Refractory anemia and the myelodysplastic syndromes.

Refractory anemia is a component of each of the myelodysplastic syndromes (MDSs). MDSs are acquired pluripotent stem cell disorders leading to one or more peripheral blood cytopenias with dysplasia in the peripheral blood and bone marrow. MDS and aplastic anemia are sometimes grouped as bone marrow failure disorders because patients present with similar peripheral blood pictures. The bone marrow in MDS is generally hypercellular, due to ineffective hematopoiesis, in contrast to the hypocellular bone marrow of aplastic anemia. MDS is more common in the elderly, differing from aplastic anemia that affects all ages. The characteristics of each of the subgroups of the MDS using the World Health Organization (WHO) classification are described. Cytogenetic analysis provides a useful part of disease diagnosis in this new classification system. There is no successful treatment for MDS other than hematopoietic stem cell transplantation which is usually recommended for patients under age 50. A prognostic scoring system has been developed to help predict the severity of disease and guide treatment. Approximately 10% to 40% of MDS cases terminate in acute leukemia. Current treatment consists mostly of supportive measures; however several new therapies are being explored.

Using cooperative learning in clinical laboratory science education.

OBJECTIVE: To compare performance of students instructed by cooperative learning (CL) activities with those taught by lecture. A secondary objective was to assess students' perceptions about their ability to work in teams before and after their exposure to these instructional approaches. DESIGN/SETTING/PARTICIPANTS: CL was incorporated into the immunology/serology course of a university-based clinical laboratory science (CLS) program. Twenty-two students participated in a 4-week study and were randomly assigned to one of two study groups. INTERVENTION: One group received the course material by CL activities, and the other group was exposed to the material through lecture. MAIN OUTCOMES MEASURE: Mean examination scores for CL and lecture groups were compared using an independent samples t-test. Teamwork knowledge, skills, and attitude (KSA) assessment rated students' perceptions of their ability to work in a team environment pre and post tests were compared using a 2 x 2 repeated measures ANOVA. RESULTS: No significant difference was found between mean examination scores of students who acquired their knowledge by CL activities (85.09%) and those taught by lecture (82.18%). Teamwork KSA means scores pre and post tests (22.5, 22.6 CL; 22.7, 21.6 lecture) were not significantly different. CONCLUSION: Results suggest that the incorporation of CL activities did not reduce the students' academic performance or self-perceptions of their ability to work in teams. The use of CL in the classroom, student laboratory, or clinical setting may help prepare students for the role they will be expected to perform as laboratory professionals.

Trans type genotype alpha thalassemia trait: a case study.

This is a case of hypochromic, microcytic red cells in a young adult Caucasian female. It illustrates the importance of performing iron studies to confirm suspected iron deficiency anemia (IDA). Thalassemia minor is often misdiagnosed as IDA and iron therapy may be needlessly administered. Moreover, the patient will be unaware of an inherited hematological disorder which may require genetic counseling. alpha-thalassemia patients with the --/alphaalpha (cis) genotype should be advised of the risk for producing offspring with Hemoglobin H disease (genotype --/alpha-). In this case, DNA analysis confirmed the diagnosis of a trans type gene deletion alpha-thalassemia trait. Ancestry on the maternal side is German and French. On the paternal side the ancestry is Dutch and Scandinavian. Additionally, there was no knowledge of any family history of anemia on either the maternal or paternal side of the family. This case reaffirms that Anglo-Saxon ancestry does not preclude the diagnosis of alpha-thalassemia. It also supports the findings of Wang that when laboratory findings are suggestive of alpha-thalassemia minor, a moderately decreased MCV, slightly elevated red cell count, and the absence of hemoglobin H inclusions is probably indicative of trans rather than cis type gene deletion alpha-thalassemia trait.