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Case report
Unexplained chronic cytopenia: is it idiopathic cytopenia of undetermined significance or myelodysplastic syndrome
  1. Preethi Ramachandran1,
  2. Burak Erdinc2,
  3. Sonu Sahni2 and
  4. Boris Avezbakiyev1
  1. 1 Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, New York, USA
  2. 2 Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, New York, USA
  1. Correspondence to Dr Preethi Ramachandran; drpreethiram{at}


Idiopathic cytopenia is a condition where there is a decrease in peripheral blood counts causing either anaemia, leucopoenia and thrombocytopaenia. Most cases of cytopenia reveal a cause on further workup. But very rarely, in some cases, a definitive cause could not be identified. Unexplained cytopenia becomes challenging and poses difficulty in diagnosis and management. Discriminating these groups of bone marrow failure disorders from myelodysplastic syndrome (MDS) becomes an important clinical question. We describe a case of a middle-aged Hispanic woman who presented with pancytopenia and on extensive workup did not reveal any specific cause. Her bone marrow examination revealed severely reduced megakaryocytes but with normal haemopoiesis of other lineages. Cytogenetics, flow cytometry, comprehensive next-generation whole genomic analysis did not reveal any abnormalities. She fit the criteria for idiopathic cytopenia of undetermined significance rather than MDS. She remained asymptomatic and her counts never improved with immunosuppressives or thrombopoietin mimetics.

  • Haematology (incl blood transfusion)
  • Medical management

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  • Contributors PR wrote the manuscript, did the literature search and looked after the patient. EB and SS helped in the literature search. BA supervised the manuscript and looked after the patient.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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