Reclassifying a case of myelodysplastic syndrome with excess blasts and erythroid dominance with complex karyotype

This article reports an interesting case of myelodysplastic syndrome with excess blasts (MDS-EB). The article provides a detailed description of the patient’s clinical and laboratory findings and illustrates the characteristic morphology of myelodysplasia. The case reported here is significant as it highlights that an increased erythroid lineage is no longer a diagnostic criterion in the newer MDS classifications, despite the possibility of its association with a poor prognosis and that it may be part of a biologic continuity with acute erythroid leukaemia. The report also highlights other important differences in the classification of myeloid neoplasms between the different classifications of haematolymphoid tumours. Contribution: The proposed change in nomenclature from MDS-EB to MDS with increased blasts (MDS-IB) and the replacement of the term ‘myelodysplastic syndrome’ with ‘myelodysplastic neoplasm’ in the new WHO classification (WHO-HAEM5) could justify inclusion in the South African National Cancer Registry and illustrate why these cases can be better classified using the latest classifications.