Some of the cellular abnormalities demonstrated in MDS can be explained by other factors, such as:
- Nutritional: vitamin B12 or folic acid deficiency
- Causes megaloblastic changes and cytopenia
- Exposure to heavy metals or toxins (examples: arsenic compounds, alcohol, lead, benzene, zinc, isoniazid)
- May cause dyserythropoiesis
- Antibiotics such as cotrimoxazole
- May cause granulocytic dysplasia
- Congenital dyserythropoietic anemia
- May cause dysplastic normoblast development
- Parvo-virus infection
- May cause temporary suppression of the bone marrow erythroid cells and megaloblastic changes
- Immunosuppressive agents are given to organ transplant patients (for example, mycophenolate)
- May cause dysplastic granulocytes and/or erythroid cells
- Chemotherapeutic agents
- Granulocyte colony-stimulating factor (GCSF) treatments
- May cause bone marrow hyperplasia, granulocytic hyper-granulation, and increased blast counts
Each factor listed above is non-clonal and may cause cytopenia and/or dysplasia. Therefore, they must be ruled out before establishing the diagnosis of MDS.
