[Greg H]

Hi All!

My recent BMB had some other oddities that I thought I'd relate, just in case anyone else has seen them and has any thoughts.

I have dysplasia in all three cell lines, which is consistent with past results.

There was some debate about my screening BMB at NIH, and Dr. Olnes classified me as RCUD (refractory cytopenia with unilineage dysplasia), arguing that I really only had significant dysplasia in my platelet line. But all the other pathologists have considered me RCMD, because I have weird megakaryocytes (platelet line), megabalstoid erythoids (red cell line), and hypogranular myeloid elements (white cell line). But the red cell and white cell problems tend to have words like "mild" and "slight" attached to them in the pathologist's report.

So, my dysplasia is more evident in my platelet line, but it's red cell transfusions that I need with increasing frequency -- go figure.

My blasts are "not increased."

I find it amusing that bone marrow pathologists use the word "increased" to mean "more than normal," and "decreased" to mean less than normal. So, when they say your iron stores are "increased," they don't mean that you have more than you did last time (which is the plain sense of the word), but rather that you have more than the typical amount of iron stores.

That kind of odd warping of language leads inevitably to a sentence like this from my BMB: "No increase in blasts is appreciated." The pathologist, of course, means she didn't see more than the typical number of blasts. But, I have to say, I do appreciate not having an increase in blasts.

Okay, enough picking on the poor pathologist.

Other oddities, none highlighted as significant:

• I have "scattered, small" CD-3 positive T-cells and CD-20 positive B-cells floating around in my marrow. I have no idea whether this means something, or is just a part of the bone marrow pathologist's travelogue.

• My core sample was 40% cellular and my clot sample was 30% cellular. These aren't low enough to be really hypocellular, but, as my transplant doc noted, most MDSers are hypercellular, so this is a distinctive characteristic of my marrow.

• No ringed sideroblasts.

• I have a mild diffuse increase in reticulin fibrosis.

• A reversed CD4:CD8 ratio, which the pathologist figures is a result of the Campath.

• Almost no plasma cells in the flow cytometry sample

• An "unusually high" hematogone proportion (2.5%). Reading on the web tells me these are lymphoid precursors. I'll bet these are an after-effect of the Campath, since it messed with my lymphocytes.

• A mild increase in my phenotypic promonocyte proportion. (Intensely CD64 positive cells showing at leas some HLA-DR expression without CD14). I have no idea what that means.

• "The sample viability is substantially lower than typically seen on analysis of bone marrow specimens studied in this laboratory; in this specimen the reduced viability's probably associated with increased apoptotic activity." This is a bit of a mystery to me, though I take it to mean I have bunches of blood cells dying before they mature. That's odd, given that the proportion of dysplastic cells is "mild" or "slight."

• The myeloid cells are almost exclusively hypogranular.

Much of this is probably not significant, but I hope to have the opportunity to have a conversation with Dr. Olnes about most of it, just so I understand what we're talking about.

If you have any insights, I'm all ears.

Take care!

Greg