Pune: A 70-year-old woman from Mumbai, misdiagnosed with myelodysplastic syndromes (MDS), a type of blood cancer specifically affecting the bone marrow, later turned out to be a case of chronic anaemia brought on by metabolic syndrome. The patient was a long-term hypertensive, obese and pre-diabetic with symptoms such as breathlessness and persistent fatigue similar to that of MDS. While a biopsy was not possible given her age and comorbidities, her treating doctor misdiagnosed her as an inconclusive case of MDS and suggested a bone marrow transplant.However, later when she was brought to Dr Vijaya Ramanan, haematologist, Yashoda Haematology Clinic, in June 2022, she was found to be a case of cytopenia or chronic anemia. “When she came to me, she was under the impression that she might need to undergo a bone marrow transplant. I checked all her reports and tested her for serum insulin levels, retic and autoimmune markers. Her insulin levels were 120+, which was equivalent to that of 12 adult men. This was when I got to know that her medications for an autoimmune disease had kicked in an excess production of serum insulin,” Dr Ramanan said. Due to the misdiagnosis, the woman was undergoing blood transfusions every three weeks to maintain her hemoglobin levels. She was also taking initially suggested erythropoietin injections twice a week for almost a year, which cost the family Rs40,000 per month. The family was also asked to arrange money for a bone marrow transplant.“Once I ruled out MDS, I immediately brought in radical changes in her diet and lifestyle,” Dr Ramanan said. “I eliminated gluten by restricting her to jowar and rajgira rotis, sugar, packaged foods, and dairy products (except a couple of teaspoons of milk in tea). Dosas, idlis, chillas all made of various pulses or millets along with some brown rice were added to her diet apart from a lot of green vegetables.”The woman’s life changed remarkably. Dr Ramanan said that within six months of these changes, her weight dropped by 15 kg. “She had black pigmentation on her legs, which various doctors attributed to varicose veins, ageing, and suntan, which suddenly started fading. She had skin tags on her neck which started reducing, and most importantly, her blood markers improved. During her last follow-up visit with me in May 2025, her serum insulin came down to a very respectable 9. She has also been taken off metformin and medication for uric acid completely. Her thyroid medication has been reduced, haemoglobin has been stable, and in general, she feels more active and energetic than before,” he added.City-based haematologists said that such a misdiagnosis is a rare thing, and non-specialists must avoid declaring MDS in a patient. Dr Deepak R Patil, clinical haematologist, DPU Super Speciality Hospital, said, “Chronic anemia is one of the commonest presentations of MDS which is often under-diagnosed in adults, especially elderly. Diagnosis of MDS should preferably be done by a haematologist. Symptoms in haematological disorders are overlapping, hence involving a haematologist is always a prudent course of action. Chronic anemia is a common condition in elderly. Misdiagnosis and underdiagnosis both are not uncommon to see in this age group.”
