Hypothetical Patient Case: Anne
Presentation
A 72-year-old patient, Anne, initially presented with fatigue. She went to her primary care physician (PCP) for evaluation and was noted to have anemia.
Patient Name: Anne
Age: 72 years
Background: Retired nurse, lives with daughter
Medical History: Diabetic and hypertensive, history of dyslipidemia
I have always enjoyed keeping active in my community through volunteering, but my last few shifts I found myself getting too dizzy to work. I’m so tired lately, I can’t play with my grandson for as long as he’d like, and I’m worried something serious is going on.
Workup
Anne’s Blood Panel ResultsAmerican Board of Internal Medicine. Accessed May 27, 2025. https://www.abim.org/Media/bfijryql/laboratory-reference-ranges.pdf
NOTES: Normal vitamin B12, iron, and folate levels; normal renal function and liver function; normal stool sample with no signs of gastrointestinal bleeding.
Further workup ruled out other causes of anemia such as B12, folate deficiencies as well as any active bleeding or malabsorption.Zeidan AM, et al. J Hosp Med. 2013;8(6):351-357. Her PCP referred her to a hematologist for further evaluation.
Referral
Peripheral smear report:
- The RBCs were noted as decreased in number and macrocytic in the peripheral smear
- Platelets are adequate
The results of Anne’s peripheral smear indicated disruption in myeloid lineage as seen by the decrease in RBCs and low Hb levels, suggestive of myelodysplastic syndromes (MDS); however, it’s essential to note that these findings alone were not conclusive for a definitive diagnosis. Further diagnostic workup via bone marrow biopsy and cytogenetic analysis was deemed crucial for confirming or ruling out MDS and was then performed.
Anne’s Bone Marrow Results
Diagnosis
Using the IPSS-R scale, Anne’s overall score was determined to be a 3, thus confirming a diagnosis of low-risk MDS.
IPSS-R Score ValuesGreenberg PL, et al. Blood. 2012;120(12):2454-2465.
Anne’s symptoms from anemia are deeply impacting her quality of life, and I want to avoid the risk of worsening cardiopulmonary function or cognitive decline by waiting to initiate treatment.Sébert M. Hematology Am Soc Hematol Educ Program. 2023;2023(1):59-64.
RBC transfusions may help manage her anemia for now, but we may need to discuss a treatment plan with her now to avoid transfusion dependency.
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