I am wondering if anyone can explain these results to me

[brextonsmom]

My son who is 8 had a bone marrow biopsy on 12/13/13. The hemotologist at U of M tells me that everything is normal from my reading of these, things are not normal. Should I get a second opinion please help. He has been diagnosed with uticaria pigmentosa at the age of 9mo, beta thallassemia minor also. I am new to bone marrow biopsys and I am lost on all this. I found this forum as I was google searching some of these words in these results. I hope that someone can help me in here!

HEMATOPATHOLOGY REPORT

Order Number: SU-13-40409 Date Received: 12/13/2013 4:00 PM
Date Completed: 12/18/2013 1:15 PM Date Collected: 12/13/2013 3:30 PM

Diagnosis:
A-B. Bone marrow, unilateral core biopsy, aspirate smear, aspirate clot
section, and peripheral blood smear: Overall bone marrow cellularity
approximately 60-70% with trilineage hematopoietic maturation. No
morphologic evidence of mastocytosis.

Signing pathologist: Smith, Lauren


Microscopic Description:
COMPLETE BLOOD COUNT (12/13/2013):
WBC (K/uL): 12.6
RBC (million/uL): 5.87
HGB (g/dL): 10.5
HCT (%): 32.9
MCV (fL): 56
RDW (%): 15.9
PLT (K/uL): 284

ADEQUACY: Adequate.

CELLULARITY: 60-70%, mildly hypocellular for age.

ERYTHROID ELEMENTS: Adequate with maturation.

MYELOID ELEMENTS: Mildly decreased with maturation.

MEGAKARYOCYTES: Adequate with normal morphology.

PERIPHERAL BLOOD: Review of the peripheral blood smear reveals microcytosis
with mild anemia and numerous target cells consistent with reported
thalassemia trait.

ADDITIONAL STUDIES: A tryptase stain is negative.

ANCILLARY STUDIES: Please refer to FC-13-5082 for concurrent flow
cytometric analysis.

Differential Counts:

Peripheral Blood

200 cells counted

Cell Type % of Total H/L Reference
Cell Range %
Count
BLAST 0.00 0% - 0%
PROMYELOCYTE 0.00 0% - 0%
MYELOCYTE 0.00 0% - 0%

Cell Type % of Total H/L Reference
Cell Range %
Count
METAMYELOCYTE 0.00 0% - 0%
NEUTROPHIL (SEG-BAND) 59.00 34% - 70%
LYMPHOCYTE 25.00 25% - 45%
MONOCYTE AND PRECURSORS 13.00 H 3% - 8%
EOSINOPHIL 3.00 0% - 4%
BASOPHIL 0.00 0% - 2%
PLASMA CELL 0.00 0% - 0%

Bone Marrow Aspirate

500 cells counted

Cell Type % of Total H/L Reference
Cell Range %
Count
BLAST 2.20 H 0% - 2%
PROMYELOCYTE 0.80 L 2% - 6%
NEUTROPHIL AND OTHER 34.00 L 40% - 65%
PREC
ERYTHROID PRECURSOR 26.40 H 18% - 22%
LYMPHOCYTE 28.80 20% - 30%
MONOCYTE AND PRECURSOR 4.80 H 0% - 1%
EOSINOPHIL AND 3.00 0% - 3%
PRECURSOR
BASOPHIL AND PRECURSOR 0.00 0% - 1%
PLASMA CELL 0.00 0% - 3%

Gross Description:
A. "Bm bx rt." Received in AZF fixative is a 1.3 cm brown, bony core,
submitted for decalcification. (1ns)
B. "Clot." Approximately 0.8 g of aspirate clot material. (1 cassette ns)
SKA

History:
Mastocytosis?

Electronically Signed By:
Lauren B. Smith, M.D.
I, the above named pathologist, have personally examined and interpreted
the slides from this case.


