Discussions By Condition: I cannot get a diagnosis.

Bone marrow issue - no isolation

Posted In: I cannot get a diagnosis. 0 Replies
  • Posted By: Anonymous
  • September 9, 2007
  • 00:22 AM


Patient is in India and has been a smoker until recently. Approximate age is about 57-59. patient has been noticing low fever from about 6 months now and this is how went to the doctor. Initial diagnosis was TB suspicion and the patient was given anti TB medication. The patient responded to the treatment. However, the hemoglobin level changes revealed the issues with bone marrow functioning.

Here's the sequence of events as i have noted down per a discussion with my cousing (patient's son):

Low red blood cell count and low level of hemoglobin (latest is 5.1)

2 Bone Marrow aspirations & a Biopsy done
1st Bone marrow aspiration test revealed MDS state around the July 1st timeframe. Biposy came out negative to leukemia and TB.

In July timeframe hemoglobin was 8.6.
Patient was given Anti TB medication, Iron and Folic acid to generate Hemoglobin

For a month Hemoglobin was constant at around 7.1 until August 23.
Around after august 23 , various tests were conducted including the second bone marrow aspiration. hemoglobin level was 6.8 when tested. they said no presence of TB, however cannot rule out its presence 2 months ago (The patient has been on anti TB drugs since the first test). Bone marrow state was not in parallel with the MDS state found per the first test i.e, Red blood cell generation is better relative to the previous result.

Patient was feeling weak around September 1st week timeframe and went to hospital. Per September 1st week test hemoglobin drops to 5.8

Diagnosis by the doctors indicated that the red blood cells being generated are not healthy.

3 possibilities were listed regarding the bone marrow problem:
1) improper input to Bone marrow
2) problem with the bone marrow functioning itself
3) virus killing the bone marrow

Regarding #1,
- per the test on august 23rd , result indicated that Iron is abundant but
not being properly untilized by the bone marrow.
- the patient was indicating signs of B vitamin deficiency through mouth
sores etc. B12 injections were given one per day "methyl cobol" along
with the anti TB medication
- Measured the levels of Erithropoetin harmone and result indicated super
activity level (abundance of the harmone) on the kidney functioning.

Doctors indicated that inputs to bone marrow were probably ok.

Doctors suggested a blood transfusion because the patient is at 5.8 level of hemoglobin.
Doctors are investigating the other possibilities with bone marrow at the moment.

Doctors wanted a third bone marrow aspiration test , but the patient was slightly reluctant towards the discomfort caused (fever and weakness).

The isolation of the problem is still pending.

Please advise if there is a way to connect with any bone marrow specialist for advice and diagnosis immediately.

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