I know a high ratio of myeloid to erythroid is problematic, i.e. 7:1. What does a ratio of 3:3 mean? Am I being simplistic in thinking an even ratio should just be represented as 1:1? Or is there significance in it being 3:3.
And I can't seem to make sense of this result, 3:3, from my BMB (bone marrow biopsy). I try to learn as much as I can, but I can't seem to figure this out on my own.
Thank you for any input!
Forums
6 posts
• Page 1 of 1
-
Toni - Name: Toni
- Who do you know with myeloma?: self - MGUS
- When were you/they diagnosed?: April 2014
- Age at diagnosis: 51
Re: Bone marrow biopsy - M:E ratio
Toni,
Wow, you really are getting down into the nits.
As I recall, you are slightly anemic, possibly due to iron deficiency.
This will reduce the M:E ratio.
http://tinyurl.com/p9gqmxo
http://tinyurl.com/ml2n9hs
At least, that is one explanation from a layman ...
Wow, you really are getting down into the nits.
As I recall, you are slightly anemic, possibly due to iron deficiency.
This will reduce the M:E ratio.
http://tinyurl.com/p9gqmxo
http://tinyurl.com/ml2n9hs
At least, that is one explanation from a layman ...
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Bone marrow biopsy - M:E ratio
Yes, I get a little granular at times. There just seem to be some things I want to understand and if I don't, well ...
Thanks for the references. I'll try not to bother y'all too much
Thanks for the references. I'll try not to bother y'all too much
-
Toni - Name: Toni
- Who do you know with myeloma?: self - MGUS
- When were you/they diagnosed?: April 2014
- Age at diagnosis: 51
Re: Bone marrow biopsy - M:E ratio
At the start of this month I underwent my third bone marrow biopsy since July 2013 and once again my M:E ratio is below normal (ranges from 1.1 to 1.3 over the past 3 yrs). Regarding my latest bone marrow report, only the first page is available (smear differential). II will receive full bone marrow results next week when I return for followup including additional labs (usual SPEP, UPEP, FLC ratio etc).
I'll ask my provider about the consistent low M:E ratio next week but I noticed this thread tonight and just wanted to point out that I have a consistently low M:E ratio in case it has any bearing on my smoldering multiple myeloma and if others have happened to experience the same continuous low M:E ratio results.
A low M:E ratio from what I've read up recently is due to the following:
1) Myeloid hypoplasia (too little white cell precursors in marrow)
2) Erythroid hyperplasia (too many red cell precursors)
In my case, bone marrow smear differential's indicate that I'm low on myeloid precursors (early white cells) and high on early red cells, which matches a low M:E ratio. I just don't know if this is really meaningful, as the ratio has been low when i was mildly anemic and it's still low as my hemoglobin value is on the low side of normal.
I've read that most erythroid hyperplasia conditions result in a noticeable anemia, which I do not have. I'm not finding cases of a low M:E ratio and normal white and red counts in peripheral blood CBC labs. So maybe my abnormal bone marrow differential smear results pasted below including a low M:E ratio are not significant?
My CBC's are pretty consistent with a normal white count (though monocytes are always high) and my hemoglobin since 2015 has been norm (I was slightly anemic until starting HRT and early 2015 after testosterone replacement therapy my hemoglobin rose from the high 12's to 14.5, where it's pretty much remained, with the norm range being 14-18).
At one time my case was tagged with a reticuloendothelial system deficiency. Perhaps that was due to the low M:E ratio and other results found below from my bone marrow smear differential reports (the date of the RES issue matched the date of my 1st bone marrow biopsy, which was read by the cancer center that now follows my case, though that bone marrow biopsy was performed locally).
Here's one set of bone marrow smear differential values. Each bone marrow biopsy has resulted in near the same results as shown below :
Progranulocytes 1 % Low (2-8)
Myelocytes 4 % Low (5-20)
Metamyelocytes 5 % Low (13-32)
Granulocytes 30 % (7-30)
Eosinophils 2 % (0-4)
Basophils 0 % (0-1)
Lymphocytes 11 % (3-17)
Plasma cells 5 % High (0-2)
Monocytes 3 % (0-5)
Reticulum Cells 0 % (0-2)
Pronormoblasts 0 % Low (1-8)
Normoblasts 38 % High (7-32)
M:E Ratio 1.1 Low (3-4)
FYI - My smear plasma cell values as expected are always much lower than CD138 staining manual counts.
