II. Pathophysiology

  1. Marrow disorder leading to Macrocytic Anemia
  2. Pre-Leukemia syndrome (precedes advanced MDS by 10 years)

III. Epidemiology

  1. Median age of onset: 70 years old
  2. Incidence: 162 per 100,000 patients (2003, U.S. Medicare population)

IV. Risk Factors

  1. Prior Chemotherapy (5-10% of cases)
  2. Prior radiation exposure (<5% of cases)

V. Labs

  1. Complete Blood Count
    1. Macrocytic Anemia
      1. Peripheral Smear with oval Macrocytes
    2. Comorbid Neutropenia or Thrombocytopenia in <50% of cases
  2. Anemia Labs
    1. Normal B12 Vitamin
    2. Normal Folate
  3. Bone Marrow Biopsy
    1. Hypercellular aspirate with dysplastic cells
    2. Increased blasts suggests higher risk of more rapid progression to Leukemia

VI. Management

  1. Erythopoetin Stimulating Agents
  2. Chemotherapy
    1. Lenalidomide
    2. Azacitidine

VII. Course

  1. Progresses to Acute Myelogenous Leukemia in 25% of cases
  2. Complications of MDS (Anemia, bleeding or infection) results ultimately in death in 50% of cases

VIII. References

  1. Mesa (2011) Internal Medicine, Mayo Conference, Kauai

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