A Case of Myelodysplastic Syndrome Characterized by Hemolytic Anemia at Presentation

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.

Biological characteristics and primary therapeutic response of acute erythroid leukemia / 白血病·淋巴瘤

Objective To observe the biological characteristics and analyse primary therapeutic response of acute erythroid leukemia.Methods The data of 28 patients primarily diagnosed as acute erythroid leukemia were analyzed.The patients were divided into with muhilineage dysplasia group and without muhilineage dysplasia group,and the morphology,immunology,cytogenetics and molecular biology characteristics and the complete remission rate of the first induction therapy were compared.Results There were 14 cases(50％)with muhilineage dysplasia,which involved in two lineage or trilineage.In 6 cases by flow cytometry,the myeloid blast immunophenotypes were common expressed.In 8 cases detected by karyotype analysis,5 cases were chromosomal abnormal,including 4 cases were complex chromosomal abnormal,1 case was trisomy 8.In 4 cases underwent WT1 detection,all of them were positive.The complete remission rate of the first induction therapy was 39.29％(11/28),the ratein the multilineage dysplasia group was 35.71％(5/14),and the ratein without multilineage dysplasia group was 42.86％(6/14),the difference had no statistical significance(P＞0.05).The complete remission rate of the complex chromosome group was 25.00％(1/4),the intermediate prognostic group was 50.00％(2/4).Conclusions Acute erythroid leukemia had special biological features different from other subtype AML:accompanyed with high frequency of multilineage dysplasia.The abnormality of karyotype were high,and it was often complex karyotype involved with chromosome 5 and/or chromosome 7,which had a low complete remission rate.The complete remission rate of chemotherapy was low,treatment effect was poor.

Membranous glomerulonephritis in a patient with myelodysplastic syndrome-refractory cytopenia with multilineage dysplasia

A 74-year-old woman presented with edema in the lower extremities. Laboratory tests revealed anemia, thrombocytopenia, hypoalbuminemia, hypercholesterolemia, and nephrotic-range proteinuria. Myelodysplastic syndrome-refractory cytopenia with multilineage dysplasia (MDS-RCMD) was confirmed by bone marrow biopsy. Renal biopsy demonstrated membranous glomerulonephritis (MGN), stage I. Based on these clinicopathologic results, she was diagnosed as having MGN with MDS-RCMD. This is a rare case report of MGN in a parient with MDS-RCMD featuring nephrotic syndrome.

A Case of Acute Myeloid Leukemia with Multilineage Dysplasia accompanying Malignant Pleural Effusion / 결핵및호흡기질환

We report a case of acute myeloid leukemia with multilineage dysplasia accompanying malignant pleural effusion. A 73 year-old male patient was admitted complaining of febrile sensations and right chest pain. The cytology of the pleural fluid revealed malignant pleural effusion showing many blasts, which had previously been identified in his bone marrow when he was diagnosed with acute myeloid leukemia with multilineage dysplasia two months earlier. His age and poor general condition had precluded chemotherapy with the exception of hydroxyurea and conservative treatment. Unfortunately, he succumbed to the disease 4.5 months after diagnosis. This case highlights the importance of determining if the pleural effusion of acute leukemia is malignant or not because it can suggest a pleural metastasis and influence the prognosis.