Thoughts please. Could this be serious

[Baileyshome7]

Hi,
I have been having problems with low platelets for a long time. In recent months they have been decreasing even more. I had a bone marrow biopsy on 3/4/16 and my platelets had decreased to 74, from 79 a month before.

I do have a diagnosis of sarcoidosis from 2001. And type 2 diabetes of about 7 years. My liver and spleen are enlarged.

Is there anyone who can help me just from thoughts on my biopsy report. I'm just trying to figure out if it looks like something may be going on.

I will paste results below, thanks in advance.

Results: Identifying info has been removed for privacy:

PATH CONS 7740 | REPORT | | () 03/12/16-0756
|
| TESTS: Consult (1)
| SS-Misc (2)
| PAX-5, IHC with Interp (1)
| HISTOPATHOLOGY TISSUE/CONSULT (1)
| CD61,IHC w/ interp (1)
| CD34,IHC w/ interp (1)
| CD3,IHC (1)
CLINICAL DIAGNOSIS / INFORMATION:
Interpretation of Submitting Facility (PRELIMINARY): Mildly
hypocellular bone marrow with maturing trilineage
hematopoiesis
SITE OF BIOPSY / SOURCE:
Block/slides - 16BM-37-A1,B1 Bone marrow, left hip (2 blks,
| 7 stnd
| slds, 1 H#E, 8 smears)
| GROSS DESCRIPTION:
| Received are two paraffin-embedded tissue blocks, 1 H#E, 7
| unstained
| slides and 8 smears labeled 16BM-37-A1,B1.
| PERIPHERAL BLOOD - CBC REPORT
| WBC: 4.0 K/uL
| RBC: 5.18 M/uL
| HGB: 15.8 g/dL
| HCT: 46.6 %
| MCV: 90.0 fL
| MCH: 30.6 pg
| MCHC 34.0 g/dL
| RDW: 14.2 %
| PLT: 74 K/uL
| DIFFERENTIAL (AUTOMATED):
| NEUTROPHILS: 66.3 %
| LYMPHOCYTES: 22.8 %
| MONOCYTES: 8.1 %
| EOSINOPHILS: 2.2 %
| BASOPHILS: 0.6 %
| MICROSCOPIC DESCRIPTION:



PERIPHERAL BLOOD: A peripheral blood smear is not received for review.
| BONE MARROW, CORE BIOPSY: The biopsy shows focal marrow
| drop-out,
| somewhat limited for morphologic evaluation. Cellularity is
| estimated at (-20-30%), hypocellular marrow for age.
| Maturing myeloid and erythroid precursors are present.
| Scattered megakaryocytes are seen. There is no lymphoid
| aggregate or metastatic tumor identified.
| BONE MARROW, ASPIRATE CLOT: Sections contain few small
| marrow
| particles, morphologically similar to the core biopsy.
| BONE MARROW, ASPIRATE: Wright-Giemsa stained aspirate
| smears are
| reviewed. They contain a few small cellular spicules,
| adequate for evaluation. Myeloid precursors appear to show a
| full range of maturation with mild left-shift. Erythroid
| precursors show a full
| range of maturation. The M:E ratio is within normal range.
| Scattered
| megakaryocytes are seen, which are mostly unremarkable in
| morphology. There is no increase in blasts or lymphocytosis.
| Scattered plasma
| cells are noted. A 300-cell differential count is: 2%
| blasts, 58%
| myeloid cells, 28% erythroid precursors, 6% lymphocytes, 3%
| eosinophils, 1% monocytes, and 2% plasma cells.
| SPECIAL STAINS: A submitted iron stain shows the presence
| of storage
| iron. Ring sideroblasts are not identified. A submitted
| reticulin stain shows focal, very mild reticulin fibrosis.
| IMMUNOHISTOCHEMISTRY: Submitted CD138 and CD34 stains were
| reviewed.
| CD34, CD61, CD3 and PAX-5 were performed in-house. Controls
| stained appropriately. CD34 shows no increase in blasts.
| CD61 stains scattered megakaryocytes, mildly decreased or
| borderline adequate in number. CD3 stains low level
| interstitial T-cells. PAX-5 stains
| scattered B-cells. CD138 stains occasional plasma cells
| (<5%).
| -------------------------- FINAL DIAGNOSIS

