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Date of last update: 10/21/2017.

Forum Name: Leukemia

Question: low levels of b12 effect on bone marrow

 1scottish - Tue Dec 23, 2008 4:51 pm

Hi Doctor,
I had a bone marrow biopsy in nov 07. It was sggestive of MDS.I have severe iron deficient anemia and vitb12 anemia. I require monthly blood transfusions and vitb12 shots 3x weekly.I also have hypoplasic bone marrow.My current hg is 3.3 hct 10.5 wbc3.1iron<10 ferritin 3.I askedmt hematologist to repeat the biopsy and they told me that as long as my b12 is abnormal then my biopsy will be abnormal.I belong to an HMO with a very bad reputation and I do not have confidence in them.Please advise.
ps platelets are abnormally large.
thanks for consideration.
 Dr. Tamer Fouad - Tue Jan 20, 2009 8:59 am

User avatar Hello,

I am sorry you feel that way about your HMO. Are you sure your hemoglobin level is 3.3 or did I misunderstand this? 3.3 is extremely low and requires more than just monthly blood transfusions in my opinion.

Does the report mention the RDW? Anisocytosis?

What stage of MDS are you? Did they say refractory anemia? Are you receiving erythropoietin?

Best regards,
 1scottish - Wed Jan 21, 2009 12:34 am

Hi Doctor,
no you did not misunderstand.the lowest my hg was2.1 hct at the lowest was8.4.
the rdw was 28.0.
anisocytosis 2+
microcytes 3+
ovalcytes micrscopy 1+
the hematolist wants to do iron sucrose iv weekly and vitb12shots 3xweekly.
I have also been more prone to infections recently but wcchas been normal.
Hope this gives youa better picture.
thanks for your input.
 Dr. Tamer Fouad - Wed Jan 21, 2009 2:23 am

User avatar Thanks for the extra info.

It's obvious there is a mixed cause for your anemia so your doctor is correct but what I think is more important is the info on you bone marrow report.

Please remember not to include any personally identifiable info - this is a public forum!
Best regards,
 1scottish - Wed Jan 21, 2009 2:53 pm

Hi, Doctor,
I found the bone marrow report. I) immunohistochemistry report
hypocellular marrow with trllineage hematpoiesis.
comment monocytes and granulocytes show decreased expression of cd33 and granulocytes also show deceased expression of CD15. these are onospecific findings but may be associated with mylodysplasia clinical and cytogenetics correlation i highly suggested.
hope you can make some sense of this because I cannot.
thanks so much
 1scottish - Thu Feb 05, 2009 7:25 pm

can you comment on bone marrow results or do they not make sense.?
 Dr. Tamer Fouad - Fri Feb 06, 2009 11:42 am

User avatar Hello,

As the report says these changes are not specific enough to make a diagnosis of myelodysplasia. At most they suggest the need to exclude the diagnosis of myelodysplasia by other means (eg, cytogenetics).

Myelodysplasia has a very specific set of criteria for its diagnosis. Blast counts, monocyte counts, the degree of dysplasia as well as proportion of iron deposition are all very important in making the diagnosis.

At this point what does your doctor suggest?
 1scottish - Fri Feb 06, 2009 1:11 pm

I do not really care what it is called as long as my quality of life last hgb was 2.6.MY Doctor suggests prbc as needed which have been appox monthly, vit b12 shots, and three hours weekly of iron sucrose.I have a cbc,and retic count weekly.
 Dr. Tamer Fouad - Fri Feb 06, 2009 1:22 pm

User avatar Hello again,

I understand your frustration but knowing what it's called is an important step to knowing how to treat your condition. I would strongly advise you to seek a second opinion from a hematologist.

I will also refer this post to our Hematology Team and hopefully someone will be able to give us more insight.

Best regards,
 1scottish - Fri Feb 06, 2009 2:03 pm

 1scottish - Mon Feb 09, 2009 4:48 am

Thankyou for your help so far!
Now I having discomfort under my left ribs x 2 days.
Feels like bruising but no external brusies or mark.
Any ideas?
 Dr. Tamer Fouad - Tue Feb 10, 2009 9:42 am

User avatar Hi,

What is your platelet count. I tried to search for them in your post but only found the bone marrow report.

Were you able to seek a second opinion from a hematologist?

Best regards,
 1scottish - Fri Feb 13, 2009 12:32 pm

my platelets have always been normal in all my cbc's.

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