Newb
 

Hi there,

I had my first BMB last month. My doctor is unconcerned with the smattering of abnormal results. I do not want to work myself up over it as you'd think I could trust a hematologist of all doctors.

So here are my questions: Can B12/Folate deficiency cause macrocytosis even if supplementing them heavily? My RBC was low and MCV was high so I thought B12 might make sense of all the options I read about.

Has anyone been told that low cellularity (I was 33 years old at BMB, 40% cellularity) was caused by vitamins or medications you were on? Did it turn out to be true?

Do small loose lymphoid aggregates matter (with T and B cells in them)?

What is mild dyserythropoeisis in erythroid maturation?

Does having <1% CD34+ myeloblasts matter? I think that was in the aspirate.

My neutrophils were high (62%) - could that "throw everything off?" The doctor's resident made it sound that the BMB was not to be taken very seriously because I likely had an infection. I did not feel sicker than I always do, although I found out soon after that my gallbladder was failing and I had a pituitary tumor I didn't know about, so maybe those could explain it.

Also from the aspirate - how can I find out what promyelo, myelo, seg, ortho, and mono mean? Those levels were off, especially the "ortho" one. I think I understand everything else well enough.

Thank you for any slice you can take on for me!
All the best,
Tessal8

I can't help with the rest of it but I think, in terms of promyelo, myelo, seg, ortho, and mono: promyelo = promyelocyte, myelo = myelocyte, seg = neutrophil, mono = monocyte. Promyelocytes & myelocyte are precursors (early versions of) netrophils that will eventually mature into neutophils (aka segs). Monocytes are a type of white blood cell. The main types of mature white blood cells are neutrophils and lymphocytes, with monocytes and eosinophils making up the rest (eosinophils are your "allergy causing" white blood cell)s. I'm not sure what ortho are.

Neutrophils of 62% is pretty normal. Aplastic Anemia shows the opposite - lymphocytes are abnormally high (60-100%) and neutrophils are abnormally low. This is because Aplastic Anemia is an autoimmune disease where your viral fighting white-blood cells, lymphocytes, wipe out your bone marrow. Similar to Type 1 diabetes where your lymphocytes attack your ability to produce insulin in your bone marrow. High neutrophils are better than low.

Viruses/infections can do all kinds of crazy things. Lyme disease, hepatitis A, and mononucleosis alone are known to cause Aplastic Anemia, and mononucleosis is known to cause leukemia (cancer of the bone marrow). Most effects to the bone marrow from viruses are transient. The issue is that most people go to the doctor, are told they have a virus, and go home. They don't have a blood test much less a bone marrow biopsy done. A few months later all may be okay, but it can take a while.

What were the symptoms that caused you to look into this in the first place? That may help us answer your questions.

OK, so I looked up osteomyelitis, and according to wikipedia, "Acute osteomyelitis almost invariably occurs in children. When adults are affected, it may be because of compromised host resistance due to debilitation, intravenous drug abuse, infectious root-canaled teeth, or other disease or drugs (e.g., immunosuppressive therapy)." It is an "infection and inflammation of the bone or bone marrow.". I find it interesting that they reference "infectious root-canaled teeth" - my mother had nothing but problems with a root-canaled tooth until they pulled it. It is one of those things that sounds crazy until it is true. Hopefully you have an infection that can be cured with antibiotics and you won't be on this board for a long time!

Thank you! Yes, it is probably unimportant and some transient infection I didn't know about caused the low cellularity. I think it's only unsettling because I'm not likely to have a second BMB just to check. The first was just to check for mast cells / mastocytosis because I have symptoms of that. It was negative, thankfully, with the macrocytosis and low cellularity being incidental findings. I had an IgG lambda chain show up on a smear the other day so I probably took this (low cellularity and results I don't understand) more seriously than necessary due to the link to cancer with that IgG lambda thing. I also have a genetic disorder that can have bone complications but I hadn't heard of marrow being part of it, so that's another reason I decided I'd feel you guys out on causes of low cellularity, etc.
Thanks again!

Regarding the B12 and folate. If you have MTHFR genetic mutations, the type of B vitamins you use is important. Do you know what your B12, folate, copper, d, iron and zinc levels were before you started supplementing?

Also, serum B12 is the least effective way to determine a deficiency. MMA and homocysteine would be useful to know.