Stable Moderate AA -- Frequency of BMBs?

[David M]

Hello All,

I have had pancytopenia / moderate AA for about 20 years (that I know of). I have been in "watch and wait" mode the entire time. I had my last Bone Marrow Biopsy (BMB) about 10 years ago (June 2009). I have a few questions:

(1) For those with moderate AA (perhaps with counts very slowly trending downward), how often do you get BMBs?

(2) Is there wisdom in getting a regular BMB -- even if your blood counts are low but relatively stable over time?

I realize my particular case may be sort of odd, even for typical Moderate AA, but there may be others out there with similar symptoms and in a similar situation.

Thanks,
David M

[Neil Cuadra]

David,

In my thinking, there's little reason to do a biopsy unless your symptoms have changed. If cellularity is decreasing or dysplasia is increasing in your marrow, you'd expect your blood counts (and probably the way you feel) to reflect the problem, and that would be a sign to get the biopsy test. Conversely, if changes in your bone marrow don't produce any new or changed symptoms, then you'd probably continue your "wait and watch" approach, so the test wasn't necessary.

Do you think your doctor would agree?

Of course, if biopsies were 100% safe, 100% discomfort-free, 100% side-effect-free, and 100% cost-free (like taking your temperature), then I'd say "why not?" But that's not the case.

[David M]

Neil,

Thanks for your reply... I actually did pose the same question to my doctor. He said about the same thing you did, but he left it up to me -- if I want a BMB he will make it happen -- but he didn't really think one was needed based on the stability of my counts.

I do get regular CBCs -- even though there are no outward or obvious changes in symptoms -- so I didn't know if we should approach BMBs similarly, i.e. "get them regularly (every few years?) whether there were outward symptom changes or not." Is it possible to have some problems occurring in your bone marrow that are not detectable in CBC result changes?

The times I have gotten a BMB, it has been a painful process... my bones are apparently hard as rocks. I do not in the least wish to have a BMB if it would not be helpful... On the other hand, it has been 10 years -- this seems like a very long time. If a BMB would give some beneficial insights, I would not hesitate to do it.

David M

[Neil Cuadra]

Originally Posted by David M

Is it possible to have some problems occurring in your bone marrow that are not detectable in CBC result changes?

David,

Without new symptoms or a series of CBCs showing dropping blood counts, I wouldn't go looking for trouble with such an invasive procedure.

That's just one layperson's opinion, but it sounds like your doctor would agree.

[Cheryl C]

Hi David

I've been relatively stable for the five years since my last BMB and my current haematologist sees no need for further BMBs unless there is a significant change.

It took me a while to accept that as there's a certain amount of "security" in being able to view detailed BMB results. However apparently if you are having regular blood tests (as I am) any significant deterioration in marrow function should become evident in these results. I find it helpful to monitor my own results by spreadsheeting and charting the most relevant ones.