[hma]

hello everyone, I am new to this forum but I have been looking through the posts here for the past couple months. This all started from a physical checkup I did in Aug, nurse called me the second day and told me all my blood lines were low. I was freaked out and rushed to a hematologist one week later. The doctor order whole bunch of tests, HIV, B12, Folate, CMV, EVB, ANA, PNH, Hep C, Hep B, LDH, Methylmalonic Acid, Homocystine, COMP panel and all came back normal except following:

Hep B Core Ab, Tot - Positive Abnormal
HBsAg Screen - Negative
CMV Ab, IgG - 15.1 High
Vitamin B12 - >1999 High (I have been taking 5000mg B12 since I suspected it was caused by B12)
Bilirubin, Total - 1.3 High

Doctor then ordered BMB and BMS a week later

BMB report:
Summary Interpretation
BONE MARROW, SITE NOT SPECIFIED, BIOPSY AND ASPIRATE:
1. Hypocellular (~40-50% cellularity) marrow with trilineage hematopoiesis, mild
erythroid predominance and megaloblastoid erythroid maturation. Megakaryocytes are mildly decreased in number. See comment.
2. Normal karyotypic analysis

Summary Comment
Erythroid elements exhibit megaloblastoid maturation. Overt dysplastic features are not seen in
the myeloid and the megakaryocytic cells. Provided folate level is within normal limts. Serum
vitamin B12 level is high. Potential secondary causes for the pancytopenia and macrocytic
anemia should be excluded. Immunoperoxidase studies performed on paraffin section of core
biopsy show no increase in the number of CD34(+) blasts cells. CD61 immunostain highlights the
mildly decreased numbers of megakaryocytic elements. Few small B-cells and small T-cells are
seen scattered in the interstitium; there is no evidence of involvement by lymphoma. Plasma cells
(<5%) are polytypic. Flow cytometery does not show evidence for an increased blast population,
abnormal myeloid maturation or lymphoproliferative disorder.


BMS report:

Body Site: Iliac Crest FLOW CYTOMETRY ANALYSIS 09/10/2013
Interpretation
BONE MARROW ASPIRATE: In the sample analyzed, there is no evidence for abnormal myeloid maturation or an increased blast
population. There is no evidence for a lymphoproliferative disorder.

Body Site: Bone marrow CHROMOSOME ANALYSIS 09/14/2013
Result
46,XY[20]
Interpretation
Normal male chromosome complement observed in all cells examined. There was no evidence of a chromosome abnormality within the limits
of the technology utilized.
There is a mixed population of maturing myeloid cells, B cells and T cells. No abnormal myeloid maturation is seen.

There is no increase in CD34 positive blasts, and they comprise 0.2% of the total cells. The B-cells (2% of total) are
polytypic and the T-cells (21% of total) show no pan T-cell antigen deletion. CD4:CD8 T-cell ratio is 1:1. NK-cells (2.9%
of total) and T-LGL (7.6% of total) are not increased

Here are the CBC results I have taken:

Last year (03/2012):
WBC - 6.4
RBC - 4.75
HGB - 14.6
HCT - 42.5
MCV - 90
PLT - 248

This year (08/26/2013):
WBC - 2.0
RBC - 3.66
HGB - 12.5
HCG - 37.1
MCV - 101
PLT - 71

This year (09/17/2013):
WBC - 2.2
RBC - 3.88
HGB - 13.3
HCT - 40.7
MCV - 105
PLT - 90

This year (10/15/2013) with reti cound and coombs direct:
WBC - 2.4
RBC - 3.85
HGB - 13.6
HCT - 40.2
PLT - 89

Reticulocyte Count: 1.3%
ARC: 50 ( I calculated it myself)
Coombs, Direct - Negative

This year (11/13/2013):
WBC - 2.8
RBC - 3.87
HGB - 13.5
HCT - 39.6
PLT - 82

I asked the doctor many times and he couldn't give a diagnosis. I am under huge stress now and have lost a few lbs. I am the father of two young children (1.5 and 5) and this if affecting my family deeply. I suspect that I have AA but my
BMB says 40-50% cellularity which could be normal for my age. I really appreciate if anyone can take a look my numbers and provide some inputs and suggestions.