Nadeem Ikram, Samina Amanat, Khalid Hassan.
Transformation of Aplastic Anemia into Myelodysplastic Syndrome (MDS).
Int J Pathol Jan ;3(1):43-5.

A 35 years old male presented with complaints of progressive weakness along with bleeding gum from the last ten days. On examination pallor, with patechial spots over legs and trunk was the positive findings. Rest of the examination was unremarkable. There was no history of blood transfusion. Complete blood counts showed haemoglobin level of 4.0 G/ dl, White Blood cell count of 2.6 X10 9/1, with mostly lymphocytes on differential count, platelet count of 07 X 109/1, reticulocyte count of 0.3% and macrocytic red cell morphology. The bone marrow aspirate showed hypoplastic fragments, without any atypical cells. The bone marrow trephine biopsy revealed mostly fat spaces with occasional lymphocyte. Reticulin was unremarkable. Diagonsis of Aplastic Anaemia was made. For a period of four years after the diagnosis patient received multiple transfusions, with a short period where he received anabolic steroids. After 4 years patient`s condition started deteriorating. He developed bleeding gums along with fever. At that time his blood counts revealed hemoglobin of 4.0 g/ dl and platelet count of 05 X109/1 with a WBC of 17X 109/1. The blood film revealed two percent blast cells, a few myelocytes, hypogranular neutrophils, pseudopelgar cells along with a few nucleated red blood cells. The bone marrow aspiration showed 12% blast cells. A diagnosis of Myelodysplastic syndrome – refractory anemia with excess of blasts (MDS – RAEB) was made.

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