If anyone has any input regarding a continuous low M:E ratio in a smoldering multiple myeloma patient (or even other forms of a plasma cell dyscrasia), or anything else that may be associated with my consistently out of range bone marrow results shown above, I would appreciate feedback.
Thanks
I'll ask my provider about the consistent low M:E ratio next week but I noticed this thread tonight and just wanted to point out that I have a consistently low M:E ratio in case it has any bearing on my smoldering multiple myeloma and if others have happened to experience the same continuous low M:E ratio results.
A low M:E ratio from what I've read up recently is due to the following:
1) Myeloid hypoplasia (too little white cell precursors in marrow)
2) Erythroid hyperplasia (too many red cell precursors)
In my case, bone marrow smear differential's indicate that I'm low on myeloid precursors (early white cells) and high on early red cells, which matches a low M:E ratio. I just don't know if this is really meaningful, as the ratio has been low when i was mildly anemic and it's still low as my hemoglobin value is on the low side of normal.
I've read that most erythroid hyperplasia conditions result in a noticeable anemia, which I do not have. I'm not finding cases of a low M:E ratio and normal white and red counts in peripheral blood CBC labs. So maybe my abnormal bone marrow differential smear results pasted below including a low M:E ratio are not significant?
My CBC's are pretty consistent with a normal white count (though monocytes are always high) and my hemoglobin since 2015 has been norm (I was slightly anemic until starting HRT and early 2015 after testosterone replacement therapy my hemoglobin rose from the high 12's to 14.5, where it's pretty much remained, with the norm range being 14-18).
At one time my case was tagged with a reticuloendothelial system deficiency. Perhaps that was due to the low M:E ratio and other results found below from my bone marrow smear differential reports (the date of the RES issue matched the date of my 1st bone marrow biopsy, which was read by the cancer center that now follows my case, though that bone marrow biopsy was performed locally).
Here's one set of bone marrow smear differential values. Each bone marrow biopsy has resulted in near the same results as shown below :
Progranulocytes 1 % Low (2-8)
Myelocytes 4 % Low (5-20)
Metamyelocytes 5 % Low (13-32)
Granulocytes 30 % (7-30)
Eosinophils 2 % (0-4)
Basophils 0 % (0-1)
Lymphocytes 11 % (3-17)
Plasma cells 5 % High (0-2)
Monocytes 3 % (0-5)
Reticulum Cells 0 % (0-2)
Pronormoblasts 0 % Low (1-8)
Normoblasts 38 % High (7-32)
M:E Ratio 1.1 Low (3-4)
FYI - My smear plasma cell values as expected are always much lower than CD138 staining manual counts.
If anyone has any input regarding a continuous low M:E ratio in a smoldering multiple myeloma patient (or even other forms of a plasma cell dyscrasia), or anything else that may be associated with my consistently out of range bone marrow results shown above, I would appreciate feedback.
Thanks
-
pinball - Who do you know with myeloma?: Myself
- When were you/they diagnosed?: 2010 MGUS, 2014 Smoldering
- Age at diagnosis: 39
Re: Bone marrow biopsy - M:E ratio
Though my M:E ratio was LOW for the third bone marrow biopsy in 3 years , my provider said it's a nonsignificant finding.
They stated that the erythroid hyperplasia was probably due to an EPO increase tied to hormone replacement therapy (HRT). Though, when I noted that I wasn't on testosterone for my first two bone marrow biopsies, they said that red cell precursors were probably high then because I was anemic prior to HRT.
I didn't bother to ask why my white cell precursors were suppressed as once again they don't think the low myeloid to erythroid ratio is of any importance.
If anyone has a low myeloid-to-erythroid ratio, please let us know of any worthwhile matching info. Thanks
They stated that the erythroid hyperplasia was probably due to an EPO increase tied to hormone replacement therapy (HRT). Though, when I noted that I wasn't on testosterone for my first two bone marrow biopsies, they said that red cell precursors were probably high then because I was anemic prior to HRT.
