PB and BM finding of MDS

 

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Cytopenia is defined by:

Hemoglobin <10 g/dL (< 6,2 mmol/L)

absolute neutrophil count < 1,8 x 10^9/L

platelet count < 100 x 10^9/L

The morphological classification is based upon number of blasts in peripheral blood and/or bone marrow, in combination with manifest morphologic dysplasia. At least 10% of a hematopoietic lineage shows dysplasia as threshold. However, the lineage(s) manifesting significant morphologic dysplasia frequently do not correlate with the specific cytopenia(s) in individual MDS cases.

Calculating blast percentage should be performed on all nucleated BM cells, not just the “nonerythroid cells.” (The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia):

 

diagnosis % myeloblasts in BM (of PB) % erytroid precursors
AML, NOS
(non-erytroïd subtype)
≥20% ≥50%
MDS
(classification based on MDS criteria)
<20% (of total)
but ≥20% non-erytroïd linaege
≥50%
MDS
(classification based on MDS criteria)
<20% (of total)
and <20% non-erytroïd linaege
≥50%
AML, pure erytroïd leukemia <20% >80% erytropoiesis & >=30% proerytroblasts

 

diagnosis cytopenias dysplastic linaeges peripheral blood
blasts
bone marrow
blasts
Auer rods ring sideroblasts
MDS-SLD 1-2 1 <1% <5% no <15% / <5%*
MDS-MLD 1-3 2-3 <1% <5% no <15% / <5%*
MDS-RS-SLD 1-2 1 <1% <5% no ≥15% / ≥5%*
MDS-RS-MLD 1-3 2-3 <1% <5% no ≥15% / ≥5%*
MDS-EB-1 1-3 0-3 2-4% 5-9% no none or any
MDS-EB-2 1-3 0-3 5-19% 10-19% EB-2 diagnosis
if Auer rods are present
none or any
MDS with isolated del(5q) 1-2 1-3 <1% <5% no none or any
MDS-U(nclassifiable)
1% PB blasts
1-3 1-3 1%** <5% no none or any
MDS-U(nclassifiable)
with single lineage dysplasia and pancytopenia
3 1 <1% <5% no none or an
MDS-U(nclassifiable)
based on defining cytogenetic abnormality
1-3 0 <1% <5% no <15
MDS-U(nclassifiable)
refractory cytopenia of childhood
1-3 1-3 <2% <5% no none

 
* ≥5% if SF3B1 mutation is present
** recorded on at least 2 separate occasions.