This post includes the CBC test results for May 30th, June 3rd and June 16. The Bone Marrow Biopsy (BMB) test results from 5/27 are provided as well. Please review and provide feedback if any additional indications may be gleaned from this information.
Answers to questions above:- There were no cytogenetic abnormalities.
- The 2nd doctor didn't perform a second BMB. He provided his initial opinion of mild or non-existent MDS based upon a review of the CBC from 5/30 and the BMB test produced by the 1st doctor.
- Regarding illness, he doesn't have any chronic problems. However, he came down with a fever/chills and joint paint on May 22rd. This is what prompted the initial office visit with his general practice doctor. Amoxillin was prescribed and he responded well in a few days.
- We plan to contact his GP doctor on Monday to explore the idea of changing blood pressure medication.
- His symptoms which may be consistent with thrombocytopenia include minor fatigue and a rash on his thighs which is healing. Interesting that he presented the rash to the 2nd doctor, but he dismissed its relevance to the case.
CBC Results
30-May........PLT @ 25, WBC @ 3.45, RBC @ 2.56, HGB @ 9.5, HTC @ 28.4, MCV @ 110.9, MPV @ 10.1
03-June.......PLT @ 17, WBC @ 2.71, RBC @ 2.32, HGB @ 9.3, HTC @ 25.8, MCV @ 111.2, MPV @ 9.9
16-June.......PLT @ 13, WBC @ 3.25, RBC @ 2.32, HGB @ 9.4, HTC @ 26.2, MCV @ 114.7, MPV @ 11.1
Bone Marrow Morphology Analysis (from 1st doctor)
Clinical Summary & Indication
Macrocytic anemia and thrombocytopenia. If non-clonal causes of dysplasia can be clinically excluded, the findings are compatible with myelodysplastic syndrome. Blasts are not increased. The findings correlate with the flow cytometric analysis.
Aspirate
Cellularity- Cellularity is appropriate for age.
- Erythroid precursor show mild dyspoiesis (megaloblastoid maturation and cytoplasmic vacuoles).
- Myeloid maturation is synchronous and progressive.
- Blasts are not increased.
- Auer rods are not observed.
Bone Marrow Biopsy
Microscopic Result
- Core contains ~ 3mm in aggregate of evalluable marrow which is varibly cellular (20-80%).
- The more cellular areas show maturing trillineage hematopoiesis.
- Rare megakaryocytes are present which show dyspoiesis (separate nuclear lobes).
- No lymphoid or plasma cell aggregates.
- No increase in mononuclear blast like cells.
- Bony trabeculae are uncremarkable.
- No detectable iron staining.
- No increase in reticulin fibers.
Biopsy Clot
Microscopic Result
- One clot section is reviewed. It is adequately spiculated.
- The cellularity is mildly increased for age (50-60%).
- There is maturing trillineage hematopoiesis.
- No increase in mononuclear blast like cells.
- The M:E ratio is within normal limits.
- Immunohistochemical studies highlight rare CD34+, CD117+ blasts. They comprise < 1% of total cells.
- MPO and CD71 highlight a mildly increased M:E ratio (~8:1). CD71 highlights few scattered megakaryocytes, many of which are micromegakaryocytes. They do not form clusters.
- Rare storage iron is observed.
Immunohistochemistry
Marker ............................Result ................................Description
CD34 (QBEND-10) ...............Rare Cells Positive ................Endothelium, Stem Cells, Blasts, GI Stromal Tumor.
CD117 (S) ..........................Rare Cells Positive ................Myeloid and Mast Cells, Gastrointestinal Stromal Tumor (c-kit)
Myeloperoxidase IHC ............Myeloid Cells Positive ............Meyloperoxidase, Myeloid LIneage Cells
CD71 (10F11) .....................Erythroid Cells Positive .........Erythroid precursor and large cell lymphoma.
CD61 .................................Megakaryocytes Positive .......Glycoprotein IIIa, Megakaryocytes, Platelets