Validation of a scoring system to establish the probability of myelodysplastic syndrome in patients with unexplained cytopenias or macrocytosis

Leuk Res. 2011 Oct;35(10):1335-8. doi: 10.1016/j.leukres.2011.05.001. Epub 2011 Jun 24.


Myelodysplastic syndromes (MDS) are clonal hematopoietic stem cell disorders primarily seen in the elderly that are characterized by ineffective hematopoiesis and a propensity to develop AML. Clinicians may be hesitant to refer older patients with unexplained cytopenias and/or macrocytosis for a bone marrow biopsy (BM), and consequently undiagnosed patients may be deprived access to effective treatments. Previously, we described factors which were independently predictive of a diagnosis of MDS at time of bone marrow: age ≥65, mean cell volume (MCV), red cell distribution width (RDW), and lactate dehydrogenase (LDH), and suggested a scoring system to calculate the post-test probability of MDS [1]. In this study we validate this scoring system in a cohort of 313 individuals who underwent bone marrow examinations for the investigation of unexplained cytopenias and or macrocytosis over a 3 year period at our institution (2006-2008). Thirty-two percent of all patients were diagnosed with MDS and 9% had suspected MDS. The post-test likelihood of a diagnosis of MDS increased from 12% when none of the four identified factors were present to 48% when 3 or more factors were present. This scoring system can be used to guide the diagnostic testing of patients presenting with unexplained cytopenias or macrocytosis.

Publication types

  • Validation Study

MeSH terms

  • Aged
  • Anemia, Macrocytic / blood
  • Anemia, Macrocytic / complications
  • Anemia, Macrocytic / diagnosis*
  • Anemia, Macrocytic / pathology
  • Bone Marrow / pathology
  • Bone Marrow Examination
  • Cohort Studies
  • Diagnosis, Differential
  • Female
  • Humans
  • Hydro-Lyases / blood*
  • Leukemia, Myeloid, Acute / blood
  • Leukemia, Myeloid, Acute / diagnosis*
  • Leukemia, Myeloid, Acute / etiology
  • Leukemia, Myeloid, Acute / pathology
  • Male
  • Middle Aged
  • Myelodysplastic Syndromes / blood
  • Myelodysplastic Syndromes / complications
  • Myelodysplastic Syndromes / diagnosis*
  • Myelodysplastic Syndromes / pathology
  • Pancytopenia / blood
  • Pancytopenia / complications
  • Pancytopenia / diagnosis*
  • Pancytopenia / pathology
  • Probability
  • Prognosis
  • Research Design*
  • Sensitivity and Specificity


  • Hydro-Lyases
  • lactate dehydratase