Question

52 yo female with pancytopenia and thought to have MDS at an outside facility had the following symptoms: Several months of increasing fatigue, and mental slowness, weakness, DM out of control with bilateral lower extremity numbness and tingling, and a wobbly gait. She had no weight loss, and no palpable lymph nodes, or masses. Her CBC showed: WBC=1900/ul, Hgb=5.3 g/dl, PLT=71,000/ul, and an MCV=109fl. On examination of her peripheral smear the following cells were noted: Her bone marrow bx looked like this: Did the outside facility get the diagnosis right? What are some other possibilities? How could you prove your guess?

          52 yo female with pancytopenia and thought to have MDS at an outside facility had the following symptoms: Several months of increasing fatigue, and mental slowness, weakness, DM out of control with bilateral lower extremity numbness and tingling, and a wobbly gait. She had no weight loss, and no palpable lymph nodes, or masses. Her CBC showed: WBC=1900/ul, Hgb=5.3 g/dl, PLT=71,000/ul, and an MCV=109fl.

On examination of her peripheral smear the following cells were noted:

Her bone marrow bx looked like this:

Did the outside facility get the diagnosis right?
What are some other possibilities?
How could you prove your guess?

52 yo female with pancytopenia and thought to have MDS at an outside facility had the following symptoms: Several months of increasing fatigue, and mental slowness, weakness, DM out of control with bilateral lower extremity numbness and tingling, and a wobbly gait. She had no weight loss, and no palpable lymph nodes, or masses. Her CBC showed: WBC=1900/ul, Hgb=5.3 g/dl, PLT=71,000/ul, and an MCV=109fl.

On examination of her peripheral smear the following cells were noted:

Her bone marrow bx looked like this:

Did the outside facility get the diagnosis right?
What are some other possibilities?
How could you prove your guess?

Added by Frank H.

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