[MissMolly]

Question about Myeloma-related anemias

by MissMolly on Tue Jan 15, 2013 1:19 pm

Hi Friends!

Have been incredibly tired for several months now. Results from last July and this month indicate I may have one of two different types of anemia: macrocytic anemia or hemolytic anemia. Has anyone experienced either of these and/or know if they can be related to SMM or multiple myeloma?

Why I think it could be Macrocytic: recent RDW test came back low. Found myself in the ER last Friday for a new problem: trigeminal neuralgia. Common link: destruction of the myelin sheath surrounding this major nerve.

Why I think it could be Hemolytic: July test - reticulocyte hemoglobin was slightly high and lactate dehydrogenase was high; Jan 13 test all of the following were high: lactate dehydrogenase, reticulocyte %, reticulocycte absolute and reticulocyte hemoglobin.

Have not reviewed any of this with my doctor yet -- always try to get smart before asking questions.

Thanks, as always, for your thoughts/insights.

[Dr. Edward Libby]

Re: Question about Myeloma-related anemias

by Dr. Edward Libby on Tue Jan 15, 2013 7:54 pm

Hello,

I dont think there is enough information here to be worried about.

Patients with hemolytic anemia usually have very high LDH and absolute reticulocyte leves. It is mandatory that the haptoglobin be checked and it must be very low or zero if a patient has a hemolytic anemia. Also the liver tests must show elevated indirect bilirubin. The real bottom line is what the hemoglobin and hematocrit are. If they arent very low you are ok.

I wish you the best.

[MissMolly]

Re: Question about Myeloma-related anemias

by MissMolly on Wed Jan 16, 2013 12:38 pm

Thanks Dr. Libby. I also have hypothyroidism and my TSH numbers are quite high from my most recent blood work (with a corresponding rise in cholesterol/triglycerides), so my extreme tiredness can also be explained by that. I'm exhausted, but also battle insomnia about 2-3 nights a week.

I have several abnormal values on this recent bloodwork on kidney function and liver function, but none are terribly far outside of normal ranges yet. However, I am seeing a trend in the wrong direction for more and more of the tests. No other test results indicate anemia, though my hemoglobin values are slowly inching downward, but still well within normal ranges. Just trying to understand why I might be turning over RBC at an increased rate in my marrow.

Still waiting on most recent FLC. M-spike is relatively stable and still relatively low. Am pending new skeletal survey to make sure there are no significant changes from my initial one when I was still MGUS.

[lys2012]

Re: Question about Myeloma-related anemias

by lys2012 on Wed Jan 16, 2013 1:30 pm

I've had a mild macrocytic anemia since my stem cell transpant more or less. My hemo is just below normal, and sometimes will dip lower but then come back up the next month, but my MCV is in the 105 range. Dr. says the red cells are bigger because of the chemo (malphalan) effect on the bone marrow. My MCV sneaks a few points higher each few months or so, but so far we are just watching and waiting since the rest of my multiple myeloma numbers are completely normal.