Irfan Yavasoglu ( Division of Hematology, Adnan Menderes University Medical Faculty, Aydin, Turkey. )
Adil Coskun ( Department of Gastroenterology, Adnan Menderes University Medical Faculty, Aydin, Turkey. )
Madam, the article entitled "Aortic valve replacement in a patient with pancytopenia secondary to myelodysplastic syndrome" written by Gangwani1 and published in one of the recent issues of your journal was quite interesting. Here, we would like to emphasize some points.
The majority of patients with myelodysplastic syndrome (MDS) have hypercellular bone marrow (BM) (cellularity level >60%). Hypocellular BM is found in a minority of patients and is referred to as hypoplastic myelodysplasia. The differential diagnosis of patients with a hypoplastic BM includes not only aplastic anaemia but also drug toxicity (for example, clopidogrel, amiodarone), Paroxysmal nocturnal haemoglobinuria, and T-cell large granular lymphocytic leukaemia. Also, patients with MDS, particularly with more advanced subtypes, may have severe chronic thrombocytopenia with associated mucosal bleeding. Thrombocytopenia, defined as platelet count less than 100x 109/L, occurs in 40% to 65% of patients with MDS. American and British cooperation group has classified MDS into seven categories. (not five).2
Also, Heyde syndrome is characterized by calcific aortic stenosis, acquired von Willebrand disease, and angiodysplasia in colon and caecum causing gastrointestinal haemorrhage.3 So, prothrombin time, active partial thromboplastin time, von Willebrand Factor level should be evaluated in these patients.
1. Gangwani AL, Hamid M, Naz F. Aortic valve replacement in a patient with pancytopenia secondary to myelodysplastic syndrome. J Pak Med Assoc 2014; 64.
2. DeAngelo DJ, Stone RM, Myelodysplastic syndromes:Biology and treatment.Hoff Man R, Benz EJ, Silberstein LE, Heslop HE, Weitz JI, Anastasi J. Hematology basic principles and practice, 6th. Elsevier 2013, pp 882-903.
3. Ayvaz O, Yavasoglu I, Kadikoylu G, Coskun A, Bolaman Z. Heyde syndrome: Case Report. Turk J Geriatrics. 2012; 15: 470-472.