A patient has 30% blasts in the bone marrow. What is the presumptive diagnosis?

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Multiple Choice

A patient has 30% blasts in the bone marrow. What is the presumptive diagnosis?

The concept here is how blast percentage sorts myelodysplastic syndromes from acute leukemia in the older FAB framework. Refractory anemia with excess blasts in transformation is the category for myelodysplastic conditions with a high, but not full, leukemic blast count—roughly in the 20–30% range in the marrow. A marrow blast count of 30% sits at that upper end, aligning with RAEB-T rather than a de novo acute myeloid leukemia by the FAB criteria. So, even though 30% blasts indicates a highly advanced disease, the best-fitting label in this scheme is RAEB-T. In contrast, true AML by FAB would be defined as 30% or more blasts with a specific AML subtype, such as AML with maturation (M2), and other options (like refractory anemia with ring sideroblasts or CMML) don’t match the blast-pct profile here. In modern practice (WHO), 20% or more blasts would be AML, but the historical exam framework points to RAEB-T for this 30% finding.

The concept here is how blast percentage sorts myelodysplastic syndromes from acute leukemia in the older FAB framework. Refractory anemia with excess blasts in transformation is the category for myelodysplastic conditions with a high, but not full, leukemic blast count—roughly in the 20–30% range in the marrow. A marrow blast count of 30% sits at that upper end, aligning with RAEB-T rather than a de novo acute myeloid leukemia by the FAB criteria. So, even though 30% blasts indicates a highly advanced disease, the best-fitting label in this scheme is RAEB-T. In contrast, true AML by FAB would be defined as 30% or more blasts with a specific AML subtype, such as AML with maturation (M2), and other options (like refractory anemia with ring sideroblasts or CMML) don’t match the blast-pct profile here. In modern practice (WHO), 20% or more blasts would be AML, but the historical exam framework points to RAEB-T for this 30% finding.

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