Hi! New here. neutropenia, abnormal bone marrow, abnormal cytogenetics questions

[roseselene]

Hi! I'm new here. I've been having neutropenia for about 7 months now. I have lupus and my rheumatologist was basically passing it off as caused by medication. but my ANC kept going lower and lower. It now is almost always <500.
So I went to see a hematologist.
I've had a bone marrow biopsy done.
My RBC's, platelets, H&H are all normal, but my white count and ANC are always low. My white count is always less than 2.0.
I'm now receiving neupogen two times per week.
She has decided to refer me to Moffitt Cancer center in Tampa. My appointment is in May.
She thinks I may have AA -- but I was confused about that since I have normal other cells.

My bone marrow shows no evidence of abnormal myeloid populations. Cellularity is 50% which is read is normal, but the report says hypocellular (i'm so confused) mild increase in mature plasma cells.
prominent decrease of myeloid elements.
absent iron stores.
ctyogenetitcs - abnormal karyotype with trisomy 18 and monosomy 19.

Does anyone have any thoughts? I know I'll be seeing a specialist in a few weeks, but I'm pretty anxious about all of this and thought I would see if anyone had any thoughts.
This is all new to me.
Amy

[Neil Cuadra]

Hi Amy.

It's possible to live with mild neutropenia, but having an ANC below 500 is downright scary. Is the Neupogen helping?

Moffitt has a great program and much expertise, so I'm glad you're heading that way. I'm sorry you have to wait another month for your appointment.

Hypocellular bone marrow and a low white count (even without anemia) can be signs of aplastic anemia, but your karyotype with trisomy 18 and monosomy 19 would seem to rule out aplastic anemia. If it was aplastic anemia you'd expect to have normal cytogenetics.

One of my first questions to the doctors would be whether the neutropenia is a result of the autoimmune nature of lupus, i.e., the disease is attacking your white cells or white cell precursors, leaving you with insufficient immune protection. If not, how do they know there's more than lupus involved, and what do the ctyogenetitcs indicate?

[roseselene]

Hi! Thanks for the reply. In regards to the neupogen. I do respond to it because they've checked a CBC the next day and my white count was 4.0 and ANC 2800 which is amazingly high for me. (that was after two consecutive days of neupogen). But right now they just have me on neupogen every monday & thursday and my ANC s always <500 when I get there.
Its just a very confusing and scary time.
Amy

[revchris5802]

I'm seven months out with severe neutropenia too. I've had no treatment and won't until they find the cause or I get a fever. Hang in there, and go to the ER if you have any kind of fever.