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Had bone marrow biopsy. Aspirate Smear showed Cellular, Myeloid lineage: Synchronous and progressive, Megakaryocytes: Occasional. Normal?

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I had a bone marrow biopsy done and I would like to know some information regarding the Aspirate Smear, here is what it said. Quality: Adequate, Cellularity: Cellular, Myeloid lineage: Synchronous and progressive, Erythroid lineage: Synchronous and progressive, Megakaryocytes: Occasional. Normal morphology. Is it normal to have Megakaryocytes in a bone marrow aspirate? Here was the differential: Blasts 0%, Promyelocytes 2%, Myelocyte/Meta 38%, Neutrophil 15%, Eosinophils 2%, Erythroid 27%, Lymphocytes 14%, Plasma cells 2%. M:E ratio 3:1, what does that mean and is it normal? Is it normal to have Promyelocytes and are all the percentages within normal ranges? Core Biopsy: Quality: Suboptimal (short core biopsy). Bone/soft tissue: Normal, Cellularity: Unable to determine but specimen is approximately 40%. Myeloid lineage: Progressive. Erythroid lineage: Progressive. Megakaryocytes: Occasional megakaryocytes with normal morphology. Others: No increase blasts or lymphoid aggregates. What does approximately 40% mean on Cellularity? Also had Special Stains: Aspirate smear Iron stain: No Histiocytic and sideroblastic iron (0/4). Core biopsy, Iron: No stainable iron. I was having Phelbotomies prior to this bone marrow test because I was given too much iron supplement, and my iron became depleted so it seems. My ferritin level at the time of the bone marrow biopsy was only 7. So is it normal to have Megakaryocytes in bone marrow aspirate, I megakaryocytes should only be in the bone marrow, not the aspirate, can you clarify this for me. And are Promyelocytes normal in the aspirate? Is the ratio normal 3:1? And is Cellularity 40%, is that normal? Would greatly appreciate your expertise opinion, thank you.
Posted Sat, 6 Jul 2013 in Lupus
 
 
Answered by Dr. Shruti Rijhwani 11 hours later
H!

Thank you for posting your query.

Dear madam,

Going through you medical history what I will be able to answer is the rheumatology concerned topic.
XXXXXXX positivity has been reported with many cancers and in hematological malignancies specially with non Hodgkins lymphoma. XXXXXXX positivity can be seen in cancers associated with dermatomyositis and with Sjogrens syndrome. Generally they are positive in paraneoplastic syndromes. In which many antibodies become positive which can be detected by doing an ENA profile which further includes specific antibodies.

You suffer from chronic neutropenia, there is less likely a possibilty that lupus will be causing that because it affects RBC and platelets more often. Yes there is definitely a possibility that viral infections are leading to increase in XXXXXXX titre.

But MDS is very less likely to be linked with XXXXXXX Positivity and your hematologist is right in saying that XXXXXXX is not a test to be used for MDS or lymphoma they have different battery of tests to be diagnosed.whether you are suffering from lupus needs additional tests like anti ds DNA antibody , anti Sm antibody etc.
Only XXXXXXX positivity is not enough for its diagnosis.

Regarding your bone marrow aspiration and biopsy report only a hematologist will be able to answer this. In autoimmune diseases autoimmune hemolytic anemia is common, which can be tested by Coombs test .

Hope it answers your query.

Take care .

Get well soon.

Dr Shruti.
Above answer was peer-reviewed by
 
Follow-up: Had bone marrow biopsy. Aspirate Smear showed Cellular, Myeloid lineage: Synchronous and progressive, Megakaryocytes: Occasional. Normal? 8 hours later
Thank you for your response. Is there much significance in that my Titer is now 1:320? The first time it was tested was July 2011, it was 1:80, then the second time it was 1:160, then it went down again to 1:80 and now it is 1:320, can you please explain this? I did have a Lymphoid Aggregate in my bone marrow and it was tested for lymphoma and the results were I did not have lymphoma, I know test are not 100% but what is the likely hood that I could possibly have a lymphoma? I don't have any symptoms thank God. Do ANA's often come up positive with lymphoma or more unlikely to be effected? And if my XXXXXXX was reading positive due to a lymphoma do you think I would have had some symptoms by now since the first positive XXXXXXX was back in July 2011? I have a appt. with a Rheumatologist next Friday, I couldn't get in any sooner than that so any information you can give my would be greatly appreciated. My hematologist told me to ask the Rheumatologist about the positive XXXXXXX and lymphoma so that is why I inquired with you. My main concern is Lymphoma and not so much an autoimmune, again I have had chronic neutropenia since 2004 so do you think the likelihood of my XXXXXXX being positive due to lymphoma is unlikely? Thank you for your help.
Sincerely grateful,
XXXXX
 
