Myelodysplastic syndrome (MDS) is a heterogeneous clonal disorder of acquired stem cells or pluripotent stem cells, characterized mainly by ineffective hematopoiesis and a high risk of evolution to leukemia. Clinical manifestations include qualitative and quantitative abnormalities in hematopoietic cells, manifesting as anemia, fatigue, or bleeding, with infections most often seen in advanced stages of the disease. The blood picture may show a decrease in whole blood cells and a decrease in any of the first or second lineage blood cells. Some patients may be asymptomatic. Some patients may have mild enlargement of the liver, spleen and lymph nodes, and a few may have sternal pressure, rib or extremity arthralgia. In addition to leukemia, most of the deaths are due to infections and bleeding, especially intracranial hemorrhage. 80% of MDS occur in middle-aged and elderly people.
I. What causes myelodysplastic syndrome?
Myelodysplastic syndrome can be divided into primary and secondary causes. In secondary cases, there is often an obvious cause of the disease, and there is often a history of exposure to benzene aromatic hydrocarbon compounds, radiation, chemotherapeutic drugs, especially alkylating agents, etc. These factors can induce cellular genetic mutations that lead to abnormal clonal cells in the bone marrow and impaired differentiation and maturation, resulting in pathological hematopoiesis, which is destroyed in the bone marrow in situ or soon after release into the peripheral blood, resulting in ineffective hematopoiesis. Therefore, persons who are frequently exposed to these substances need to have regular checkups for them.
Second, what laboratory tests are required for patients with myelodysplastic syndrome?
The laboratory tests that need to be done are
1. blood picture. 50% to 70% of patients have peripheral blood whole blood cytopenia, and first or second lineage hematocrit reduction is rare.
Bone marrow aspiration or bone marrow biopsy. 1/3 to 1/2 of patients have significantly active bone marrow and a small percentage have hypoplasia.
3. karyotype analysis. 40% to 70% of patients have abnormal karyotype of bone marrow cells.
4. in vitro culture of bone marrow cells.
5.According to the condition, clinical symptoms and signs, ultrasound, X-ray and biochemical examinations can be done.
How to treat myelodysplastic syndrome?
Because the etiology and pathogenesis have not been fully elucidated, there is no unified specific treatment plan for MDS so far, but there has been a gradual convergence in the understanding of the principles of MDS treatment.
1. Supportive treatment. Regular transfusion of concentrated red blood cells in severe anemia to maintain a better quality of life. Those with platelet counts of 20×109-30×109/L and a significant bleeding tendency can be transfused with concentrated platelets. Those with co-infection can be treated with anti-infection therapy, supplemented with intravenous gammaglobulin infusion if necessary.
2. Promote hematopoiesis and differentiation maturation and reduce ineffective hematopoiesis. Such as the application of androgens, cytokines, etc.
3. Inducing differentiation. Retinoids and vitamin D drugs may be applied.
4.Immunosuppressive therapy. Such as corticosteroids, cyclosporine, antithymocyte immunoglobulin and thalidomide (reaction stop).
5, low-dose single agent chemotherapy and intense combination chemotherapy.
6, hematopoietic stem cell transplantation.
7.Other, such as traditional Chinese medicine, etc.
IV. What is the prognosis for patients with myelodysplastic syndrome?
Myelodysplastic syndromes are a group of acquired heterogeneous hematopoietic cell development abnormalities. Some patients can be transformed into acute leukemia. The prognosis of patients with this disease is related to age, peripheral blood picture and signs, typing and bone marrow picture, and chromosomal abnormalities. The prognosis of elderly patients is generally worse than that of middle-aged patients, who have severe anemia especially hematocrit <30
Among the five types, refractory anemia (RA) and ring iron-granulocytic refractory anemia (RAS) are less likely to transform into leukemia, and the prognosis is relatively good.
How does TCM treat myelodysplastic syndromes?
Myelodysplastic syndrome belongs to the categories of “deficiency labor”, “blood evidence”, “internal injury and fever”, “stasis evidence” and “The disease is caused by liver depression and spleen deficiency. The disease is based on liver depression, spleen deficiency and kidney deficiency, with deficiency of qi and blood, yin and yang first, liver depression and qi stagnation, followed by internal congestion of evil toxins and stagnant flow of qi and blood, resulting in a mixture of deficiency and reality. The disease is initially superficial as “two deficiencies of qi and blood”, but further development of the disease may result in “two deficiencies of qi and yin” or “two deficiencies of yin and yang”. Clinically, qi and blood deficiency can be seen in pale face, pale lips and nails, dizziness, fatigue, palpitations and shortness of breath, pale tongue with white fur, and weak pulse, which should be treated by benefiting qi and nourishing blood. In kidney deficiency, dizziness and weakness, less florid face, waist and leg weakness, tinnitus and forgetfulness, clear and long urine, weak pulse or late pulse deficiency. For kidney yin deficiency, we can see five heart trouble, low fever and night sweating, dry mouth and stool, light red tongue with little coating, thin and weak pulse, treat with nourishing yin and tonifying the kidney. The treatment is to warm the kidneys and tonify the yang. In the case of kidney yang deficiency, the body is cold, the face is swollen, the night urination is frequent, the abdomen is distended, the stool is loose and soft, the tongue is light and fat, the moss is thin and white, and the pulse is sunken.