First bone marrow biopsy inconclusive?

[Laurendo]

Hi everyone,

Not sure if this is the right place, or even if I have enough information for someone to help, but here goes...

My gran (69) recently was admitted to hospital with chest pains. She is a bit overweight so it was initially thought to be due to heart problems. However, her heart is fine and the pain was in fact caused by acute anaemia, causing, as the nurse put it to me, by the heart spasming due to lack of oxygen. They also thought she had a chest infection.

Blood tests shows decreased red blood cells (hence anaemia), white blood cell, platelets and haemoglobin (I think) and abnormal/deformed haemoglobin OR white blood cells. I'm honestly not sure which as think my gran was a little confused however someone here might be able to tell me which is more likely? She felt no classic anaemia symtoms but was told they were amazed at that as it was so acute.

She was given numerous pints of blood, and various scans. They discharged her after a few days and instructed her to return for a bone marrow biopsy and further blood tests. When she went back for her first bone marrow biopsy they also gave her two more pints of blood.

She went to get her results today and they still didn't know what was wrong and took another bone marrow sample. So we are now waiting on that.

I'm worried about what this could mean and thought that maybe someone with experience may have an idea? My gran sounded down on the phone, and she is one of the most strong, upbeat people I know. She insists the sites where they took samples are not sore though. She mentioned that it could be a form of leukemia, but when I stopped and asked if the doctor said that, she said again that they didn't know... but that she may need treatment in the new year....

How can the first biopsy not show anything? What would they have tested for in the first instance and what are they testing for now?

Really worried.

[djopierce]

Hello, I'm sorry about your Gran. I am also new to this, but have a similar situation with my father, also 69. He was found to have low counts across the board too. His 1st bone marrow biopsy back in October was also inconclusive. However, his platelets got so low on Thanksgiving that he was hospitalized and given lots of blood too. A second bone marrow biopsy was done and we finally got the complete results this week. Initially, there were abnormalities found in the DNA but they weren't sure what. The sample was sent to a more high tech lab where a more conclusive dx was made. He has MDS and begins Vidaza on Monday. I am quite scared too. Just trying to learn all I can and came across this forum. It has helped a lot.

It has helped that we at least found out what it is and can begin some sort of treatment. But the more I learn, the more worried I get. His platelets only went up to 51 yesterday after transfusion. I hope he can be strong enough to get through his treatments.

I hope you get some (good) news on your Gran and she can be helped as soon as possible.

[Laurendo]

Thank you for your reply. The more I thought about it last night, the more I wondered if she did in fact know something but wanted to tell my mum before she told me, and I was right.

Found out this morning it is acute myeloblastic leukemia. I don't know anything more specific - perhaps the second biopsy is to find that out. Apparantly it is one of the more treatable forms?

My poor gran. Don't want her to have to go through awful treatment, and don't know what my grandad would do without her.

I hope your dad works out ok and that the medication is effective. It's so scary.

[Neil Cuadra]

Laurendo,

If your gran's diagnosis is AML then I recommend contacting the Leukemia & Lymphoma Society (LLS) for information, support, and advice. AML is more common than MDS so much is known about it.

AML patients need to know their subtype: M0, M1, M2, M3, M4, M5, M6, M7. Subtypes M0, M1, and M2 are the ones called myeloblastic. Certain chromosome abnormalities, such as the one called "8;21 translocation" in the M2 subtype, are known to be more favorable than others, so you'll know more after her chromosomes are tested.

[Laurendo]

Thank you for that information, the lls website is interesting. I will try and talk to her about it a bit more when I see her this weekend. Could that be the reason for the second bone marrow sample, to find out the subtype?

Is chemotherapy generally the treatment for this type?

[Neil Cuadra]

A second bone marrow biopsy shouldn't be needed to establish a subtype if she's already had a chromosome analysis. However, patients may be given multiple bone marrow biopsies because previous samples had too few cells, or to evaluate changes in chromosomes over time.

I've read AML that is usually treated with chemotherapy but a different drug is used for subtype M3. The LLS can provide authoritative information about it. But generalizations can get you only so far. Every patient is unique so you'll want to know the confirmed diagnosis and treatment recommendation from your gran's doctors.