Master the board step 3

Hematology
Myelodysplasia
This condition presents in elderly patients with pancytopenia, elevated MCV,
low reticulocyte count, and macroovalocytes. There is a special neutrophil
with 2 lobes called a “Pelger-Huet cell.” Look for a normal B12 level. There
will be a small number of blasts but not enough to be considered acute leukemia.
Myelodysplasia is like a mild, slowly progressive preleukemia syndrome.
Just as cervical dysplasia may sometimes progress to cervical cancer,
myelodysplasia may progress to acute leukemia. The most common cause of
death is not leukemia; most patients die of infection or bleeding.
Lenalidomide has
tremendous efficacy in
decreasing transfusion
dependence in MDS.
Treatment is largely supportive with transfusions as needed. Azacitadine,
decitabine, and lenalidomide are specific therapies for myelodysplasia (MDS).
Those with the 5q minus syndrome are treated with lenalidomide. Only azacytadine
increases survival.
Pelger-Huet
cell
Myeloproliferative Disorders
Chronic Myelogenous Leukemia (CML)
Look for an elevated white cell count that is predominantly neutrophils.
Splenomegaly is frequent.
Basic Science Correlate
Untreated CML has
the highest risk of
transformation into acute
leukemia of all forms
of myeloproliferative
disorders.
Mechanism of Early Satiety in CML and CLL
The spleen is anatomically right on top of the stomach. When the spleen
is enlarged, it presses on the stomach and compresses it. This stomach
compression makes a person feel full right after eating.
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