109/L)
• Anisocytosis
• Tiny forms to atypical large or giant
platelets
• Bizarre shaped or agranular platelets
may also be seen
35.
36. Myelodysplastic/myeloproliferative neoplasm
with ring sideroblasts and thrombocytosis
• Bone marrow aspirate:
• Usually hypercellular
• Reversal of M:E ratio
• Erythroid hyperplasia
• Dyserythropoiesis: marked
• >15% ring sideroblasts present on Prussian blue stain
• Megakaryocyte hyperplasia
• Megakaryocytes are predominantly large hypersegmented and show focal
clustering
• Multilineage dysplasia may also be seen
37.
38.
39. MDS/MPN-RS-T: Mutational pathogenesis
Mario Cazzola, Luca Malcovati, Rosangela Invernizzi,
Myelodysplastic/Myeloproliferative Neoplasms,
Hematology Am Soc Hematol Educ Program, 2011
40. • Genetic profile:
• Cytogenetic abnormalities: ~10% cases
• Somatic mutation involving RNA splicing gene (SF3B1): ~60-90%
• SF3B1 mutation commonly associated with JAK2 V617F mutation
• Rare association of CALR or MPL W515 mutation with SF3B1 has also been reported
• Detection of SF3B1, JAK2 V617F, CALR & MPL W515 mutations are not required for
the diagnosis
• Their presence supports the diagnosis and carry prognostic significance
Myelodysplastic/myeloproliferative neoplasm
with ring sideroblasts and thrombocytosis
41. Prognosis and predictive factors
• Median overall survival: 76- 128 months
• Prognostic factors: patient age, JAK2 V617F and SF3B1 mutation
• SF3B1 mutation: significantly longer median overall survival
• JAK2 V617F mutation: more favourable outcome
Myelodysplastic/myeloproliferative neoplasm
with ring sideroblasts and thrombocytosis
42. MDS/MPN-RS-T MDS-RS ET
Median age (in years) 72-75 60-73 ~60
Anemia Present Present Absent
Leukocytosis Not common Not common Not common
Thrombocytosis Present Absent Present
Ring sideroblasts >15% >15%/>5% Absent
Dysplasia Present Present Absent
JAK2 V617F mutation <10% Rare Common (50-60%)
SF3B1 mutation 60-90% 80-90% Absent
Median overall
survival
76-128 months Short (69-108 months) Long (120-180 months)
Myelodysplastic/myeloproliferative neoplasm
with ring sideroblasts and thrombocytosis
43. Montalban-Bravo G, Garcia-Manero G. MDS/MPN-RS-T justified inclusion as a unique
disease entity? Best Practice and Research: Clinical Haematology. 2020 Jan 1. 101147.
45. • Introduction: It is characterized by dysplastic proliferation of one or more
myeloid lineages and simultaneously effective proliferation of another
myeloid lineages with no history of a preceding MPN
• Age: Elderly (median age ~70years)
• Male predominance
• Sites for extramedullary involvement: spleen and liver may be involved
• C/F: overlap with those of entities in the MDS and MPN
• Weight loss, fever and night sweats: Effective proliferation
• Fatigue, infection and bleeding: Dysplastic proliferation
Myelodysplastic/myeloproliferative neoplasm,
unclassifiable
46.
