Thank you for all of your input and suggestions. To summarise the case thus far:
- 68 year old lady referred with a macrocytic anaemia and thrombocytosis:
- Haemoglobin 87 g/L (115 – 165)
- White cell count 5.2 x 109/L (4 – 11)
- Platelets 538 x 109/L (150 – 450)
- Mean Cell Volume 108 fl (80 – 100)
- No reversible cause identified on further investigation, and her blood film demonstrated some dysplastic features:
We therefore organised a bone marrow aspirate which confirmed trilineage dysplasia, no excess blasts and no excess ring sideroblasts:
Cytogenetics has subsequently confirmed a diagnosis of MDS with isolated del(5q) (like many of you suggested – good work!)
The patient comes back to clinic for results. How would you communicate her prognosis? What treatment options, if any, would you discuss?
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