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Diabetic. Have chronic heart failure and COPD. Provided attachment. Do you have a diagnosis/prognosis? Is there a serious risk of infection?

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Do you have a diagnosis/prognosis? Is there a serious risk of infection at present? What course of action would you take and why? Please see attachment?
Posted Mon, 14 Oct 2013 in Blood Disorders
Answered by Dr. Robert Galamaga 7 hours later
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Detailed Answer:
This is a very elderly patient with what sounds like a myelodysplastic syndrome - but blood counts are remaining relatively adequate. this can be followed conservatively.

As for the monoclonal B-cell lymphocytosis this can also be followed conservatively with a repeat CBC in a few months.

it would be reasonable to check quantitative immunoglobulin levels which can sometimes be depressed in a setting of lymphoma or MDS.

Otherwise - focus on other conditions including the heart issues and diabetes. these are just as important to keep under control.

Right now the blood counts look adequate.

Thanks again for the query. Let me know of I can be of any additional assistance.

Dr Galamaga
Above answer was peer-reviewed by
Follow-up: Diabetic. Have chronic heart failure and COPD. Provided attachment. Do you have a diagnosis/prognosis? Is there a serious risk of infection? 39 hours later
Medical History of 90 year-old male:diabetes 2; chronic heart failure; COPD; occurrences of pneumonia and pulmonary oedema; overlap myelodysplasticity/myeloproliferative disorder (3 years).

Current Status: hypoxia; delirium; suspected sepsis with a very poor prognosis.

Could you advise on whether Pt's blood is presently adequate? Has there been a transformation of the overlap myelodysplasticity/myeloproliferative disorder? Why/why not? Please see attachment for pathology results.
Answered by Dr. Robert Galamaga 23 hours later
Brief Answer:

Detailed Answer:
it does not appear that there has been any major transition of the function of the bone marrow. From the information you have submitted it looks like the hemoglobin is adequate. The white blood cell count is also adequate. Platelets are at the low-end of normal but are still not dangerously low. it really matters in this type of situation is what the trend is. That is to say has the count changed significantly over the last several months. would really doubt this is the case as again the hemoglobin, white blood cells and platelets all seemed to be relatively adequate.

The total lymphocyte count is mildly elevated. this is consistent with the previous diagnosis of monoclonal lymphocytosis.

one possible way to assess for any problem would be to perform a CT scan of the chest abdomen and pelvis to see if there is any significant enlargement of lymph nodes. I don't think there is an absolute indication for this right now.

above the age of 90 with a hemoglobin of 12.9 - this is actually excellent in my opinion. there is a problem with bleeding or if there are infections which seem to be recurring on a frequent basis this would be something that needs to be explored. Sometimes we check a total quantitative immunoglobulin levels which can sometimes be depressed if there was some type of disorder affiliated with the bone marrow.

thanks again for sending your question. I hope my response has been somewhat helpful. I'm sure you might have some additional concerns which I would be happy to review with you as well.

Dr. Galamaga

Above answer was peer-reviewed by
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