Acquired elliptocytosis of myelodysplastic syndrome.

A 75-year-old man with a 5-year history of myelodysplastic syndrome (MDS) subsequently developed worsening fatigue, dizziness, and dyspnea on exertion. There was no family history of hematologic diseases. On examination he was cachectic with no hepatosplenomegaly and petechiae, but purpuric lesions were present on his hands. The complete blood count showed pancytopenia (hemoglobin 10.2 g/dL, white blood cell count 2.8 k/uL, absolute neutrophil count 1.6 k/uL, platelets 23 k/uL) with a mean corpuscular volume of 101.3 fL. Reticulocyte count was not performed. The peripheral smear showed striking elliptocytosis (see figure). Bone marrow biopsy revealed hypercellularity with prominent megakaryocytic and granulocytic dysplastic. Conventional cytogenetic analysis detected a del(20)(q11.2) with a sideline showing a marker chromosome. The earlier hematologic assessment 5 years prior showed an isolated del(20q)(q11.2) with no evidence of elliptocytosis.