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Megablastic Anemia & Hemolysis
Aug 20, 2007

I'm a 35yr old woman. I've been HIV+ since 2001. My VL is undetectable, but my T-Cell count is at 45. Because of this & not being able to get my WBC above 1500 without the use of Neupogen (which my ins will no longer auth), my doctor sent me to a Hemotologist for a bone marrow biopsy. I just got the results of my recent bone marrow biopsy. Luckily, they did not find anything major like lymphoma. However, it does state that it is "highly suggestive of megaloblastic anemia or hemolysis." I'm a little confused. This test came about because we can't get my WBC above 1500 without using Neupogen. My RBC have always been in the normal range. I did just do a blood test that will be back in a week. I'm just confused as to how I could have any form of anemia if my RBC have always been normal. I don't know if it helps, but here's their findings from the bone marrow biopsy: 1. Slightly hypocellular bone marrow for age 2. Hyperplastic erythropoiesis w/mild mega-oblastoid changes 3. Hypoplastic & left shifted granulopoiesis 4. Orderly thrombopoiesis 5. Normal storage iron, No ringed sideroblasts 6. Mild to moderate reticulin fibrosis 7. No fungi or acid fast bacilli identified

Any insight is GREATLY appreciated!

Response from Dr. Frascino

Hello,

This is a complex topic to explain and beyond the scope of this forum. Your hematologist and HIV specialist will go over these results with you in great detail. Basically the results show your bone marrow (the factory for blood cells red, white and platelets) has fewer developing blood cells than would be expected. The red cells are growing at an increased rate and are slightly larger than normal in size. This could suggest the red blood cells are being broken down to quickly elsewhere (hemolysis). The white cells are growing at a slower rate than normal and include more immature cells. The platelet production and number appear normal. No fungus or mycobacteria were seen.

There are a number of possible causes for results such as these, including drug side effects. Your physicians will help in the next stage of the evaluation to pin down the underlying cause of your problem. In the interim your HIV specialist and hematologist should help you battle your insurance company if they are refusing to cover any recommended therapy!

Good luck.

Dr. Bob


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