Approach to myelodysplastic syndromes Quiz: Ace Your Exams

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A 65-year-old woman presents to the hematology/oncology clinic as a referral for abnormal blood counts. Over the past year, the patient has become more fatigued and short of breath with exertion and has noticed easy bruising. She was hospitalized twice for bacterial pneumonia in the past year. The patient does not use tobacco, alcohol, or recreational drugs. She works in a rubber production factory. Vital signs are unremarkable. On physical examination, she is pale with conjunctival pallor and scattered petechiae on the arms and legs. Serum complete blood count shows white blood cells 3200/mm³, hemoglobin 7.9 g/dL, platelets 45,000/mm³ and 5% blasts on peripheral smear. Bone marrow biopsy is performed and shows over 10% dysplastic cells in all three cell lines and 12% blasts. Which of the following is the most likely diagnosis?

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Myelodysplastic syndrome (MDS) with increased blasts

Myelodysplastic syndrome (MDS) with low blasts

Acute promyelocytic leukemia (APML)

Acute myeloid leukemia (AML)

Hypoplastic myelodysplastic syndrome (MDS)