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April 15, 1992

Myelodysplastic Syndrome

Author Affiliations

From The Johns Hopkins University School of Medicine, Baltimore, Md. Dr Dang is a Leukemia Society of America Scholar.

JAMA. 1992;267(15):2077-2080. doi:10.1001/jama.1992.03480150083042

CASE PRESENTATION  —Lawrence Nair, MDA 54-YEAR-OLD white man was referred to The Johns Hopkins Hospital because of refractory anemia. In 1988, anemia and neutropenia were noted, and in July 1990 he was admitted to another hospital, with a hemoglobin level of 55 g/L. Bone marrow biopsy revealed myeloid hyperplasia, and the proportion of blast cells was 0.02 to 0.03. The patient was thought to have a myelodysplastic disorder, and was given weekly transfusions of packed red blood cells (RBCs).In August 1990, the patient was referred to the National Institutes of Health for a second opinion. Bone marrow biopsy was repeated, and the findings were thought to be consistent with myelofibrosis. He was started on a trial course of danazol, as well as cyanocobalamin, pyridoxine hydrochloride, and folic acid. However, in September, the patient was readmitted with severe pain in the left upper quadrant of the abdomen, and a