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Old Tue Jun 6, 2017, 10:13 PM
DanL DanL is offline
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Join Date: Dec 2010
Location: Denver, CO
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Some of the other items outside of bone marrow blasts and cytogenetic abnormalities include:

cellularity - basically how dense the marrow is. Hypercellular means more cellular, or more dense, than expected, normocellular - about what is expected, hypocellular, less density than expected. Most MDS patients are normocellular to hypercellular, although about 1/4 of cases are hypocellular.

Basically, hypercellular marrow is too dense to let new cells out and may represent cell destruction in the marrow from the improperly formed cells, hypocellular means that there is not enough marrow present to produce enough healthy cells

rule of thumb is that you take your age from 100 and that is what the expected cellularity would be - in my case, I am 43, so the expectation would be between 50% and 60% cellularity.

Myeloid to erythroid ratio or M:E - basically a ratio of early white blood cells to early red blood cells - normal is 1.2:1 all the way to 5:1.

CD4/CD8 ratio - normal is 2:1. Low means a reduced ability to fight infections, Higher means the immune system is either really fighting something or just stronger than normal.

Marrow Fibrosis - sometimes measured as MF-1, MF-2, MF-3, or mild, moderate, or severe is a reflection of scarring of the bone marrow. Most MDS cases have little to no marrow fibrosis. The lower levels MF-1 and MF2 are reticulin fibrosis, MF-3 represents a hardening of the marrow into collagen strands.

Reticulocyte count - basically how many immature red blood cells are in the marrow - .5% to 2.5%, but is higher in patients with anemia as the marrow is trying to put out more red blood cells.

Granulocyte count - basically how many developing white blood cells are being produced - this includes neutrophils, monocytes, basophils, lymphocytes, etc. They differentiate later in the process.

Dyspoesis - simply means misshapen cells
Myeloid cells may be referred to as hypo or hyper granular
Megakaryocytes - a fancy name for platelets

Generally, the only cells that should have nuclei are the white blood cells, platelets and red blood cells should not be nucleated nor should they have multiple lobes, be teardrop shaped (anisocytosis), nor listed as ovalocytes.

In the peripheral smear, they look for Nucleated Red Blood Cells (NRBC), which are basically treated as a red blood cell version of a blast, metamyelocytes, promyelocytes, and myelocytes, which are all immature white blood cells that were released into the blood stream before being ready to function. Segs/Bands are normal white blood cells.

The peripheral smear should not contain plasma cells.

CD34+ cells are basically considered blast cells -

CD as a list of items are just checking for various proteins that may be reactive.

cytopenias simply refers to a reduced number of platelets, red blood cells, or white blood cells. Pancytopenia means that all three are lower than expected.

This is by no means exhaustive, and I am not a doctor, but this is my understanding of the items that show up pretty commonly with MDS patients.

Hope it helps.

Dan
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MDS RCMD w/grade 2-3 fibrosis. Allo-MUD Feb 26, 2014. Relapsed August 2014. Free and clear of MDS since November 2014 after treatment with Vidaza and Rituxan. Experiencing autoimmune attack on CNS thought to be GVHD, some gut, skin and ocular cGVHD. Neuropathy over 80% of body.
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