CPT Codes:
Specimen CPT Code Number of Charges
D 85060 1
C 85097 1
A, B 88305 2
A 88311 1
A 88342 1

[Kathy S]

I would always look for a second opinion and ask for detailed explanation if you are questioning the first opinion. If the doctor does not sit down and explain what was found, search for another doctor. That is my opinion. You need to feel comfortable with the doctor, and nothing is more important than your son.

[Heather8773]

Where are y'all located? I'm sure someone here can refer you to a specialist close to you. I cannot express enough my gratitude to the people on this site (and pnhdisease.org) that pushed us to see someone who really had in depth knowledge on these tricky to diagnose/treat diseases. Until we made the switch to meet w a specialist my husband was only being treated for a secondary marrow disease and his first Dr completely missed the primary disease.
And if anything peace of mind is priceless....
If your questioning that something's been missed why not double check?
Hope you recieve the care and answers y'all diserve!

[brextonsmom]

We are located an hour and half south of Ann Arbor Michigan. I am confused on all of this. She the dr says they are fine but when I look up why he would have low bone marrow celluarity I found aplastic anemia. I ask her what causes low bone marrow celluarity and get no response. I'm really hoping someone in here can help me!

[Heather8773]

Awe my mom is from Ann Arbor and lived in Lansing. Well I think it's about a 3 hour drive but could you get to cleveland or Cincinnati or Chicago? All three cities have a great reputation in hematology.at least to get a diagnosis and then see if they can have you see a local dr that reports to them. I think some Drs at the Cleveland clinic do that. Maybe someone eles here knows? Are you currently going to the university of Michigan hospital? That one I think would be the best in your area(?)
Well I think that is low for your son to have that hypocellularity showing in the marrow at his age. But these things are so complex all I can offer is that it's low enough for a second opionion if your current Dr seems unconcerned.
My husband is 31 and his first biopsy showed 30-50% hypocellular. His first Dr seemed unconcerned as well but turns out long story very short he had aplastic anemia. Quick unofficial guide cellarity goes down about 10 pts per 10 years your alive starting from 100. So my husband being 30 should have been closer to 70%. With that said most aplastic anemia dx aren't given until under 20-30% hypocellular.plus there are a lot of anemias.
Sorry hope I didn't make a though situation more confusing! I remember being scared and scowering the Internet so I'm sorry your going through this.
I see in the BMB report it says to refer to the flow cetometry.. What did it say?

[Heather8773]

Has your son had any other CBC or complete blood count test? His peiriphial blood numbers don't look low but idk adolescent numbers normal range.
Did they say why the WBCs are so high?

[brextonsmom]

Heather could you send me your email address or email me at brextonsmom@hotmail.com. I was told that his cellularity should be at a 80% or higher with his age and all this Dr from here at the University of Michigan is doing is emailing, well her nurse practioner is and I am unsure of the rest of the results as to I have not seen them I asked for them but have not got a response on that. I looked all over the internet for answers and that is how I found this forum in hopes someone could help me out! I am hoping to find someone on here who can suggest a hemotoligist to me. As I am going to have another dr read these results to me in person! They tell me there is no reason to see him again until he has his CBC levels tested in May again. His mastocytosis specialist handles all that by the way. He has thallassemia which makes him anemic to begin with so I asked if he could have aplastic anemia and they told me they don't see that possible. I am so confused. I am at a loss, from what I am reading on low bone marrow cellularity it isn't normal and this dr is telling me it is.

[Heather8773]

First of all you are entitled to those reports! Next time you go in don't leave until they print every test performed! We went through that too at the first doc... Idk why maybe bc he knew we were leaving. Then keep a binder w each medical. Report it's so helpful! Is thalassemia something that runs in yalls family? Just asking bc there are other forms of anemia that are aquired that cause hemolysis. Does thalassemia effect the bone marrow? Maybe that's where the hypocellularity is coming from? My email is hporter2@me.com

[Heather8773]

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1860346/

This is an artical liking mastocytosis to hypocellular marrow