9 replies to this topic

[kat73]

Has anyone ever had nucleated red blood cells (nRBC) show up on their CBC?  If you Google it, you get pretty scared.  Normal is none, up to 0.01.  I recently showed 0.02, which my onc said was virtually normal and that it was probably due to mild anemia.  I've had this show up once before; in between it's been 0.  He said it should be followed (not sure sure what that means, actually) but that there's nothing to be done "at this time," which sort of didn't reassure me a whole lot.  Online it sounds like prognostic of mortality, as in highly.  Eeek.  There seems to be some missing info I need.  How serious is this and what's going on?  is this a CML thing?

[snowbear]

I have along with other red blood cell abnormalities that come and go.  My Onc watches it because of anemia, but I don't know what the significance of it is to the CML.

[mlk210]

I'm sorry, things like this can make your mind crazy until your next appointment. I don't show that on my CBC? Does it only get reported if it shows up?

[kat73]

Thanks Snowbear and mlk.  My CBC at my current center always has a line for it, but the place I was before did not.  I assume there they would've just reported a positive.

 

Trey - do you have any thoughts on my question?

[Trey]

Working level red blood cells (RBCs) do not have a nucleus.  They start out life in immature stages with a nucleus but shed it as they become mature, making more room for carrying hemoglobin, and also allowing them to shrink into a concave shape for better function.  RBCs are mostly made in the marrow, as are all blood cells.  The marrow sequesters (holds onto) all immature blood cells until they mature, then releases them into the blood where the mature RBCs can do their work carrying oxygen and CO2. 

 

When a person has anemia, they do not have enough RBCs in the blood, or at least they do not have enough hemoglobin, which is tied to RBC quantity.  The body will often try to overcome the shortage by releasing the RBCs early, before full maturity.  In some cases they are released when they still have a nucleus (then they are called nRBC) which means the blood will have immature RBCs floating around which are not very functional, but it is the body's attempt to solve a problem. 

 

This is not exactly a CML issue, but since CML patients can often be more anemic than the general population, it is something that can be found in CML patients.  It does not have a prognostic meaning for CML patients other than if the anemia prevents taking enough drug, that can slow down drug response. 

 

If anyone is still reading, I can get even more geeky.  With CML, the translocation begins very high in the blood making stem cell chain, higher than any other leukemia.  Because of this, CML leukemic cells are ancestors to not only the myeloid WBCs, but also the lymphoid WBCs, RBCs, and platelets.  So every blood cell line is affected by CML, whereas with most leukemias only certain cell lines are affected.  Technically, working level RBCs and platelets are not leukemic since they have no nucleus, and therefore no chromosomes, and therefore no Philadelphia Chromosome.  But the cells which made them are either leukemic or normal.  After the leukemic burden is reduced and normal (non-leukemic) blood cells generally regain control, this mostly reverses and all blood lines become relatively normal again, except that there will be some leukemic cells remaining, depending on the level of response.  As the normalization of the blood occurs, which can sometimes take years, the issues such as anemia generally will be reduced or even go away for most, but unfortunately not for all.  And the TKI drugs also have an anemia inducing effect, which is why decreased dosage can be helpful.

Edited by Trey, 26 February 2016 - 10:02 AM.

[Melanie]

Great explanation Trey!
Kat, I've had them show up in my labs off and on for years. Pretty scary when you look them up on the Internet so I was always happy when they didn't stick around. Trey's explanation made them much less scary and just another pesky baby cell running around needing to grow up. 😊

[kat73]

Thanks, Trey, for your extensive and thorough answer - I certainly read all the way to the end   In terms of myelosuppression, it made a difference for me to switch from Gleevec to Sprycel, and then from 100 down to 70 of Sprycel; although the improvement may have happened anyway, with time, as you say.  At any rate, I'm thinking hard about reducing further to 50 and seeing if that helps boost my red numbers over the line; I'm usually just under the low end of normal on all of them, and platelets as well.

 

Thanks, mbrown - it's nice to know it happens to others!  Others who are alive and kicking

[gerry]

Trey is that perhaps another reason why some are turtles? You indicated the uptake of the TKI is less due to this.

[Trey]

When I said "if the anemia prevents taking enough drug, that can slow down drug response" I meant reduced intake (by mouth) not reduced uptake (two steps: from alimentary canal into blood plasma, then from plasma into leukemic cells).

[gerry]

Thanks Trey.