Persistent Abnormal Blood Counts: MDS and Beyond

Q: Persistent Abnormal Blood Counts: MDS and Beyond

Hello： It turns out that not only are your white blood cell counts elevated, but your platelet counts are also high. <br>If that's the case, I wouldn't consider you to have Myelodysplastic Syndromes (MDS), as MDS would typically show at least one hematopoietic lineage being low;

Blood Cell Issues 2

I apologize, but my platelet count (PLT) is between 450 and 600, which is considered elevated, and my white blood cell count (WBC) ranges from 13,000 to 17,000.
During my first bone marrow biopsy, I was diagnosed with Myelodysplastic Syndromes (MDS), but during the second biopsy, without any treatment, no blast cells were found in the bone marrow.
I am puzzled as to why my WBC and PLT are consistently abnormal (when I am not ill or infected).
Although I have asthma, I do not frequently use corticosteroids and only use Symbicort.
My pulmonologist mentioned that my medication would not affect my blood.
I do not have any congenital abnormalities; previously, my WBC was slightly elevated at around 11,000 to 13,000, while my PLT was normal.
Now, my PLT has also started to rise, and although the values are still acceptable, I feel uneasy seeing them slowly increase year by year.
Is there anyone else experiencing this? Is there something wrong with my blood? Thank you!

chun, 30~39 year old female. Ask Date: 2015/12/21

Dr. Chen Yunfang reply Oncology

Hello: It turns out that not only are your white blood cell counts elevated, but your platelet counts are also high.
If that's the case, I wouldn't consider you to have Myelodysplastic Syndromes (MDS), as MDS would typically show at least one hematopoietic lineage being low; having all elevated counts would rule out MDS.
Therefore, I believe your first bone marrow report was inaccurate, while the second one seems more reasonable.
Generally, abnormalities in the bone marrow that are non-cancerous can be categorized into two main types: the first category is Myelodysplastic Syndromes (MDS), and the second category is Myeloproliferative Neoplasms (MPN).
I would classify your diagnosis within the MPN group, possibly as Essential Thrombocythemia (ET).
However, MPN usually has a better prognosis than MDS, with a lower chance of progressing to acute leukemia.
Nonetheless, regular blood tests are still necessary to monitor your condition, including abdominal ultrasounds to check for splenomegaly.
Additionally, you may want to ask a hematologist to test for JAK2 gene mutations (which usually costs around $2000 out of pocket) to further confirm the diagnosis of MPN.
Thank you for your attention!

Reply Date: 2015/12/21

More Info

Understanding persistent abnormal blood counts can be quite complex, especially when dealing with conditions like Myelodysplastic Syndromes (MDS) and other hematological disorders. Your situation, characterized by elevated white blood cell (WBC) counts and platelets (PLT), raises several important considerations.

Firstly, it’s essential to clarify the nature of MDS. Myelodysplastic Syndromes are a group of disorders caused by poorly formed or dysfunctional blood cells. Typically, MDS is characterized by one or more cytopenias (low blood cell counts) due to ineffective hematopoiesis. In your case, the initial diagnosis of MDS was made based on the presence of abnormal blood counts, but the subsequent bone marrow biopsy showing no blast cells and the absence of significant cytopenias suggest that the initial diagnosis may need reevaluation.

The persistent elevation of your WBC and PLT counts, particularly in the absence of infection or other acute illness, could indicate a different underlying condition. One possibility is a myeloproliferative neoplasm (MPN), which is characterized by the overproduction of blood cells. Essential thrombocythemia (ET) is a specific type of MPN that can lead to elevated platelet counts. In MPNs, the bone marrow is often hypercellular, and patients may experience elevated counts without the presence of blasts, which aligns with your second bone marrow biopsy results.

Your concern about the gradual increase in these counts is valid. While the numbers may still be within a range considered acceptable, the trend of rising counts can be indicative of an evolving hematological condition. Regular monitoring is crucial, and it’s advisable to maintain close follow-up with a hematologist who can assess your blood counts over time and determine if further investigation is warranted.

Additionally, the suggestion to test for JAK2 mutations is pertinent. JAK2 V617F mutations are commonly associated with MPNs, particularly polycythemia vera and essential thrombocythemia. A positive result could help confirm a diagnosis of an MPN and guide treatment options.
It’s also important to consider other factors that could influence blood counts, such as chronic inflammation, stress, or even medications. While your asthma medication (Symbicort) is not typically associated with significant hematological changes, it’s always wise to review all medications and their potential side effects with your healthcare provider.

In summary, while your initial diagnosis of MDS may not fully explain your current blood count abnormalities, the possibility of an MPN should be explored. Regular monitoring, further genetic testing, and consultations with a hematologist will provide clarity and help guide appropriate management. It’s understandable to feel anxious about these changes, but staying informed and engaged with your healthcare team is the best approach to managing your health.

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