 
Answered by Dr. Shruti Rijhwani 14 hours later
Hi,


1: 320 titre of XXXXXXX is positive and significant; further it has an increasing trend. In this circumstance, the possibility of getting XXXXXXX positive in lymphoma ranges from 20 -25% which is a significant amount.
XXXXXXX is also positive in some people who don't have any autoimmune disorder . XXXXXXX positivity also increases with age - that is old people can have strongly positive XXXXXXX
So there are multiple factors affecting the situation and nothing can be said with precision.

If your doctors are unable to find the cause, then consult your rheumatologist and get an ENA profile and anti dsDNA antibodies along with anti Sm antibodies done. That should clarify all doubts.

Rest, I agree with your hematologist.

Let me know if you need clarificatinos

Take care and Get well soon .

Dr. Shruti.
Above answer was peer-reviewed by
 
Follow-up: Had bone marrow biopsy. Aspirate Smear showed Cellular, Myeloid lineage: Synchronous and progressive, Megakaryocytes: Occasional. Normal? 5 hours later
Hello and thank you for your response. My primary doctor had ordered a full XXXXXXX panel on me will that cover the test you mentioned? Also you mentioned you agreed with my hematologist what is it you agree with them on? The lymphoid aggregate they found was reactive and their was only one and it was small, I know those could be present in lymphoma and that is my concern, but again I have no symptoms. Do you suggest I get a second opinion from another Pathologist on my bone marrow report, I know Pathologist interput things different? I am 55 years old I am a runner and workout regularly, you said XXXXXXX could be high in older people, is 55 to young to have a XXXXXXX that high? If all the other XXXXXXX test come out negative what do you suggest I do then? Thank you so much for your help. Sincerely grateful,XXXXX
 
 
Answered by Dr. Shruti Rijhwani 17 hours later
Hi.

Dear madam,

Reagarding the relationship of antibodies with age ,The prevalence of XXXXXXX in healthy individuals not suffering from any autoimmune disoarder is about 3-15%. These autoantibodies are strongly age-dependent, 10-37% of healthy persons over the age of 65 are positive for them. People with viral infections like EBV as you have can also have a positive XXXXXXX but it reverts back to normal after some time .

I agree with your hematologist that if he says you dont have lymphoma . but yes these reports are observer dependent so you can definitely go for a second opinion if possible .

I understand your concern and wish to look beyond. But XXXXXXX is a complex situation to opine on until you are thoroughly investigated it would be extremely complex and complicated to comment. So consult your treating doctors and act as they advise you.

I will be available here for a second opinion.

Dr. Shruti
Above answer was peer-reviewed by
 
Follow-up: Had bone marrow biopsy. Aspirate Smear showed Cellular, Myeloid lineage: Synchronous and progressive, Megakaryocytes: Occasional. Normal? 2 hours later
Hello,
I should be getting back the results of my Autoimmune Disorder Panel this week. Do you know if a Autoimmune Disorder Panel will include the test you suggested I have? I will let you know the results and thank you for your input.
Sincerely,
XXXXX
 
 
Answered by Dr. Shruti Rijhwani 1 hour later
Dear madam ,

I dont know that but I assume that your doctor must have ordered these tests which i have suggested earlier as these are the ones determining the presence of lupus .

Take care .

Get well soon .

Dr. Shruti
Above answer was peer-reviewed by
 
Follow-up: Had bone marrow biopsy. Aspirate Smear showed Cellular, Myeloid lineage: Synchronous and progressive, Megakaryocytes: Occasional. Normal? 9 hours later
Thank you, I will let you know the results. Sincerely, Donna XXXXXXX
 
 
Answered by Dr. Shruti Rijhwani 10 hours later
Dear Madam,

Take care. Get well soon . Waiting for your query with reports.

Dr. Shruti
Above answer was peer-reviewed by
 
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