Hypogranular neuts and large platelets

[Cheryl C]

Has anybody had the above noted on their CBC results, and if so do you know whether these are significant? Thanks!

(I posted this recently but no one replied that I know of so am trying again).

[Julianna]

Hi Cheryl! I often have those words on my results. My platelets are so strange that they have to manually count them. I've had one life threatening infection & regular fevers. But overall my blood count is not too bad when simply looked at. But it is obviously not working well if I keep having these fevers instead of a normal virus. But that could be specific to me. Not sure if Drs even know what is going on. Maybe we just try & make the most of times when we are symptom free.

[Chirley]

I've had the large platelets but can't say I've noticed the neut comments. I have no idea what it means. My current blood tests mentions low platelets with large ones present...no idea of the significance. I've about given up on keeping up with it all now. Sometimes a comment will spark my curiosity. Sad isn't it?

[Julianna]

I understand the worry. But try not to. My MDS is very slow progress & inbetween dramas I live pretty unscathed. Hang in there Cheryl xo

[Barbara K]

Hi, Cheryl--My husband is currently going in for testing every three months, and his lab results come back listing "large" or "giant" platelets about half the time, or maybe more like two-thirds. It comes up a lot. His platelets average about 130.

But hypo granular neutrophils has never come up that I can recall. Instead, he used to get "toxic granulation" back a lot, and more recently he has been getting that plus "vacuolated neutrophils" and "Dohle bodies." His WBC count has been around 1.9 to 2.0 and his ANC around 900.

My impression is that his hematologist views these results, including the large platelets, mostly as a sign of intense bone marrow stimulation. I think she said large platelets tend to be younger, which suggests that the bone marrow is releasing them somewhat prematurely in an effort to keep enough of them in circulation.

He's going back in this coming week but seeing a new person, so I'll ask him to inquire again.

Take care,
Barbara

[Cheryl C]

Thanks everyone for taking the time to reply.

I feel well most of the time even though my neuts are averaging around 0.4 this year and WCC 1.2 so I don't normally let these things worry me too much. However I guess it's good to know if something sinister is starting to happen. I have monthly CBCs and often I have macrocytes and Pelger-Huet neutrophils and I'm used to that. My platelet count has also been higher at around 130 this year and even went up to 151 one month so what you said makes some sense, Barbara.

I'll see what my specialist has to say about it in a couple of weeks and let you all know.

[Julianna]

Yep would love to know what they say. xo

[Barbara K]

So . . . my husband saw his new hematologist this morning. As is typically the case these days, platelets at 129 and RBC at 4.36 aren't much below their cut-off for normal. (His RBC and associated counts went up from about 3.6 at diagnosis once they started him on iron supplements, but now they have leveled off about where they were today. They never quite make it to the normal range.) But his ANC was at 704, so the neutropenia is still his main problem area. His lymphocytes were up to 1135, though; usually they hover around 600-700.

He asked about some of the terminology that often comes back in his labs: the resident told him that the occasional nucleated red blood cells and frequent large platelets are a sign that his bone marrow is under stress and is thus pushing out some blood cells a bit early. He had less to say about the other findings (Dohle bodies, toxic granulation, vacuolated neutrophils), except that they might be of prognostic significance in another setting but were not for my husband. Who knows. My husband didn't ask about hypo granular neutrophils since he has never had those. At any rate, at least for my husband, the large platelets don't seem to be anything to worry about in and of themselves, and I hope it's the same for you, Cheryl.

Next up: return in three months for labs unless he develops a fever. Possible second BMB if the ANC count continues on its downward trajectory. I also noticed requests for Serum Protein Electrophoresis and immunoglobulin tests and for copper as well as iron levels for next time. I was glad to see that, as I keep wondering if there might be some issue related to absorption since he has to take iron tablets every day just to keep his iron barely at low normal.

I'd rather he log in a few more neutrophils, but, all in all, it was a good report, enough to tide us over until early October.

Take care, everyone,
Barbara

[Cheryl C]

Visited my haematologist yesterday and asked about the large platelets and hypogranular neuts. She said they are quite typical of MDS and not of any particular concern.

Barbara - Interested to hear about your husband's reaction to the iron supplementation. I have been feeling really tired and sleeping terribly (4-5 hours) so about a month ago started on organic iron supplementation (Floradix). Had my 4-weekly CBC yesterday and guess what? My haemoglobin had dropped from 11.5 to 11.3 and there was no difference in my RBC (still 3.3) or haematocrit. So that was a waste of time and money! WCC improved a little this time, though that could be because I've just got over an infected burn on my hand and am battling dermatitis on my neck.

Had my gamma globulin infusion and that always helps me sleep a bit better for a couple of weeks.

Hope you guys are winning with your battles!