Need help understanding BMB report

[surabhi]

Hello,

My mom has undergone 7 chemo sessions and her latest BMB report seems scary. We cannot see the doctor until Friday and I am getting restless. She is complaining of not nausea and pain in the eye (tiring feeling). Her period has been going on for about 9-10 days now. Her Hb is 7-8 and Platelets are around 30,000 only.

I will be grateful if someone can explain to me what this holds for her:

Microscopic Examination:

Adequate bone marrow biopsy with 9-10 hypercellular bone marrow spaces with cellularity >90%. Majority of cells are aggregate of dyspoietic megakaryocytes which are grossly increased in number. Other cells are myeloid and show maturation upto bands but show abnormal localization of immature precursor deposits.

Erythroid series shows megaloblastic maturation.

Results of IHC:

CD34 - Positive in blasts which form 14% of all nucleated cells
CD61 - Highlights both dyspoietic micromegakaryocytes & large normal megakaryocytes,

Reticulin

Reticulin not increased in 50% spaces while other spaces show grade I myelofibrosis.

Opinion

A known case of MDS RAEB type 2. Earlier in grossly hemodiluted bone marrow aspirate - BM/173/14, 9% blasts MDS in RAEB Type 1 given, however in view of 14% blasts on biopsy diagnosis is upgraded to MDS in RAEB type 2.

Once again, I am very very thankful for the help and eagerly waiting for response.

Thank you very much

[DanL]

Bharti,

I will start by telling you that I am sorry that your mother has been diagnosed with MDS, and then qualify my response as I am not a doctor, but I have had MDS for 4 years now and have learned quite a bit about the disease and will do my best to help.

To start her hemoglobin being in the range of 7-8 would explain fatigue very well, as the normal range is over 13 for women. Platelets are also very low in number at 30,000, as the low end of normal is listed as 140k to 150k.

Marrow cellularity is a measure of how packed your marrow is. As a general rule, people like to say that your cellularity should be 100 minus your age, so in my case, I am 40 years old, so we would expect a marrow cellularity of roughly 60%, give or take a few percentage points. When cellularity is high, it means that your marrow is working very hard to produce an adequate number of blood cells, but they are not usually of high enough quality to make it out of the marrow and cause more crowding. The next part talks about platelet pre-cursors (megakarycytes), which as in my case is ironic - your mother is producing a lot of platelet precursors in the marrow, but they are abnormally formed (dyspoetic) and not making their way into the blood stream, which may be the cause of the marrow fibrosis that is mentioned later. Fibrosis is another word for scarring or damage to the marrow and ranges from reticulin fibrosis to collagen fibrosis, the collagen type being heavier and harder to reverse. As for the myeloid series, these are the white blood cell precursors, and bands are still immature as they have not fully developed. The abnormal localization means that they are clustering in sections instead of being normally distributed.

The CD34 positive cells are what are measured for blast cells, these are immature white blood cells, and are commonly measured for progression of MDS, along with red blood counts, platelet counts, and changes in chromosomes, which i did not see on the report provided.

The MDS RAEB2 diagnosis is considered a more advanced MDS than she may have had previously as noted in the comments by the pathologist.

I hope this helped explain the report.