White cell differential question

[JordanN]

Hi, Everyone!

My father has a CBC and white cell differential done twice a week. These are standing orders that I don't think the doctor alters from week to week. The particular laboratory he uses reports the percentages of white cells, the morphology of the platelets, and the morphology of the red cells all under the heading of "white cell differential."

We have noticed that each time we get the results there are a large number of differences in what is included in the report. For example, on Monday the report will show myelocytes, dacrocytes, ovalocytes, but on Thursday these items are absent. I am wondering if these cells aren't seen on one day but are on another or if the doctor is specifically ordering a check for certain items at certain times. There doesn't appear to be any pattern for when certain items show up or disappear.

Does a differential report anything that the pathologist sees even if not specifically ordered by the doctor or are certain tests such as red cell morphology, blast counts, etc only reported if ordered by the doctor? Do the variable counts really reflect that one day he as a huge variety of abnormal cell shapes (6 or 7 types) in large quantities (1+ to 3+) and two days later he only has one or two abnormal cell types? The recent appearance of some items such as blasts in the peripheral blood is concerning, and I'm wondering if blasts were not there before but are now (only 1% now), or if they have been there all along and the doctor is only now asking to report it.

Thank you as always for all the wisdom and support everyone on this forum gives to all of its members! You are all an amazing group of people!

[Birgitta-A]

Hi Jordan!
When my doctor wanted to see a differential he always ment a WBC differential from blood. He was interested in the blast cells. During many years I had 0.1 - 0.2% blast cells that is common among MDS patients. They should be 0.

When I had been taking Thalidmide during three years my blast cells i blood was 0.

After my 4th neutropenic fever period (2014-12-24 - 2014-12-30) my blast cells in blood was 2.5% and my doctor explained that my MDS was transforming to AML.

Here is info about WBC differential:
http://www.mdguidelines.com/myeloid-leukemia

As far as I understand MDS patients can have a lot of dysplastic (malshaped blood cells) so looking very often at the morphology of the platelets and the morphology of the red cells is really not so important.
Kind regards
Birgitta-A

[JordanN]

Hi, Birgitta!

Thank you so much for your reply! Once again, you've amazed me with your knowledge, willingness to help, messages of hope, and gentle realism! I know your situation has been especially difficult recently, and I truly hope that things improve for you soon but know that you will handle each of the hurdles you must face with all the grace, dignity, and determination that you always have done.Your daughters and grandchildren must be so proud of you as are all of us who visit these forums (plus, I have a soft spot for you as my grandmother emigrated to the US from Sweden many years ago, and I grew up with so many wonderful Swedish traditions).

As you noted, I think the doctor is trying to assess if my dad is transforming into AML as he failed treatment with Vidaza and is not transplant eligible. He has thankfully been pretty stable and remarkably resistant to infection, but we know that being very high risk MDS his time to disease progression was probably not destined to be very long. He is the most wonderful, amazing, intelligent, gentle, fun dad, and I am so lucky to have him for my dad. Just hoping things can stay stable and comfortable for him as long as possible and that our family gets to have a little more time with him.

Thank you again and best wishes for many happy times!

[Birgitta-A]

Hi Jordan!
Thank you very much for the kind words ! It is true that I have had this dx during almost 9 years and initially I was prepared for a much shorter time. Then I like to read posts at MarrowForums and sometimes write myself - I still want to learn more about our disease as I do when I try to answer questions.

Good that your father seems to be stable !
Kind regards
Birgitta-A

[JordanN]

Hi, Birgitta!

Thank you for your sweet reply! I love the fact that you are always trying to learn more, and that you so skillfully translate some of the more difficult medical jargon into terms that we can all understand even when you are not feeling your best. You're incredible!

Hope a beautiful Swedish spring is on its way for you to enjoy!