[Hopeful]

Hi Rarity,

PNH is a separately ordered test. It is usually part of the differential diagnosis when a patient presents with unexplained bone marrow failure and anemia, especially in the presence of elevated LDH. If your husband hasn't had it done, I would not delay in requesting it.

Even having a small percentage of PNH cells is significant when determining a treatment plan. Having a large PNH clone may require a different treatment plan all together then typical MDS, even though the two may occur simultaneously. So, it is important to rule this out.

As I have a small PNH clone, my hematologist will periodically monitor my LDH to determine whether the clone is expanding in size. My LDH has never been elevated but I do have a sub-clinical PNH clone. I am sure if my LDH became elevated and I was severely anemic, my doctor would retest my PNH.

I also have NRBCs, schistocytes, teardrops, etc, but in small numbers. I agree with maggiemag that it is the percentage that matters.

Likewise, I think that it is the relative cellularity that matters. Mild hypocellularity would be less concerning than 10% cellularity, for example. Keep in mind that the marrow can be patchy and not consistently hyper- or hypo- cellular.