Abstract
Thrombocytopenia can arise from various conditions, including myelodysplastic syndromes (MDS) and bone marrow failure (BMF) syndromes. Meticulous assessment of the peripheral blood smear, identification of accompanying clinical conditions, and characterization of the clinical course are important for initial assessment of unexplained thrombocytopenia. Increased awareness is required to identify patients with suspected MDS or BMF, who are in need of further investigations by a step-wise approach. Bone marrow cytomorphology, histopathology, and cytogenetics are complemented by myeloid next-generation sequencing (NGS) panels. Such panels are helpful to distinguish reactive cytopenia from clonal conditions. MDS are caused by mutations in the hematopoietic stem/progenitor cells, characterized by cytopenia and dysplasia, and an inherent risk of leukemic progression. Aplastic anemia (AA), the most frequent acquired BMF, is immunologically driven and characterized by an empty bone marrow. Diagnosis remains challenging due to overlaps with other hematological disorders. Congenital BMF, certainly rare in adulthood, can present atypically with thrombocytopenia and can be misdiagnosed. Analyses for chromosome fragility, telomere length, and germline gene sequencing are needed. Interdisciplinary expert teams contribute to diagnosis, prognostication, and choice of therapy for patients with suspected MDS and BMF. With this review we aim to increase the awareness and provide practical approaches for diagnosis of these conditions in suspicious cases presenting with thrombocytopenia.
Highlights
Academic Editors: Hugo ten Cate and Department of Hematology and Central Hematology Laboratory, Inselspital Bern, University of Bern, Department for BioMedical Research, University of Bern, 3008 Bern, Switzerland
With this review we aim to increase the awareness for myelodysplastic syndromes (MDS) and bone marrow failure (BMF), providing practical approaches in suspicious cases presenting with thrombocytopenia
Depending on the cell lineages affected by cytopenia, MDS patients suffer from a variety of symptoms at presentation, which comprise fatigue, dyspnea, tachycardia, bacterial infections, or mucocutaneous bleeding [3]
Summary
General practitioners are commonly involved in the initial diagnostic assessment of patients with unclear thrombocytopenia. Their role is crucial in identifying suspicious cases of both MDS and BMF and initiate the correct diagnostic assessments timely. Knowledge on the characteristic clinical features for MDS or BMF are helpful
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