Immature granulocytes high 19.8. Should I be concerned?

[Nanabr123]

Having bone and joint pain in leg and arm. Also itch skin especially when taking shower or bath.  Concerned about a blood cancer. Could something else cause this such as arthritis?

[Ken_PA]

Well, those three relate to red blood cells (being small and/or immature) and this seems to point to something wrong in the marrow.

Have your got your bone marrow biopsy results? Is it something inconclusive?

[Ken_PA]

Yep, that was very fast, though they conceivably could have done the 1st step on the biopsy sample which is looking with a microscope. I'd wondered if for some reason they'd rushed yours. That 1st part shouldn't take 2 weeks, though, unless there's something special in looking for PMN.

Advanced tests are often sent out to another place.

[Nanabr123]

I’m still waiting on BMB results, but I got some more lab results in my patient portal yesterday. I’ve never seen this before and have no clue what it is or means and was wondering if you might could help Anisocyte 1 + (Abnormal), Microcyte 1 + (Abnormal), and Polychrom 1 + (Abnormal).

[Ken_PA]

If the figures you're giving are from the biopsy (not from a CBC), there are no figures for blasts?

Those three you posted seem only slightly out or range. So your doc might not bother with advanced testing, such as looking for genetic mutations for PMN. That's my guess.

The biopsy would have shown mastocytosis if it were present, as they would have done the special staining for MCs.

Btw, for the record, it's not unusual for MCAS to cause eosinophilia as a downstream effect

[Nanabr123]

These figures are from my CBC that was done yesterday before the biopsy. That said it would be about 2 weeks before I get biopsy results back.

[Ken_PA]

On your profile, there's a place to upload photos. But you should black out any name etc

I'll be back tomorrow.

[Nanabr123]

It want let me upload. I keep getting a message that say iOS devises doesn’t support photo upload.

[Ken_PA]

Can you post the report, and any ranges?

[Nanabr123]

Neutrophil percent 49.4, Monocytes percent 7.6 and Eosinophil percent 6. I was going to try and send a photo copy of the report, but couldn’t figure out how.

[Ken_PA]

I really would try any generic BenGay ointment. It might sound too simple to work, but there's a good chance it will on finger joints. I'd look for menthol of 10%, some are lower.

Let me know the results, either way.

------------

Here's the study recommending dual, bilateral BMBs for mastocytosis:
https://www.ncbi.nlm.nih.gov/pubmed/14983941

Full paper:
https://pdfs.semanticscholar.org/962c/2e359f3d883786bee069c4caadf3476d114f.pdf

If you're not getting that, I'd ask the hema why, and show that paper.

[Nanabr123]

I had the BMB today and they did lab work. My neutrophil percent low, monocytes percent high and eosinophil percent high. All other results are in normal range. Could this be an indication of an MPN?  I viewed results online after I got home, so wasn’t able to discuss with dr.

[Ken_PA]

Mastocytosis refers to having way too many Mast Cells. But on the other hand, the majority of people with an MC disorder have a normal number of MCs, but they get set off too easily, releasing their array of powerful biochemicals when they shouldn't. Their MCs can release too many biochemicals, too easily, too often and sometimes for too long.

E.g., histamine is released from MCs and that explains the itching caused by water.


Do you have problems with finger joints at all? Or just large joints?

[Nanabr123]

Yes, my finger joints hurt off an on. It depends on what I’m doing or if I’m using my hands a lot.

[Ken_PA]

I would guess that an MPN disorder would show up in a CBC. Then again, it is there with the eosinophilia.

For mastocytosis, that won't show up on a CBC. Mast cells get born in the marrow and only circulate in the bloodstream very briefly until they take up their station in some tissue -- sort of on stationary guard duty against invaders. They coordinate and direct other immune cells.

A noted MC doc named Afrin says that he always does a double (bilateral, one in each hip bone) BMB, because there is a 1 in 7 chance of missing the mastocytosis cells in a single BMB.

They look for a 'KIT' mutation, which is kind of like a sensor on the surface of MCs that tells MCs to multiply too much.

The hema could have done a blood test for Tryptase. If that's strongly high for a while, that's a good sign that a BMB would show mastocytosis. But if it's normal, or only slightly high, there might still be mastocytosis. Still, your BMB(s) are a two for one approach so that seems good. It's not a big deal of a procedure, either. You can probably find youtubes of it being done.

My guess is that you have a MC disorder but not mastocytosis -- because you're not all that bad, relatively.

One thing you want to be on guard of is this: MCs can sort of summon eosinophils to an area, and it's the eosinophils that do the  damage called 'remodeling'. Like making scar tissue. So be very aware of any problems such as swallowing food. Catch it early.

Good luck to you. Let me know how the BMB(s) go.

[Nanabr123]

What is a MC disorder and how is it different from Mastocytosis?

[Ken_PA]

That the average platelet size. Check out this recent post: https://medhelp.org/posts/Leukemia--Lymphoma-/About-gum-bleeding/show/3033191#post_14377108

[Nanabr123]

I saw my hematologist today. He said today my blood count looked good except my eosinophil count was high. Because of my symptoms he has scheduled me to have a bone marrow biopsy to look at gene mutations to check for MPN disorder or check for Mastocytosis. I got to thinking after I got home if I have an MPN disorder or Mastocytosis wouldn’t shonething show up in my blood work?  Or is bone marrow biopsy sometimes the only way to diagnose it?

[Ken_PA]

That is: THousands (of cells) per Cubic MilliMeter (of blood)

[Nanabr123]

What is Mean Platelet Volume?

[Ken_PA]

Mast cells are powerful immune system cells. There is such a thing as reactive/inflammatory arthritis which is caused by immune reactions. You should take careful notice if food reactions lead to arthritis flares.

[Nanabr123]

Thank you for all your help. I went to see another dr today and he repeated my lab work, but I can’t read it. It’s wrote up different from the previous lab test. When it says TH/cmm by the results/range what does that mean?  I have no clue what to campare it to.

[Ken_PA]

For your appointment, I  would print out that page that I linked to. It's is from the official government NIH site, not just some random internet thing. I'd ask the doctor or NP about the part that says:

"-increased mast cell degranulation - release of granules rich in histamine and other compounds into the body by mast cells, a special type of cell that plays a role in the immune system
-increased circulating histamine"

You have multiple food sensitivities, which would involve mast cells . So all of your conditions are possibly linked. Unfortunately, though, mast cell diseases are not widely known in the medical community yet. So the person you talk to at your appt might not be aware.

[Ken_PA]

Hi. If you're thinking of CML, your regular CBC would likely be showing elevated granulocytes (the counts of eosinophils, basophils and possibly neutrophils). But you don't mention that.

Rheumatoid arthritis can cause elevated immature granulocytes, because it's an inflammatory condition. I don't know if RA also can cause the aquagenic pruritus (itch from water). If it doesn't, here is a list of possible causes:
https://rarediseases.info.nih.gov/diseases/10278/aquagenic-pruritus

Do you happen to have a lot of allergies?

[Nanabr123]

My eosinophils are high, but my basophils and neutrophils are in normal range. The only allergies I know of is several food related. I have a dr appointment tomorrow with an immunologist.

[Nanabr123]

I had a nurse practitioner tell me that RA would elevated it but usually not that high. Not sure if that’s correct or not. I’ve had a lot of nausea and I can tell my appitate isn’t like it had been.