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may have MDS and only with continued observation and testing will a diagnosis be unequivocally established. Others may have been exposed to a bone marrow insult (toxin, infectious agent, etc.), which may never be identified, but which may permit eventual complete or partial marrow recovery over months or years. In these latter individuals, in the absence of clear diagnostic evidence, patience, continued observation, and supportive care may be the best approach pending a declarative diagnosis. One other consideration for these patients would be an immune-mediated injury to hematopoietic stem cells. The differential in these patients includes large granular lymphocytic leukemia, where T-cell receptor and immunoglobulin gene rearrangement studies may be informative.69

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