Blood Counts in Myeloid Leukemia: Key Insights for Patients

Q: Blood Counts in Myeloid Leukemia: Key Insights for Patients

Hello： Although you did not explicitly state your diagnosis, based on your description, I suspect you may have been diagnosed with myelodysplastic syndrome (MDS). <br>Our hematologists consider MDS to be a precursor to blood cancer, and if left untreated, there is a significant c

The blood cell counts of patients with leukemia typically show elevated white blood cell (WBC) counts, decreased red blood cell (RBC) counts, and reduced platelet counts (thrombocytopenia)?

Dear Dr.
Chen,
I have been diagnosed with myelodysplastic syndrome (the doctor mentioned it is on the verge of becoming acute).
After that, I underwent treatment for two months (subcutaneous injection of targeted therapy), with weekly blood tests.
The doctor informs me of my white blood cell count (currently at 800), red blood cell count (6.0), and platelet count (7500).
Overall, the trend has been downward, though sometimes the decrease is more significant than at other times.
When the drop is too severe, the doctor asks the nurse to administer blood and platelet transfusions.
I sometimes (but not always) ask the doctor if these decreasing values indicate a worsening condition, but the doctor says these values are just for reference, and the actual indicators of my condition are something else (which he did not specify).
This raises several questions for me: For instance, which values are truly related to my condition? Is there a quantitative measure for each blood test? Why does the doctor always report the white blood cell, red blood cell, and platelet counts? How can I determine if the treatment I am undergoing is effective?
May I ask you these questions, Dr.
Chen? Thank you!

Rong Hong, 60~69 year old female. Ask Date: 2015/08/31

Dr. Chen Yunfang reply Oncology

Hello: Although you did not explicitly state your diagnosis, based on your description, I suspect you may have been diagnosed with myelodysplastic syndrome (MDS).
Our hematologists consider MDS to be a precursor to blood cancer, and if left untreated, there is a significant chance it could evolve into blood cancer within a few years (which is much harder to treat! The mortality rate is high, and even if treated successfully, many people may still suffer greatly).
Therefore, we typically administer chemotherapy agents to treat it, hoping to reverse the abnormal blood profile and return it to normal.
Even if it cannot return to normal, at the very least, we aim to stabilize it to prevent future progression to blood cancer.
Currently, the standard chemotherapy agent covered by health insurance is Azacitidine (brand name Vidaza), which is administered via subcutaneous injection (you may have misunderstood; it is expensive, but it is not a targeted therapy, rather it is a chemotherapy drug!).
Generally, it is injected subcutaneously for 7 consecutive days (some hospitals may adjust this to 6 days due to Sundays), followed by a 21-day rest period, with a cycle every 28 days (I hope I am not mistaken!).
Since this drug is a chemotherapy agent, it has common side effects related to blood cell suppression, so blood tests are frequently performed to monitor whether the dosage is too high for your body to tolerate (the doctor must carefully adjust the dosage—not too high, but not too low, just right—which is why you may feel like you are having blood drawn often; those numbers are indeed very important to the doctor! If blood cell counts drop too low and pose a risk, you may need a transfusion).
As for the efficacy, generally, blood tests can provide an indication; if effective, your blood profile should gradually normalize.
However, after completing the 4-month treatment course, a bone marrow biopsy will be performed again for confirmation.
I still believe it is essential for you to have a thorough discussion with your physician, as the treatment of hematological diseases is complex and challenging.
Understanding the purpose of your treatment should help alleviate some of your concerns.
Thank you!

Reply Date: 2015/08/31

More Info

Understanding blood counts in the context of myeloid leukemia, particularly acute myeloid leukemia (AML), is crucial for both patients and healthcare providers. Blood tests are a fundamental part of monitoring the disease and the effectiveness of treatment. In your case, the values you mentioned—white blood cells (WBC), red blood cells (RBC), and platelets—are essential indicators of your hematologic status and overall health.

Key Blood Count Parameters
1. White Blood Cells (WBC):
- Normal ranges for WBC are typically between 4,000 and 11,000 cells per microliter. A count of 800 is significantly low (a condition known as leukopenia), which can increase the risk of infections. In leukemia, WBC counts can fluctuate due to the disease itself or as a response to treatment.

2. Red Blood Cells (RBC):
- Normal RBC counts vary by gender but generally range from 4.2 to 6.1 million cells per microliter. An RBC count of 6.0 is on the higher end of normal, but in the context of leukemia, it may not be sufficient if hemoglobin levels are low (which you indicated is 7.9, below the normal range of 12-16 g/dL for women and 14-18 g/dL for men). Low hemoglobin indicates anemia, which is common in leukemia patients.

3. Platelets:
- Normal platelet counts range from 150,000 to 450,000 cells per microliter. A count of 7,500 is critically low (thrombocytopenia), leading to an increased risk of bleeding and bruising. This is a significant concern in leukemia patients, especially when undergoing treatments that can further suppress bone marrow function.

Interpreting Trends and Treatment Efficacy
The downward trend in your blood counts can be concerning, but it is essential to understand that fluctuations are common in leukemia treatment. The goal of therapy, which may include chemotherapy or targeted therapy, is to reduce the number of malignant cells in the bone marrow and restore normal blood cell production.

- Why Monitor These Values?:
- Your healthcare team monitors WBC, RBC, and platelet counts closely to assess the impact of treatment. These values help determine whether the treatment is effective or if adjustments are needed. For instance, if your WBC count is dropping too low, it may indicate that the treatment is too aggressive, necessitating a dose adjustment or a break in therapy.

- What Values Matter Most?:
- While WBC, RBC, and platelet counts are critical, your doctor may also consider other factors, such as bone marrow biopsy results, cytogenetic analyses, and molecular markers, to assess your disease's status. These tests provide a more comprehensive picture of your leukemia and its response to treatment.

Communication with Your Healthcare Provider
It’s understandable to have concerns about your blood counts and their implications for your health. Here are some tips for effective communication with your healthcare team:
1. Ask Questions: Don’t hesitate to ask your doctor to clarify which specific values are most relevant to your condition and treatment. Understanding the rationale behind your treatment plan can alleviate anxiety.

2. Discuss Symptoms: If you experience new or worsening symptoms, such as increased fatigue, fever, or unusual bruising, inform your healthcare provider immediately. These could indicate changes in your condition that require prompt attention.

3. Inquire About Treatment Goals: Ask your doctor how they measure the effectiveness of your treatment. This could involve discussing expected outcomes, timelines for improvement, and what to watch for in your blood counts.

4. Follow-Up: Regular follow-up appointments and blood tests are crucial. They allow your healthcare team to monitor your progress and make necessary adjustments to your treatment plan.

Conclusion
In summary, understanding your blood counts in the context of myeloid leukemia is vital for managing your health. While the numbers can be daunting, they are tools that your healthcare team uses to guide treatment decisions. Open communication with your doctor will help you navigate this challenging journey and ensure that you receive the best possible care. Remember, you are not alone in this process, and your healthcare team is there to support you every step of the way.

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