47. Myelodysplastic/myeloproliferative neoplasm,
unclassifiable
Peripheral blood:
• RBC:
• Anemia
• Macrocytosis
• nRBCs may be seen
• WBC count:
• Increased in number (~70%)
• Neutrophilic precursors
• Neutrophils may show dysplasia
• Blasts: <20%
• Platelets:
• Increased/decreased in number
• Giant and hypogranular platelets
may be seen
48. • Bone marrow aspirate:
• Hypercellular
• M:E ratio: increased/decreased
• Proliferation of any or all myeloid lineages
• Significant (>10%) dysplastic features in at least one cell line
• Dysgranulopoiesis and dysmegakaryopoiesis: ~50% cases
• Blasts:<20%
• Bone marrow biopsy:
• Moderate to marked fibrosis (20-30%)
Myelodysplastic/myeloproliferative neoplasm,
unclassifiable
49. • Cytochemistry and immunophenotype:
• Cytochemical abnormalities or immunophenotypic characteristics are similar
to MDS or MPN
• Genetic profile
• No specific cytogenetic or molecular genetic findings
• High frequencies of TET2, NRAS, RUNX1, CBL, SETBP1 and ASXL 1 mutations
have been reported
Myelodysplastic/myeloproliferative neoplasm,
unclassifiable
50. • Prognosis and predictive factors
• Median overall survival: ~12-18 months
• AML transformation: ~20-30%
• Thrombocytopenia: negative impact on survival
• Thrombocytosis: favorable predictor for an improved survival
Myelodysplastic/myeloproliferative neoplasm,
unclassifiable
Primarily occurs de novo. However…implicated in some cases
The aspirate smears show a myeloid predominance with increased monocytes (16%) and 2% blasts. There are subtle dysplastic features in the neutrophils.
The aspirate smears show a myeloid predominance with increased monocytes (16%) and 2% blasts. There are subtle dysplastic features in the neutrophils.
The trephine core is hypercellular for age with increased numbers of monocytes.
Bone marrow biopsy in chronic myelomonocytic leukemia showing a proliferation of granulocytes and monocytic elements. The monocytes are prominent in this case and show clustering (right), but in some cases they are only slightly increased in the marrow.
Chronic myelomonocytic leukaemia. A Some degree of fibrosis may be seen in as many as 30% of cases; this bone marrow biopsy specimen shows streaming of cells
suggestive of underlying reticulin fibrosis, the presence of which was confirmed by reticu lin silver staining
Ihc: strong mem positivity for cd123
strongly recommended
whenever the diagnosis of
CMML is considered {2985). Alpha-naphthyl
butyrate esterase or alpha-naphthyl
acetate esterase (with fluoride inhibition)
staining of blood and bone marrow aspirate
smears, alone or in combination
with naphthol AS-D chloroacetate esterase
(CAE) staining, is extremely useful
for assessing the monocytic component,
A higher proportion OF BLASTS may indicate poor
prognosis or higher risk of rapid transformation
to acute leukaemia
Therefore, it is critical to prove a clonal neoplastic process in CMML. In addition to these neoplastic causes, reactive mono should be ruled out before diagnosing cmml
it is estimated that there are only
1-2 aCML cases for every 100 cases of
BCR-ABL1-positive chronic myeloid leukaemia
Most of the leukocytes in the blood are granulocytes with 10% or more immature forms (promyelocytes, myelocytes, and metamyelocytes). Granulocytes are dysplastic with hypogranular cytoplasm, nuclear atypia, and hypolobation (Fig. 17.37). It is also observed in some cases that neutrophils may show abnormal chromatin clumping with multiple nuclear lobes HYPO GRANULAY CYTO, HYPOLOBATED NUCLEUS, HY
Wbc count can reach upto 3l/
Absolute mono count >1000
Platelets are decreased in approximately one third to one half of the patients.
M:E ratio is increased with a left shift and pseudo Pelger Huet forms.
Abnormal nuclear lobulation is noted in the neutrophils. There is also maturational arrest in the myeloid series.
BM smear showing granulocytic hyperplasia and erythroid hypoplasia. Mature neutrophils are agranular and show abnormal nuclear segmentation.
most of the remaining
patients die of marrow failure
HEPATOMEGALY INFREQUENT
PB film from a patient
with MDS/MPN‐RS‐T/refractory
anaemia with ring sideroblasts
and thrombocytosis showing mild
anisopoikilocytosis, dysplastic
neutrophils, thrombocytosis
and giant platelets; there is
one hypochromic erythrocyte.
Bone marrow biopsy:
Mild fibrosis
SF3B1 Codon 700
ON THE OTHER HAND SOMATIC MUTATION
Mds-rs ring sideroblasts %15/5
Morphological and mutational features of MDS/MPN-RS-T, MDS-RS and ET
CANNOT BE CLASSIFIED INTO ANY OF THE KNOWN DISEASE SUBTYPES
