thrombocytopenia or thrombocytosis? nancy rosenthal, md
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Thrombocytopenia or thrombocytosis?
Nancy Rosenthal, MD
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Case history
• 65 year old female• Outside case referred for a second opinion• No CBC data was sent with the case
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Refractory anemia with ring sideroblasts associated with marked thrombocytosis (RARS-T)
• New WHO (coming 2016) will likely change this from a provisional to a full entity
• Classified as an overlap syndrome (MDS/MPN)• Must be a de novo diagnosis, not arising from
an myelodysplastic syndrome with ring sideroblasts
• Often has both a JAK2 mutation and SF3B1 mutation
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RARS-T
• MPN –like– Thrombocytosis– Need cytoreduction– Megs are clustered,
bulbous, large– JAK2+, rarely CALR/MPL+
• MDS- like– Macrocytic anemia– Require transfusions– Ring sideroblasts– Erythroid dyspoiesis– SF3B1+ (80-90%)
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Schematic representation of our current understanding of the relationship between the occurrence of a somatic SF3B1 mutation and the formation of ring sideroblasts in patients
with RARS. Previous studies found reduced expression of ABCB7 in CD34-positive ce...
Cazzola M et al. Blood 2013;121:260-269
©2013 by American Society of Hematology
319-351-0109
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Schematic representation of the multistep molecular pathogenesis of RARS-T supporting its nature of true MDS/MPN (combination of SF3B1 and JAK2 or MPL mutations).
Mario Cazzola et al. Hematology 2011;2011:264-272
©2011 by American Society of Hematology