| BONE MARROW, CORE BIOPSY, ASPIRATE AND ASPIRATE CLOT
| (16BM-37-A1, B1):
| - HYPOCELLULAR MARROW (-20-30%) WITH TRILINEAGE
| HEMATOPOIESIS - STORAGE IRON PRESENT - SEE MICROSCOPIC
| DESCRIPTION AND COMMENT
| QL/STR
| COMMENTS:
| The provided CBC data show mildly elevated hemoglobin
| level/RBC count and thrombocytopenia.
| The concurrent flow cytometric analysis (CH116574I) revealed
| no atypical findings. Cytogenetic analysis showed normal
| karyotype.
| Morphologic examination demonstrates a hypocellular marrow
| for age with trilineage hematopoiesis. Megakaryocytes are
| borderline adequate or mildly decreased in number.
| Significant dyspoiesis is not observed. Secondary causes for the thrombocytopenia should be evaluated. In addition, the
| significance of the mildly elevated RBC count/hemoglobin
| level is uncertain. Clinical correlation and close follow up
| are recommended.

[bailie]

Welcome Baileyshome7.
The platelet movement isn't too alarming except that they are low. The 2% blasts are still low but definitely important if they move up. It will be important to keep checking. It is so important to nip this as early as possible and hopefully this won't amount to anything significant. For me it was the low platelets that showed up first, but importantly everyone is different. What happens to one person usually doesn't follow with another person.

This is a very good forum to bounce your questions off other people/experiences. Again welcome.

[Baileyshome7]

Thank you Bailie. I meet with the Oncologist on Thursday. I've had issues for so long, and was told for some of those years that there was nothing wrong. One doctor told me back in the beginning to go home and lose weight, I was too fat. Thursday seems so far away. Part of me wants to finally put a name to the issues that have been going on. Yet, on the flip side, I don't know what that will mean.

I guess I'm trying to read into results that are very complex. In one report I have they are testing to confirm if MDS is the diagnosis or the Sarcoidosis now affecting the bone marrow.

This looks like a great forum. Will keep everyone updated.

Thanks.

[rar]

Platelets are critical at 10. I had lower. My wife has the same medical conditions as yours including platelet value. She saw my oncologist who did a bunch of tests and concluded nothing wrong, but continue monitoring. His explanation was The spleen is a small organ about the size of your fist located just below your rib cage on the left side of your abdomen. Normally, your spleen works to fight infection and filter unwanted material from your blood. An enlarged spleen — which can be caused by a number of disorders — may harbor too many platelets, causing a decrease in the number of platelets in circulation.

Ray

[Baileyshome7]

Thank you, Ray for your insight. I have had a liver biopsy in the past, via regular needle aspiration. I had a second biopsy where they went in through my neck they did a portal pressure and another liver biopsy. It showed portal hypertension, and early cirrhosis. I've never smoked or drank in my lifetime, so they were surprised by the results of the biopsy etc.

In May, they are hoping to repeat those tests to see if there are any changes. Just hoping for answers. Sarcoidosis and lymphoma can co exist, so any changes always brings renewed anxiety until I get results.

Thank you everyone...

[HannahG]

Baileyshome7... I ran across your post from last year through a Google search. We have very similar issues, and thought I'd see if you'd like to chat. I'd be interested to know what you found out from the doctor. Hope you are well! Blessings.

[sundco]

My mds is stage one with platelets ranging from 30K to 50K for 6 years now. Don't worry unless they fall below 30K. Transfusions needed if they hit 20's. I need open heart surgery to replace an aortic heart valve but I am putting it off since I may bleed out after the operation. That is the big concern with platelets, major surgery
S