Nucleated RBCs – Significance Help?

[Malissa Kirszenbaum]

Hello I hope this post finds everyone doing well. I haven’t been on for a a while as we were waiting for the next set of blood test results. Those results came in this morning but our hemo/onco appointment is not until next week. I wanted to throw out a question, maybe someone here is more familiar with this. My husband is on a wait and watch for MDS. Is RBC and WBC counts are lower than normal and his total neutrophils are low too. We know from his BMB that he is macrocytic and has increased iron stores. The blast count was at 2%, plus wait and watch. The smear showed macrocytes too. What I saw this morning is that they found 3% in blood smear of nucleated RBCs. Truthfully until I looked this up, I did not understand its significance. I know the Internet can be a helpful resource but it can also be scary too. EveryThing I am reading does not sound good and possibly he is making that transition into a more definitive MDS diagnoses. Is anyone familiar with this particular account? The other disturbing count that I saw was his ferritin level. Although it is just above normal at 379 within the last eight months it has doubled. That upward trend disturbs me. If anyone can help me understand this better, I sure would appreciate it.

Thanks!
Lyssa

[Diana]

Your husband symptoms are very similar to mine. My ferritin was 777 when diagnosed.
What is your husband blood copper level? Was blood copper tested? Is copper deficiency ruled out?

Curlygirl posted this at
http://forums.marrowforums.org/showthread.php?t=5290

This is not about MDS but sideroblastic anemia, however the reason for the sideroblastic anemia was that 13 people were taking high levels of zinc for long periods, resulting in copper depletion, which resulted in “anemia, granulocytopenia, and bone marrow findings of vacuolated precursors and ringed sideroblasts”. So while the woman in your second article (the original I read) had a copper absorption problem, if you take a lot of zinc it can be causing the same low copper problem.

http://onlinelibrary.wiley.com/doi/1…60217/abstract

Abstract

Zinc ingestion has become increasingly popular in the lay and food faddist population. Herein described by way of a case report and review of the 13 cases in the literature is the syndrome of severe anemia associated with excessive and prolonged intake of oral zinc. The syndrome is characterized by anemia, granulocytopenia, and bone marrow findings of vacuolated precursors and ringed sideroblasts. Serum analysis reveals increased zinc levels, decreased copper levels, and a decrease in ceruloplasmin. The mechanism appears to be zinc-induced copper deficiency, which is instrumental in producing the profound bone marrow abnormalities, as zinc itself is of low toxicity. Importantly, the syndrome is totally reversible with cessation of zinc intake. Hematologists should be aware of this form of reversible sideroblastic anemia.

• This reply was modified 5 years, 8 months ago by Diana. Reason: Correct

[Malissa Kirszenbaum]

Thank you Diana. Yes, this was ruled out. He also had a high number of bands in his CBC. That count coupled with uncleared RBC show both red and white immature blood cells present in peripheral blood. I am concerned.

Many thanks. I hope you are feeling good.

Lyssa

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