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Bone marrow test done. Squid test showed high liver iron levels. Found iron deficiency. Worried for leukemia

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i had a bone marrow test done on 6-20-12 for a low white count, it has been running about 2.4 to 2.9 since january of 2012 along with a low neutrophil count around 1.1 -1.4, that's absolute. I have had a low white count going back as far as 2006. it has come up before but tends to run low. I went for my follow up today to the hematologist and she told me that in my bone marrow report last year which I have a copy of, it says a low evoling MDS could not be ruled out due to mild dyserythropoiesis with and the following, RBC: normal in number, normochromic/normocytic, mild anisopoikilocytosis, including occasional elliptocytes. WBC: mildly decreased in totoal number due to mild absolute neutropenia, normal morphology. Negative for circulating blasts and atypical lymphoid cells. Plt: normal in number and morphology. It also said Despite the lack of overt anemia demonstrated in the provided CBC, there is no definite storage or erythroid iron in the bone marrow suggesting iron deficiency. I asked the hematologist I went to today if the lack of Iron in bone marrow could cause anisopoikilocytosis and dyserythropoiesis in my red cells, she said no lack of iron would not cause that. I was having phlebotomies done for 4 months because my previous hematologist had me on iron for 4 years and sent me for a squid test to check for iron in my liver which showed a little above normal so he did phlebotomies on me, so at the time of the bone marrow I guess my iron storage was low if any. Everything I look up about mild dyserythropoiesis and anisopoikilocytosis is related to MDS. I feel fine and I workout and run up to 9 miles a day, I am very scared of developing leukemia. Today my WBC was 2.9 normal range 4.3-11.0 neutrophils1.1 normal range1.3-7.4 and my pheriphal smear read mild absolute neutropenia wit occasional reactive-appearing lymphocytes, my lymphs were 50 normal being 20-45, I do feel a cold coming on that I probably caught from my husband. So can the lack of Iron storage cause my red blood cells to be abnormally shaped?
Posted Sun, 24 Mar 2013 in Blood Disorders
 
 
Answered by Dr. Robert Galamaga 9 hours later
Hello and thank you for sending your question.

First of all I do not think you have leukemia at this time. It is certainly possible that you have a mild degree of myelodysplasia. Myelodysplasia is a change in the bone marrow which causes sometimes a low white blood cell count or red blood cell count or even platelets.

Usually this is followed over a long period of time. Sometimes if the red blood cell count gets too low medication might be given to help stimulate production of red blood cells.

If this is truly myelodysplasia there is a risk that this could progress at some point to something more serious such as leukemia. This clearly does not seem to be the case right now.

Regarding your iron studies I think I would need to review the actual results including your total iron level as well as your iron binding capacity and your serum ferritin level.

If the ferritin level was actually low with a low serum iron I think it would be reasonable to start you on some degree of iron supplementation. This needs to be supervised by your primary care or hematologist physician.

Lastly if you would like me to review the actual bone marrow biopsy report I would be happy to do that at some point. You could scan that and I would be happy to comment on those results.

Right now it does not appear that you have any serious life-threatening type of situation. Again I would consider a thorough Review of your iron studies to see if you might benefit from iron supplementation.

Low iron level generally causes small red blood cells to be seen on the referral blood smear. The changes in size and shape as commented on by the pathologist may be related to what they think is a mild degree of myelodysplasia.

Thanks again for sending your question. Please let me know if you have any additional concerns.

Sincerely,

Dr. Robert
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Follow-up: Bone marrow test done. Squid test showed high liver iron levels. Found iron deficiency. Worried for leukemia 6 hours later
I just sent a copy of my bone marrow test would like to know if you received it? Also my iron levels are all okay now I took iron supplements and that is no longer a problem. My iron storage was low if any on my bone marrow test and I would like to know if that could possibly have caused the dyserythropoiesis and anisopoikilocytosis. My WBC is low and so is my Neutrophil count, everything else is normal, my RBC count is normal. The hematologist just had me follow up with blood test every 2-3 months. If you had a chance to review my bone marrow test can you please let me know what your recommendation is? A flow cytometery was done on my bone marrow test that I included for your review.
Thank you,
Sincerely,
XXXXXXX
 
 
Answered by Dr. Robert Galamaga 6 hours later
Hello and thank you for the follow up information.

I reviewed all of your submitted information including the bone marrow biopsy report and additional studies. I suspect that your white blood cell count is Lower than normal not because of any severe or progressive active disease process.

There is a population of patients that simply has a mobile account but this does not necessarily reflect an active disease. In your case your neutrophil count is slightly below normal but you have not manifested any issues associated with this including recurrent infections such as pneumonia or Severe recurrent viral infections.

