Refractory Cytopenia with Unilineage Dysplasia

Refractory Cytopenia with Unilineage Dysplasia

Carla S. Wilson, MD, PhD

The blood film shows macrocytes image and moderate anisocytosis with occasional target cells in this patient with refractory anemia (RA). Red blood cell folate and serum vitamin B12 levels are normal.

This aspirate smear fulfills the criteria for RCUD-RA with ≥ 10% erythroid precursors showing dysplastic features, including asynchronous nuclear:cytoplasmic maturation image and megaloblastic changes.



  • Refractory cytopenia with unilineage dysplasia (RCUD)


  • Group of myelodysplastic syndromes (MDS) that present with RCUD

    • Refractory anemia (RA) is most common in adults

    • Refractory neutropenia is rare

    • Refractory thrombocytopenia is rare

    • Bicytopenia may be present but not pancytopenia

  • Unilineage dysplasia involves ≥ 10% of cells in affected cell lineage

    • Dysplasia is usually of same lineage as cytopenia


Environmental Exposure

  • Chemicals or solvents such as benzene

  • Toxins such as cigarette smoke

Acquired Disorder

  • Clonal hematopoietic stem cell disease

    • Increased apoptosis with ineffective hematopoiesis

    • Immune dysregulation plays a role

      • Allows growth of dysplastic clone



  • Incidence

    • 10-20% of MDS

  • Age

    • Older adults, median age 65-70 years

  • Gender

    • Similar incidence for males and females


Jun 13, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Refractory Cytopenia with Unilineage Dysplasia
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