title: Validation of a scoring system to establish the probability of myelodysplastic syndrome in patients with unexplained cytopenias or macrocytosis.
abstract: 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.
authors.affiliation: Internal Medicine, University of Toronto, ON, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Rauw
authors.forename: R A
authors.initials: RA
authors.lastname: Wells
authors.forename: A
authors.initials: A
authors.lastname: Chesney
authors.forename: M
authors.initials: M
authors.lastname: Reis
authors.forename: Liying
authors.initials: L
authors.lastname: Zhang
authors.forename: Rena
authors.initials: R
authors.lastname: Buckstein
mesh_terms: D000368:Aged; D000748:Anemia, Macrocytic / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D001853:Bone Marrow / Q000473:pathology; D001856:Bone Marrow Examination; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006836:Hydro-Lyases / Q000097:blood*; D015470:Leukemia, Myeloid, Acute / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D010198:Pancytopenia / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D011336:Probability; D011379:Prognosis; D012107:Research Design; D012680:Sensitivity and Specificity
chemical_list: D006836:Hydro-Lyases; C045581:lactate dehydratase