I would agree with checking your complete blood count on an interval basis. I do not expect to see any progression of your current situation in the near future. The bone marrow biopsy shows essentially normal blood cell production.

I saw that your XXXXXXX Was positive in the past. This could indicate that there is some mild autoimmune process going on which could also contribute to a lower white blood cell count.

I would recommend continued observation for the current time being. If you have additional specific questions please let me know and I would be happy to discuss those with you as well.

Sincerely,

Dr. Robert
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Follow-up: Bone marrow test done. Squid test showed high liver iron levels. Found iron deficiency. Worried for leukemia 4 hours later
Thank you for your response, I would like to ask you why did the Pathologist put in my biopsy report "given the mild dyserythropoiesis, an evoling, low-grade myelodysplastic syndrome cannot be completely excluded." Also on RBC: Normal in number; normochromic/normocytic; mild anisopoikilocytosis, including occasional elliptocytes. I know that anisopoikilocytosis means abnormal in shape and that could mean MDS. Also can you clarify when stated in the bone marrow test, "Despite the lack of overt anemia demonstrated in the provided CBC, there is no definite storage or erythroid iron in the bone marrow suggesting iron deficiency." Does that mean there is or isn't any iron? Do they just put cannot rule out MDS to basically cover themselves? Again thank you so much for your responses, I am so glad to have found this website. I like to understand my reports and Doctor's just don't seem to have the time to answer all the questions, appointments are so brief. I will be passing this website along to other people I know will be glad to know about it.
Sincerely,
XXXXXXX
 
 
Answered by Dr. Robert Galamaga 15 hours later
Hi and thank you for your additional question.

Interpretation of very subtle changes in bone marrow can vary among pathologists. Again the myelodysplastic syndrome in your case seems unlikely but it is remotely possible which is why they comment on this.

Also regarding the iron I think would be reasonable for your doctor to check your iron level and ferritin level to see if there is any evidence of iron deficiency. The fact that the iron stain indicated that there may be some iron Deficiency should be definitively ruled out with these additional tests.

Finally if you would like you can requesting a bone marrow because I waited by another physician or pathologist so you can have more of a sense of security regarding the findings. Again it appears there are some very subtle changes in your bone marrow. It is remotely possible that this could be very early myelodysplastic syndrome but right now it is not going to cause you any symptoms and should not be anything of immediate concern. I think it would be important for you to see your doctor periodically and have CBC done once or twice per year.

I know this can be very stressful and anxiety provoking and I hope we have provided you with some reassurance regarding the testing. Thanks again person your question.

Sincerely,

Dr. Galamaga

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Follow-up: Bone marrow test done. Squid test showed high liver iron levels. Found iron deficiency. Worried for leukemia 53 minutes later
Thank you so much for answering my question. You stated "Finally if you would like you can requesting a bone marrow because I waited by another physican or pathologist so you can have a more sense of security regarding the findings." The part I don't understand is where you said "because I waited by another physican or pathologist", did you mean to say I could have another physican or pathologist do another bone marrow, that's what I think you meant to say. You have given me some peace of mind over this matter and I truly appreciate that, I think I will just continue to monitor my CBC, thankfully my Iron levels have returned to normal with iron supplements. Again thank you so much very your responses, I am so grateful.
Sincerely,
XXXXXXX
 
 
Answered by Dr. Robert Galamaga 2 hours later
Hello again.

I Apologize for the typographical error. What I meant to say was that you could have a second opinion of the bone marrow biopsy and another pathologist could review the sample to give his or her impression. I don't think this is necessary but it is an option.

Thanks again for sharing your health concern with us. I would be happy to follow up with you at any time in the future if you have additional concerns.

Sincerely,

Dr. Galamaga
Above answer was peer-reviewed by
 
Follow-up: Bone marrow test done. Squid test showed high liver iron levels. Found iron deficiency. Worried for leukemia 1 hour later
Thank you, you have cleared up all my concerns and I feel more reassured. Very grateful for your responses, this a great website. Sincerely, XXXXXXX
 
 
Answered by Dr. Robert Galamaga 15 hours later
My pleasure.

Take good care,

Dr Galamaga
Above answer was peer-reviewed by
 
Follow-up: Bone marrow test done. Squid test showed high liver iron levels. Found iron deficiency. Worried for leukemia 1 hour later
Hi there again, sorry to bother you one more time but I have one more question regarding my XXXXXXX that was high. I realize that could lower my white count, could it also be the cause of why my red cells had mild anisopoikilocytosis. I know XXXXXXX has to do with autoimmune. Thank you, Sincerely grateful, XXXXXXX
 
 
Answered by Dr. Robert Galamaga 1 hour later
Hello again.

