How do bone marrow abnormalities found in myelodysplastic syndrome (MDS) differ from those found in aplastic anemia?

Updated: Jan 29, 2021
  • Author: Sameer Bakhshi, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Characteristic bone marrow abnormalities that are often found in MDS include the following:

  • Dyserythropoietic red blood cells (RBCs)
  • Neutrophils with hypogranulation, hypolobulation, or apoptotic nuclei reaching to the edges of the cytoplasm
  • Dysplastic megakaryocytes (easily highlighted on immunohistochemistry by CD41 and CD61)
  • Increased or decreased cellularity
  • Increase in blasts

Myelodysplastic features are usually observed in hematopoietic precursors and progeny. Islands of immature cells or abnormal localization of immature progenitors (ALIP) indicate MDS. Patients with MDS may have megakaryocytic abnormalities (micromegakaryocytes, megakaryocytes with dyskaryorrhexis), greater than 15%/5% ring sideroblasts (observed only on iron stains), and granulocytic abnormalities (pseudo–Pelger-Huët cells, hypogranulation, excess of blasts). On occasion, marrow fibrosis may be observed. Monocytes are similarly hypogranular, and their nuclei may contain nucleoli.

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