Stase HOM

Myelodysplasia syndrome multi lineage dysplasia

Myelodysplasia syndrome (MDS)
• Stem cell disorder with ineffective hematopoiesis defects in
maturation of all cell lines of myeloid lineage
• Man > woman, mostly erderly 50-80 y.o
• Could be caused by 
de novo mutation
Evironmental exposure : benzene, chemo, radiation
• Dysplasia and cytopenia  fatigue, bleeding, infection
• BMP blast < 20%, hypercellular marrow (bisa juga hypocellular)
• Pre-leukemic  Risk transformation to AML (30% cases)
Harrison 20th edition
 MDS pada usia muda

Myelodysplastic syndromes: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
 MDT tanggal 23/10/2019
MDT pada MDS Eritrosit Dominasi mikrosit, normosit, ovalosit, sel burr,
sedikit fragmentosit, normokromik
Leukosit Jumlah menurun, limfosit meningkat, granulosit
immatur (mielosit, metamielosit), granulasi toksik
netrofil, limfosit atipik
Diff manual: mielosit 1%, metamielosit 2%, stab
5%, segmen 51%, limfosit 40%
Trombosit Jumlah menurun, morfologi dan penyebaran sulit
dinilai
Kesan - Anemia dengan kelainan morfologi eritrosit
- Lekopenia, limfositosis relatif, reaktivitas
netrofil dan limfosit
- Trombositopenia
Kesimpula Gambaran MDT saat ini pada pasien terdiagnosis
n MDS (BMP 09/10/19) terdapat gambaran anemia
pada penyakit kronis
Saran - Monitor darah tepi & MDT
Myelodysplastic syndromes: ESMO Clinical Practice HB - AE - AL 8.4 - 3.09 - 2.74 - 3
Guidelines for diagnosis, treatment and follow-up - AT
 BMP tanggal 09/10/2019

BMP pada MDS Kepadatan

Seluler
Kesan normoseluler hiposeluler, partikel (+), globul lemak (+)

Trombopoetik Kesan menurun, ditemukan satu megakariosit

Eritropoetik Kesan meningkat, ditemukan 39 sel NRBC (pronormoblas 2 sel, normoblas

basofilik 8 sel, normoblas polikromatofilik 11 sel, normoblas asidofilik 18 sel)
Diseritropoietik : asynchronized of NRBC, intercytoplasmic bridging,
megaloblastoid changes, coarsely clumped chromatin, distorted shape,
multinucleation, irreguler lobation, partial loss of nucleus

Granulopoetik Kesan cukup, ditemukan mieloblas 2%, promielosit 4%, mielosit 16%,
metamielosit 15%, stab 20%, segmen 20%, monoblas 6%, monosit 3%, eosinofil
2%
Disgranulopoietik : uneven granulation, peanut cell, hypolobulated

Lain-lain Ditemukan limfoblas 1%, limfosit 8%, sel plasma 3%

Kesan - Penurunan trombopoietik

- Peningkatan eritropoietik
- Granulopoietik kesan cukup
- Ditemukan displasia eritropoietik dan granulopoietik
- Ditemukan mieloblas 2% , monoblas 6%, limfoblas 1%

Kesimpulan Preparat BMP saat ini mengarah pada diagnosis Myelodysplastic Syndrome
with
Multilineage Dysplasia (MDS-MLD)
Catatan :
- Riwayat ITP ?
- Terdapat diskrepansi antara selularitas dengan jumlah sel di counting area

Myelodysplastic syndromes: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
 BMP

intact
Megakariosit

Multinukcleated
red blodd cell
Klasifikasi resiko SKOR : 5

Myelodysplastic syndromes: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
Myelodysplastic syndromes: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
MDS pada kehamilan
Target trombosit pada persalinan pasen MDS
Prognosis
Sintesis Stase
S/ Perempuan 23 tahun, lemas memberat , Gusi berdarah, BAB hitam ,
saat ini hamil 30 minggu.
O/ kepala : konjungtiva pucat (+)
Hb 8,7 Al 2,55 AC 1080 AT 1
BMP 9/10/19 : MDS MLD
A/ MDS MLD dengan (anemia mikro hipo, trombositopenia berat,
neutropenia)
P/ Best Supportive care
Terimakasih
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