Transcript
OKEWA Japheth Siome Elizabeth Adoyo Rolex MaklagoKevin OkothKIPKIRUI Nicholas Herold Kipkirui Aduwa ClintonMARSA Subo Hassan Odoyo Mike Laura KimondoKIPRONO Dominic Rosebella Chamoro Marcia Obondi
Lecture Objectives
Introduction to MDS
Classification of MDS: FAB & WHO
Aetiology & Pathogenesis
Clinical features of MDS
Diagnosis
Management
Introduction
Group of clonal disorders of multipotent
hemopoietic stem cells
Qualitative and quantitative
abnormality in all 3 myeloid lines.
Cytopenias develop Progress to AML, but death results before
this.
Classification
FAB Classification WHO classification
Modality of classification
RA- Dysplasia in RBC only
RCMD- Dysplasia in 2 or more myeloid lineage
RAEB- Blasts increase in blood or bone marrow
5q syndrome- Good prognosis
Unclassified- Unilineage dysplasia of myeloid or megakaryocytic lineage
• Poor prognosis
Aetiology
Primary MDS• Major one• 30-50% cases are of
chromosomal abnormality• Exposure to low doses of
chemotherapy and organic chemicals
Secondary/Therapy related MDS• Long term cytotoxic chemo,
radiotherapy & Autologous transplant for lymphoma• Risk increases 4-10 years after Rx
with alkylating agents eg chlorambucil
Pathogenesis
Inherited
Acquired
DNA Damage
Myeloid Stem Cell
Myelodysplastic Clone
Myelodysplastic Syndrome
AML
Increased Angiogenesis
Immune Damage
Increased Apoptosis
Abnormal marrow microenvironment
Secondary genetic and epigenetic
abnormalities
Clinical Features
• 4/100000 incidence
• Discovered by chance• ½ of patients are over 70yrs and
< 25% are less than 50 years
• Symptoms of anemia, infection, easy bruising and bleeding• Splenomegaly uncommon unless
in CMML MDS
I just
discover
ed that
you have
MDS
I didn't know that I have MDS
Diagnosis
Observe symptoms of bone marrow
failure
Splenomegaly in 10% of
CMMLBlood film
BM aspiration & Trephine
biopsy
Chromosome analysis
Erythroid lineageBlood Bone marrow
Increased marrow cellularity
Multinucleate normoblasts
Ring sideroblastsHypocellular cells like in
aplastic anemiaFibrosisAbnormal chromatin
pattern
Hypochromic cells. Sometimes normoblasts
MacroovalocytesBasophilic
stiplingsreticulocytopenia
Myeloid (Blood)GranulocytopeniaHypogranular
neutrophilsPegler abnormality (bi-
lobed nuclei)Hypolobated neutrophil
nucleimyeloblasts
Megakaryocytic
Blood• Agranular platelets• megakaryocytes
Marrow• Macro megakaryocytes• Micronulclear• Mononuclear• Megakaryocytes with separated
nuclei• Binuclear/polynuclear forms
Cytogenetics
• Partial or total loss in chromosome 5/7 or trisomy 8• N-RAS oncogene mutation in 20 % of cases• FMS mutation in 15% of cases
ManagementBefore management, consider: Age General fitness Severity of the condition Prognosis If the disease is stable or
has progressed
Prognosis
Complications of MDS
Anemia
Increased risk of bleeding
Recurrent infections
Increased risk of cancer (AML)
Ocular manifestations: Cotton wool spots, retinal hemorrhage, corneal ulceration
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