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Surgical pathology criteria– search this site only stanford medical sites ways to give find a person alumni lane library ways to give find a person refractory anemia with ring sideroblasts associated with marked thrombocytosis (rars-t) definition provisional entity exhibiting features of both rars and essential thrombocythemia note in at least some patients this represents acquisition of a prothrombocythemic jak2 mutation in a background of rars diagnostic criteria must satisfy diagnostic features of rars refractory anemia - hemoglobin <10 mg/dl dysplasia involving erythroid lineage (see below for criteria for dysplasia) must involve ≥10% of erythroids ring sideroblasts (see definition below) must involve ≥15% of total erythroid precursors sustained platelet elevation ≥450 x 103/μl bone marrow biopsy with megakaryocytic hyperplasia large to giant mature megakaryocytes abundant cytoplasm deeply lobulated nuclei (staghorn-like) not hyperchromatic and clustered (as in cellular phase primary myelofibrosis) not monolobated or multinucleated (as in mds) jak2v617f (present in about 60%) mpl w515k/l mutation less frequent <5% blasts in the marrow morphologic features of erythroid dysplasia dyserythropoeisis dimorphic red blood cells (rbc) mixture of normal or macrocytic rbc and hypochromic microcytic rbc high rdw basophilic stippling (pappenheimer bodies) bone marrow erythroid lineage abnormalties ring sideroblasts ≥5 iron granules encircling ≥1/3 of the nucleus must involve ≥15% of erythroids to make the diagnosis of rars usually either many or none erythroid hyperplasia megaloblastoid / megaloblastic changes dyssynchronous maturation of nucleus and cytoplasm of erythroid precursors nucleus lags behind cytoplasm cytoplasmic vacuoles also seen in copper deficiency nuclear changes multinuclearity nuclear budding, hyperlobulation and satellite nuclei internuclear bridging often increased iron in histiocytes due to lysis of defective erythrocytes differential diagnosis exclude non-neoplastic causes of ring sideroblasts drug/toxin to include alcohol, isoniazid, lead, benzene zinc excess/copper deficiency congenital sideroblastic anemia if chemotherapy or radiation therapy related, should be reported a. other pills that work like viagra viagra help you last longer buying generic viagra online generic viagra joke cheap viagra online buy cheap viagra crestor viagra drug interactions generic viagra online Over the counter viagra in india cheap viagra http://classicmotocrossimages.com/mbs-uk-viagra-sales-yg/ Buy viagra cebu philippines crestor viagra drug interactions viagra cheap online crestor viagra drug interactions drinking alcohol and taking viagra viagra without a doctor prescription safe online pharmacies viagra cheap viagra http://classicmotocrossimages.com/mbs-viagra-cheap-pills-ji/

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