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- Sun Sep 14, 2008 3:41 pm
i am a 63 year old man and started feeling very week 6 months ago and my hands and under-feet became numb, my gum became white and would bleed when brushing my teeth. each time i take a walk i would feel a tight squeeze in my chest esp. on the right breast and instantly i would feel faint and at times woul just fall down since all my joints would suddenly loose power and would be dizzy. I sometimes suffer from blurred vision when i stat feeling faint.
I went to a doctor in May who sent me to a physician in a neighbouring town and fom the blood tests he took, he indicatedto me that i had anemia and my hb was 4.5.
I was admitted into a hospital in August and i was transfused with 4 units of blood and was discharged. After the transfusion i was well again and had no problems at all. However after 3 weeks the same symptoms started again and i returned to the physician who then conducted a series of tests i.e bone marrow tepline, protein electropheresis, bence jones. when the results came back he told me my hb was low again and that no definitive diagnosis was done and i had to go for another transfusion.
The physician then referred me to a specialist physician with the following note:
this 63yr-old man had suffered from pancytopenia fo more than 6months. In July 2008, he had Hb 5.0g/dl, WBC 5.3 and platelets 104. Last week, the same picture holds, showing preservation of white cells.
Bone marrow was hypocellular, suggesting myclofitrosis, but the FBC does not entirely fit. One of the blood flms showed cold agglutinins and polychromasia. This would suggest peripheral consumption (but the hypocellular marrow does not fit). I suggest high dose corticosteroids and lets discuss.
I took the note to the pecialist physician and was transfused 4 more units of blood. After the transfusion he told me my Hb had risen to 5.6, WCC 5.3, p/t 89, MCV 92.3. He then gave me a 30day supply of Prenisolone to be 60mg once daily and asked me to come for a review after the 30 days.
I went back home and tarted the dose 3 days ago. I still feel weak and am very worried since all the tests never proved the cause of this blood loss. I don't bleed from my gums anymore but the squeeze in my chest i getting worse in the morning before i take the medication and i lose my voice whenever the pain in my chest starts. I end up trying to clear my throat but to no avail. I have also started drinking lots of water at least 4litres a day.
please assist, what could be wrong with me?
| Dr. Safaa Mahmoud
- Thu Oct 23, 2008 3:44 pm
It is quite obvious that you have severe degree of anemia which explain your symptoms like generalized weakness and the chest pain. Bleeding gum is explained by the low platelet count and or defective platelet function.
However, the result of the bone marrow examination as a hypocellular marrow is not coinciding with the peripheral count. The peripheral blood count shows a normal total leucocyte count and a platelet count fluctuating between low normal to a true thrombocytopenia.
It would be more helpful if you can provide us with the detailed results of at least the last blood picture, reticulocyte count (if it was done) and the bone marrow exmination. It would be also helpful if you can inform us about any history of recent (before the onset of these symptoms) drug exposure, infections especially viral, and any family history of blood diseases.
Aplastic anemia is diagnosed by pancytopenia (decline in erythrocyte, platelet, and leukocyte count in the peripheral blood) and a hypocelllular bone marrow (decline in all blood precursors in the bone marrow).
Bone myelofibrosis (which seems more likely to be the cause) is diagnosed by anemia and normal or increased total leukocyte and platelet count although the platelets count may become low with disease progression. Confirmation of the diagnosis can be done with the finding of bone marrow fibrosis on bone marrow biopsy and a dry tap on bone marrow aspirate. The presence of neutophil and megakaryocytic hyperplasia is also a very common finding.
In bone marrow myelofibrosisis, anemia is usually not that severe and when the Hb level is that low an associated autoimmune hemolytic anemia or thrombocytopenia should be looked for (e.g.Cold agglutinin as in your case). High LDH is a common finding too. Myelofibrosis is classified as a myeloproliferative disease in which there is an abnormal bone marrow stem cell growth, and subsequent replacement of the bone marrow with fibrous connective tissue.
- The condition should be differentiated from other causes of secondary bone marrow fibrosis like lymphoma,myeloma, autoimmune disorders (eg, systemic lupus erythematosus) and hyperparathyroidism associated with vitamin D deficiency.
- MDS hypoplastic variant can give a picture similar to yours and should be excluded and cytogenetic study of the bone marrow is helpful.
I advise you to follow up with your doctor.
Hope this information is useful.
Please keep us updated.