Question: I have been diagnosed with the following: hypothyroidism (2002), membranous nephropathy (2013) (glomerulonephritis and proteinuria), gout (2015), a DVT (9/16), myelodysplasia (12/16) (refractory cytopenia with multilineage dysplasia) (Aranesp injections did not help and were discontinued after 4), weight loss of 35 pounds in 6 months, drenching night sweats, low grade fevers several days a week (usually starting in the early evening), itchy skin rashes that come and go, migrating arthralgias, a dry cough, and worsening hoarseness. I have been to many doctors and had many tests/scans and tons of blood work and nothing is coming up that ties all this together. On blood work, the following are always elevated: WBC, erythrocyte sedimentation rate, C-reactive protein, BUN, Rheumatoid Factor, Haptoglobin, and Neutrophils (# & %). Always low on blood work: RBC, hemoglobin, hematocrit, and Lymphocytes. I know, it's complicated, but, any thoughts for next steps?

Thank you, doctor.

First of all, do you feel that all of my symptoms would fall under my myelodysplasia diagnosis (including the fevers, drenching night sweats, rashes, elevated WBC and inflammation factors, etc.), or are they separate issues? There seems to be an autoimmune issue, correct? Is that part of the myelodysplasia?

How do I go about getting a 'risk stratification' for my myelodysplasia?

My hematologist has tried erythropoietin shots and they have not helped. Would a next step be the lenalidomide immunomodulator? Is that a typical 'next step' after erythropoietin? Is that a new treatment, as I haven't heard of it from my local hematologist? Would a hematologist provide that?

Thank you.