Myelodysplastic syndrome

Case
A 29 yo woman complains of weakness and pallor. She had a dengue fever about 2 months ago. Her
menstrual cycle is normal, no other bleeding history. Physical diagnostic: look pale, no organ
enlargement.
Lab findings: Hb 8.6 g/dL, MCV 86 fl (N : 80-93), MCH 29.8 pg (N: 27-31) RDW 18% (N: 11.5-14.5),
WBC 3,000/L (N: 4,500-10,500), platelet 88,000/L (N: 150,000-450,000), and reticulocyte count
0.8% (N: 0.5-2%). Bone marrow aspiration: hypercellularity, there are myelodysplasia megaloblastic
changes in hematopoietic (erythro, granulo, and thrombopoietic) system.
Module tasks:
1.
2.
3.
4.
5.

List the problems of the patient!

What is the diagnosis and differential diagnosis of this patient?
Explain the pathogenesis of this disease!
Describe the FAB classification of this disease!
Describe in brief the treatment of this case!

Leukemia
Case
A 18-year-old boy referred to the General Hospital because of malaise and pallor. He also complains
of fever and gum bleeding. There was no history of blood loss or bloody stools. Physical exam: a
palpable mass in the left upper quadrant and distinct pallor.
Lab findings: Hb 9.4 g/dL, MCV 84 fl (N : 80-93), MCH 27.8 pg (N: 27-31) RDW 13% (N: 11.5-14.5),
WBC 210,000/L, platelet 108,000/L, and reticulocyte count 0.4% (N: 0.5-2%). Peripheral blood
differential counting: 70% blast, auer rod positive. Peripheral blood smear: Bone marrow aspiration:
domination by blast cells, about 50% myeloblast with auer rod and 40% monoblast and
promonocyte.
Module tasks:
1.
2.
3.
4.
5.

List the problems of the patient!

What is the diagnosis and differential diagnosis of this patient?
Explain the pathogenesis of this disease!
Describe the FAB classification of this disease!
Describe in brief the treatment of this case!

Lymphoma
Case:
A eight year-old boy was brought in by his mother as he appears pale, fever, and had not been
gaining weight. The child also had a mass in both side of his neck since 1 year ago. On physical
examination, the boy looks pale. There are lymphadenopathy, and spleen was palpable 5 cm below
the left costal margin.
Lab findings: Hb 7.6 g/dL, MCV 76 fl (N : 80-93), MCH 24.0 pg (N: 27-31) RDW 21% (N: 11.5-14.5),
WBC 13,000/L, platelet 348,000/L, and reticulocyte count 1.5% (N: 0.5-2%), LDH 766 mU/mL. The
result of fine needle aspiration biopsy from cervical lymphonode: lymphoid cells and histiocytes with
two prominent large nuclei.
Module tasks:
1.
2.
3.
4.
5.

List the problems of the patient!

What is the diagnosis and differential diagnosis of this patient?
Explain the pathogenesis of this disease!
Describe the histologic classification of this disease!
Describe in brief the treatment of this case!