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Non-Traumatic Urinary Bladder Hematoma Secondary To Myelodysplastic Syndrome: A Rare Case Report

This case report discusses a 76-year-old male with urinary tract infection symptoms and hematuria, ultimately diagnosed with Myelodysplastic Syndrome (MDS) and a non-traumatic urinary bladder hematoma. Despite treatment, the patient's condition deteriorated, leading to his death shortly after discharge. The report emphasizes the importance of early diagnosis and the potential for spontaneous bladder hematoma to be an initial presentation of MDS.

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22 views4 pages

Non-Traumatic Urinary Bladder Hematoma Secondary To Myelodysplastic Syndrome: A Rare Case Report

This case report discusses a 76-year-old male with urinary tract infection symptoms and hematuria, ultimately diagnosed with Myelodysplastic Syndrome (MDS) and a non-traumatic urinary bladder hematoma. Despite treatment, the patient's condition deteriorated, leading to his death shortly after discharge. The report emphasizes the importance of early diagnosis and the potential for spontaneous bladder hematoma to be an initial presentation of MDS.

Uploaded by

International Journal of Innovative Science and Research Technology
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Volume 10, Issue 3, March – 2025 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/25mar064

Non-Traumatic Urinary Bladder Hematoma


Secondary to Myelodysplastic Syndrome: A Rare
Case Report
1
Dr. Devyani Khorate; 2Dr. Suvarna Pai; 3Dr. Pritam Bhatmare
1,2,3
KAHER’s Jawaharlal Nehru Medical College, Belagavi, Karnataka

Publication Date: 2025/03/17

Abstract: A 76-year-old male patient presented with a 4-5 day history of urinary tract infection symptoms and two days of
hematuria with clot formation. The patient was treated briefly with transfusions at an outside hospital. He is a known
diabetic and hypertensive for 20 years, had a cerebrovascular accident 9 years ago, and had multiple hospitalizations and
transfusions due to undiagnosed persistent thrombocytopenia and anemia for 3 to 4 years. General physical examination is
unremarkable. Routine lab tests, Urine microscopy and culture, Ultrasonography and Bone marrow examination (BMA)
were performed. The BMA and biopsy revealed Normomegaloblastic hypercellular marrow with trilineage dysplasia,
suggestive of Myelodysplastic syndrome (MDS). MDS cytogenetics (FISH) was positive for Monosomy 7. Despite
comprehensive supportive management, the patient’s clinical condition progressively worsened.

Keywords: MDS , Monosomy 7, Urinary Bladder Hematoma.

How to Cite: Dr. Devyani Khorate; Dr. Suvarna Pai; Dr. Pritam Bhatmare (2025) Non-Traumatic Urinary Bladder Hematoma
Secondary to Myelodysplastic Syndrome: A Rare Case Report. International Journal of Innovative Science and Research
Technology, 10(3), 181-184. https://doi.org/10.38124/ijisrt/25mar064

I. INTRODUCTION demonstrated Cystitis with thick dependent echogenic debris


within urinary bladder; suggestive of blood clots. (Fig 1)
Myelodysplastic syndromes (MDS) are a group of Provisional diagnosis of Urinary tract infection with
hematopoietic stem cell disorders marked by ineffective bladder hematoma and refractory cytopenia was made.
blood cell production and cytopenia. In India, the reported
incidence of MDS is approximately 3 per 100,000 B. Management:
individuals, while the global prevalence stands at around 7 Patient was treated empirically with intravenous
per 100,000. Most common presentation is anemia [1]. ceftriaxone and intravenous fluids along with 3 pints of
RBC and 4 pints of platelet transfusions which enhanced his
II. CASE REPORT hemoglobin level from 4.6 to 9.7gm/dl. He was then planned
for cystoscopic bladder hematoma evacuation. Meanwhile,
A 76-year-old male was referred to our center with on Day 3 his platelet count dropped significantly to
symptoms of urinary tract infection since 4 to 5 days and 81,000cells/cumm from1,57,000cells/cumm and since
hematuria with clots since 2 days. Patient was treated briefly patient had past history of persistent thrombocytopenia and
with transfusions at an outside hospital. anemia, an intraoperative Bone marrow aspiration (BMA)
and biopsy was performed along with cystoscopic urinary
He is a known diabetic and hypertensive since 20 bladder hematoma evacuation. During evacuation neither
years, had cerebrovascular accident 9 years ago, had injury nor any abnormality was detected in the urinary
multiple hospitalizations and transfusions due to bladder and thus it was concluded to be a spontaneous
undiagnosed persistent thrombocytopenia and anemia since hematoma (Fig 2).
3 to 4 years. General physical examination was
unremarkable. Bone marrow aspiration and biopsy revealed
normomegaloblastic hypercellularity with trilineage
A. Investigations: dysplasia, indicative of Myelodysplastic Syndrome (MDS),
Routine lab tests at admission showed WBC count of a disorder affecting hematopoiesis (Fig 3, 4). Further,
13,400x103/uL, Hemoglobin of 4.6gm/dl and Platelet count heparinized bone marrow aspirate was sent to an outside lab
of 1,57,000cells/cumm. Urine microscopy revealed for MDS cytogenetics by FISH which revealed Monosomy7
significant number of RBCs and WBCs. Urine culture was positivity in multiple clones in 70% of bone marrow cells.
positive for Klebsiella Oxytoca. The USG abdomen-pelvis

