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  #1  
Old Sun Mar 29, 2015, 12:03 PM
cal12 cal12 is offline
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Bone marrow results

Hi I am wondering if anyone can help me try to figure out my bone marrow biopsy results. The hemo I saw was not helpful and did not explain the results to me. The doctors I have showed the results to told me that this is over their head and I need to see a hemo. Its going to take 12 months to get an appt with a new hemo. A geneticist I saw recently told me the results are not normal but he didn't go into details about what the abnormalities mean.

I have been unwell for almost 3 years now and the doctors can't seem to figure out what is wrong with me. I have been tested for numerous conditions but all the tests have come back normal

My bone marrow findings are: hypocellular marrow with an overall cellularity of approximately 30 percent ( I am 46 years old) with trilineage hematopoiesis;Toxic changes noted in neutrophils

bone marrow differential : absent iron storage 0/6 but sideroblasts appear increased, no ringed sideroblasts; megakaryocytes appear slightly reduced with normal morphology; increased monocytes, reduced myelocytes, increased PMN mature; erythroid precursors appear adequate with normoblastic maturation and no significant dysplagia.

There's more but I thought I would start with this and see if anyone has any insight into what this means and what questions I should be asking the doctor.

Thank you
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  #2  
Old Sun Mar 29, 2015, 02:06 PM
bailie bailie is offline
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The information from my first BMB (just had my 9th) that was significant was my "blast" count. I had no idea what a "blast" was at that time, but since that first BMB the blast count has been part of my life. That should have been told to you in very clear terms.
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age 70, dx RAEB-2 on 11-26-2013 w/11% blasts. 8 cycles Vidaza 3w/Revlimid. SCT 8/15/2014, relapsed@Day+210 (AML). Now(SCT-Day+1005). Prepping w/ 10 days Dacogen for DLI on 6/9/2017.
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  #3  
Old Sun Mar 29, 2015, 05:37 PM
cal12 cal12 is offline
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I am not sure what a blast count is? After I had the bone marrow biopsy the hemo never contacted me to discuss the results. I had to call the hospital and they mailed me a copy of my results but I am not sure what any of it means. Even the doctors I have showed it to have no clue. They tell me I need to see a hemo but the wait here is 12 months.

I only found out after the geneticist looked at the results that there is something not normal but I don't know what it is that not normal.
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  #4  
Old Sun Mar 29, 2015, 09:13 PM
bailie bailie is offline
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How have your numbers been on your blood tests (CBC)? Have your white cells, red and platelets been in acceptable ranges? What prompted the bone marrow biopsy?

The difficulty getting information from your doctors would be very discouraging. I would keep pushing for answers if possible. There is much to learn on this forum and the internet so you will probably need to do as much as you can yourself.
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age 70, dx RAEB-2 on 11-26-2013 w/11% blasts. 8 cycles Vidaza 3w/Revlimid. SCT 8/15/2014, relapsed@Day+210 (AML). Now(SCT-Day+1005). Prepping w/ 10 days Dacogen for DLI on 6/9/2017.
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  #5  
Old Mon Mar 30, 2015, 12:45 AM
Hopeful Hopeful is offline
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Hi,

As Bailie had mentioned, you should get a copy of your CBC, flow cytometry, as well as cytogenetic report. I can try and put your BMB into simpler terms...

Quote:
Originally Posted by cal12 View Post
My bone marrow findings are: hypocellular marrow with an overall cellularity of approximately 30 percent ( I am 46 years old) with trilineage hematopoiesis;Toxic changes noted in neutrophils
You are low in progenitor blood cells (hypocellular) but your marrow is still making all 3 types of blood cells (trilineage hematopoiesis). Something is wrong with your neutrophils (a type of white blood cells) that may be due to toxic exposure (drugs, alcohol, chemicals, benzene, etc).


Quote:
Originally Posted by cal12 View Post
bone marrow differential : absent iron storage 0/6 but sideroblasts appear increased, no ringed sideroblasts;
You are anemic and should probably discuss iron supplementation with your primary care doctor. You have no ringed sideroblasts, which is good, as this is seen with some forms of MDS. I don't know that the significance of increased sideroblasts.

Quote:
Originally Posted by cal12 View Post
megakaryocytes appear slightly reduced with normal morphology).
Your platelets precursors are slightly reduced but they are normal looking, which is good.

Quote:
Originally Posted by cal12 View Post
increased monocytes, reduced myelocytes, increased PMN mature;
Not sure of the significance of this.

Quote:
Originally Posted by cal12 View Post
erythroid precursors appear adequate with normoblastic maturation and no significant dysplagia.
Your red blood cell precursors look good.

Hope this helps!
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52 yo female, dx 9/08, AA/hypo-MDS, subclinical PNH, ATG/CsA 12/08, partial response. Tried slow cyclosporine taper over 4+ years. Platelets fell, so back on cyclosporine. Trisomy 6 clone in 5% of cells.
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  #6  
Old Mon Mar 30, 2015, 10:43 AM
cal12 cal12 is offline
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Thank you both for your help. This is more help than I have received from the doctors so i do really appreciate it.

