小结
定义
病史和体格检查
关键诊断因素
- 老年
- 乏力
- 运动不耐受
- 苍白
- 瘀斑或出血
- 既往化疗和/或放疗
- 先天性疾病
- 细菌感染
其他诊断因素
- 存在的危险因素
- 自身免疫性疾病
- 脾肿大
- 肝肿大
- 淋巴结肿大
危险因素
- 年龄＞70 岁
- 既往化疗
- 既往接受过放射治疗
- 既往自体造血干细胞移植
- 先天性疾病
- 烟草
- 苯
- 再生障碍性贫血
- 阵发性睡眠性血红蛋白尿 (PNH)
诊断性检查
首要检查
- FBC 和分类计数
- 外周血涂片
- 网织红细胞计数
- 红细胞内叶酸
- 血清维生素 B12
- 铁检测
- 骨髓穿刺涂片和铁染色
- 骨髓穿刺活检
- 基因检测
需考虑的检查
- 病毒血清学
- 血清促红细胞生成素
- 乳酸脱氢酶
- HLA 分型
- 流式细胞术
治疗流程
较低风险 MDS：无症状血细胞减少
较低风险 MDS：无 del(5q) 的有症状血细胞减少
较低风险 MDS：有症状血细胞减少伴 del(5q)
较高风险 MDS：移植候选者
较高风险 MDS：非移植候选者
撰稿人
作者
Vijaya Raj Bhatt, MBBS, MS
Associate Professor
Section Leader, Malignant Hematology
University of Nebraska Medical Center Division of Hematology-Oncology
Nebraska
NE
利益声明
VRB has participated in a Safety Monitoring Committee for Protagonist Therapeutics. He has received consulting fees from Imugene; research funding (institutional) from Abbvie, Pfizer, Incyte, Jazz, and NMDP; and drug support (institutional) from Chimerix for a trial.
Prajwal Dhakal, MBBS
Clinical Assistant Professor of Internal Medicine-Hematology, Oncology, and Blood and Marrow Transplantation
University of Iowa
Iowa City
IA
利益声明
PD declares that he has no competing interests.
鸣谢
Dr Vijaya Raj Bhatt and Dr Prajwal Dhakal would like to gratefully acknowledge Professor Apar Kishor Ganti and Associate Professor Alissa Marr, previous contributors to this topic.
利益声明
AKG has received research support from Amgen, Apexigen, Bristol-Myers Squibb, Janssen, Merck, New Link Genetics, Pfizer, and Takeda Oncology. AKG has been reimbursed for consulting work for AbbVie and Genentech. None of the grants or payments relate to work involving myelodysplastic syndrome. AM declares that she has no competing interests.
同行评议者
David P. Steensma, MD, FACP
Associate Professor of Medicine (Hematology) and Oncology
Division of Hematology
Department of Medicine
Mayo Clinic
Rochester
MN
利益声明
DPS declares that he has no competing interests.
Adrian C. Newland, BA, MB, BCh, MA, FRCP, FRCPath
Professor of Haematology
Queen Mary University
London
UK
利益声明
ACN declares that he has no competing interests.
鉴别诊断
- 再生障碍性贫血
- HIV 感染
- 其他病毒感染（例如细小病毒、CMV 或肝炎）
更多 鉴别诊断指南
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