A primary care approach to myelodysplastic syndromes

Abstract

Myelodysplastic syndromes (MDS) are probably the most common hematologic malignancies in adults over the age of 60 and are a major source of morbidity and mortality among older age groups. Diagnosis and management of this chronic blood cancer has evolved significantly in recent years and there are Food and Drug Administration-approved therapies that can extend patients' life expectancy and improve quality of life. Primary care physicians (PCPs) are often involved in the process of diagnosis and follow-up of MDS patients, especially those in low-risk groups. They can therefore play an important role in improving patient care and quality of life by ensuring early referral and participating in supportive management. There is also a shortage of oncologists which increases the importance of the role of PCPs in management of MDS patients. In the face of limited resources, PCPs can improve access and quality of care in MDS patients. This article provides an overview of the common manifestations, diagnostic approaches, and therapeutic modalities of MDS for PCPs, with a focus on when to suspect MDS, when a referral is appropriate, and how to provide appropriate supportive care for patients diagnosed with MDS.

Keywords: Bone Marrow Diseases; Cytopenia; Myelodysplastic Syndromes; Primary Health Care.

Figure 1

Peripheral blood film stained with May-Grünwald-Giemsa (MGG), at 40× Magnification. Macrocytic anemia.

Figure 2

Diagnostic approach to myelodysplastic syndromes. MDS, myelodysplastic syndromes; PCP, primary care physician.

Figure 3

Peripheral blood film stained with May-Grünwald-Giemsa (MGG), at 40× Magnification. Dysplastic red blood cell.

Figure 4

Peripheral blood film stained with May-Grünwald-Giemsa (MGG), at 100× Magnification. Dysplastic neutrophil with pseudo-Pelger nucleus.