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Dr. Thomas, MD
Dr. Thomas, MD, Board Certified Physician
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Experience:  Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
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I am looking at my fathers CBC workup. He has been diagnosed

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I am looking at my father's CBC workup. He has been diagnosed with CMML (Chronic myelomonocytic Leukemia). His symptoms have gotten much worse recently and he is currently on Hydroxyurea. I am concerned that this is possibly not the best med for him. I have read much on Vidaza and Dacogen for treating CMML. I am finding it hard to decipher his blood work paperwork.

There is a "Anisocytosis (size) 2+" in his blood work and a
"Morph 1 plt. est. decreased-few giant forms noted"

What does this mean? Also what would a "NRBC (M) 2/100wbc" mean?

I am seeing that they can type CMML into type 1 or 2 and I don't know which his is or how to determine that.

I see him going downhill, platelets at 50 and wbc 166 (down from 230). The doctor has done no ultrasounds or CT scans. Would this be something that might be good to check on his liver and spleen and see if cancer could be growing in other parts of his body?

Help!
Submitted: 9 months ago.
Category: Medical
Expert:  Dr. Thomas, MD replied 9 months ago.
Hello from JA
The NRBC means nucleated read blood cells.
It is not really a normal finding, but this is a low amount.
It can be from neoplasia, spleen problems and other difficulties.'

You can not "type" anything from a CBC.

Platelets dropping is not a good sign.

He has a high white count however, and this is an indication for hydroxy urea...and the fact that the WBCs are coming down is a good sign.

His platelets are not at a critical level.


There is absolutely nothing wrong with getting an ultrasound to look at his spleen if there is a concern.


I would discuss these issues with his doctors, but it sounds like the treatment is probably correct at this point, with some progress.

As you know, this is not a curable disease, so the treatment is to improve symptoms, not numbers per se. The fact that his symptoms are not better warrants discussion at this point.


Use reply to let me know if you have further questions.
Please do not forget a positive rating.
Customer: replied 9 months ago.

Well he seems to have nosebleeds that are really affecting the quality of life. He has them cauterized, rhino rockets, chemical cauterization but they have had to give him platelets twice now to get them to stop. He and my mom would like to be able to travel a little in their motorhome but dare not venture out considering this happens twice a week or so.


 


I'm not sure what can be done about the nosebleeds. He sees an ENT after his ER trips. I imagine if there was something that could be done he (the ENT) would suggest it.


 


MD Anderson has a Pronostic Scoring System that gives survival times and I'm just wondering how would we get the details on that.


 


Otherwise he is not nauseous or otherwise incapacitated by the medicine. It would be nice to see them use the motorhome before he passes as he just retired.

Expert:  Dr. Thomas, MD replied 9 months ago.
Simply ask his hematologist for the prognosis.

What is he doing besides conventional therapy?
Customer: replied 9 months ago.

Ok. We can do that.


 


He is taking a few supplements that I thought would help.


Curcumin for inflamation


another for liver detoxing


 


and just trying to eat properly. I've been trying to get him to purchase some intense vitamins like Juice Plus etc...


 

Expert:  Dr. Thomas, MD replied 9 months ago.
What are the ingredients in the liver supplement
Customer: replied 9 months ago.

It's olive leaf extract and my mom says she doesn't think he is taking it regularly.


 


 


Is the NRBC count the number of blasts in the blood. Are nucleated red blood cells the blasts?

Expert:  Dr. Thomas, MD replied 9 months ago.
No these are not the blasts. These are immature red blood cells.

The curcumin can thin the blood, so this can make his bleeding problems worse.

I would get him seen by a good Reiki practitioner; we have some significant evidence that this helps in the stability of cancer patients. Acupuncture might help in the same sense.

Also medical massage, and other therapies.

I would talk to his doctors about the curcumin.

Use reply to let me know if you have further questions.
Please do not forget a positive rating.


Customer: replied 9 months ago.

What is the blast count than? Will it just say "blast"?

Expert:  Dr. Thomas, MD replied 9 months ago.
It would indicate immature white cell types..which your report does not.


Use reply to let me know if you have further questions.
Please do not forget a positive rating.

Customer: replied 9 months ago.

well there's all sorts of stuff here I didn't include. Do any of these stand out to you?


ANC 124.5


Myelocyte 8%


metamyelocye 6%


Monocyte 3%


Eosinophil 1%


lymphocyte 5%


neutrophil 59%


promyelocyte 2%


band 16%

Expert:  Dr. Thomas, MD replied 9 months ago.
Prommylocytes and bands...but they are low...so good enough.
Use reply to let me know if you have further questions.
Please do not forget a positive rating.
Dr. Thomas, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 55951
Experience: Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
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