20 replies to this topic

[KARA1993]

Hi, please, can you give me explanation-my bone marrow aspiration test  twice showed hypercellular bone marrow with overgrowth of WBC and megakariocytes with all stages of maturing including micromegakariocytes. But the same time  second BMA made bone marrow biopsy showed normocellular bone marrow.  Is something like that possible or is there a question of seriously mistake during reading of BMB sample? The  doctor who made BMA and BMB told  that  current person has no fat in the bone marrow, the health position of current person is worsening, the bone pain, fatigue, abdominal pain, night sweating  is more and more intensive, the person is not recieving any treatment for that. Thank you for your reply.

[Red Cross Kirk]

My suggestion is that you ask your doctor what your treatment options are and then follow through with treatment.

 

Have you been diagnosed with CML?  If so, have you been told what phase the leukemia has reached? Chronic, accelerated or blast phase?

 

If your doctor can't explain these things to you then you need to quickly find a doctor that is able to.

[KARA1993]

Thank you for reply.

 

The problem is the doctor to who that person was refered the last said nothing regarding that. The previous doctor who was exellent told it should be leukemia, after some tests were performed that person was called to emergency appointment. After that the hospital changed the doctor, following days mad BMA/BMB result was as described above.  In my opinion there is a question of life treatening  medical condition, I think somebody wants to protect by that way ssomebody who caused a seriously mistake in previous treatment.

 

Please, can somebody answer to the question regarding above noted BMA and BMB result-how BMB result should be "normocellular" , but BMA result twice (before and the same time)hypercellular with just few drops of fat (the first time) with micromegakariocytes and other pathological changes and increased number  of megakariocytes and WBC.

 

Please, can anybody help with opinion?             Many thanks!

[Trey]

Your description does not show CML leukemia since the BMB did not show the Philadelphia Chromosome translocation, so this is not a diagnosis of CML leukemia. 

 

"hypercellular bone marrow with overgrowth of WBC" does not say how much they are increased.  This can be from many illnesses or sometimes a leukemia, but not always.  Maybe another form of leukemia other than CML.

 

"and megakariocytes with all stages of maturing including micromegakariocytes" -- that is a normal condition.

 

It could possibly be another condition, maybe a short term illness, but potentially another type of leukemia, or possibly very early stages of developing CML which is not yet able to be diagnosed.  If developing CML you would need to be re-tested in a few months. 

 

Sometimes diagnosing a developing myeloproliferative disease (MPD) can be difficult and take time since often the disease must advance to a certain level before it can be seen by the tests.  But the symptoms you describe require a continued attempt to diagnose.

 

https://www.lls.org/...ne-marrow-tests

 

https://www.mskcc.or...rative-diseases

[Red Cross Kirk]

It's hard to say from this side of the screen if a mistake has been made and there has been an attempt to save face.

 

You mention treatment. Do you mean previous attempts at diagnosis or has there been drugs or some other therapy given?

[KARA1993]

 bm.pdf   567.19KB   20 downloads  bm.pdf   567.19KB   20 downloadsTray, many thanks. Please, see my BMA result of Feb.2017 and BMB/BMA of March 2017. I cant believe BMB result is correct, Philadelphia test had not been done to me, so nothing about mutation of this gene is known. Iam just scared  last BMA/BMB test results are not correct (taking into consideration of worsening of health position). Best regards! 
----------------------------------------------------------------------------------------------------
Cytological Examinations:[/size]
Sample: Bone Marrow[/size]
Exam                                                                     result[/size]
Cell Density                                                          Increased [/size]
Nr. Megakaryocytes                                           15[/size]
G/E                                                                       6.00[/size]
Immature blood cells (%)                                 4[/size]
Appendix:[/size]
Number of megakaryocytes: seen at zoom 100x[/size]
G/E: Granulocytes - erythroblast[/size]
Immature blood cells: all core cells [/size]
Description:[/size]
In exanimated sample are individual parts of BM. Density of cells is evidently increased, fat drops are still present. G/E is 6:1. Red blood cells are normoblastic, the majority is polychromatic and basophil normoblasts. No signs of dyserytropoiesis. Overgrowth of granulocytes, more cells in pool of proliferation. Some promyelocytes have sharper granulation of cytoplasm. Immature blood cells is 4%. In some parts increased number of eozynofiles. Individual lymphocytes and mature plasma cells, increased number of megakariocytes evidented clearly also in 15 pool of small zoom. Present all stages of maturing, also micromegakaryocytes and hypolobulated  shapes. [/size]
Opinion:[/size]
Hypercellular BM. Fat drops still present. Interruptions of maturing of granulocytes, without accumulation of immature cells. Numerous megakaryocytes with interruptions of maturing. The result should be in accordance of myeloproliferative disease including essential thrombocytosis. [/size]
-----------------------------------------------------------------------------------------------------------------------[/size]

 

 

[KARA1993]

Hi, Red Cross Kirk,

 

untill now I was adviced to take once a day Aspirin Protect (100) for trombocythosis, it relieves me chest pain very succesfull. No other therapy  was  got,  (no drugs, no other type of medicamentation), but health position is worsening as described previously.

