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Old Mon Oct 29, 2018, 03:28 PM
bandit224 bandit224 is offline
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Join Date: Oct 2018
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Confused about BMB Report

I have a history of chronic anemia which has in the last year expanded to include leukopenia and sporadic neutropenia. I have pernicious anemia and I was historically on a B-complex and monthly injections of cyanocobalamin. My numbers were getting worse on this regimen and my GP put me back on loading doses of b12 (every other day injections). I have been taking these for weeks and in September I saw a hematologist because the anemia and leukopenia are not correcting despite the massive doses of B12 and Folic Acid (5mg per day).

The hematologist checked the CBC again and we saw a low reticulocyte count and normal RDW indicating my marrow is not responding to the treatment. We did a BMB a few weeks after that and I reviewed the results with her on Friday. I have been trying to understand the report as I thought were trying to rule out MDS. It appears she did leukemia/lymphoma panel instead? I have been burying myself in research to determine if anything in this report rules out MDS. She says my report is normal - but it looks odd to me based on what little I have been able to find. Any help is appreciated!

Day of CBC:
WBC 3.9K/uL, RBC 3.53M/uL, Hgb11.8 g/dL, Hct 34.3%, MCV 97.1fL, MCH 33.5pg, MCHC 34.5g/dL, RDW 12.7%, plts2 281K/uL, MPV 7.2fL.
Auto diff(%): Segs+bands 51.5, Lymphs 39.4, Monos 7.3, Eos 1.6, Basos 0.2.

Report:
PERIPHERAL BLOOD AND BONE MARROW (ASPIRATION & BIOPSY, ILIAC CREST) DIAGNOSIS:
NORMAL CELLULARITY (50%) With TRILINEAGE HEMATOPOIESIS.
ADEQUATE IRON STORES.
PERIPHERAL BLOOD: MILD NORMOCYTIC ANEMIA AND MILD LEUKOPENIA WITHOUT SPECIFIC CYTOPENIAS (ANC - 2.1K/uL, ALC - 1.4K/ul)

ANCILLARY STUDIES
Cytogenetic Analysis:
Apparently normal female bone marrow chromosome analysis, No clonal numerical or structural abnormalities were observed.

Flow Cytometry - Leukemia/Lymphoma Profile:
No definitive immunophenotypic evidence of high-grade hematopoietic neoplasia, lymphoproliferative disease or a plasma cell neoplasm.
Abnormal bone marrow cells: No immunophenotypic abnormalities detected

MICROSCOPIC DESCRIPTION
Peripheral smear:
Manual differential : Segs+bands 55, Lymphs 37, Monos 7, Eos 1, Basos <1.
WBC: morphologically mature granulocytes, lymphocytes and monocytes; occasional neutrophils with abnormal segmentation
RBC: mild anisopoikilocytosis, minimal polychromasia
Platelets: estimate agrees with the reported count, granulation is normal,
average size is not increased
Marrow aspirate smear/touch prep:
Marrow differential count(% marrow nucleated cells), 500 cells: Blasts 3,
Promyelocytes <1, Myelocytes 7, Metamyelocytes 9, Segs+bands 20, Lymphs 17, Monos 6, Eos 2, Mast cells/basos <1, Plasma cells 4.
Myeloid total 44, RBC precursors 32, M:E ratio 1.4:1
Particles: touch preps are adequate; aspirate smears have scattered cells
Myeloid cells: progressive maturation
Erythroid precursors: normoblastic maturation; minor nuclear contour irregularities
Megakaryocytes: present
Dyspoiesis: minimal dyspoietic changes observed
Lymphocytes: morphologically mature
Plasma cells: morphologically unremarkable
Overall cellularity: 50% (I am 41)

Megakaryocytes: adequate in number; occasional hypolobated nuclei
M/E ratio: estimate agrees with differential count
Granulomas: absent
Lymphoid aggregates: not demonstrated
Infiltrates: absent
Ancillary stain(s) :
Iron stain performed on aspirate smear, aspirate clot and biopsy:
Storage iron: adequate
Ring sideroblasts: none demonstrated
Immunohistochemistry performed on biopsy:
CD34: Highlights scattered immature cells, 3%; also highlights occasional megakaryocytes
CD117: Highlights scattered immature ce1Is, <1%; also highlights rare scattered mast cells
p53: Highlights rare positively staining cells, <1%
CD138: Highlights scattered plasma cells, 5%
CD20: Highlights scattered small B ceI1s, 3-4%

Can anyone interpret? Is this normal? Does anything here rule out MDS?

Last edited by bandit224 : Mon Oct 29, 2018 at 03:42 PM. Reason: Copy paste error corrections
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