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    Old 07-01-2013, 05:50 AM   #1
    Suetun
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    Bone marrow biopsy

    Hi Im new here and after any advice or answers, I am a 38 yr old woman with a year long history of a mild aneamia( Hb now at 9.1). I have autoimmune disease of Psoriasis, Palmoplantor pustulosis and Psoriatic arthritis and have been on methotrexate for this for almost 2˝years now at 22.5mg week currently with 5mg folic acid the day after. Other meds are norspan patch, naproxin, venlafaxin and nexium.

    I have had tests which showed a functional anaemia, so I know I have the iron I just cant use it. No B12 or folite decifiency. I have also had more recently more tests into this and it is not a thyroid or celiac disease problem, I do not have the results of my coombs test or reticulyte count, or heamatocrit but I am assuming they are normal as he now wants a bone marrow biopsy.

    My question is what is he possibly looking for? my platelet count is high and my crp and esr which shows inflammation so what is he looking for further than it being as a result of chronic illness? It has me worried as I am terrified of having a bone marrow biopsy and worried as to what he is looking for too.

    Any ideas or help?

     
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    Old 07-02-2013, 02:00 AM   #2
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    Re: Bone marrow biopsy

    Have you ever heard of aplastic anemia? Aplastic anemia is when your body stops making new red blood cells, white blood cells, and platelets. It can be diagnosed through a bone marrow biopsy. There are many many reasons why a bone marrow biopsy is being performed, without going overboard and thinking to extreme, I would definitely consider that is why he is doing it. Have you had a full CBC work up? If so what are those numbers? I would be curious as to what your white blood counts are as well as your platelets?

    Have you asked the Dr. what exactly he is looking for?

    Last edited by Heatherx5; 07-02-2013 at 02:08 AM.

     
    Old 07-02-2013, 02:05 AM   #3
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    Re: Bone marrow biopsy

    My white cells are normal. My platelet count is high around 500. Everything points to it being an anaemia of chronic illness. All my other values are normal with exception of the inflammatory markers which are usually raised slightly.

     
    Old 07-02-2013, 02:10 AM   #4
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    Re: Bone marrow biopsy

    Well with cancers your white blood cell count wouldn't be normal. It would be really high. When I first got anemia I thought that was what was causing mine and my Dr. said no way because my WBC was normal.

     
    Old 07-02-2013, 02:58 AM   #5
    Suetun
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    Re: Bone marrow biopsy

    yeah which is why I dont understand what hes looking for. IT is the rheumy who is wanting it. I have had coombs tests and all that too to rule out those immune causes and I am assuming they are negative as I havent been given the results of them. Im ok in folate and vit B12 so its not from the methotrexate. Only thing I can think of he is looking for is the type ie megaloblastic or macrocytic. He isnt going to be able to treat it whatever further than treating the PsA better.

     
    Old 07-02-2013, 03:10 AM   #6
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    Re: Bone marrow biopsy

    The anemia level is moderately severe, and he probably just wants to be thorough. There are many other tests that could be helpful. Is your Dr a hematologist or rheum? I would recommend seeing a hematologist, and also just ask your Dr what he is looking for? No point in worrying and trying to guess. The Coombs and retic count may answer the question, in which case the bome marrow wouldn't be needed. Some additional things I would recommend: checking anti=phospholipid antibodies. Since your platellets are high, if APL antibodies are positive, you'd be at high risk for blood clots, and should be on something for prevention. Checking ferritin. You can have low ferritin indicating iron deficiency with a normal serum iron level. Do you know what your MCV on blood count is? If it is normal, it is likely from chronic disease or hemolytic, what the Coombs test will tell you. A GI slow bleed should be ruled out since you are on Naproxen. That can be done with stool checks for hidden blood. An ANA test to check for lupus, as anemia, high or low platellets and elevated inflammatory markers can go with that. Your platelets may be high just from the inflammation. If the Coombs comes back positive, testing for lupus is mandatory. I hope some of this helps.

