Immune Compromised?

[Bossywife]

Is someone with MDS RAEB-1 considered immune compromised? His WBC is below normal, but not alarmingly low. Does it have to be alarmingly low to be considered immune compromised?

[Neil Cuadra]

Originally Posted by Bossywife

Is someone with MDS RAEB-1 considered immune compromised?

Not necessarily. Being immunocompromised (at risk of infection) isn't a yes/no question. It's a sliding scale from normal to low risk to medium risk to higher risk to highest risk. Typically, the assessment is made based on a blood test known as a differential, which shows the percentages or quantities of various types of white cells. The doctor who orders your routine CBC (complete blood cell count) may ask for a differential test too.

You can ask for a copy of your blood test results, including any differential that's performed. You'll probably see measures on it with names like POLY, NEUT, SEGS, BANDS, EOS, BASO, LYMPH, or MONO.

The risk of infection is called neutropenia. The differential lets you and your doctor assess your Absolute Neutrophil Count, which can be used to classify your risk of infection as normal, mild neutropenia, moderate neutropenia, or severe neutropenia.

To help patients understand their differential results, Marrowforums provides an ANC Calculator. Feel free to try it out, and let us know what ANC number and risk level it shows.

[DanL]

Immune compromised has a lot of components to it. The one that is followed the most is the ANC (absolute neutrophil count) which is what Ray was referring to. I know that above 2000 is considered pretty good for a person with MDS, although doctors don't get really worried until you are below 1000.

A low lymphocyte count can be a problem as well since lymphocytes are involved in identification and destruction of pathogens, as well as memory of those pathogens to mount an effective response quickly.

Some of the treatments both pre and post transplant can suppress the immune system without reducing the white blood cells in the system. They basically are made to be less effective temporarily.

The most direct answer to your question though is that somebody who is RAEB-1 may or may not be immune compromised. I had fairly normal white and red blood cell counts for about 3 years after my diagnosis and did not really have issues with getting infections except when my immune system was suppressed by drugs. RAEB-1 means that you have at least one of the three blood lines (platelets, red blood cells, white blood cells) that is below normal and you have above normal blasts, or immature white blood cells in your marrow.

[Bossywife]

Thank you! His ANC is quite high, above normal, so that's good.

[Naive]

Hi, I recently had an infection and low neutrophils (on IV antibiotics) but the haematologist wasn't concerned because he said the neutrophils I did have were functional. So I think it depends on the quality of the neutrophils as well. Also my lymphocytes are always extremely low but the haematologist never even mentions them so I have assumed it's not a problem. I think I will ask him specifically about them now because I have been curious if the lymphocytopenia could be a problem.

Carol

[jmarshall23]

Hey,

I don't have a lot of experience with this disease yet(I have a family member that's going through it right now). But I believe everyone here is correct, just because you have RAEB-1 doesn't automatically mean your immocomprimised. My grandpa wasn't considered immocompromised until they started him on Procrit shots.

Justin