The myelodysplastic syndromes (MDS, formerly known as "preleukemia") are a diverse collection of haematological conditions united by ineffective production of blood cells. Anemia requiring chronic blood transfusion is frequently present. Hematology is the branch of medicine that is concerned with blood and its disorders. ... Anemia ( American English) or anaemia ( Commonwealth English), which literally means without blood, is a lack of red blood cells and/or hemoglobin. ... Blood transfusion is the taking of blood or blood-based products from one individual and inserting them into the circulatory system of another. ...

Signs and symptoms

Abnormalities include:

• neutropenia, anaemia and thrombocytopenia (low cell counts of white & red blood cells and platelets, respectively)
• abnormal granules in cells, abnormal nuclear shape and size
• chromosomal abnormalities, including chromosomal translocations.

Symptoms of myelodysplastic conditions: Neutropenia is a haematological disorder characterised by an abnormally low number of neutrophil granulocytes (a type of white blood cell). ... Anemia ( American English) or anaemia ( Commonwealth English), which literally means without blood, is a lack of red blood cells and/or hemoglobin. ... Thrombocytopenia (or -paenia, or thrombopenia in short) is the presence of relatively few platelets in blood. ... Figure 1: Chromosome. ... Chromosomal translocation of the 4th and 20th chromosome. ...

• Anaemia - chronic tiredness, shortness of breath, chilled sensation, sometimes chest pain
• Neutropenia (low white cell count) - increased susceptibility to infection
• Thrombocytopenia (low platelet count) - increased susceptibility to bleeding

All these conditions have an increased risk of developing acute leukaemia, which is notoriously resistant to treatment ("secondary leukaemia"). This article discusses the medical condition. ... Neutropenia is a haematological disorder characterised by an abnormally low number of neutrophil granulocytes (a type of white blood cell). ... Infection is also the title of an episode of the television series Babylon 5; see Infection (Babylon 5). ... Thrombocytopenia (or -paenia, or thrombopenia in short) is the presence of relatively few platelets in blood. ... Bleeding is the loss of blood from the body. ... Acute myelogenous leukemia (AML), also known as acute myeloid leukemia, is a cancer of the myeloid line of white blood cells. ...

Diagnosis

Investigation:

• Full blood count and examination of blood film
• Bone marrow aspirate and biopsy with examination by an experience hematopathologist
• chromosome studies.

A full blood count (FBC) or complete blood count (CBC) is a test requested by a doctor or other medical professional that gives information about the cells in a patients blood. ... A microscopic view of an abnormal blood film. ... A metaphase cell positive for the bcr/abl rearrangement using FISH Cytogenetics is the study of the structure of chromosome material. ...

Pathophysiology

MDS is due to genetic defects in the multi-potent blood stem cell of the bone marrow. Most of these are not yet described. Differentiation of the abnormal cells is impaired. Clonal expansion of the abnormal cells lead to production of abnormal cells and decreased production of normal bone marrow products. Mouse embryonic stem cells. ... Bone marrow is the tissue comprising the center of large bones. ... Cellular differentiation is a concept from developmental biology describing the process by which cells acquire a type. The morphology of a cell may change dramatically during differentiation, but the genetic material remains the same, with few exceptions. ...

Death from bleeding (due to lack of platelets) or infection (due to lack of white blood cells) is the outcome for about 60% of MDS patients. In about 25-35% of patients there is a further genetic mutation in one of the abnormal blood stem cells which eventually results in acute leukemia. The progression of MDS to leukemia is a good example of the multi-step theory of carcinogenesis in which a series of mutations occur in an initially normal cell and transform it into a cancer cell. For interesting facts link to www.h-e-l-l-psyndrome.blogspot.com A 250 ml bag of newly collected platelets. ... White Blood Cells is also the name of a White Stripes album. ...

Types and classification

In 1974 and 1975 a group of pathologists from France, the United States, and Great Britain met and deliberated and derived the first widely used classification of these diseases. This French-American-British (FAB) classification was published in 1976 and revised in 1982. Cases were classified into 5 categories:

• Refractory anemia (RA) - characterized by less than 5% primitive blood cells (myeloblasts) in the bone marrow and pathological abnormalities primarily seen in red cell precursors;
• Refractory anemia with ringed sideroblasts (RARS) - also characterized by less than 5% myeloblasts in the bone marrow, but distinguished by the presence of 15% or greater red cell precursors in the marrow being abnormal iron-stuffed cells called "ringed sideroblasts";
• Refractory anemia with excess blasts (RAEB) - characterized by 5-19% myeloblasts in the marrow;
• Refractory anemia with excess blasts in transformation (RAEB-T) - characterized by 20-29% myeloblasts in the marrow (30% blasts is defined as acute myeloid leukemia);
• Chronic myelomonocytic leukaemia (CMML) - not to be confused with CML - characterized by less than 20% myeloblasts in the bone marrow and greater than 1000 * 10^9/uL monocytes (a type of white blood cell) circulating in the peripheral blood.

The best prognosis is seen with refractory anemia with ringed sideroblasts and refractory anemia, where some patients live more than a decade (the average is on the order of 3-5 years); the worst outlook is with RAEB-T, where the mean life expectancy is less than 1 year. About 1/4 of patients develop overt leukemia. The others die of complications of low blood count or unrelated disease. Anemia ( American English) or anaemia ( Commonwealth English), which literally means without blood, is a lack of red blood cells and/or hemoglobin. ... Chronic myelogenous leukemia (or CML) is a form of chronic leukemia characterised by increased production of myeloid cells in the bone marrow. ...

