FISH Panel Testing as a Screening Tool for MDS in Elderly Patients with Anemia
KT Codispoti, L DePalma. The George Washington University Medical Center, Washington, DC
Background: A substantial proportion of the American elderly population is anemic and the presence of anemia has been associated with adverse outcomes, including increased mortality. The most common causes of anemia in the elderly are nutritional deficiency and chronic disease/inflammation. However, over 1/3 of cases are unexplained. A significant proportion of these unexplained anemias could represent early or undiagnosed myelodysplastic disorders (MDS). We assessed the utility of using a FISH panel for common chromosomal abnormalities seen in MDS as a screening test in elderly patients with unexplained anemia who underwent bone marrow biopsy.
Design: We included 102 elderly patients (defined as 65 years old) who presented with anemia (<13g Hb/dL for men and <12g Hb/dL for women) in the outpatient setting. Patients did not have other clinical or laboratory findings which would explain their cytopenia(s) and as a result had a bone marrow biopsy performed. Pathology reports, conventional cytogenetic analysis (CC), and FISH panel including DNA probes specific for chromosome regions 5p15.2, 5q31, 7cen, 7q31, 8cen, and 20q12 were reviewed.
Results: 22 (21.5%) of the 102 patients had MDS. A combination of CC and FISH identified characteristic chromosomal abnormalities in 18 (82%) of the patients with MDS. The remaining 4 (18%) patients were diagnosed with MDS based solely on WHO morphologic criteria. Two (11%) of the patients had incongruent CC and FISH results. Except in one case, FISH did not reveal abnormalities not already detected by cytogenetics. Of the 80 patients who did not have morphologic or chromosomal findings of MDS, 61 (76.3%) had anemia of chronic disease, 10 (12.5%) had iron deficiency, and 9 (11.3%) had an unknown cause for their anemia.
Conclusions: A FISH panel for common chromosomal abnormalities in MDS is not useful as a screening diagnostic test in the elderly population with unexplained anemia. FISH results confirmed the morphologic findings and conventional chromosome results in the majority of the patients with MDS. Most cases of anemia in patients without positive CC or FISH could be explained as a result of chronic disease or iron deficiency. A minority of patients in our study did not have a definitive cause for their anemia identified after evaluation of their bone marrow and neither CC nor FISH added additional diagnostic information.
Wednesday, March 11, 2009 1:00 PM
Poster Session VI # 190, Wednesday Afternoon