An elderly patient presents with recurrent infections and easy bruising. Blood tests reveal leukopenia, thrombocytopenia, and normocytic anemia. Bone marrow biopsy shows hypercellularity with dysplastic changes. What is the most likely diagnosis?
- A) Acute Lymphoblastic Leukemia
- B) Chronic Lymphocytic Leukemia
- C) Acute Myeloid Leukemia
- D) Myelodysplastic Syndrome ✓
Step 1: Analyzing Symptoms and Blood Test Results
The elderly patient presents with recurrent infections and easy bruising, which are significant clinical symptoms. Recurrent infections suggest an issue with the immune system, while easy bruising indicates a problem with blood clotting or platelet function.
Blood tests reveal:
- Leukopenia: a decrease in white blood cells (WBCs), which can lead to increased susceptibility to infections.
- Thrombocytopenia: a decrease in platelets, leading to easy bruising and bleeding tendencies.
- Normocytic anemia: a reduction in red blood cells that are of normal size, indicating that the body is not producing enough red blood cells.
These findings suggest a hematological disorder affecting multiple cell lines.
Step 2: Bone Marrow Biopsy Findings
The bone marrow biopsy shows hypercellularity with dysplastic changes. Hypercellularity indicates that there is an increased number of cells in the bone marrow, which can be seen in various hematological malignancies. Dysplastic changes refer to abnormal development or maturation of blood cells, which is characteristic of myelodysplastic syndromes (MDS).
Step 3: Differential Diagnosis
Now let’s evaluate the options provided:
A) Acute Lymphoblastic Leukemia (ALL): Typically presents with leukocytosis rather than leukopenia and would show more pronounced lymphoblasts on examination.
B) Chronic Lymphocytic Leukemia (CLL): CLL typically presents with lymphocytosis rather than leukopenia and does not usually cause significant thrombocytopenia or anemia at initial presentation.
C) Acute Myeloid Leukemia (AML): While AML can present with similar symptoms, it usually shows more acute presentation with blasts predominating in peripheral blood smears rather than just dysplastic changes.
D) Myelodysplastic Syndrome (MDS): This condition is characterized by ineffective hematopoiesis leading to cytopenias (like leukopenia and thrombocytopenia) and dysplastic changes in the bone marrow. The age of the patient and the findings align well with this diagnosis.
Step 4: Conclusion
Given the combination of recurrent infections, easy bruising, leukopenia, thrombocytopenia, normocytic anemia, hypercellularity in bone marrow, and dysplastic changes, the most likely diagnosis for this elderly patient is:
Myelodysplastic Syndrome
