re-post ferritin increase and platelet decrease after bmt

[wanglucky]

My daughter on 25 May 2015, just do BMT with haploidentical method, already 11 months.So far Hb stable at 11-12. WBC at 8000-9000.

Last sunday, we just re check the ferritin test and blood routine test. Ferritin is increase from 2700 (7 January 2016), to 3251 (24 April 2016). And Trombosit on january is 125.000 , on april decrease to 97.000.

How ferritin can increase without any blood transfution ? Is it normal for POST BMT patient ?

For Trombosit, since BMT, almost 1 years, why trombosit never reach normal value ? This matter has relation with late rejection ? How long we can tolerate this matter ?

[Neil Cuadra]

From what I have read, there are a number of reasons that a post-transplant patient's ferritin level could be high and their platelet count (trombosit) could be low. Those reasons include graft-versus-host disease, inflammation, side effects of drugs, infections, or in the worst case a relapse.

I can understand why you are worried about this. Her doctor may want to run tests to determine the cause, and what can be done about it. But I should mention that one pair of blood tests may not prove that there is a trend. Lab results can be inconsistent, so it may require a few more blood tests over the coming weeks to know if her levels are stable or her counts are really going in the wrong direction.

Has your daughter had a recent bone marrow biopsy test? That can provide a better picture of her bone marrow health than judging by blood counts.

[wanglucky]

Neil,

thanks for reply. We never have marrow biopsy test. We only have SEX Kromosoin FISH XY (Donor is me , male, and patient is Female). And the test is 100% XY.

Is this the same test ?

[Neil Cuadra]

A bone marrow biopsy and aspiration is a surgical procedure to extract a bone marrow sample (part solid, part liquid). The sample is studied in a laboratory to learn about the numbers and conditions of cells in the bone marrow. This is one of ways in which a bone marrow-related disease is diagnosed, and can also be used to judge how a post-transplant patient is doing.

For example, they measure cellularity, the volume of marrow cells vs. fat cells, which indicates whether enough new blood cells are being formed in the bone marrow.

The bone marrow sample is also used to study chromosomes. The FISH test is one of the ways they can do this. The purpose is to see if there are genetic mutations that would explain bone marrow production problems.

Nobody wants to undergo a bone marrow biopsy unless they need to. But sometimes the doctors need to know what's going on inside the bone marrow, and simple blood tests can't tell you that.

I've been assuming that your daughter was diagnosed with bone marrow failure, since you came to these forums. What was her specific diagnosis?

I don't think you can judge your daughter's condition yourself, and you need her doctor to tell you what's going on or how they will find out.

[wanglucky]

My daughter caught suffering from thalassemia since the age of 3 years. And she was do bmt procedure last year. Hgb, WBC, etc every thing is normal. except Platelet little bit low. Her doctor said every thing is normal, platelet is last blood element is rising slowly, no problem. But I compared to other child, when at 11 months,since bmt, their platelet already normal. I just worry this matter...

[GoodDay5150]

Hello, I had a BMT 4 yrs ago for PNH. The explanation that Neil gives is accurate. In my case, my platelets are usually near the lower range of the standard scale, but my transplant doc has said that a lot of healthy people; that is, no blood disease, have similar levels. I do not think that my ferritin levels were ever an issue. The same doc has also told me that almost all post-BMT patients have lab results that are not always "normal". I have been lucky in that respect. I am surprised that your daughter has never had a bone marrow biopsy. The 1st specialist that examined me and reviewed my blood tests was insistent that a biopsy was necessary for an accurate diagnosis. Since that time in 2011, I have had 3 more. Good luck to you and your daughter.

Mario

[wanglucky]

Mario,

thanks for sharing ur experience. For Bone Marrow Biopsy, this procedure paint full ? or have any side effect ?

[Neil Cuadra]

Originally Posted by wanglucky

Mario,

thanks for sharing ur experience. For Bone Marrow Biopsy, this procedure paint full ? or have any side effect ?

There's a good description of procedure here.

Some patients report more pain than others, but some kind of pain medication is almost always necessary, and it's routinely given.

It's a small surgical procedure, so there's always some risk, but it's routinely performed without side effects nearly all of the time. Soreness is a typical after-effect.

[wanglucky]

Neil,

thanks for sharing this information....

[GoodDay5150]

Hi Wanglucky, the biopsies are a bit painful, but not that bad. You can choose to be put under, that is asleep for the procedure, but I chose the basic procedure in a doctors office w/ a local anesthetic. I had some lingering pain after one of them, but the other 3 went well.

Mario

[wanglucky]

thanks mario, for ur information, we will discuss with our doctor regarding this test