The CBC that seem to be most affected are hemoglobin, RBC, WBC, and MPV. These ones fluctuate from below normal to low normal. Neutrophils go from below normal to completely normal. Iron and Ferritin range from low normal to below normal.

RDW and TIBC are always within normal.

Testing for urinary tract infections can come back positive one day and then the next day be completely normal showing no signs of a UTI. I have seen a urologist about this and he told me he does not know why this happens.

As for the toxic neutrophils
Perhaps a UTI is the reason for this? I was exposed to Kerosene for many years from heating the cabin not sure if that would have an impact. I do drink alcohol but I am not a heavy drinker. I don't take any drugs other than antihistamines.

The reason for the bmb was because of the fluctuating CBCs and to rule out mastocytosis as I present with many of the symptoms. Masto was ruled out and Cytogenics was not done I guess because there was nothing abnormal in the bone marrow results.
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  #7  
Old Mon Mar 30, 2015, 12:59 PM
Hopeful Hopeful is offline
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Quote:
Originally Posted by cal12 View Post
As for the toxic neutrophils
Perhaps a UTI is the reason for this? I was exposed to Kerosene for many years from heating the cabin not sure if that would have an impact. I do drink alcohol but I am not a heavy drinker. I don't take any drugs other than antihistamines.
I researched "toxic neutrophils" and hadn't realized that it was a term normally used in pathology to described the accelerated production of neutrophils to fight a bacterial infection or severe inflammatory condition. So, it may very well be that the UTI is causing this. Hopefully, you are being treated for it.

I would still discuss whether you should supplement iron, under a doctor's supervision, as your iron stores are depleted. You must be under a doctor's supervision if you are taking iron supplements as it can build up to toxic levels in your body. This could help your HGB, RBC, and energy level.

Don't panic Good luck!
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52 yo female, dx 9/08, AA/hypo-MDS, subclinical PNH, ATG/CsA 12/08, partial response. Tried slow cyclosporine taper over 4+ years. Platelets fell, so back on cyclosporine. Trisomy 6 clone in 5% of cells.
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  #8  
Old Mon Mar 30, 2015, 02:30 PM
triumphe64 triumphe64 is offline
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Quote:
Originally Posted by cal12 View Post
Hi I am wondering if anyone can help me try to figure out my bone marrow biopsy results. The hemo I saw was not helpful and did not explain the results to me. The doctors I have showed the results to told me that this is over their head and I need to see a hemo. Its going to take 12 months to get an appt with a new hemo. A geneticist I saw recently told me the results are not normal but he didn't go into details about what the abnormalities mean.

I have been unwell for almost 3 years now and the doctors can't seem to figure out what is wrong with me. I have been tested for numerous conditions but all the tests have come back normal

My bone marrow findings are: hypocellular marrow with an overall cellularity of approximately 30 percent ( I am 46 years old) with trilineage hematopoiesis;Toxic changes noted in neutrophils

bone marrow differential : absent iron storage 0/6 but sideroblasts appear increased, no ringed sideroblasts; megakaryocytes appear slightly reduced with normal morphology; increased monocytes, reduced myelocytes, increased PMN mature; erythroid precursors appear adequate with normoblastic maturation and no significant dysplagia.

There's more but I thought I would start with this and see if anyone has any insight into what this means and what questions I should be asking the doctor.

Thank you
There is an Aplastic Anemia MDS organization in Canada. They should be able to help.

http://www.aamac.ca/e/
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Dallas, Texas - Age 76 - Pure Red Cell Aplasia began March 2005 - Tried IVIG - Then cyclosporine and prednisone. Then Danazol, was added. Then only Danazol . HG reached 16.3 March 2015. Taken off all meds. Facebook PRCA group https://www.facebook.com/groups/PureRedCellAplasia/
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  #9  
Old Mon Mar 30, 2015, 09:06 PM
cal12 cal12 is offline
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Thank you for the information.

I am not being treated for iron deficiency but I think I should be considering how low my iron level is. I was told to take a iron pill and that was about it. My Vitamin C level is also very low so perhaps that is contributing to the absorption of the iron as my diet is very high in iron but yet my levels stay very low.

The doctors have told me that the lymph nodes in my neck are swollen but they said that is normal. The low iron they say is female related due to menses. I can't seem to get any answers even though I am very sick.

I will take a look at that website thank you
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  #10  
Old Mon Mar 30, 2015, 09:49 PM
Cheryl C Cheryl C is offline
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You sound miserable and worried! I'm surprised that swollen lymph glands in the neck are declared to be "normal". That would usually indicate a throat infection wouldn't it? I hope you can get some help soon.

Just wondering if you have considered taking Cranberry capsules every day for your bladder health. A naturopath should be able to advise you on dosage. You are no doubt aware that drinking sufficient water (min. 2-3 litres daily) is essential to assist in avoiding UTIs.
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Dx MDS RAEB 10% blasts + hypogammaglobulinemia, Sep 2011. Jan 2012 BMB - blasts down to 2% w/out treatment so BMT cancelled. Re-diagnosis RCMD. On watch and wait since Feb 2012. IVIg 5-weekly. BMB Feb 2014 - no blast transformation. 2018 still stable.
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