Possible Bone marrow bx for WBC low-2.8, Platelets 8,000 today- got IVIG

Wanted to update you all and see if you had any input.
1. Has anyone had a bone marrow biopsy? If so was it for low WBC count and at what count? Did you get sedation?
2. On Promacta 50 mg since 8/6, Upping Promacta today to 75mg. If that dosen't help will probably get bone marrow biopsy and then dr said I need to decide if do nplate vs Rituxin. I am thinking Nplate any thoughts?
3. Stopping CDB cause I am wanting to have a true WBC count next week.
Thanks,
Cindy

Cindy - I had a bone marrow biopsy. My doctor did it in his office. It took about 20 minutes, no sedation. It sounds worse than it is. First I got an injection to numb the skin, then got an injection to numb the muscle. When he did the actual bone marrow draw, I felt like I got zapped but by the time my brain registered it, it was over. I left with a band-aid on my butt. I was sore for a few days, but just did my normal thing....work, run kid around....

I'd rather have a bone marrow biopsy then a filling. Nowhere near as unpleasant.

Same here, Mrs B. I can't stand the dentist!

Thanks that is reassuring! Do you remember what your wbcs were when they decided you needed a bmb?

That is good news, I was nervous!
Why did they do your BMB. Low WBC?

I was really nervous. When I was a brand new nurse, I saw one done 35 years ago and it looked horrible! I guess things have improved. That was so helpful!

As far as I know. my WBC was in normal range.

Recall that a ITP diagnosis is a process of elimination. A bone marrow examination is the elimination of bone cancer and MDS . Supposedly if one has an IVIG response then MDS is already eliminated. Those that have MDS don't respond to IVIG.

For me, that side of my, ahhh, buttocks hurt for a couple of weeks to sit on. Literally, a BMB is a real pain in the as.

75mg Promacta? WELL ITS ABOUT TIME !

Thinking about what to do if Promacta fails is good planning. As for Rituxan, since you seem to have a steroid (and IVIG) response, that seems plausible. As I and others will point out (coughSandicough) there are significant cautions with it. If you go onto Nplate getting to a stable count is a bit of a question mark if emergency IVIG treatments enter the picture.

Cindy, why are you worried about WBC's all of a sudden?

When I was at Mayo 8/28 my WBC were 1.8 so he said to keep an eye on them. The last count 9/21 was 2.8. But on 9/8 it was 7.6.
It is all so confusing to me. I tried to google what parameters indicate a bone marrow bx with little success.
Have a good Sunday!

Cindy - having a bone marrow biopsy is usually a doctor preference. I had one because my doctor suggested it, but if I had known then what I know now, I would have said no.

With ITP, protocol states that a bone marrow biopsy should be done if a patient is over 60, if they do not respond to treatment and sometimes prior to splenectomy. If other counts are abnormal (reds and whites), that is also cause to consider a BMB.

Hi,
I just thought to cut and paste so you could see all my numbers today. They are wanting to schedule a BMB.
Here are my questions...
1. Platelets only went from 8,000 Friday to 15,000 today. All I got Friday was IVIG. Do you have any thoughts on what could be causing the slow climb?
2. How does IVIG effect bllod numbers? MY WBC were down from 2.8 Friday. Could that be due to IVIG Friday because that is just what happened when I went to Mayo? IVIG Friday and 1.8 WBC Monday.
3. Do you think doctors need to do the BMB? They have nurse practioners and PAs doing them.

Todays LABS in case it is helpful to you.
White Blood Cell Count 1.8 10*9/L 4.0 - 11.1 10*9/L
Red Blood Cell Count 4.51 10*12/L 4.18 - 5.64 10*12/L
Hemoglobin 12.9 g/dL 12.1 - 16.3 g/dL
Hematocrit 39.0 % 35.7 - 46.7 %
Mean Corpuscular Volume 86.5 fL 80.0 - 100.0 fL
Mean Corpuscular Hemoglobin 28.6 pg 27.5 - 35.1 pg
Mean Corpuscular Hemoglobin Concentration 33.1 g/dL 32.0 - 36.0 g/dL
Platelet Count 15 10*9/L 150 - 400 10*9/L
Red Cell Distribution Width CV 13.3 % 11.7 - 14.2 %
Segmented Neutrophil Percent 32.3 % %
Lymphocyte Percent 40.9 % %
Monocytes Percent 22.2 % %
Eosinophils Percent 2.3 % %
Basophils Percent 2.3 % %
Immature Granulocytes Percent 0.0 % %
Neutrophils Absolute 0.6 10*9/L 1.8 - 6.6 10*9/L
Lymphocyte Absolute 0.7 10*9/L 1.0 - 4.8 10*9/L
Monocytes Absolute 0.4 10*9/L 0.2 - 0.9 10*9/L
Eosinophils Absolute 0.0 10*9/L 0.0 - 0.4 10*9/L
Basophils Absolute 0.0 10*9/L 0.0 - 0.2 10*9/L
Immature Granulocytes Absolute 0.0 10*9/L 0.0 - 0.05 10*9/L
Thanks for any insights.

Cindy:
I don't know the answers to your questions. I can only answer one. Yes, I think you should do the bone marrow biopsy if your doctor is recommending one.

Your neutrophils are low which is what they worry about. Low neutrophils can mean getting infections easily so avoid people with colds and viruses if you can. Good luck with the bone marrow biopsy.

Hi Hal,
Just rereading posts. Could you tell me what significant cautions you have with Rituxan?
Thanks,
Cindy

Cindy,
There is lots of info out there on the subject. Wikipedia is as good a place as any to get started. As I recall it is 'PML' and 'JC' virus that are the big threats.
en.wikipedia.org/wiki/Rituximab

But this article seems the most comprehensive and the one most capable of scaring one silly. Perhaps I'm a numbers person and it was the numbers that scared me. Lots of numbers in it. Also realize that one would want to read it from the context of treatment for ITP - it covers a lot more. As I recall the biggest take away from the article is that one doesn't want to be taking more than just Rituxan (eg steroids) when taking Rituxan.
www.iwmf.com/sites/default/files/docs/Rituximab-Associated_Infections-Seminars_in_Hematology.pdf

You might want to read through this thread on hypersensitivity reactions too, just to be fully informed.
pdsa.org/discussion-group/7-treatment-general/29710-identifying-hypersensitive-reactions-to-rituxan.html#59609