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  #1  
Old Sat May 21, 2016, 11:38 AM
Data Data is offline
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Question Red Blood Cell Morphology

I had a stem cell transplant on 6 April from a matched unrelated donor. With the exception of my Red Blood Cells (RBC) my blood counts have improved significantly. My RBC is holding around 3 mil/cu mm. What concerns me is the Complete Blood Count (CBC) come back with the RBC morphology as:

"Moderate, Macrocytosis, S1 Polychromasia, Marked Anisocytosis".

I would not have expected this after the transplant since the RBCs were probably derived from the donor stem cells.

Does anyone have any thoughts on this.

Thanks!!


Data
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Prostate Cancer: Treated in early 2013 with HDR Brachytherapy. MDS-RCMD: Oct 2014. Biopsies: 46,XY,t(7;18)[2]: 46,XY,del(7)( q22)[3]: 45,XY,-7[6]: 45,XY,-7[10]: 45,XY,-7[13]. HSCT in April 2016.
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Old Sat May 21, 2016, 12:39 PM
bailie bailie is offline
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My RBCs have hardly budged for my 660 days post transplant. The high has been 3.86 and the low at 2.68 and almost always around 3.4. I cannot feel any negative effects from these RBC counts.
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  #3  
Old Sat May 21, 2016, 04:36 PM
Data Data is offline
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More concerned on the morphology that quanitity

Quote:
Originally Posted by bailie View Post
My RBCs have hardly budged for my 660 days post transplant. The high has been 3.86 and the low at 2.68 and almost always around 3.4. I cannot feel any negative effects from these RBC counts.
Bailie,
Thanks for the comment. I am more concerned about the morphology than the blood counts. Any thoughts on that?

Cheers

Data
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Prostate Cancer: Treated in early 2013 with HDR Brachytherapy. MDS-RCMD: Oct 2014. Biopsies: 46,XY,t(7;18)[2]: 46,XY,del(7)( q22)[3]: 45,XY,-7[6]: 45,XY,-7[10]: 45,XY,-7[13]. HSCT in April 2016.

Last edited by Data : Sat May 21, 2016 at 08:54 PM.
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  #4  
Old Sun May 22, 2016, 11:32 AM
PaulS PaulS is offline
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Hi Data - are you still in the hospital? How's the GVHD? How frequently are you getting CBC's - and is the morphology consistent in all of them? What does your doctor say - is he concerned? I question I frequently asked was "How worried should I be about...?"

Issues with my blood counts (mostly slow engraftment and a long time for my counts to rise - then falling and low platelets after GVHD) usually worried me more than my doctor - he generally had a relatively benign explanation - or at least a theory as to what was going on - My issues were explained by the nature of my transplant (marrow v peripheral stem cells) GVHD, drugs used to prevent GVHD etc - and eventually things improved -

This can be a scary time in the process - you want everything to be normal and OK - but its not yet - and probably won't be for a while - it takes time and patience. Stay strong and positive!

Best,
p
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Old Sun May 22, 2016, 01:32 PM
DanL DanL is offline
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Data,

While it is possible, relapse that quickly is unusual, and could still reflect some of your old RBCs in the process of dying off. Also, due to the relative stress on the marrow to reproduce an entirely new set of cells for all three lines, it is possible to see some variables in the blood cells that would not normally happen. You have afterall just blasted your entire blood making system.

I would be more concerned in a couple of months with this reading, but only a little over a month out, it is hard to say if this reading means anything. I would be more concerned about nucleated red blood cells or blasts showing up, but the other items are more a function of marrow stress, and not necessarily indicative of residual disease as far as I know. These things will occasionally pop up when fighting infections as well.

Quite literally: Polychromasia - too many RBCs being released to the blood stream early, Anisocytosis - wide range of size in the RBCs, Macrocytosis, lots of large red blood cells.

I am not a doctor, but I vaguely recall these conversations with my doctor shortly after transplant as well.

Stay positive and get plenty of quality rest during this time.

Dan
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MDS RCMD w/grade 2-3 fibrosis. Allo-MUD Feb 26, 2014. Relapsed August 2014. Free and clear of MDS since November 2014 after treatment with Vidaza and Rituxan. Experiencing autoimmune attack on CNS thought to be GVHD, some gut, skin and ocular cGVHD. Neuropathy over 80% of body.
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Old Mon May 23, 2016, 08:03 PM
Data Data is offline
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Quote:
Originally Posted by PaulS View Post
Hi Data - are you still in the hospital? How's the GVHD? How frequently are you getting CBC's - and is the morphology consistent in all of them? What does your doctor say - is he concerned? I question I frequently asked was "How worried should I be about...?"

Issues with my blood counts (mostly slow engraftment and a long time for my counts to rise - then falling and low platelets after GVHD) usually worried me more than my doctor - he generally had a relatively benign explanation - or at least a theory as to what was going on - My issues were explained by the nature of my transplant (marrow v peripheral stem cells) GVHD, drugs used to prevent GVHD etc - and eventually things improved -

This can be a scary time in the process - you want everything to be normal and OK - but its not yet - and probably won't be for a while - it takes time and patience. Stay strong and positive!

Best,
p

Paul,
No I am not in the hospital and longer. They are treating the GVHD in clinic with prednisone and cyclosporine.

II get CBC at every clinic visit (and daily while I was in the hospital). They are pretty consistent. I haven't asked the doc yet. I should.

Cheers
Data
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Prostate Cancer: Treated in early 2013 with HDR Brachytherapy. MDS-RCMD: Oct 2014. Biopsies: 46,XY,t(7;18)[2]: 46,XY,del(7)( q22)[3]: 45,XY,-7[6]: 45,XY,-7[10]: 45,XY,-7[13]. HSCT in April 2016.
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  #7  
Old Mon May 23, 2016, 08:04 PM
Data Data is offline
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Quote:
Originally Posted by DanL View Post
Data,

While it is possible, relapse that quickly is unusual, and could still reflect some of your old RBCs in the process of dying off. Also, due to the relative stress on the marrow to reproduce an entirely new set of cells for all three lines, it is possible to see some variables in the blood cells that would not normally happen. You have afterall just blasted your entire blood making system.

I would be more concerned in a couple of months with this reading, but only a little over a month out, it is hard to say if this reading means anything. I would be more concerned about nucleated red blood cells or blasts showing up, but the other items are more a function of marrow stress, and not necessarily indicative of residual disease as far as I know. These things will occasionally pop up when fighting infections as well.

Quite literally: Polychromasia - too many RBCs being released to the blood stream early, Anisocytosis - wide range of size in the RBCs, Macrocytosis, lots of large red blood cells.

I am not a doctor, but I vaguely recall these conversations with my doctor shortly after transplant as well.

Stay positive and get plenty of quality rest during this time.

Dan
Dan,
That makes sense. I need to chill for a while. Thanks for the input.

Cheers

Data
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Prostate Cancer: Treated in early 2013 with HDR Brachytherapy. MDS-RCMD: Oct 2014. Biopsies: 46,XY,t(7;18)[2]: 46,XY,del(7)( q22)[3]: 45,XY,-7[6]: 45,XY,-7[10]: 45,XY,-7[13]. HSCT in April 2016.
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