I didn't bother to ask why my white cell precursors were suppressed as once again they don't think the low myeloid to erythroid ratio is of any importance.
If anyone has a low myeloid-to-erythroid ratio, please let us know of any worthwhile matching info. Thanks
-
pinball - Who do you know with myeloma?: Myself
- When were you/they diagnosed?: 2010 MGUS, 2014 Smoldering
- Age at diagnosis: 39
Re: Bone marrow biopsy - M:E ratio
I had two bone marrow biopsies in November of 2016 and just recently another bi-lateral set of biopsies and again the M:E ratio remains low (many more red precursors than normal as opposed to white cell precursors).
My free light chain ratio is still abnormal, Bence-Jones protein still present, IgG kappa M-spike steady at 1.0 g/dL , IgM is still low near 20, etc.
The only real difference is that this time my (fourth) PET/CT indicated FDG avid activity L1 thru T6 (SUV values from 3.6 to 4.7), though no myeloma lesions were found on the companion CT thankfully. Sadly, I will have to undergo a repeat PET/CT body scan since the FDG uptake activity is "new" and not found on past PET/CT scans. I'm not excited about waiting to obtain updated PET results to explain the abnormal rather high SUV FDG uptake as I've read 2.5 and above normally indicates malignant cells, plus I'd rather not be exposed to additional radiation as my wife underwent 14 CT scans before developing leukemia a few years ago when she was under the age of 40, which is young for her type of cancer.
Anyway, I've yet to get any additional information on my very low M:E ratio which appeared on my first bone marrow biopsy report in 2013 thru my most current and 6th and 7th marrow aspirate / biopsies (I'm counting the recent bilateral biopsies as two separate items), so I guess it's nothing to worry about. My RBC remains just at normal even with EPO raised via testosterone supplementation, which has resolved my anemia of unknown origin over the past few years, for my level of EPO / testosterone my hemoglobin and hematocrit should be higher as well, but is at the bottom of the normal range, so I guess there's some sort of defect in my marrow producing healthy red cell precursors, especially as my M:E ratio remains low (my wife due to her leukemia has a high M:E ratio according to each bone marrow biopsy report).
I'm planning to smolder for many more years and hopefully the FDG-avid PET activity was a glitch, and I just wanted to note that I've asked again about the repeat low M:E ratio and was told it's "no big deal."
My free light chain ratio is still abnormal, Bence-Jones protein still present, IgG kappa M-spike steady at 1.0 g/dL , IgM is still low near 20, etc.
The only real difference is that this time my (fourth) PET/CT indicated FDG avid activity L1 thru T6 (SUV values from 3.6 to 4.7), though no myeloma lesions were found on the companion CT thankfully. Sadly, I will have to undergo a repeat PET/CT body scan since the FDG uptake activity is "new" and not found on past PET/CT scans. I'm not excited about waiting to obtain updated PET results to explain the abnormal rather high SUV FDG uptake as I've read 2.5 and above normally indicates malignant cells, plus I'd rather not be exposed to additional radiation as my wife underwent 14 CT scans before developing leukemia a few years ago when she was under the age of 40, which is young for her type of cancer.
Anyway, I've yet to get any additional information on my very low M:E ratio which appeared on my first bone marrow biopsy report in 2013 thru my most current and 6th and 7th marrow aspirate / biopsies (I'm counting the recent bilateral biopsies as two separate items), so I guess it's nothing to worry about. My RBC remains just at normal even with EPO raised via testosterone supplementation, which has resolved my anemia of unknown origin over the past few years, for my level of EPO / testosterone my hemoglobin and hematocrit should be higher as well, but is at the bottom of the normal range, so I guess there's some sort of defect in my marrow producing healthy red cell precursors, especially as my M:E ratio remains low (my wife due to her leukemia has a high M:E ratio according to each bone marrow biopsy report).
I'm planning to smolder for many more years and hopefully the FDG-avid PET activity was a glitch, and I just wanted to note that I've asked again about the repeat low M:E ratio and was told it's "no big deal."
-
pinball - Who do you know with myeloma?: Myself
- When were you/they diagnosed?: 2010 MGUS, 2014 Smoldering
- Age at diagnosis: 39
6 posts
• Page 1 of 1