Dear Ellen,
I wouldn't worry about dropping neutrophils. My mother's hematologist said that aplastic anemics have autoimmune neutropenia that is usually isolated (meaning other aspects of the immune system are usually working well). Neutropenia that is neither autoimmune nor isolated is way more dangerous. That said, it's always best that neutrophils stay at around 500 or more, but being 300-500 is not that big of deal if the neutropenia is autoimmune and isolated. It's when the neutrophils average under 200 that real problems can arise, no matter the cause of the neutropenia. But, again, there are people who will have neutrophils that are under 200 for a long time and won't get serious infections. It's all a mystery. My mother's doctor said that some people have what appears as a perfect immune system and end up deathly ill from infections, viruses, etc.
By the way, what kind of MDS does your friend now have? Is it hypocellular MDS (rare autoimmune form of MDS), which is treated the same as classic aplastic anemia? Proper MDS is not autoimmune, as you probably know, and is treated very differently than aplastic anemia. My mother's doctor said that hypocellular MDS and aplastic anemia are so similar that they are sometimes not distinguishable from each other, except for the higher presence of dysplastic cells in the bone marrow. And, sometimes, the amount of dysplasia changes drastically over time, going back between aplastic anemia and hypocellular MDS.
I am sincerely wishing you the best of health, dear Ellen. May you be happy and healthy.