This might cause changes in the size and shape of your red blood cells. What is somewhat more important is for in investigation to be done to see if there is some type of autoimmune process such as lupus for rheumatoid arthritis which is explained by the positive XXXXXXX test result.

Thanks again for touching base.

Dr. Galamaga
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Follow-up: Bone marrow test done. Squid test showed high liver iron levels. Found iron deficiency. Worried for leukemia 7 hours later
Thank you again for your response, you have been most kind.
Sincerely,
XXXXXXX
 
 
Answered by Dr. Robert Galamaga 7 hours later
Again my pleasure.

Take care,

Dr Galamaga
Above answer was peer-reviewed by
 
Follow-up: Bone marrow test done. Squid test showed high liver iron levels. Found iron deficiency. Worried for leukemia 2 days later
Hi Dr. XXXXXXX it is me again. I was reviewing my labs again last night and wanted to run this by you. My last lab on 2-27-13 WBC 2.4 (4.0-10) Neutrophil 47 (49-74) Absolute Neutrophil 1.1 (2.0-8.00), Platelets 219 (150-400), everything else was withing normal range. Going back as far as 2006 my WBC was 2.7 Neutrophils 46.2, don't have an absolute for Neutrophils, Platelets 275. My platelets on 8-31-2012 were 220 and have not come back up. I know that my platelet count is still within normal range but it has come down over time. Everything I read about neutropenia and low counts has to do with MDS, could this be Indolent MDS? Could my counts be coming down slowing due to Indolent MDS. Also with MDS do the counts that are low do the cells have to look abnormal? I sent you my bone marrow test for your review, I am pretty sure you will remember me.
Sorry I left some information out on the last reply I sent you. I had some testing done for DNA antibody and it was 1, within range, Sjogren's antibodies negative. My last XXXXXXX test done on 2-27-2012 was Titer 1, 1:160, Pattern Speckled. I read that some cancers can cause a positive XXXXXXX could MDS cause a positve ANA? In 2007 my XXXXXXX was NOT positive and my WBC 3.2, Neutrophils Absolute 1.70, (1.60-8.00). I don't think I have an autoimmune because my WBC was low even when my XXXXXXX was not positive. So again could MDS be causing a positive XXXXXXX and could this be indolent MDS? Thank you kindly for your help.
Sincerely worried,
Thank you so much,
Sincerely very worried,
XXXXXXX
 
 
Answered by Dr. Robert Galamaga 7 hours later
Hello again,

In a case of MDS There is not necessarily a direct association between that disorder and a positive XXXXXXX Again I am not sure your case that we are dealing with a case of myelodysplastic syndrome.

I have seen several patients who have a mild decrease in total white blood cell count and mildly decreased neutrophils and these patients are followed over many many years without any problems.

I think in your case time will tell us what exactly is going on in the bone marrow. You may have a process that is going to remain chronic for the rest of your life. Again it is remotely possible that things might change in there could be some progression of changes within your bone marrow but at this point with all of the information we have this is very difficult to predict.

I think it would be beneficial if you could review your test findings with a rheumatologist. The rheumatologist can further elaborate on a possible mild autoimmune process.

Again I don't think you have anything to worry about right now related to your blood cells. You can continue to lead a healthy life. I would encourage you to continue eating a well-balanced diet as well as exercising regularly. I would not let this limit your enjoyment of life at all. I do not think this is going to limit your lifespan the way things look right now.

Thanks again for sending your question.

Dr. Galamaga
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Follow-up: Bone marrow test done. Squid test showed high liver iron levels. Found iron deficiency. Worried for leukemia 27 minutes later
Thank you again, I appreciate your help. I have just been so worried about this, my mother passed away Dec. 2011 and I was her caregiver and saw her suffer and lost so many people I knew last year, including 2 neighbors within the same week of each other, it just makes you realize how life can change so quickly. I did read something else that said Epstein-Barr virus and CMV can also cause Neutropenia, which I have antibodies for both viruses. I eat healthy and exercise regularly, I just worry too much. I did see a Rheumotologist and she said without symptoms to do nothing, she sent me back to the Hematologist. Again I thank you for your response.
Sincerely,
XXXXXXX
 
 
Answered by Dr. Robert Galamaga 1 hour later
Hello and thanks for the additional question.

I'm very confident that cytomegalovirus and Epstein-Barr virus are not related to your concerns regarding your white blood cell called. These viruses might cause a temporary drop in count but would not be related to a long-term lower than average count.

In your case as I mentioned this may be something you will have for the rest of your life - with no progression. Your platelet count is absolutely fine and not a concern at this time.

Again time will tell if there is some change in the bone marrow that progresses. This may take many many years. For now continue to enjoy good health.

Dr Galamaga
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