Case 46 – #UnofficialCSIM2 Update 1

Thanks for all your hard work so far.

We’ve established that Mr Ordie has a macrocytic anaemia with normal thyroid function tests, normal B12 and folate and no significant alcohol history. He takes methotrexate and folic acid for rheumatoid arthritis. Methotrexate can cause a mild macrocytosis, or in overdose (intentional, due to drug interaction, or due to acute renal failure and accumulation) can cause a significant pancytopenia.

We then requested a blood film, which looked like this:


The formal report for this film was as follows:

“Mild macrocytic anaemia noted. Film contains frequent pseudo-pelger cells with occasional red cells containing basophilic stippling. Suggestive of myelodysplasia; referral to haematology is advised.”

Which tests might be done in the haematology clinic? How do they help to confirm the diagnosis?

Please respond on twitter using #unofficialCSIM2. Please join in the case and learn as you go! More updates later this week.

About TeamHaem

Online education and discussion about all things haematological
This entry was posted in Acute leukaemia, Anaemia, Bone marrow failure and tagged , , . Bookmark the permalink.

3 Responses to Case 46 – #UnofficialCSIM2 Update 1

  1. Tamer says:

    Lab work up
    1.serum ferritin assay
    2. Bone marrow aspirate and trephine biopsy to assess the degree of cellularity cytogenetics analysis molecular study for MDS panel include 5q- 7q-
    3. Serum erythropoietin level.

    • teamhaem says:

      Thanks for all of your useful comments. We try to do most of the discussion via Twitter – next time reply to us and use #teamhaem! Thanks!

  2. Soha abuelela says:

    BM aspiration and cytogenetics

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