Objective:To explore the characteristics of bone marrow morphology and the phenotypic features involved in the flow cytometry (FCM)-based erythroid scoring system in low-risk myelodysplastic syndromes (MDS).Methods:A retrospective case series study was conducted. The clinical data of 13 low-risk MDS patients and 20 non-MDS patients (including 8 cases of iron deficiency anemia, 5 cases of thrombocytopenia, 3 cases of infectious diseases, and 4 cases of leukopenia) collected from outpatient or inpatient samples of multiple hospitals from March 2019 to December 2023 were retrospectively analyzed. The bone marrow morphology examination was performed using Wright-Giemsa staining; the immunophenotypic profiles of erythroblasts were evaluated by FCM; G-banding technique was used to analyze the chromosome karyotypes; next-generation sequencing technology was used for molecular biology detection.Results:Among the 13 low-risk MDS patients, there were 6 males and 7 females, with a median age of 61 years (IQR 15 years). Bone marrow morphological examination showed that the dysplastic hematopoietic morphology of erythroblasts was observed in the bone marrow of 13 low-risk MDS patients, with abnormal nuclear morphology such as odd nuclei, mother-daughter nuclei, petal nuclei, inter-nuclear bridges, multinucleated giants (including abnormal pentanucleated forms), and small megakaryocytes; pathological hematopoiesis in bone marrow accounted for 10%-15% of the erythroblasts system; FCM detection showed that the myeloid primitive cells occupied 0-1.2% of nuclear cells in the bone marrow of low-risk MDS group, expressing CD117, HLA-DR and CD33, partially expressing CD34 and CD38, and not expressing CD19, CD56 and CD7; the developmental pattern of granulocyte CD13/CD16/CD11b was basically normal; partial expression of CD36 and CD71 in erythroblasts was missing. The expression of CD36 and CD71 in erythroblasts of non-MDS group was normal. The expression rates of CD36 in low-risk MDS group and non-MDS group were (51.57±0.13)% and (93.50±0.03)%, respectively ( t = -6.32, P < 0.001), while the expression rates of CD71 were (22.24±0.05)% and (87.94±0.04)%, respectively ( t = -9.47, P < 0.001), with statistically significant differences. The coefficient of variation (CV) of mean fluorescence intensity of CD36 in low-risk MDS group and non-MDS group were 155±8 and 57±10, respectively ( t = 29.18, P < 0.001), and the CV of mean fluorescence intensity of CD71 was 204±33 and 56±6, respectively ( t = 19.43, P <0.001), with statistically significant differences. Among 13 low-risk MDS patients, 4 had abnormal bone marrow chromosome karyotypes, including -7, 8, del(20q), -Y, +15, etc; 5 cases had clonal gene mutations detected by next-generation sequencing, such as ASXL1, SRSF2, TET2, DNMT3A, etc; no 5q-, SF3B1 or TP53 gene mutation was detected. Patients were followed up until December 2023, among the 13 low-risk MDS patients, 7 cases achieved good clinical efficacy, 2 cases transformed into high-risk MDS with excess blasts after 1 year, 3 cases transformed into acute myeloid leukemia M 2 2 years later, and the treatment efficacy of 1 case was unknown. Conclusions:Low-risk MDS patients have pathological hematopoiesis of erythroblasts morphologically. FCM detection shows abnormal developmental patterns of erythroblasts combined with elevated CV of average fluorescence intensity, and often accompanied by genetic abnormalities.

Objective The reseach of hepatic vein (HV) and inferior vein cavity(IVC) obstruction recanalized with catheter needle were evaluated. Methods 16 cases of BCS diagnosed with angiography in recent 5 years were all undergone interventional treatment. Five with HV web occlusion principally and 9 with IVC complete occlusion were treated with introducing a catheter needle to penetrate the block through jugular vein or femoral vein. Stenosis or needle track was dilated with balloon. Stent was planted to IVC in 10 cases. Results All cases were successful in technic including a segmental obstrution of IVC and with a lower IVC atresia. Venography demonstrated the patency of blood flow. HV pressure of 5 cases was reduced 1.85kPa, and IVC pressure of 11 cases was reduced 1.21kPa on an average.Conclusions The use of catheter needle technique increases the successful rate in BCS treatment.