Roshan Koshy Jacob: When Unexplained Severe Anemia Points to Myelodysplastic Neoplasms
Roshan Koshy Jacob, Consultant Medical Oncologist at NMC Royal Hospital Sharjah, shared a post on LinkedIn:
“The Diagnostic Odyssey of Severe Anemia: A Case of Myelodysplastic Neoplasm (MDS) with Marked Bone Marrow Fibrosis
Abstract
Severe anemia with preserved iron stores, normal vitamin levels, and no evidence of hemolysis presents a significant diagnostic challenge.
Although nutritional deficiencies and occult blood loss remain common causes, primary bone marrow disorders should be considered when routine investigations fail to identify an etiology.
We present the case of a patient who developed rapidly progressive severe normocytic normochromic anemia over a few months, associated with exertional dyspnea, generalized weakness, and low back pain.
Extensive evaluation excluded nutritional deficiency, hemolysis, gastrointestinal blood loss, plasma cell dyscrasia, and hematological malignancy.
Autoimmune workup demonstrated positive ANA and intrinsic factor antibodies with atrophic gastritis.
Bone marrow examination revealed a hypercellular marrow with erythroid hyperplasia, mild dyserythropoiesis, marked reticulin fibrosis (MF-3), and increased marrow macrophages without excess blasts.
According to WHO HAEM5 (2022), the findings were most consistent with a myelodysplastic neoplasm with low blasts after exclusion of secondary causes.
The patient was initiated on darbepoetin alfa therapy and remains under close hematology follow-up.
This case highlights the importance of considering myelodysplastic neoplasms in patients with rapidly progressive unexplained anemia despite an apparently unrevealing initial workup.”
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