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Hi!
I'll try to answer your questions
1. the PNH clone has a survival advantage vs normal cells, which means it has more protection against destruction by the autoimmune T-cells. There are studies which demonstrate that the autoimmune response against Stem Cells in AA is actually triggered by an abnormal clone (MDS or PNH). When the autoimmune response is full blown the patient presents with marrow failure and pancytopenia. After IST, the autoimmune response subsides and the original clone can expand. In this scenario, the normal marrow suffers collateral damage from an autoimmune response directed against an abnormal clone.
2. regarding your second question, the only concerning word there is dysplastic changes, but I can tell you that 10 Pathologists will look at the same smear and will come with 10 different reading when it comes to stuff like this, I think your doctor should talk to the Pathologist and see what he means by that. If you do it again, the dysplastic changes might be gone next time.
Hope this helps.
Dan
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