Immature Granulocytes and Nucleated red blood cells with E.T ?

[mother2britton]

I was recently diagnosed with E.T Calr+ about a week ago (platelets 670). I have been seeing my GP and Hematologist. All my blood labs were great except I had minimal Nucleated Red Blood Cells show up. My absolute nucleated red blood cells were .02 and the norm is 00 - .01. My Immature Granulocytes were .24 the norm 00 - .09 but have been like that for the past 4 years since they started testing for them on my annual physical. When I asked my hematologist why they were like this she didn't know and said maybe one popped through but to not worry about it since my other labs were so good. I asked my GP again and he said no worries again.....but I am. I looked on Dr. google and what little I could find did say when the spleen is working hard with MPN disorders it may happen from time to time. Also my spleen was ok upon palpation examination. Does anyone have any experience with this or have had this happen before? So far I feel great with no symptoms yet.

[hunter5582]

There is a complex balance of factors at play in determining what is going on. What are your iron levels like? Note - that is just one factor. What meds are you on? What other cooccurring conditions do you have?

Best suggestion at this point is to consult with a MPN Specialist rather than a regular hematologist. Most docs lack the KSAs to provide optimal treatment for MPNs as they do not have experience with these rare disorders. Here is a link just in case you have not seen it. mpnforum.com/list-hem./ .

Hope you get answers soon.

[mother2britton in reply to hunter5582]

Thanks for your reply hunter. I’m currently on Asprin only no other meds at all. All my iron tests (I can’t remember all of them) were in normal ranges. I don’t have any other conditions that I’m aware of other than the ET diagnosis. I’m in the process of finding another hematologist although it’s going to take some travel, we only have one in my area. The next one I will see has good credentials but none for mpn and is 100 miles away. I won’t be able to see him for at least a couple more weeks at that point was going to see if he would be able to work with an mpn specialist if needed. I think my first stop will be the Denver area as I have a relative in that area but its a 600 mile drive for me, that’s the closest specialist to me within driving distance. Thank you for the list.

[hunter5582 in reply to mother2britton]

With the tele-video-medicine option in play, you may not have to drive. One silver lining to the COVID crisis is that so many institutions have really opened up to this.

[clubdino]

Nucleated red blood cells and immature granulocytes in the blood is something you would see in myelofibrosis. But your numbers are barely out of range so maybe very early myelofibrosis? I have ET CALR and have had a slight elevation in my immature granulocytes for the past couple years but never any nucleated red blood cells. Were you diagnosed by blood test only or did you have a BMB also? Pre-myelofibrosis can look very similar to ET and sometimes pre-mf will be misdiagnosed as ET. Nucleated red blood cells should not be seen in normal blood so I would find that reason enough to request a BMB or see a MPN specialist. Nucleated red blood cells are immature cells pushed out of the marrow too soon. More than one nrbc was found if your count was .02. Let's say your RBC count is 5...which is really 5 million. 5 million x 0.02 is 100,000...so that would be 100,000 nrbc squeaked by. Definitely deserves a follow up.