Patients with persistent anemia (hemoglobin <10g/dl) not responding to three months of dietary modification, iron and folate supplementations and after excluding common hemoglobinopathies were labeled as having refractory anemia
. Rickets was defined on clinical examination according to age with patients showing frontal bossing, widely open anterior fontanel, widening of the wrist joint, and bowing of the legs.
Dyr, "Plasma proteome changes associated with refractory anemia
and refractory anemia
with ringed sideroblasts in patients with myelodysplastic syndrome," Proteome Science, vol.
Menatetrenone, a vitamin K2 analog, ameliorates cytopenia in patients with refractory anemia
of myelodysplastic syndrome.
This sample study included total of 205 suspected cases of afebrile malaria comprising patients with refractory anemia
, thrombocytopenia, leukocy-tosis and elevated alanine transaminase (ALT) or bilirubin with negative viral screen in the study.
According to World Health Organization criteria (23), the patients were classified as follows: 8 cases of refractory anemia
, 7 cases of refractory anemia
with ringed sideroblasts, 7 cases of refractory anemia
with excess blasts, and 8 cases of refractory anemia
with excess blasts in transformation.
Regardless, when mutations occur, they are usually found in the high-risk morphologic subtypes of MDS that are associated with a poor outcome and a propensity to evolve to AML, that is, refractory anemia
with excess blasts (RAEB) and refractory anemia
with excess blasts in transformation (RAEBT).
In general, the clinical course of hyperfibrotic MDS or MDS with myelofibrosis is rapidly progressive with short survival, except when myelofibrosis is associated with refractory anemia
(RA) or refractory anemia
with ring sideroblasts (BARS) subtypes [1,3,4].
Factors that should be addressed include infection, inflammation, malignancy, secondary hyperparathyroidism, blood loss, hemolysis, iron deficiency, bone marrow dysplasia, refractory anemia
due to nonrenal conditions, aluminum toxicity, vitamin deficiencies, and concomitant medications that may affect production of red blood cells.
These findings led to the diagnosis of myelodysplastic syndrome (MDS, refractory anemia
with excess of blast-1) in accordance with the WHO 2008 classification  and MDS with multilineage dysplasia in accordance with the 2016 revision of WHO classification .
Often the sole presenting feature of the disease might be refractory anemia
. (2) Fisgin et al studied 22 patients with celiac disease and have reported anemia alone in 19 patients.
Table 1: Factors Associated with Acute Hyporesponse to Epoetin alfa * Inadequate Epoetin alfa doses * Blood loss * Acute inflammation/infection * Iron deficiency * Poor nutritional status * Vitamin deficiency * Concomitant medications Table 2: Additional Documentation Required When Epoetin alfa Doses Exceed 10,000 Units/Administration * Patient weight * Current Epoetin alfa dose * Historical record of Epoetin alfa doses given * Hb (Hct) response to date * Iron indices * Concomitant conditions such as infection, inflammation, or malignancy * Blood loss, concomitant hemolysis, bone marrow dysplasia * Refractory anemia
due to nonrenal conditions (e.g., aluminum toxicity) * Compromised bone marrow * Concomitant medications * Vitamin deficiencies References
Published reports indicate that the risk for development of acute leukemia in refractory anemia
(RA) is approximately 10%, which closely matches that of patients with SDS.