[Greg H]

Hey Vicki!

Doctors can be a real pain in the tuchas, no?

Seems to me the big question is whether the substantial levels of fatigue you are having is linked to the marginally low blood counts -- or if something else is going on, unrelated to the blood counts. So, the BMB should answer some questions about whether you have something broken in your marrow.

(I wonder if very physically active folks are more sensitive than couch potatoes to lower Hgb. It would kind of make sense, given that really high performing athletes sometimes (illegally and unadvisedly) take EPO to increase their Hgb and their performance.)

All the BMBs that I have seen look at more than cellularity. The pathologist will provide a breakdown of the various types of cells blood cells in the marrow in their various stages of development and note any misshapen (dysplastic) forms. The presence of those dysplastic forms is the key to an MDS diagnosis. Low cellularity is a hallmark of aplastic anemia, though some folks have low cellularity with MDS. (hypo-MDS or h-MDS).

Sometimes BMBs include cytogenetic analysis, to see if you have any broken chromosomes. But this isn't always included. You might want to see whether they are planning to do this. It adds to the cost (though not the pain). Since the prognostic staging for MDS depends in part on which if any chromosomes are broken, not having cytogenetics in the BMB leaves you with less info than you need to decide about treatment, if in fact, dysplasia is found in your marrow.

Usually a BMB includes information on iron stores in the marrow. I'm not smart about iron stores, but I think knowing about it will help determine whether your marrow is not getting enough to work effectively.

Here's hoping your BMB is normal and you can go find some other reason for your fatigue.

Take care!

Greg