help

[chongpeng68]

my mother was diaged with MDS-RA in oct, 2000. she has been relied on transfusion sice early 2004.

in the last couple of weeks, my mother has been in the hospital with high fever, i think doctors have tried every kind of antibios, but without any improvement. the doctor said that my mother has infection in lung for sure, but did not know if there are any other infections.

as of today, my mother’s red cell and platte are so so, but white cell count is extreamly low (only 800, i cannot even believe it when i heared this from the doctor).

after reading messages on this board, i think the low white cell count maybe the cause of the infection and high fever. i am wondering if any MDS patient here knows how to increase the white cell count.

thanks a lot.

[Neil]

Neupogen is a drug commonly used to boost White cell counts. White cell transfusions are rarely used. White cells only live for a few hours.
Are they certain she has RA?
Is she being treated by a hematologist experienced in treating MDS?
Notice you live in San Jose. Stanford is nearby. Dr Peter Greenberg is an excellent doc at Stanford. You might wish to have him see her.

[chongpeng68]

neil:

thanks for your kindly reply. unfortunately, my mother is not with me here in san jose. she is in china.

i am pretty sure she is MDS-RA, the diag was done by not only one but several doctors in china.

due to her kidney failure, the doctor asked her to do haemodialysis, twicw a week. do you guys think that haemodialysis could have some negative impact to white blood cell count?

[andrzej g.]

Chong Peng,

As you probably know no case of particular MDS is predictable.

Coexisting morbidities complicate the course of disease.
Among patients suffering only from kidney failure hemodialyses do not significantly influence the WBC level.
The reason why leukopenia arises must be due to the dysgranulopoiesis within the bone marrow.

Again, repeating after Neil, I must ask you whether it is certain she has Refractory Anemia. When there are no blasts, and cytopenias touch other series than erythrocytes, one has problably Refractory Cytopenia with Multilineage Dysplasia, I guess.

To be quite sure to diagnose her properly she has to undergo a trephine biopsy again (when did she have her last one?). It would be useful to evaluate her cytogenetics again, too.

Referring to the hemodialysis question – this is probably (I don’t know her biochemic tests) too vital to give it up. Insufficient kidneys cause death within days.

Referring to the infection question – you have to be informed not only about her total WBC, but also – respectively – the granulocyte and lymphocyte level. My father has had 400-500 granulocytes for the last three months (it is thought as it follows: <1000 makes you prone to infection, <500 is considered very dangerous, <200 is critical) and didn't get sick at all. Granulocytes are responsible for immunity against fungi and bacteria. Lymphocytes defend us against viruses.

In case of infection there are usually introduced two wide-spectrum ranged antibiotics iv and an antifungal agent. It happens quite often it is impossible to diagnose the site of infection.

Some introduce G-/GM-CSF in case of leukopenic fever. It may work but – again – it’s not a rule.
Some studies indicate that this therapy may be responsible for blasts proliferation.

Take care

[andrzej g.]

You have too look into your Mom’s peripheral blood past data to check whether leukopenia somehow relates to the time when dialyses started.

From time to time it may arise due to cellophanemebrane dialysis equipment and concerns mainly granulocytes and monocytes. It is transient however.

But again – in her case I would definitely wish to have her current trephine biopsy evaluated.

Take care

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