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Bone marrow test results


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#1 Calalily

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Posted 22 May 2013 - 05:14 PM

Hi folks,

I haven't been on this board in a while as have been getting pretty used to the meds and I think have been doing ok as things have calmed down a lot and I'm back to work so don't have as much time to think about it all!

I got my PCR results, it was 144% at diagnosis in Nov. I started the medication and it went down to 118% in Jan and then at last result I got 0.9% at the end of feb (3 months on medication.) I was told I wouldn't need another bone marrow test as my marrow was clear- yippee!

So roll on yest when my friend who is a nurse at the hosp sent me the final report from my bone marrow. It says;

Blast cells-0  Promyelocytes-0, Myelocytes-7, Metamyelocytes-7, Polymorphs-39, Basophils-0, Eosinophils-3, Lymphoctes-14, Monoblasts/Promonocytes-0, Maturing Monocytes-2, Plasma cells 0, Erythroblasts-27, M:E Ratio 3:1

Blood film; Red cell anisocytosis. Platelet anisocytosis with occasional giant platelets seen.

Marrow report; Bone marrows smears received with hypocellular fragments and trails for age. Megakaryocytes appear increased and are mostly small with hypolobated nuclei. Prominent sea-blue histiocytes. The myeloid and erythroid series are represented at all stages of maturation. No abnormal infiltrates seen.

Iron stain; absence of stainable iron in granules and precursors.

Comment: tri lineage haematopoeisis. Consistent with morphological remission in cml.

Ok so then I started googling and didn't like what I read about the sea blue histiocytes being a sign of MDS? Also didn't like to hear that my red blood cells were looking funny either. Anyone any idea am I freaking out unnecessarily and this is normal for cml people or should I be a bit worried about the above showing some more abnormalities in my marrow besides cml.

Would appreciate your opinions thank you and hope you are all doing well and coping well with your cml.

Calalily



#2 Trey

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Posted 22 May 2013 - 09:16 PM

Zantedeschia aethiopica,

That is all "CML normal" stuff.  No worries.

The sea blue histocytes are a CML induced "peudogauchers syndrome" which has no particular significance.  It goes away over time as the marrow normalizes. 

http://calicutmedica...g/2010/3/e9.pdf

CML and the TKI drugs both act to distort the cell morphology.  Over time these normalize.  Ask me again in 3 years if you still have them. 



#3 Calalily

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Posted 26 May 2013 - 11:40 AM

Thanks Trey,

I appreciate your information on those results, it really put my mind at ease. I should really have asked you before I went to Dr Google! I had to google 'Zantedeschia aethiopica' though!

Thanks a million,

Zantedeschia aethiopica!



#4 Tedsey

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Posted 26 May 2013 - 12:49 PM

The red blood cells (erythroid cells) look like that because you probably have anemia, esp. since you have no stainable iron.  This is common.  What does your doc want to do about that?  Are you feeling tired?  How are your platelets (megakaryocytes)?  They may be low or higher than last time.  Also common.  From what I am getting, what looks like MDS is likely a result of TKI therapy.  But I am not an expert, just a patient for the last 3.5 years.  I have dealt with both PLT issues and anemia.

Take care,

Tedsey



#5 Calalily

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Posted 26 May 2013 - 04:14 PM

Hi Tedsey, thanks for your input! the only other bone marrow report i can compare it to is the one at diagnosis when i wasn't on the meds. The results for that one in Oct are as Follows;

Blast Cells: 1

Promyelocytes: 6

Myelocytes: 17

Metamyelocytes; 11

Polymorphs; 49

Eosinophils; 2

Lymphocytes;10

Monoblasts/promonocytes; 8

Monocytes;4

Erythroblasts;7

M:E Ratio:1

Clinical Information; Increased neutrophils and myelocytes in peripheral blood

Blood Film; Increased neutrophils and myelocytes

Marrow Report; Bone marrow smears received with markedly hyper-cellular granules and trails. Megakaryocytes appear increased but morphologically normal. Myelopoeisis is markedly increased with two peaks seen; myelocytes and neutrophil peak. There is also an increase in monocytic lineage noted. THere are occasional seablue histiocytes seen. Erythropoeises is seen at all stages of maturation.

Iron Stain; Markedly reduced iron seen in granules but not in precursors.

The hospital i attend don't seem to check the iron as standard but i did request it be checked and in January it was 54.

Platelets over the last few tests have been; 217, 201, 253, 228, 229, 231.

RCC; 4.10, 4.49, 4.49, 4.23, 3.9, 3.9, 3.7,

Neutrophils; 3.9, 1.2, 3.5, 2.7,2.6,2.6, 2.4

WCC; 6.2,3.4, 5.5, 5.2, 4.7, 4.4, 4.1

HB; 12.0, 12.9, 13.1, 12.3, 11.5, 11.3, 11.2

Things that i see as marked are; HCT; low at 0.353, Albumin is always; Multiple, Bilirubin is marked high at 18, Gamma Glutamyl Transferase always high latest one is; 57,

I always ask for my results and the nurse i deal with is really lovely but just says i need to know my Wcc, Neuts, platelets and hb. I get my friend who works in the hosp to print me off my results as any time i insisted, i felt like i was really putting them out and being an awkward patient- I figured I need to keep on their good side so don't persist too much. I think I will ask them to check the iron next time though. I have asked a lot about taking vitamins and was told to hold off taking them for another while.  I do feel tired but think i always did anyway before diagnosis and work is just crazy busy at the moment so i guess i put it down to that. I have learned so much from this site and various other cml groups/ sites over the last few months but this is one area i'm still learning a lot about. I think a lot of the doctors and nurses just say to patients; you're doing fine don't worry about it or question it but I'm one of those people who want to be really informed about it and I guess be on top of the game in case I need to ask about something or encounter a problem along the way. I guess it's still so new to me that i still am getting used to reading about distorted results and trying to figure out what all the results mean!

How is your treatment going for you now? I must get back at reading more of the posts when work settles down over the next week or so.

Best Wishes,

Calalily



#6 Tedsey

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Posted 27 May 2013 - 05:12 PM

Sorry Calalily!

I now realize this is your first bone marrow report.  It appears typical for CML.  Although Trey is much better at this.  We usually are anemic and have high blood platelets at diagnosis.  Not sure what the values are for the lab where you get blood work done.  But it appears in the early stages of anemia you can have no stainable iron but normal hemoglobin.  The numbers getting lower are indicative of that.  After a while on treatment, your numbers should come up closer to normal.  If they don't, you can always call on me.  I am told I am doing well, and feel well, but my blood counts are still outta whack!  Hang in there.  Keep reporting how you are doing.  As you can see, I am still learning too.  I know how scary this is in the beginning.  It gets better with time. 

Quick healing to you!

Tedsey






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