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Are my blood reports indicative of bone marrow problem ?

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Practicing since : 2002
Answered : 2565 Questions
I am a 50yr old female and I have hypothyroid, breast cancer, and fibro just to name a few. I had a bilateral mastectomy 6/23, and removal of my gallbladder at the same time. My surgeon ordered cbc w/dif and these were the abnormalities: platelets 665, alk phos. 195, rbc 3.57, hemo 11.0, hematocrit 34.2, mpv 5.8, lymph 19,mono 11, and EO 7. I am wondering if this could be a bone marrow problem, or something else. I know it points to anemia but Im just wondering if something is going on with my bone marrow. Your thoughts?? I XXXXXXX t believe I have any vitamin deficincies, but with high alk phos, platelets and low rbc, Im inclind to go the bone marrow route. Thanks!
Posted Tue, 17 Apr 2012 in Blood Disorders
Answered by Dr. Robert Galamaga 14 hours later
Hello and thanks for the query.

I will try to provide you with some information and recommendations regarding what is going on.

Let me reassure you that it is unlikely that we are dealing with a bone marrow problem. What needs to be done is another CBC as well as a careful review of the peripheral smear of blood cells under the microscope. If your blood count is again low additional studies including iron and vitamin levels should be done. Beyond that we generally want to make sure no gastrointestinal bleeding is happening so a colonoscopy and upper endoscopy may be recommended.

If this workup is negative you might end up seeing a hematologist for a consultation.

In short it is premature to conclude that a primary bone marrow problem is going on.

Thanks again for the question. I hope my response serves to be helpful and informative. If you have additional questions I would be happy to address them.


Dr. Galamaga
Above answer was peer-reviewed by
Follow-up: Are my blood reports indicative of bone marrow problem ? 2 hours later
I went to the hemotologist today, which was about useless. She did a CBC and the results were low in lymphs (1.8), Neut (1.9) and MPV low at 7.1. The alk phos tests did not come back yet. I don't know what these mean but also, if the alk phos comes back high what does that mean?
Answered by Dr. Robert Galamaga 1 hour later

It is certainly necessary for you to see the hematologist and it may take a bit of time before some results come through to render an accurate diagnosis. Do you have a copy of the most recent lab work from the hematologist? Specifically were the hemoglobin and platelets normal?

I am not concerned about the lymph percentage or the MPV. These can fluctuate and the fact that they were at a low range does not indicate that a disease process is going on with your bone marrow.

I actually suspect that you have no issues at all with your blood and bone marrow and I think the additional tests will confirm this.

Alk phos is elevated in cases of gallbladder disease or if there is some expression of flow of bile through the liver. It can also be elevated in pregnancy or in cases where there is bone disease such as elderly patients who may develop problems in their bones. The alk phos was only mildly elevated previously and I suspect a followup test will likely reveal that it is improved or back to normal.

Again I think there is likely no significant disease process going on related to your blood. I think the laboratory abnormalities were transient and likely related to your surgery and the inflammatory process which occurs in the body at the time of and after a surgery.

Thanks again for the query. I hope this serves to be helpful and informative. If you have any additional concerns I'd be happy to address them. I otherwise await the additional lab data if you are able to provide it. It can be sent to my attention at YYYY@YYYY


Dr. Galamaga
Above answer was peer-reviewed by
Follow-up: Are my blood reports indicative of bone marrow problem ? 1 hour later
Here is a copy of the new blood work, with the exception of having the results for alk phos, and whatever else. The one issue that makes me very uncomfortable is when I asked about the areas that were low, I was told they weren't sure what exactly they meant. When I asked what if the alk phos comes back high, I was told they wouldn't know what to do then. They looked at my chest afterwards, and said, Boy, that does look horrible. Not something I that was acceptable and shouldn't they know how to read a cbc test and what they meant? With all due respect, as a medical professional, reading lab results is bio 101. After I get the alk phos I think I will take them to my radiologist oncologist just to be sure.
Answered by Dr. Robert Galamaga 18 hours later

Thanks again,

I am sory your experience with these physicians recently was less than ideal. I hope I can add a helpful perspective to things for you.

I am thrilled to see the CBC has showed improvement in your hemoglobin as well as platelets. Your body is generating red blood cells appropriately and your hemoglobin will likely be back in a normal range within 2 weeks. The platelet count will often rise after a surgical procedure and then slowly return to normal which is what appears to have happened in your case.

So many things can raise the alkaline phosphatase including medication, trauma and obstruction of bile flow as well as gallstones. Let's wait and see what the serum alkaline phosphatase result shows and then go from there.

I am glad to see you are on top of your health and your test results and that you are assertive in wanting to know what is going on. I hope I can partner with you to achieve a better understanding of everything in the future. I am always here for followup concerns for you as well.


Dr. Galamaga
Above answer was peer-reviewed by
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