Is this really MDS?

[Tory]

Hello everybody,

I have an aunt who lives overseas who has been follow with serial bone marrow biopsies for 4 years. She is 39 years old and her doctors are calling her condition MDS with neutropenia. They are now recommending bone marrow transplant. I’ve looked over her data but don’t have a good understanding of what is progressing that is making them recommend a transplant. If anybody has any insight into interpreting the lab values, I would greatly appreciate it. I’m listing them below. Thank you.

Cell Type 01/07/08 05/06/08 09/02/08 12/03/08
HG 14 14.1 14 13.2
HCT 40 40 41 38
WBC 3.11 3.23 3.28 3.94
PLT 209 239 224 181
%NEUTRO 51 50 54 67
%LYMPH 32 30 31 20
%MONO 14 17 13 11
%EOS 0.6 1 0 0
%BASO 0.3 0.6 0.3 0.1

Peripheral Smear
%LYMPH 37 24 20
%MONO 8 15 12
%SEGM 49 58 68
%BASO 1 2
%EOS 1 0

Bone Marrow 02/22/05 11/17/05 12/11/06 12/03/08
Erythro 14.5 22.5 12.4 12.5
Proerythroblast 0.5 0.5
Basophil 5 1.9 1.5
Orthochromatic 4.5 4 3.9 2.5
Polychromatophlic 10 16 6.6 8
Mono 6.5 2 6.2 5.5
Granulo 72.5 59.5 64 73
Myeloblast 1 2.5 1.6
Promyelocyte 2 1.5 3.5 1
Myelocyte 15.5 9 1.6 5
Metamylocyte 21.5 8 4.7 8
Bands 10 10.5 8.3 18
Segmented 21.5 24.5 44 40
Eosinophils 1 3.5 0.4 1
Lymphocytes 3.5 11.5 16 7
Plasmacytes 3 1.5 0.8 2

[jaxem]

tory
i see nothing of significance but others may write about something I’m missing. WBC’s are a little low & MONO’s a bit high but . . .
neutropenia? is she sick with infections often?

[billboy]

Hi Tory,

I fail to much in the data signifying MDS characteristics. At the date of the last CBC, there was no neutropenia, which is defined by the World Health Organization (WHO)as having an ANC equal to or less than 2000. The first three CBCs do indicate an ANC of less than 2000, however(in the 1550 to 1600 range). See:

http://www.realnurseed.com/t1000.htm

Her ANC was 2600 in December ’08 (3940 x 0.67). Perhaps the pathologists reviewing the marrow and aspirate saw cellular characteristics not provided by the above counts,significant blasts, or abnormal chromosones. There must be more to the story.

Best of luck in getting to the bottom of this.

Bill

[Anne G]

Hi Tory

I have to agree with the others. However, we are only seeing part of the picture and like Bill suggests there may be anomalies in the cells which would suggest MDS. Sometimes doctors do not explain themselves very well or maybe your aunt has struck a plateau where there is very little change and the disease has slowed up for a while.

Maybe your aunt needs to take a note pad with her to Haemotogolist with a list of question she needs answered.

Good luck

Anne

[lindajo]

Blood counts are always only part of the story. There are many other factors considered before recommending a transplant. Her other health considerations, chromosonal changes and genetic studies generally factor in.

Most doctors welcome second opinions to cover themselves on liability if for no other reason. Get a second opinion before progressing.

Many times my local hematologist would "recommend" a transplant in order to get me to go to a center of excellence for a more complete evaluation. Often they don’t have the ability to due all of the tests at a local hospital.

I have been evaluated at three different Centers of excellence and turned down for transplant every time. My local hematologists(plural) learned something new that helped us monitor and control the disease every time I went. At 39 she is one of the new patient age categories. In the early 1990s there were no women or really anyone under age 50 given the diagnosis. Now there are many women and even children given the diagnosis. Categories are being expanded and changed all the time. Currently their are two classification systems. FAB is the French American British system and the WHO world health Organization system. Has she received a classification yet?

[Tory]

Thank you all so much for you help I will pass along the information. They have not classified her to my knowledge, but I am having a very difficult time ascertaining her condition due to a language barrier and her lack of medical training. I think she is being kept in the dark and I will recommend she get a second opinion. Only other option would be to get the slides and actually look at the morphology with a US pathologist…although it probably wouldn’t pass airport security I wish you all a happy healthy day and once again appreciate so much for you taking the time.

Tory

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