Hi all,
I got my peripheral smear report today.
My wbc got down to 8800 and platelet went down from 122 (last week) to 82 today. Also myeloblast increased from 0 to 1%. Pathologist noticed few gaint platelets. Not sure what its is.
I am really worried. Kindly help me with your thoughts.
Regards
Kiran
Hello,
you have not posted much information.
How long have you been on therapy, which therapy, what was your results at the begining. It is quite common to have various degree of thrombocytopenia after few weeks at the beginning of the treatment. Anizotrombocytosis - that means there are platelets of different size on blood smear is frequent when thrombocytosis is stimulated - it could be if your bone marrow tries to solve the problem with low platelets.
Have you had some myeloblasts in your blood smear previous?
You will get the best answer from your haematooncologist, because he or she knows all your results.
Evelinka
Hi Evelinka/David/Sandy
I am in the 4th week of tasigna. My last peripheral smear report (18th jan) showed myeloblast as 0% and today report (25 jan) shows 1%. Is tasigna not working for me. Please suggest.
Best regards
Kiran
I understand, the blood smear catched few myeloblasts, I asked for WBC, neutrofil count at the beginning. It does not necessary mean, that nilotinib is not working. It just need some time. The fact, you had not any blasts at the beginning does not mean there were not any... they just had not been catched. If neutrophils and platelets are dropping, it is a good sign. I think it is too early, you will have more info after bone marrow aspiration. You could have some additional mutations, ut it us highly unlikely.
Thanks Eve. Here are the details.
Wbc count - dropped.from 10300 to 8800
Platelets - dropped from 122 to 82
Rbc count - 4.15 to 4.07
PERIPHERAL SMEAR
Erythrocytes : show a mildly variable morphology with normocytic
normochromic, normocytic hypochromic cells seen along with occasional
macrocytes. Mild degree of anisocytosis is seen. No nRBCs or
polychromatophilic cells are seen.
Leucocytes : are normal in count with a shift to the left of myeloid
series noted. Myeloblast-01%, Promyelocyte-00%,
Myelocyte-03%, Metamyelocyte-01%, Band form-05%, Neutrophil-45%,
Eosinophil-07%, Basophil-01%, Lymphocyte-35%, Monocyte-02%.
Thrombocytes : are reduced in count. Giant platelets are seen and no
platelet clumps are noted.
Haemoparasites : not found
Kindly suggest.
Regards
Kiran
You started with quite low wbc in case of cml, so I would expect more rapid drop than to 8800 with 2nd generation TKI - nilotinib. You have some immature neutrophils of various degree (myelocytes, metamyelocytes...myeloblasts are the most immature ones) on the smear. Have you had some of these earlier? This could be because of cml, but It is sometimes seen during infections, pregnancy... (not blasts, but more mature forms). Did you cope with an infection when giving a blood sample ?
Erythrocytes are ok. Slightly lower in count.
You started treatment with 122 platelets, which is mild trombocytopenia. It usually indicates that the disease lasts longer... but in that case I would expect much more neutrophils.
I think it is early to say how well Tasigna works. However if the immature forms rises, it is not ideal sign.
This is really a question for a haematooncologist and I am just pediatrician.
Best wishes.
Eva
