Concerned about results

[lizzziep]

I’ve just been comparing some blood test results, first two from haematology, third from GP

29th May 2024

RBC 2.68 10*12/L

WBC 5.5

Haemoglobin 78 g/L

Haematocrit 0.24

RDW 19.4

Nucleated RBC 1/100 WBC H

Platelets 281

Blast cells 0

27th June 2024

RBC 2.66 10*12L

WBC 5.9

Haemoglobin 78

Haematocrit 0.23

RDW 19.0

Nucleated RBC 1/100

Blast cells 0

Platelets 227

1st July 2024

RBC 2.52

WBC 5.9

Haemoglobin 76

RDW 19.1

Platelet 254

Blast cells 0.2 10*9/L

Comment - Disease progression?

All other results in normal levels, including WBC, I put those in for comparison

So, previously I haven’t had any blast cells but only a few days after my test results from haematology the GP requested blood test results shows 0.2 10*9L, followed by the comment “disease progression?”

I don’t know what percentage this is, should I be worried about it? I don’t see the haematologist until 23rd July, should I contact them and see what they say? Is my MF progressing to AML?

I have post ET MF and several mutations including ASLX1, and TET. Otherwise I am well. I take 2 x 20 mg Rux per day, plus aspirin and EPO injections.

At my last haematology appointment the doctor said everything was stable, results have been very similar for the last 3 or 4 months. Could things change in just a few days?

Any input will be appreciated.

[hunter5582]

Sorry to hear about the worry regarding possible disease progression. I would be hesitant to interpret a single finding with a difference from June 27 Blast Cells = 0 to July 1 Blast Cells = 0.2. As I understand it, for the Blast Cells to increase so rapidly in just four days in unusual but not impossible. It is an indicator that your need a prompt response to this finding. While it could just be an anomalous finding, you do not want to assume that it is. I would think that at a minimum, your care team would want to repeat the CBC ASAP.

I would consider this to be an emergent issue and would not wait until July 23 to review the finding. Hopefully, this is just an artifact. If the finding is confirmed however, then it needs immediate attention. Waiting would not be in your best interests.

Hopefully this will turn out to be a tempest in a teapot. Please do let us know what you the findings are and how you are getting on. Until then, you will be in thoughts and prayers.

[lizzziep in reply to hunter5582]

Thank you

[LIGEBA in reply to hunter5582]

How are blast cells labeled on a CBC with Differential (if there is nothing that actually says "Blast Cells"?

[hunter5582 in reply to LIGEBA]

I suspect that means that the Blast Cells were not looked for on that panel. My routine CBC panels do not include them either. It does show when a Peripheral Blood Smear was done. CBCs and blood smears can detect blasts. I expect that this particular lab has to be specified when the doctor is writing the order.

[LIGEBA in reply to hunter5582]

Ahhh. Ok. So hard to keep up with all the names and acronyms sometimes. Appreciate the clarification.

[jointpain]

From our experience of GPs the note written will just show the GP doesn't know anything about MF or patients. I worry that my wife's MF maybe progressing to AML, but only because her neutrophils are often ten to twenty times normal. Speak to the Hematology consultant.

[lizzziep in reply to jointpain]

Thank you

[EPguy]

I have found some relevant info on these numbers. But before getting too deep, I see that your two results from hematology are ok, only the GP result is off. As Hunter says, a change that fast brings uncertainty. So you should request another reading from hematology, and opinions from the specialist. Also inquire whether the lab providers were the same or used the same procedures.

[lizzziep in reply to EPguy]

Thank you, the same lab, at the hospital, does the GP’s and haematology tests.

[Hatchie]

I have post ET MF also with ASXL1. I've been getting bloods taken weekly for the past 6 months and my blasts one week can be zero and then up to 3% then back to zero. My heamtology specialist said it's nothing to worry about. I was told it's only a sign of progression if it continually and constantly rises.

[lizzziep]

Thank you. Hopefully that’s will be the case with me.

[Carol0925]

Sorry to read this. Hopefully 🙏 it’s a one off. Thinking of you and please keep us posted.

[artydutch]

I am sorry to read about your concerns. As far as I know the bloods results on blast can vary. I have had some results with 2 % and some with zero and in between. As long as they stay under 5% there is no real concern, as the bloodtest is only ever a snapshot. Can you contact the Hematology nurse to ask on how to interpret this result? Good luck!

[lizzziep in reply to artydutch]

Thank you. I’m waiting for the specialist nurse to call me back.

[ainslie]

I wouldn’t assume anything just from those labs, first thing is results can fluctuate a bit anyway due to simple things such as hydration etc, I noticed years ago when venisecting my counts varied depending on where and when the blood was drawn, if I had bloods taken at the hospital the results were different to at GP even although the blood went to the same lab, I don’t know exactly why that was, maybe at clinic it goes straight to lab but at GP can lie around for a few hours, time of day and level of hydration can make a substantial difference. Many docs have told me never assume anything from one test, it’s the trend thats relevant.

I don’t know much about blasts but if I recall correctly your level is not concerning and can fluctuate. One to ask your Haem.

However, we are patients not docs so my advice would try to speak to you Haem sooner to get some re assurance and maybe do another blood test ideally at clinic, try to do similar time of day and hydration. Your Haem may suggest waiting a few weeks.

I would also say that if your Haem said all was stable at your last appt which appears to be 27 June it’s likely to be the case still.

[lizzziep]

Thank you, I’ve called the clinic this morning and someone is supposed to be calling me back. The girl who took my blood at the GP’s had great difficulty in getting any, she tried both arms twice, 3 times in each hand before she got any, that was in the morning, I don’t know what time it would go to the lab. At my usual phlebotomy place they get it first time, even though I have deep veins.

[ainslie in reply to lizzziep]

what you say about the nurse may be relevant and could possible affect the labs

[lizzziep in reply to ainslie]

Thank you, nobody has phoned me back so I’ll phone them again tomorrow.

[AnBee]

the nurse may also have had difficulty if you were dehydrated

[MCW22]

I too worry about progression to AML, Having already progressed from PV to MF. My blasts have been ever so slowly creeping up and at my last blood test were 2.48 My white count is still high at 35 HB 99 I'm taking 15mg of ruxolitinib twice a day. I had been taking one iron tablet every other day for the last 6 months but have now been told to stop them.So far I have not had any transfusions or epo injections but I expect that's only a matter of time.

I'll be following your progress with interest.

Carol.

[lizzziep in reply to MCW22]

We’re in the same boat, let’s hope it doesn’t capsize! The worry this disease causes is immense!

[MCW22 in reply to lizzziep]

I just noticed on the bottom of my last blood report it says blood film referred to consultant haematologist for comment. It then goes on to say numerous teardrop poikilocytes, pronounced basophilia and 7% blasts. I'm assuming that the lower 2.48% blasts is in the peripheral blood and the blood film is a closer inspection hence the higher reading. It's very confusing but I do know teardrop cells are not good. I've had them before on blood tests but this is the first time it's described them as numerous. I also saw a new high reading on my liver function test. After googling and seeing it can be caused by too much iron, I came to the conclusion that must be why I was told to stop taking the iron tablets.

[lizzziep]

You wouldn’t think blood could have so many aspects to it. Hope all goes well for you. 🙏🏻🤞❤️