Hypocellular bone marrow: What do I need to know?

@nicolekapr Hi Nicole, A little joke between my hematologist/oncologist and me... “Life’s a blast until you find them in your blood.” So good news on your BMBX (bone marrow biopsy and exam) and not having any blasts!

Having had over 12 biopsies in the past 2 years I can read these reports like a mystery novel...all is revealed in the end from the little clues along the way. 😉

From what I understand PV is very rare and causes high red blood counts.
Do you have results of a current complete blood count you can share? (CBC). It will give the number for your RBC, also your Hemoglobin (Hg) and LDH. Those would be important numbers to know along with the results of the biopsy.

All in all, on the microscopic evaluation, your neutrophils and monocytes are just on the edge of the low side. Having RA might account for the low neutrophils and lower WBC (white blood count) because of the immune attack on your joint linings. Are you currently taking any immunosuppressants or anti inflammatory medications?

Are you working with a hematologist or rheumatologist? I’d say at this point, if they’re not raising eyebrows with any of the outcome of the biopsy you can just set that worry aside.

Wow, thank you so very much for your response Lori. I have felt like I am sitting in a vacuum waiting for something to happen, all the while feeling sicker and sicker. I’m menstrating now and was during the second CBC here, so thankfully I at least have that to assist (I was pregnant and breastfeeding the last year and a half- this hit the worst after I stopped breastfeeding).

I am JAK2 negative and Exxon’s negative as well, but one doctor said I could have a new gene marker for PV, another was waiting for the bone marrow to confirm (I have not visited them yet). But all the labs from this year has my HCT above 42 (for women) and historically I have always been high red cells. However, the hupocellularity AND low MCV cell size, idk. Could be a giant RA flare. I just know my body is making a ton of red cells but I feel so very anemic and getti worse. I hope they can help.

I so appreciate you taking the time out to look at the report. Thank you.

12 biopsies is so many! How are you feeling now?

@nicolekapr Hi Nicole, I’m feeling great, thank you for asking. Another
BMBX coming up in July to celebrate my 2nd re-birth day post bone marrow transplant. Not anticipating any bad news!! ☺️

Being a new mom and facing all these health issues has to be incredibly stressful and distressing for you. I’m so sorry you’re having to go through all of this without any answers. But it does sound as though you have a good medical support system behind you trying to get to the bottom of the issues.

Looking at your latest CBC results it strikes me that there’s nothing really remarkable in these numbers or your BMBX. Which is good news but not answering your questions. Are you still waiting for genetic results?

Regarding your CBC:
RBC/Hg are only slightly elevated but not significantly. Usually fatigue is caused by these numbers being low.

ANC (absolute neutrophil count) should be between 1.55 and 8.00 The test isn’t indicating an actual count but says it’s >1.55 Greater than 1.55 to what degree? Is it higher than 7.00 or 8.00?

Hematocrit number is elevated but most often is a sign of dehydration. How’s your liquid intake? Have you also been checked for Magnesium, calcium, sodium and potassium levels?
However a high number is also present with PV which I know is suspected.

MCH~ Mean Corpuscular Hemoglobin/ MCHC are testing to evaluate presence of anemia. The results on your CBC show these numbers are low~but just below the norm.

The rest of the numbers are within the normal ranges. It’s not uncommon to have some CBC values fluctuating a little high/low depending on many factors such as minor infections, menstruation, RA or other issues...

Have you by any chance had your blood oxygen level tested with an oximeter or blood test? Do you experience shortness of breath?

How about any muscle pain? I know you have RA and experience severe joint pain. But do your muscles ache like you’ve exercised too much?
I’m just wondering if there is something happening where your red blood cells aren’t able to transfer the oxygen in their hemoglobin across cellular membranes to the cells in your body. That could explain why you have a good hemoglobin and RBC but why you’re still fatigued.

A couple of other thoughts. Do you have a blood pressure cuff and also a finger Oximeter? It would be interesting to see what your BP is when you’re particularly fatigued and your oxygen level.
It might be beneficial for you to keep a little diary which could be helpful to your physician at your next appt. Is your consultation soon?

In the meantime eating a healthy diet of foods containing folate, iron, Vit B-12 and Vitamin C could be of value.
Dark green leafy veggies, green peas, kidney beans, peanuts and enriched grain products and dried fruits contain folate
Vitamin B-12 foods include meat, dairy products, fortified cereals.
And vitamin C rich foods like citrus fruits, peppers, broccoli, tomatoes lemons and strawberries help increase iron absorption.

This reads like a novel but... ☺️
Stay strong, dear. I know you’re powering through on a wing and a prayer right now. You’ve got this!! Lori.

@nicolekapr Now that I think about the food links, since you have RA you’ll also need to be eating foods which are good for preventing inflammation. They do overlap with some of the foods i listed above. However, here is a link to Mayo Clinic for their anti-inflammatory foods! Sorry I missed that!!
https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/how-to-use-food-to-help-your-body-fight-inflammation/art-20457586

Hello again,
I posted some months ago I was diagnosed two years with MGUS/IGG Lambda subtype, which is approaching 10% from my biopsy in Feb. of this year. However, doctors did not look further to see that my bone marrow was stated to be moderately hypocellular, and the cellularity is 20%, which puts me to be an elderly person of 70+. I am 57 yrs. old. My erythroid is 19% (on the low end, but still in norm range). They stated if the erythroid falls out of the normal range, it would be anemia, but she did not specify. Now everyone (Dana Farber & my local oncologist) is on the alert and now want a repeat biopsy in February. My questions:
1. would I need a bone marrow transplant as I age or at some point?
2. If the erythroid does fall out of range, would it be considered Aplastic anemia or?
3. What other questions should I address with the doctors?
I want to make sure I address everything as they did not discuss the above with me when the report was first released.

Mitten1

Hi Mitten, you're asking good questions and have great experts on your team to help monitor your condition.

I moved your post about hypocellular bone marrow to this existing discussion where @nicolekapr asked similar questions. See here:
- Hypocellular bone marrow: What do I need to know? https://connect.mayoclinic.org/discussion/hypocellular-bone-marrow/

I did this so you can connect with Nicole as well as read through some of the previous helpful posts.

You might also be interested in this discussion where @lfevold talks about MGUS and hypocellular activity
- Newly Diagnosed with Smoldering Multiple Myeloma: Watch & wait https://connect.mayoclinic.org/discussion/newly-diagnosed-with-smoldering-multiple-myeloma/