     
    Old 07-02-2013, 04:14 AM   #7
    Suetun
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    Re: Bone marrow biopsy

    I have had the tests that came back that it was functional and not absolute iron deficiency and the Dr that took that test was the general one at the health centre. My rheumy is the one wanting to look into it further, so I was tested for multiple things including thyroid function, celiac disease, had coombs test, hct reticulocyte count, folite levels, B12 etc its all been tested for. I know the thyroid and celiacs was negative and b12 and folite normal but I dont know the coombs test results of hct and reticulocyte results but I assume they are normal since he is now saying he wants a biopsy done. I have a bone scan next month and am thinking I will wait until after that and see if I do need the biopsy still. I have a feeling it may light up like a christmas tree and prove even more its a chronic illness anaemia. My platelet levels I have been told are just connected to the inflammation. My last set of bloods the results I know are Hb9.1, WCC 8.2, plats 484, CRP 17, ESR 24 neutrophils 5.29. Highest my platelets have been is 522.
    I know that methotrexate can cause problems but I cant see it being that as surely he would have taken me off that and my other cell counts would also be affected from it? I was also on methotrexate for a year before the problems started and the blood results have hovered around the same levels for the last year. This also happened with my last 2 pregnancies where my Hb dropped and no matter how much iron I took it didnt improve, I can only assume then this was the same functional problem and not absolute iron deficiency then also.
    Just feeling rather fed up of all the tests and worry this autoimmune disease if bringing lately.

     
    Old 07-02-2013, 04:23 AM   #8
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    Re: Bone marrow biopsy

    I also should add that I dont even know if the tiredness and concentration problems are more a result of the anaemia or the PsA or both. My mouth is really sore all the time and I am addicted to ice lollies at the moment which probably isnt helping the mouth lol, corners of my mouth are split also and I just generally feel so run down with it all. Cant remember what it feels like to be a normal me anymore. Thanks all for listening and giving your input it is very much appreciated.

     
    Old 07-02-2013, 08:53 AM   #9
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    Re: Bone marrow biopsy

    Suetun,
    It is possible that this could be anemia from a side effect of one of your drugs. Drugs typically cause aplastic anemia, as mentioned before. I would suggest you look up each drug and under side effects, check the hematology section for aplastic anemia. Why are you on Nexium? A hematologist would do the bone marrow biopsy, so I would be sure you get an evaluation from that Dr first, not just the procedure. Take all your previous test results with you so they don't repeat the entire thing, and ask for the tests I mentioned previously. I would call Dr's office and get the Coombs, retic count too, as that would be helpful info. This could be related to MTX as well, since bone marrow suppression is one of its most common side effects. Perhaps a different treatment for the PsA would help. Just food for thought and fodder for discussion with your rheum.

     
    Old 07-25-2013, 09:45 AM   #10
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    Re: Bone marrow biopsy

    Do you have an update Sue? Curious as to what they found out and how you are doing.

     
    Old 07-25-2013, 09:56 AM   #11
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    Re: Bone marrow biopsy

    I'm just waiting of the dr coming back off his holidays to have the biopsy. My hb is now only 8.7 and I'm cross matched 2 units should it drop more or should I feel I need it. This time my FtR came back as being iron deficient also so I am now taking some iron tablets. How can it be functional and deficient?
    Got more of my results anyway.

    Coombs test was negative

    Retic was 2.1 slight high
    HKR 29.9 low
    MCV 81 slight low
    MCH 25.1 low
    MCHC 296 low
    Throm 404 high

    Eosopils 0.52 high
    Leuk 9.1 high

    These are the abnormal ones now

    Feeling a bit fed up with it all now. Blood tests again next week to see how it's going.

     
    Old 07-25-2013, 10:37 AM   #12
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    Re: Bone marrow biopsy

    The high retic count pretty much rules out aplastic anemia (bone marrow production slow). Any elevated bilirubins in past? Spleen enlarged? Those would indicate hemolytic anemia (excessive breakdown of RBCs) in addition to iron deficiency. Hemolytic anemia goes along with some autoimmune diseases. Is your kidney function ok? There are lots of things to consider, and I think the iron treatment will help, but may need to be given IV if not absorbed well. Taking Vit C with the iron helps absorption. You are close to getting answers. I know how discouraging it gets to have to wait when you feel awful and can hardly function. Let us know how it goes, please.

    Last edited by ladybud; 07-25-2013 at 10:38 AM. Reason: deleted a question

     
    Old 07-25-2013, 11:04 AM   #13
    Suetun
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    Re: Bone marrow biopsy

    Liver functions and kidney functions are ok. Bilirubin has only ever been elevated as a child when I got hep A from school. Spleen was ok on exam. I really think it all boils down to the arthritis all others show inflammation is going on. I have a bone scan in a couple of weeks and I think it may light up like a Christmas tree lol. It is very frustrating and every time I feel like I'm turning a corner lately something knocks me down again, so I'm not getting my hopes up that the iron works this time. Thanks for the feedback and advice. I'll keep you posted with next weeks results.

     
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