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You have a  patient with chronic pancytopenia due to myelodysplasia attending the day unit because of temperatures.  She is 69 years old and has suffered from myelodysplasia for the past 7 years.  Myelodysplasia is a malignant clonal stem cell disorder characterised by dysplastic changes on bone marrow examination and results in ineffective haematopoiesis causing varying degrees of panctopenia.  Her normal full blood count approximately: Hb 90g/L, platelets 100×10*9/L and neutrophils 0.9×10*9/L.  Her haemoglobin is supported by a transfusion programme, with approximately 2 units of packed red cells every two months.

Questions:

• What is your approach in this patient?
• Are you concerned?
• Any investigations?

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