Internal Medicine, University of Toronto, ON, Canada.
Leuk Res. 2011 Oct;35(10):1335-8. doi: 10.1016/j.leukres.2011.05.001. Epub 2011 Jun 24.
Myelodysplastic syndromes (MDS) are clonal hematopoietic stem cell disorders primarily seen in the elderly that are characterized by ineffective hematopoiesis and a propensity to develop AML. Clinicians may be hesitant to refer older patients with unexplained cytopenias and/or macrocytosis for a bone marrow biopsy (BM), and consequently undiagnosed patients may be deprived access to effective treatments. Previously, we described factors which were independently predictive of a diagnosis of MDS at time of bone marrow: age ≥65, mean cell volume (MCV), red cell distribution width (RDW), and lactate dehydrogenase (LDH), and suggested a scoring system to calculate the post-test probability of MDS [1]. In this study we validate this scoring system in a cohort of 313 individuals who underwent bone marrow examinations for the investigation of unexplained cytopenias and or macrocytosis over a 3 year period at our institution (2006-2008). Thirty-two percent of all patients were diagnosed with MDS and 9% had suspected MDS. The post-test likelihood of a diagnosis of MDS increased from 12% when none of the four identified factors were present to 48% when 3 or more factors were present. This scoring system can be used to guide the diagnostic testing of patients presenting with unexplained cytopenias or macrocytosis.
骨髓增生异常综合征（MDS）是一种主要发生于老年人的克隆性造血干细胞疾病，其特征为无效造血和发展为 AML 的倾向。临床医生可能不愿意为原因不明的血细胞减少症和/或大细胞性贫血的老年患者进行骨髓活检（BM），因此未确诊的患者可能无法获得有效治疗。此前，我们描述了在骨髓时独立预测 MDS 诊断的因素：年龄≥65 岁、平均细胞体积（MCV）、红细胞分布宽度（RDW）和乳酸脱氢酶（LDH），并提出了一种评分系统来计算 MDS 的后验概率[1]。在这项研究中，我们在 313 名患者中验证了该评分系统，这些患者在 3 年内因不明原因的血细胞减少症和/或大细胞性贫血在我院接受骨髓检查（2006-2008 年）。所有患者中有 32%被诊断为 MDS，9%为疑似 MDS。当四个确定的因素均不存在时，MDS 的后验可能性从 12%增加到 3 个或更多因素存在时的 48%。该评分系统可用于指导出现不明原因血细胞减少症或大细胞性贫血的患者的诊断性检查。