IJISRT25MAR064 www.ijisrt.com 181


Volume 10, Issue 3, March – 2025 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/25mar064

III. RESULTS  Megakaryocyte are adequate in number with >10%


showing features of micromegakaryocytes and
Urosepsis with bladder hematoma secondary to multinucleation.
Myelodysplastic syndrome.
D. Bone marrow trephine biopsy (fig 4)
 Patient Outcome  Markedly hypercellular marrow with disorganized
Patient’s condition deteriorated despite all the haematopoiesis
supportive care. Patient was discharged on 18th day of  Dysplastic megakaryocytes with nuclear atypia
admission against medical advice with Platelet count of  Abnormal localization of erythroblasts.
23,000cells/cumm and Hemoglobin of 7gm/dl.
IV. DISCUSSION
He passed away within 2 days of discharge;
Median age at diagnosis in Indian population is 65
A. USG abdomen-pelvis (fig 1): years [1].
 Large, well defined, bladder hematoma (yellow arrow)
 Hyperechogenic area consistent with blood clots (red  The patient in this case presented with persistent
arrow) cytopenia for 3 to 4 years but was not worked up for
 Normal urine within bladder lumen (white arrow). MDS elsewhere
 Bone marrow aspiration showed 8% blast cells.
B. Cystoscopic bladder hematoma (fig 2) evacuation shows  This case highlights that non-traumatic spontaneous
extensive Blood clots. bladder hematoma may be an initial presentation of
MDS, in context of immunological deregulation of
C. Bone marrow aspirate (fig 3) Myelodysplasia, particularly in patients with prolonged
 Hypercellular marrow (80%) with dysplastic changes cytopenia, patient who has not been diagnosed before
affecting all three hematopoietic lineages, and not treated for MDS before.
 Erythroid series show megaloblastic dyserythropoiesis,  MDS represents a diverse spectrum of hematological
nuclear budding, intranuclear budding and delayed malignancies, influenced by aberrant hematopoietic stem
maturation of nuclei. cell activity, immune dysfunction, and genomic
 Myeloid cells show maturation arrest at metamyelocyte instability [2].
stage with reduced number of mature granulocytes.  Non traumatic spontaneous bladder hematoma can
Myeloid cells are hypogranular and hyposegmented. appear with some other rare conditions like Hemophilia,
Increase in blast cells (8%). irradiation and urinary retention [2].

V. IMAGES

Fig 1: Ultrasound Imaging of Bladder Hematoma in MDS-Associated Urosepsis

IJISRT25MAR064 www.ijisrt.com 182


Volume 10, Issue 3, March – 2025 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/25mar064

Fig 2: Cystoscopic Visualization and Evacuation of Spontaneous Bladder Hematoma

Fig 3: Bone Marrow Aspirate Findings in Myelodysplastic Syndrome with Monosomy 7

Fig 4: Bone Marrow Trephine Biopsy showing Myelodysplastic Syndrome with Trilineage Dysplasia

IJISRT25MAR064 www.ijisrt.com 183


Volume 10, Issue 3, March – 2025 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/25mar064

VI. CONCLUSION

MDS encompasses a range of rare hematological


disorders with complex etiologies. Early diagnosis through
comprehensive investigations is crucial for effective disease
management. While supportive therapies offer symptomatic
relief, allogenic hematopoietic stem cell transplantation
remains the only curative option. Our case presented here is
a unique finding in our observation, needs thorough study
and this article further adds to the existing literature.

REFERENCES

[1]. Garcia-Manero G. Myelodysplastic syndromes: 2023


update on diagnosis, risk-stratification, and
management. Am J Hematol. 2023;98(8):1307-1325.
[2]. Li H, Hu F, Gale RP, Sekeres MA, Liang Y.
Myelodysplastic syndromes. J Clin Oncol.
2021;39(16):1751-1761.
[3]. Hellström-Lindberg E, et al. Myelodysplastic
syndromes: moving towards personalized management.
Lancet Haematol. 2018;5(12):666-679

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