“No More Delays; We’re Going”

Those were the words from Ryan’s transplant doctor today.  His bone marrow transplant will be May 29^th.  She stated that “His continued dependence on platelet transfusions and his dangerously low ANC are not compatible with life.”

I actually half expected another delay.  I recently noticed some differences in his labs in the past month.  He has had a lot of unusual red cells noted on his labs: his MCV (mean cell volume) has been steadily climbing, he has had teardrop and elliptical shaped cells, along with polychromasia (an abnormally high number of red blood cells found in the bloodstream as a result of being prematurely released from the bone marrow during blood formation.)  All of this strange red blood cell activity has resulted in his hematocrit staying fairly level (although still low), and he has gone almost three months without a red blood transfusion (he normally only goes about a month in between transfusions).

On the other hand, his platelets and ANC have tanked.  He has been requiring more frequent platelet transfusions and is considered neutropenic due to his low ANC.  This puts him at great risk for hemorrhage and infection.  His doctor said that even if his red cell line / hematocrit was completely normal, she would still recommend transplant due to the other two cell lines being continually low.

As a result of the recent changes noticed in his cells and counts, the transplant team coordinated an early bone marrow transplant last week rather than waiting for our “re-arrival” at SCCA this week. Preliminary results show his cellularity at around 40%, which is lower, but there still are no clues as to the exact cause of his bone marrow failure.

The pathologist who has reviewed all of Ryan’s biopsies over the last year said that his marrow looks “a little less normal” in this most recent biopsy than it has in the past, and it does have some “pre-dysplastic” characteristics.  With MDS the marrow becomes dysplastic (“dysplastic” refers to abnormal growth or development.)  It seems that maybe Ryan is moving toward MDS, but there still is no solid evidence.  SCCA is currently doing another round of cytogenetic testing on this sample.  Results should be back in a few days, so if a clear sign of MDS is discovered his diagnosis could change, but as of 1:00 this afternoon, his official diagnosis is “Underlying Bone Marrow Failure.”