Morphologic Subtypes Refractory Anemia RA

Anemia is the main manifestation (hemoglobin below 11 g/dl with a low reticulocyte count) with variable dyserythropoiesis alone or accompanied by DysG and DysM (Table 14-7). However, the first hematological manifestation could be thrombocy-topenia alone or more rarely neutropenia alone. Therefore, this type might be more appropriately termed refractory cytopenias (RC). Granulocytopenia or thrombocytopenia or both may be minimal or absent. Blast cells are not present in the peripheral blood (less than 1 percent) and less than 5 percent in the bone marrow. Ringed sideroblasts should be less than 15 percent. The WHO committee11 has proposed to separate refractory cytopenia patients into two categories: RC with minimal dysplasia and RC with the multilineage dysplasia, a distinct subset with an unfavorable outcome.

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