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Old Mon Jul 12, 2010, 07:29 PM
ocelot ocelot is offline
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Join Date: Jul 2010
Location: Georgia
Posts: 1
Thumbs up Re: Macrocytosis and low RBCs

Rachel,

As a patient with a very similar set of lab results and clincal experiences, I would try to reassure you that, whatever your present symptoms, it doesn't look like you have MDS.

For what it's worth, aside from your thyroid, C reactive protein and low monocyte results, I have had nearly identical lab results over the last 18 months. The CBC has shown MCV in the 103 to 108 range, with RBCs of 3.2 to 4.1, slightly low hematacrit, hemaglobin at the low end of the normal range and MPV of 6.4-6.9. By the way, all of the CBC results can vary out of the normal ranges from time to time; 5% of the healthy population will show an abnormally high or low result on a test on any given day. It is only where the abnormal result persists for months that you should be concerned.

After my hematologist followed my test results monthly for seven months, and having ruled out all other causes of the low red blood cell counts and macrocytosis (including a few medications that theoretically could affect folate metabolism), I had a bone marrow biopsy last winter.

I resisted the biopsy but now feel it was worth the trouble and expense. The biopsy results showed: some megaloblastic changes (i.e., malformation) in red blood cell precursor cells, increased iron stores and lymphocytic aggregates with some fibrotic infiltration. There also were no cytogenetic abnormalities. The biopsy was deemed non-diagnostic, but the pathologist could not rule out either early MDS, myelofibrosis or idiopathic cytopenia of undetermined significance (a mouthful simply meaning they don't know why some of your blood counts are low). The hematologist told me that there is something amiss in my bone marrow but that it is not anything serious or worth worrying about.

The bottom line is that the blood counts you and I exhibit are not low enough to qualify for inclusion in the MDS diagnosis unless there are significant dysplasic (malformed) changes in the blood cell precursors in the marrow or cytogentic abnormalities in cells taken from the bone marrow aspirate. In your case, the thyroid, monocyte and C reative protein results probably require further investigation. C reactive protein can be a marker of many conditions that involve inflammation as either a primary or secondary aspect of disease. I would ask your hematologist for a further explanation of the thyroid and CRP results at your next appointment. The monocyte values should also be followed. If they remain low it would be further confirmation of the need for a biopsy.

I would not be hesitant to undergo a bone marrow biopsy of your hemo cannot attribute your CBC results to a thyroid condition. The biopsy was quite painless, in part because they gave me small amounts of fentanil, which they sometime use to knock you out when you have a tooth pulled. It didn't render me unconscious, and in fact I talked with the staff throughout the procedure. I went through a whole lot of worrying about it beforehand and wish I had had it done much sooner.

I happened to have gone in for my most recent six month follow-up today. My CBC is unchanged and the doctor wants me back in another six months. If things remain stable then he will put me on a 12 month follow-up schedule.

In short, there is no reason to assume or expect that you have MDS or any other serious bone marrow problem at this point. I would be interested to hear how it goes for you from here.

Best of luck.



Quote:
Originally Posted by Rachel View Post
Hello Everyone!

I picked up my newest set of results today. Unfortunately I am not to go back to the doc until the end of July. Maybe they will mean something to some of you?

T4 Total Thyroxine 12.7 H
T-Uptake .73L
Free Thyroxine Index 9.3
TSH 4.272

HEMATOLOGY
WBC 4.9
RBC 3.76
HGB 13.8
HCT 38.8 L
MCV 103.2
MCHC 35.5
RBC Distribution 12.0
Platelet Count 268
Mean PLatelet Volume 6.5L
Grans, Electronic 69.3
Lymphs, Electrom 24.5
Monocytes, Elect 3.1
Eosinophils 2.4
Basophils .74
Grans, Absolute 3.4
Monos, Absolute .2
Lymphs, Absolute 1.2
EosAbsolute.1
Baso, Absolute .0

Retic Count 2.5 H
Retic Asbolute .0940

B12 300
Folate Serum 24
Folate RBC 730
Ferritin 171

Haptoglobin 116
C REactive Protein 12.80H


Thanks for your help! I am hoping this means something to someone because I can not find an answer.

THANKS!!!

Last edited by ocelot : Wed Jul 14, 2010 at 07:58 PM. Reason: typo
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