Myelodysplastic Syndromes

Acquired Pelger-Huet Anomaly
associated with drugs
• a predominance of uni-lobed neutrophils (with
occasional bi-lobed forms present); in some cases
many band forms may also be seen
• Abnormally coarse nuclear chromatin
• uniformity in appearance of the neutrophil
population
• ABSENCE OF OTHER MORPHOLOGIC
DYSPLASIA
Dyserythropoiesis Dysgranulopoiesis Dysmegakaryopoiesis
Chemotherapy/bone marrow Chemotherapy/bone marrow Chemotherapy/bone marrow
regeneration
regeneration
regeneration
Vitamin B12/folate
Vitamin B12/folate
Vitamin B12/folate deficiency
deficiency, and rarely deficiency, and rarely (some cases)
pyridoxine (B6) deficiency pyridoxine (B6) deficiency
Infections (parvovirus, HIV) Infections (HIV) Infections (HIV)
Autoimmune conditions Autoimmune myelofibrosis
Post-transplant Post-transplant
Medications, alcohol and
other toxins, heavy metals
(e.g. arsenic) etc.
Rapid erythroid proliferation
in response to anemia;
erythropoietin therapy
Aplastic anemia/PNH
Paraneoplastic Paraneoplastic myelofibrosis
Medications (e.g. tacrolimus,
mycophenolate mofitel,
gancyclovir, purine analogs)
Exogenous (G-CSF) or
endogenous (e.g. sepsis)
cytokines
Hemophagocytic
Hemophagocytic
lymphohistiocytosis lymphohistiocytosis
Congenital dyserythropoietic Congenital (e.g. Fanconi
anemias
anemia)
Hemophagocytic
lymphohistiocytosis
Transient abnormal
myelopoiesis of Down
syndrome; other congenital
disorders
Copper Deficiency
• Granulocytes:
−left shifted
−vacuolization of precursors
• Erythroid series:
−Left shifted with mild megaloblastic
changes and terminal
dyserythropoiesis
−vacuolated cytoplasm
−ringed sideroblasts
• Megakaryocytes: usually normal
• Variable marrow cellularity
• Blasts are generally NOT increased.
G-CSF may result in increased blasts and neutrophil dysplasia
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