[Trey]

The two documents you attached are the same document, not two different ones. The ones attached show you have no MPD disease.  And certainly NOT CML with that WBC (3.3).  Maybe the other document shows something you wanted us to see???

[MACELPatient]

I see in the report that Eos are present. What does the CBC show? Have they tested for HES or any other MPD as Trey alluded to?

[KARA1993]

Hi, in body of my measage is one BMA report, attached  is another-BMB plus BMA, both made a month after first one (seen in the body of my question). Because the doctor who made second BMB and BMA told there is no fat in my BM the result of BMB "normocellular BM " can not be correct, it is in contrario to the same day mad BMB, too. Let me add that my free kappa light chain test result was increased, lambda test normal, kappa/lambda ratio increased, TIBC 33 , Iron 7, ALT increaed, liver enlarged.

[Trey]

Your reports only show a mildly abnormal bone marrow.  This can be an ongoing infection of the body, or a developing MPD which is not yet diagnosable.  The bone pain, fatigue, abdominal pain, night sweating suggest you should watch for a developing MPD, but I would not ignore the possibility of a body infection.  I do not see anything that would suggest any doctor is covering up your diagnosis.  You certainly do not have CML, which is what we focus on here.

 

I would suggest you focus on determining if you have some type of non-MPD body infection.  The enlarged liver would be a clue that should be followed.  If it is a developing MPD I would focus on looking for signs of polycythemia vera, essential thombocythemia, or primary myelofibrosis.

Edited by Trey, 28 April 2017 - 08:21 AM.

[KARA1993]

Thank you. Let me explain I had a year before infiltrative BCC in my chin surgical removal, at that time mental and marginal mandibular nerve were injuried, the wound was infected  with staphilococcus  aureus, next surgery vas 14 months ago (nerve repair and 2 stages Mohs surgery), that time I was told there vas rich infiltration of lymphocytes in removed tissue. PET CT in January showed enlarged neck lymphnodes (diameter 8mm, SUV uptake in lymphnodes and in some muscles (tonzill area, esophagus), up to 10,2), Diffuse ncreased uptake was in bone marrow in pelvis and in the spine, increased uptake in some bone, both humeruses, in abdomen ( sacral illiac) up to 17 SUV, right abdomen up to 13 SUV.

I do not believe to have infection, but I am scared of having metastasses of BCC. I do not know what does mean  kappa test was increased.

[KARA1993]

Sorry-first surgery-BCC removal was 17 months ago.

[Trey]

It seems that your body is fighting a blood bacterial infection.  Possibly still from your previous sepsis.  Such issues will cause the marrow to attempt to counter the threat by manufacturing increased neutrophils, and cause other odd bone marrow test results as you have.  The liver can also be damaged by such an infection.  You should ask your doc about antibiotic infusions.

 

https://labtestsonli...light/tab/test/

[KARA1993]

Do you think over a year old infection without any treatment-why  WBC is not increased in such case? All your answer are based on predisposition BMA and BMB results  of  March are correct made. But I think they are not. They are better than February made one, but my health position is worse. I do not know if immature WBC and platelets can just disapeare, as nor as micromegakariocytes, but I feel worse. One haematologyst in February told me he thinks it should be  a type of leukemia, after new blood tests I was called to emergency appointment. Then I was suddenly referred by someone in hospital to another haematologyst and I got after that such a result of BMA and BMB....I do not know what does mean eosinofils are prominent.... DBC of  March 13 is not normal...(WBC 3,2, lymph.2,3, neutrofils 3,2, monocytes 0,7)...So, peripheral blood tesst result in March was worse than those in feb., so BMB and BMA can not be better than previous one....Please, can somebody answer to me regarding that? Thank you

[Trey]

We have established that you do not have CML leukemia.  That is all we can help you with.

[KARA1993]

Notwithstanding test for Philadelphia mutation was not done? And notwithstanding of clear proven doubt in correctness of  BMA and BMB results? What about lymphoma or another type of leukemia  or myeloma?

[gerry]

Trey and the other's have a large amount of knowledge about CML, but they are not doctors. You need to go and see a doctor for further consultations and information on any of the other types of blood disorders.

[Gail's]

I agree with Gerry. Your doctor needs to explain the test results clearly to you. I'm sorry you are feeling so ill. The symptoms you describe can be caused by many other diseases than leukemia. If you are not getting clear explanations, take a trusted friend to the appointment to listen and clarify for you.

[Trey]

The BMB tests for the Philadelphia Chromosome.  It was not present according to your BMB results.  Neither was any other leukemia mutation identified by the BMB.  I offered three suggestions about possible MPDs you should discuss with your doctors.  But I have no idea what is wrong with you.