The FAB classification was used by pathologists and clinicians for almost 20 years. In the late 1990s a group of pathologists and clinicians working under the auspices of the World Health Organization (WHO) modified this classification, introducing several new disease categories and eliminating others. One new category was refractory cytopenia with multilineage dysplasia (RCMD), which includes patients with pathological changes not restricted to red cells (i.e., prominent white cell precurso and platelet precursor (megakaryocyte) dysplasia. RAEB was divided into RAEB-I (5-10% blasts) and RAEB-II (11-19%) blasts, which has a poorer prognosis than RAEB-I. The category of RAEB-T was eliminated; such patients are now considered (by the WHO authors, at least) to have acute leukemia. 5q- syndrome, typically seen in older women with normal or high platelet counts and isolated deletions of the long arm of chromosome 5 in bone marrow cells, was added to the classification. CMML was removed from the myelodysplastic syndromes and put in a new category of myelodysplastic-myeloproliferative overlap syndromes. Not all physicians concur with this reclassification. This is because the underlying pathology of the diseases is not well understood. It is difficult to classify things that are not well understood.

The average age at diagnosis for MDS is about 65 years, but pediatric cases have been reported. Some patients have a history of exposure to chemotherapy (especially alkylating agents such as melphalan, mustard, cyclophosphamide, busulfan, and chlorambucil) or radiation (therapeutic or accidental), or both (e.g., at the time of stem cell transplantation for another disease). Workers in some industries with heavy exposure to hydrocarbons such as the petroleum industry have a slightly higher risk of contracting the disease than the general population. Males are slightly more frequently affected than females.

All of these conditions are characterized by abnormalities in the production of one or more of the cellular components of blood (red cells, white cells other than lymphocytes and platelets or their progenitor cells, megakaryocytes). Human red blood cells Red blood cells are the most common type of blood cell and are the vertebrate bodys principal means of delivering oxygen to body tissues via the blood. ... White Blood Cells is also the name of a White Stripes album. ... A lymphocyte is a type of white blood cell involved in the human bodys immune system. ... A 250 ml bag of newly collected platelets. ... The megakaryocyte is a bone marrow cell responsible for the production of blood platelets when cytoplasm processes become fragmented. ...

Epidemiology

The exact number of people with MDS is not known because it can go undiagnosed and there is no mandated tracking of the syndrome. Some estimates are on the order of 10,000 to 20,000 new cases each year in the United States. The incidence is probably increasing as the age of the population increases.

Therapy

Treatment:

1. No treatment (watch and wait)
2. Conservative (eg periodic blood transfusion)
3. Hematopoietic growth factors (e.g., erythropoietin)
4. Chemotherapy (although often patients do not tolerate chemotherapy well).
5. Biological agents such as thalidomide, 5-azacytidine, decitabine, lenalidomide
6. Bone marrow transplant (particularly in younger, more severely affected patients)

Blood transfusion is the taking of blood or blood-based products from one individual and inserting them into the circulatory system of another. ... Chemotherapy (pronounced keem-o-therapy) is the use of certain drugs to treat disease, as distinct from other forms of treatment, such as surgery. ... Thalidomide was a drug, sold during the 1950s and 1960s as a sleeping aid and to pregnant women as an antiemetic to combat morning sickness and other symptoms. ... Bone marrow transplantation (BMT) is a hematological medical procedure that involves stem cell transplantation. ...

History

Since the early 20th century it began to be recognized that some people with acute myelogenous leukemia had a preceding period of anemia and abnormal blood cell production. These conditions were lumped with other diseases under the term "refractory anemia". The first description of "preleukemia" as a specific entity was published in 1953 by Block et al. The early identification, characterization and classification of this disorder were problematical, and the syndrome went by many names until the 1976 FAB classification was published and popularized the term MDS. Acute myelogenous leukemia (AML), also known as acute myeloid leukemia, is a cancer of the myeloid line of white blood cells. ... Anemia ( American English) or anaemia ( Commonwealth English), which literally means without blood, is a lack of red blood cells and/or hemoglobin. ... A blood cell is any cell of any type normally found in blood. ...

References

• Bennett JM, Catovsky D, Daniel MT, Flandrin G, Galton DA, Gralnick HR, Sultan C. Proposals for the classification of the myelodysplastic syndromes. Br J Haematol 1982;51:189. PMID 6952920.
• Block M, Jacobson LO, Bethard WF. Preleukemic acute human leukemia. J Am Med Assoc 1953;152:1018-28. PMID 13052490.
• Harris NL, Jaffe ES, Diebold J, Flandrin G, Muller-Hermelink HK, Vardiman J, Lister TA, Bloomfield CD. World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues: report of the Clinical Advisory Committee meeting-Airlie House, Virginia, November 1997. J Clin Oncol 1999;17:3835-49. PMID 10577857.

JAMA is the acronym for the Journal of the American Medical Association, a leading medical journal. ...

External links

• Cancer Medicine (http://www.ncbi.nlm.nih.gov:80/books/bv.fcgi?rid=cmed.chapter.32804). Online textbook. Chapter by Lewis R. Silverman on Myelodysplastic Syndrome.
• Website of MDS-Foundation with a lot of helpful materials (http://www.mds-foundation.org)