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August 23-24, 2018 | London, UK
Hematology and Oncology
2
nd
International Conference on
Journal of Hematology and Blood Disorder | Volume 2
Diagnostic difficulties in myelodysplasia: Role of morphology and molecular techniques in age related
clonality, cytopenia and life-style choices
Manzoor Mangi
University of East Anglia, UK
Back ground:
MDS are heterogenous clonal disorders ranging
from single to multi-lineage cytopenia and dysplasia. The link
between haematopoietic aging, clonality and bone marrow
failure syndromes remains unclear. There are diagnostic
difficulties. To this end we present a case of myeloneuropathy
and myelodysplasia.
Methods:
47-year old care worker referred for worsening
myalgia and weakness in lower limbs. She was anemic with low
BMI andshort stature.Neurological examinationrevealed lossof
pin-prick/vibration up to both knees and mild tandem gait. Her
Complete blood count (CBC) showed HB:82g/L,WCC:1.5x109/
L,Plt:219x109/L,ANC:0.6x109/L, no blasts. All other blood
and radiology investigations normal. Neutropenia got worse
(WCC:0.8x109/L). A bone marrow test and molecular myeloid
makers were performed. Bone marrow Fish for trisomy 8.
Monosomy7,5qwerenormal.Furtherbiochemicaltestsincluding
trace elements for lead, mercury, copper, zinc was performed.
Lumber puncture and CSF examination was unremarkable.
Results:
Trace element results show normal levels of Selenium,
lead and mercury. Serum iron and Vit D was low. Serum
Copper low <1.0 (NR=11-22umol/L). 24-hour urinary copper
was low at 0.06umol/L (NR: 0.1-1), high ceruloplasmin, raised
serum zinc 27.1umol/L (NR:11-22) . Patients diet and Upper GI
endoscopy normal. Patient was commenced on Iv copper and
Iron, no growth factors or blood products were used. Further
investigations revealed that patient has been using dentures for
16-yearsandsomeof thedenturecream/gluecontainzincwhich
may have caused zinc overload and neurological symptoms.
Conclusions:
In patients with unexplained neutropenia and
anemia, trace elements and copper level should be checked
and denture questions should be asked in patients with MDS/
cytopenia.
Speaker Biography
Manzoor Mangi is a Consultant Haematologist and Hon. Senior Lecturer Norwich Medical
School.
e:
mhmangi@aol.com