Dr. Mark Fleming talking about pathology vs molecular testing in MDS. He first reminds us the difference of childhood MDS from adult MDS -- and these WHO guidelines, childhood MDS is only classified into these two subtypes. #ASH22 1/n 
The issue is that the "dysplasia" definition has been defined by the cytogenetic abnormalities and genotypes of adult MDS so the criteria for blast %age, extent of dysplasia -- but does this apply?? #ASH22 2/n
MDS in pediatric patients is more normo or hypocellular than hypercellular. There is not ringed sideroblasts in persons <30 and he also reminds us that there are a number of baseline dysplasias in germline BMF pts that are mistaken for MDS! #ASH22 3/n
So, take home point for me so far. Can I have Dr. Mark Fleming review all my bone marrow failure patient slides? Hats off and #ASHKudos to our hematopathologists! #ASH22 4/n
So many questions, does the concept of CHIP apply here? What about needing to find clonal hematopoeisis in these dysplastic marrows to call it a "neoplasm"? And does that classification change your clinical decision?! #ASH22 5/n
Saving this for myself -- but YES, sometimes germline variants do help get us to a more useful classification. #phodocs - check out the last question -- how do we classify this? how do we clinically follow these patients? #ASH22 6/6
Dr. Shimamura shared in the Q&A that in the Schwachman community we DO know something abt the patterns of genomic evolution & they offer a board that can review the results of the pt to be able to tell you if this is usual, requires more monitoring, requires intervention! #ASH22
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