TOPIC:

I had a BMB of both the aspirate and core sample taken before they started me on the Eltrombopag and i was never told it was being used as diagnostic method for ITP. Infact they said it wouldn't tell them anything about it but they had to make sure i didn't have Leukaemia or a few other nasty things.

It was sore when they took the aspirate but not greatly sore but when the doc took the core sample i thought something had crushed my hip but when she removed the needle it stopped. it was a bit sore after and made me stiff for a few days but all in all was a relatively simple and deal-able procedure.

Mark - the point of the post is to make people aware that the bone marrow biopsy does not prove that platelet production is adequate. The Doctor threw in the bit about the TPO's on his own, but that's okay because we have had patients who had doctors who said it wouldn't work for them since production was not affected. That is false.

I guess the question is, is there a test that would show platelet production?

There is a test that shows inadequate platelet production, but it is used for study purposes only, not diagnostic.

i'm also treated by giving omeprazole actually, methylpredisolon and sandimun neoral, i have told that sandimun is for lupus is it right?

Why would anyone wait to ask for lidocaine? By that time the bone marrow biopsy is about over. I don't understand the lack of sedation and the lack of lidocaine. Didn't your hospital/doctor give you a sheet telling exactly what would happen and when in the biopsy? Makes me awful glad I am in the IU health system. I only had two procedures-- picc line and bone marrow biopsy and neither was uncomfortable at all. I didn't know they were happening for the most part.

Boy< so much of this sounds like a combination of myself and my daughter> The only difference- I did have colon cancer- stage 3. She definitely had mild MDS for years- slowly progressing. They finally found a match and had a perfect protocol for the Bone Marrow Transplant for her age. It was a good thing we did it when we did. When we went into the preconditioning for the transplant her blasts had doubled and she was considered to have AML- yep within 4 months time. They are suspecting that I have MDS now also. Most hospitals hold on to the slides till the patient passes away. The hospitals still have my daughter's slide from her first BMB 22 years ago. Why dont' they send them? They are too fragile. They will sometimes send the blood sample from that biopsy, and sometimes the slides, but not very often. It is a shame as my daughter's first BMA and BMB was at the age of 11 months. The docs are pretty sure she was born with MDS, but they will never know. We have found through the years that different pathologists will read them differently. We are retired military now (just recently) but our Hen/Onc have always gone and looked at the slides themselves.
As for me- I have failed prednisone and IVIG therapies everytime. My daughter failed prednisone and IVIG (also had an allergic reaction to both types of IVIG) numerous times. So, I had the challenge of having a toddler with lower than 50,000 on a good day, but most of the time in her 20s out of dangerous for her, normal for a toddler, situations. The poor child never got to ride a bike, go down a slide, ride a merry go round- the normal stuff because by the time she hit re-k, her platelets avg 30, by 2nd grade the 20's, and by 4th grade we were happy to see a 20 every once in awhile. At the time of her transplant, her avg count was 6.
Me, I never had known issues until my 2nd pregnancy. I am not dangerously low, but my white count is low also- hence the worry of the MDS- maybe that is a problem no one is telling you about? I am considered immunocompromised.

Can a second bone marrow biopsy show signs of any cancer or any types of leukemia months later that the first one didn't show,, Can you get MDS from chemotherapy drugs,,, such as Promacta,, or Predisone Steroids,, ??
its been a yr and a half since I first was told I had ITP,, my count was at 0 ,,then, Had my spleen removed 3weeks in and today my count is still below 20,000........

I would think that a second bone marrow biopsy could have different results than the first since patients can develop an illness at any time. I knew a woman who supposedly had ITP, but a second bone marrow biopsy months later revealed MDS. She was in her 70's though, so that was not surprising. It's probable that her first biopsy didn't show anything because the MDS hadn't developed enough to be diagnosed.

Promacta and Prednisone are not chemotherapy drugs. There are no reports of MDS occurring due to any ITP treatments that I am aware of. Years of immunosuppressant drugs can raise the risk of cancer though.

This is why a bone marrow biopsy does not prove that platelet production is normal:

The pathophysiological mechanisms contributing to the decreased platelet count in immune thrombocytopenia (ITP) are not entirely understood. Here, we investigated the key step of proplatelet formation (PPF) by studying the effect of ITP plasma in thrombopoiesis. Normal cord blood-derived mature megakaryocytes were cultured in the presence of recalcified plasma from ITP patients, and PPF was evaluated by microscopic analysis. Patient samples induced a dose-dependent inhibition in PPF, as well as decreased complexity of proplatelet architecture. Although slightly increased, plasma-induced megakaryocyte apoptosis was not related to PPF impairment. Purified IgG reproduced the inhibitory effect, while platelet-adsorbed plasma induced its reversion, suggesting the involvement of auto-antibodies in the inhibition of thrombopoiesis. Impaired PPF, induced by ITP plasmas bearing anti-GPIIb-IIIa antibodies, was related to their ability to interfere with the normal function of this integrin, as assessed by megakaryocyte PAC-1 binding and β3 integrin phosphorylation while the presence of anti-glycoprotein Ia-IIa auto-antibodies was associated with loss of normal inhibition of PPF induced by type I collagen. In conclusion, abnormal thrombopoiesis comprising decreased PPF and morphological changes in proplatelet structure are induced by patient samples, unveiling new mechanisms contributing to decreased platelet count in ITP.

www.ncbi.nlm.nih.gov/pubmed/24673454

That was a very interesting article. I hope it leads to new studies and treatments.

Hello,
Is it normal in a BMB of an ITP patient for doctors to say that your bone marrow is producing immature platelets?
Thanks,
Maggie

It depends on what he means by that. 'Immature' platelets are usually the same as 'reticulated' platelets. All platelets are reticulated when first produced. They start out big and get smaller as they age. I'd ask him to be more specific; he might be talking about a perfectly normal occurrence.