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Myelodysplastic syndrome — RACP Adult Medicine MCQ

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HardHaematologyMyelodysplastic syndromeRACP Adult Medicine

A 76-year-old man has fatigue and recurrent infections. Full blood count shows macrocytic anaemia, neutropenia and thrombocytopenia. B12, folate and TSH are normal. Blood film shows hypogranular neutrophils and oval macrocytes. What is the most likely diagnosis?

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Correct answer: E — Myelodysplastic syndrome

Unexplained cytopenias with macrocytosis and dysplastic neutrophils in an older adult suggest myelodysplastic syndrome. Iron deficiency is microcytic and does not cause neutropenia. Acute blood loss, hereditary spherocytosis and reactive thrombocytosis do not fit pancytopenia with dysplasia.

Reference: eviQ haematology resources; AMH