Hi, Carolyn.
I'm glad that you and Melissa have found each other here. We know that connecting with other patients who understand what you're dealing with can be very helpful. One of you could start a thread for Londoners in the
Your Local Area forum, and see who else shows up!
It's understandable that you still have worries about your slightly low blood counts, and the unresolved question of a lingering illness. Doctors generally don't want to do BMBs unless there is evidence that something is changing. From my experience, I know that you might not actually feel dropping blood counts if you are busy with family, etc. so you need to keep up with having your counts checked regularly.
Regarding the information you provided from your 1999 BMB, it sounds like "Myeloplastic Anaemia" was probably the best diagnosis they could give you. Your anemia was evident from your low blood counts and the BMB indicated other elements that are characteristic of myelodysplasia. Here's a layperson's interpretation of your old report:
"mildly pancytopenic" means that all of your blood counts (red, white, platelets) were lower than average but not extremely low. Some people have naturally lower counts and live that way asymptomatically, but it can also be a sign of a bone marrow failure disease.
"an increase in megakaryocytes" -- megakaryocytes are the cells that mature into platelets. An increased production of these cells in the marrow combined with low platelet counts in the blood are often seen in bone marrow diseases.
"hypocellular trephine" -- Trephine is the word for the bone sample taken during the BMB. From this they studied your overall cell counts (cellularity) and found you to have fewer than the normal number of cells (you were "hypocellular"). A rule of thumb for bone marrow cellularity is that it should be about 100 minus your age. At age 14, your cellularity should have been 85-90%. Anything significantly lower would be characterized as hypocellular, which is characteristic of aplastic anemia. There is also a hypocellular form of MDS in which the bone marrow is essentially empty but the cells that do exists are dysplastic, that is badly shaped or the wrong size.
"antigranulocyte and antiplatelet antibodies were negative" -- this means that you didn't have any antibodies that were fighting your white blood cells (granulocytes) or platelets.
inconclusive "chromosome and immunological studies" -- chromosome studies are the key to distinguishing aplastic anemia from MDS. It's good that they didn't spot any clear abnormalities. The results may have been deemed inconclusive because of the hypocellularity -- not enough cells to get a good sample. Likewise, it seems that they couldn't determine if your immune system was the cause of your low counts. If you were to have another BMB, you might be able to get a more definitive diagnosis but there are many patients who remain in the gray area between the two diseases. The importance of knowing the difference is to decide, when the time comes, on the treatment options.
Whatever condition you have must be very stable since you've gone 10 years, and through pregnancy and childbirth, with depressed but not extremely low counts. I'm sure it's comforting to know that aplastic anemia is almost always acquired, not inherited.
Regards,
Ruth