What is Erythroid Hyperplasia?

[Hispit]

I received another BMB, on which the diagnosis states:

"75-80% panhyperplastic marrow showing predominance of erythroid hyperplasia."

Also:
"Single small lymphoid aggregate, interpreted to be benign"

Anyone know what this means?

[Hopeful]

I'll take a swing at this. I am no expert, but I did take a medical terminology course a couple years ago. Who knew it would be so invaluable...

pan = all
hyper = excessive
plastic = pertaining to growth

So panhyperplastic marrow seems to mean excessive growth of all cells.

Erythroid hyperplasia is excessive growth of immature red blood cells. If you have this and your red blood cells are normal shaped, the problem may be more likely that something is destroying your red blood cells rather than a problem in production. Have you been tested for PNH? I have erythroid hyperplasia as well and was told that it was a good marker for response to immune suppressant therapy.

[Lisa V]

Hopeful's interpretation sounds good to me. And you just answered my question (from the BMB thread) about your cellularity. It sounds full rather than empty, which is just the opposite of what you'd see with AA. That combined with your CBC makes an AA diagnosis a total mystery!

[Hispit]

Oh GOODY GOODY GOODY!!!!!!!!!!!!!!!!!!!! [**sarcasm, sarcasm, sarcasm**]

You see, I went to the Hemo-doc in March with the usual symptoms, and counts:
RBC: 2.5
HGB: 8.5
HCT: 11

He did all the usual bloodwork... said it was a MYSTERY!

Said it seemed like Hemolytic Anemia, and he would try to TYPE it.
Each type came back NO...
He said my case was a MYSTERY!!!!!

Tested for PNH=NO
Tested for Lead=NO
Tested, tested, tested....................

Did the BMB... said it was AA.........
Then, NO................. said that it's STILL a MYSTERY!!!

Now it shows that EP-thing...but says my case is still a MYSTERY!!!!!
And, that there were NO iron stores....but NORMAL iron!!!!!

And this Hematologist was touted as one of the BEST in Phoenix!!!!!

He decided to give me an iron infusion therapy, which I had a month ago. Since, I have felt WORSE, w/symptoms of AA, yet no more #'s of it.....PLUS I am having more petachiae appear.....

So you see WHY I am posting here... and I am SO SO SO frustrated.....not to mention that w/the differing diagnoses and worsening symptoms, I have grown depressed and quite stressed. The fatigue most days starts in at 8 or 9 a.m.....I drive a schoolbus, and by then have been to work for 3 hours already, and am now considering quitting my job, because of the inability to continue to function w/any quality of life.

Anyhow...... your comment...that it is a MYSTERY..... sent me spiraling..... you aren't my hemaologist, are you?????

Venting.........................

[Lisa V]

No, I'm not your hematologist, and I certainly didn't mean to trigger a meltdown! All I meant was that given the test results you've told us, it is beyond me how he could arrive at a diagnosis of AA. You don't meet most of the criteria.

I can certainly understand your frustration, though. Sounds like you and your doctor need to have a heart-to-heart. He's probably frustrated too at not being able to figure this thing out, but you both need to figure out what you're going to do about your symptoms. I know they are often reluctant to do anything without a solid diagnosis because they don't want to be hit with a malpractice suit, but he needs to be reminded that you're a person with a life, not a puzzle that can be set aside until it's solved. Regardless of the diagnosis, your Hgb is too low and it is interfering with your life and your ability to earn a living. What are they going do RIGHT NOW to address that? Are they going to transfuse RBCs? Are they going to try EPO? These are some questions to ask. These are temporary measures and don't solve the underlying problem, but they can buy you some time and help you function better while you're waiting.

I wish I had a better answer, but I wish you good luck!

[tytd]

Hello Hispit,
Try to hang in there. I know it is discouraging not to have an official diagnosis but sometimes it can take a series of tests and treatments to get to the bottom of things. It appears that at the least you have an iron deficiency component to your anemia although that may not be the whole story. Your hematologist is giving you iron since lack of iron stores in the bone marrow is indicative of iron deficiency even though your serum iron was normal. The next question is why are you iron deficient which I'm sure your hematologist is looking into. Has your Hb risen after the iron therapy?? When you see your hematologist next time write down all the questions that you don't understand to ask him.

[Marlene]

Even though your doc is the best in the area, it's time for another opinion. And when you get one, don't tell them what your current doc's thoughts/opinion is. It can influence their thinking. You can get copies of all your results to take with you.

What were your B12, Folate, B6 and copper serum levels. Your B12 should be at least 500. If you are taking supplements, this can throw off the reading.

Marlene

[Hawaii Bill]

I agree with Marlene that a second opinion is the way to go, and I suggest Dr Paquette, a bone marrow specialist at UCLA. Take all your records.

I saw him once in June 2008, and because of his treatment advice, I now have almost normal blood counts.

[Hispit]

Finally, I'm getting somewhere. Saw my Hematologist yesterday. Initially his 1st diagnosis was Hemolytic Anemia. Then he thought it was the AA. Now after another round, it is decidedly: Hemolytic Anemia, inherited. Also, due to my previous gastric bypass, it is determined that the RBCs are OVERproducing... and they are QUICKLY being destroyed due to changes in my blood/marrow due to malabsorptive issues. I may need to have weekly nutritional infusions that include fat soluble vitamins. Doc wants me to go on Disability.

Anyhow, at present the AA is no longer the issue, and I am thankful that it is not...I was so scared.

Hispit