Matsuda et al developed a prognostic score for evaluating patients with refractory anemia. This can help identify patients with a worse prognosis who may require more aggressive monitoring or therapy. The authors are from Saitama Medical School, Nagasaki University, and the National Institute of Radiological Sciences in Japan.



(1) pseudo-Pelger-Huet anomaly in mature neutrophils in the bone marrow

(2) karyotype on bone marrow cytogenetics

(3) hemoglobin

(4) micromegakaryocytes in the bone marrow


The patient is high risk if the pseudo-Pelger-Huet anomaly is seen in >= 3% of neutrophils.


A patient is intermediate risk of any of the following are present:

(1) karyotype is other than good

(2) hemoglobin <= 6 g/dL

(3) micromegakaryocytes in the bone marrow are >= 10%


A patient is low risk if not either high or intermediate risk.



• Good karyotype is as defined for the International Prognostic Scoring System (above) - normal, isolated del(5q), isolated del(20q), Y(-).

• For evaluation of megakaryocyte morphology, >= 25 megakaryocytes are examined.

• A micromegakaryocyte is either mononucleated or binucleated and <= 1.5 times the diameter of a promyelocyte.

• For evaluation of the Pelger-Huet anomaly, >= 200 neutrophils in the bone marrow are examined.

• The Pelger-Huet anomaly involves hypo-segmented mature neutrophils.

Risk Group

Median Survival in Months

high risk

18 months

intermediate risk

100 months

low risk

> 225 months

from Figure 6, page 1732.


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