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Low Blood Counts: Myelosuppression | Myelodysplastic Syndrome | Comparing Blood Cells

Myelosuppression is an overall suppression of the blood cells -- red blood cells, platelets, and white cells, such as neutrophils and lymphocytes - that are produced in the bone marrow. Myelosuppression is a common side effect of chemotherapy and radiotherapy. It can also indicate that lymphoma is present in the bone marrow. 

There are three different types of cells that are produced in the bone marrow: red blood cells, white blood cells, and platelets.  

Anemia (low red blood cells) - causes fatigue
Cytopenia - describes a deficiency in some cellular elements in the blood. 
Neutropenia (low white cells) - susceptibility to infection
Thrombocytopaenia (low platelets) - susceptibility to bleeding

The origin of blood cells - click to enlarge

Also see Comparing blood cells below

How to treat? The treatment for myelosuppression depends on the underlying cause and the type of blood cell involved (see below.) For persistent myelosuppression, obtaining tissue from the bone marrow might be required in order to diagnose the cause. When related to treatment, for example, the condition can resolve in days,  weeks, or months after treatment is withheld.  When it is caused by the the disease, treating the lymphoma will often resolve the condition. Sometimes biologic growth factors, such as Neupogen, are used to induce the body to produce more blood cells. It might also be helpful to include quality proteins in your diet, B₁₂ and folic acid to give your body the nutrients it needs to produce blood cells. Steroids may help if the neutropenia is caused by an autoimmune reaction.

Some causes of myelosuppression:  cancer, allergic disorders, chemo drugs and radiation, some types of infections, Myelodysplastic syndrome (MDS),  autoimmune disease, deficiencies in vitamin B₁₂ and folic acid, insecticides and toxins, and some hereditary diseases. - adapted from merck.com 

Resources

	Hypersplenism as cause of cytopenia (low WBC)  Merck "Hypersequestration of blood in a large spleen is the predominant mechanism for cytopenia..."
	White Blood Cell Disorders  Merck Manual   Discusses various kinds of white cell disorders and causes.
	About CBC Lab Test Results  PAL
	Understanding your Complete Blood Count, neupogen.com  PDF - PDF-Help
	Biologics for the treatment of myelosuppression  Lymphomation.org
	Chemotherapy treatment support page Avoiding Trouble - general | Avoiding Infections Page   Diet for Immune suppressed Page | Fight nausea   Fight Constipation | Oral Health | When to call your doctor

Myelodysplastic Syndrome

TOPIC SEARCH: PubMed | ASCO | Medscape

Myelodysplasia encompasses a heterogeneous [varied] group of disorders that result in ineffective hematopoiesis [formation of blood cells]. 

Historically, a wide variety of terms has been used to describe these syndromes, including preleukemia, refractory anemia with excess of myeloblasts, subacute myeloid leukemia, oligoleukemia, odoleukemia, and dysmyelopoietic syndromes.

The myelodysplasia syndromes (MDS) are *clonal stem cell disorders* characterized by progressive cytopenia or cytopenias [too many or too few blood cells], usually in the presence of a hypercellular bone marrow and multilineage dysplasia [different classes of abnormal cells].

Usually, all 3 cell lines (myeloid/monocyte, erythroid, megakaryocyte) are involved. MDS is rare in childhood, and most children have a rapidly progressive course. MDS disorders have been defined by their predilection to evolve into acute nonlymphocytic leukemias (AML), yet not all cases terminate in leukemia. 

Source: http://www.emedicine.com

	Myelodysplasia Syndromes, Basic Explanations  PDF | PDF-help Aplastic Anemia & MDS Intl Foundation | 1-800-747-2820 "Rare and potentially fatal blood disorders that occur when the body starts incorrectly manufacturing  the three types of blood cells - white, red, and platelets - resulting in malformed, immature cells."
	Myelodysplasia and acute myeloid leukemia following therapy for indolent lymphoma  with fludarabine, mitoxantrone, and dexamethasone (FND) plus rituximab and interferon alpha  pubmedcentral.nih.gov7
	Therapy-Related Myelodysplastic Syndrome: Morphologic Subclassification  May Not Be Clinically Relevant Posted 02/22/2007  medscape.com/  (free login req.)
	PLWC Guide to Myelodysplastic Syndromes  PLWC  People Living with Cancer (a division of ASCO)
	Clinical Data From REVLIMID(R) Study in Myelodysplastic Syndromes  Reported in NEJM  prnewswire.com  "The recent clinical data from this Phase II study evaluating REVLIMID as an oral MDS treatment not only demonstrates hematologic response, but this is the first MDS treatment to demonstrate this level of cytogenetic response." said Dr. Alan List, Professor of Oncology and Medicine, and Chief, Malignant Hematology Division at the H. Lee Moffitt Cancer Center.
	ASCO 2005 - MDS Hematologic and Cytogenetic (CTG) Response to Lenalidomide  (CC-5013) in Patients with Transfusion-Dependent (TD) Myelodysplastic Syndrome (MDS)  and Chromosome 5q31.1 Deletion: Results of the Multicenter MDS-003 Study.    "highly effective in MDS pts with del5q31 with unprecedented hematologic and  CTG remitting activity."
	Vidaza (azacitidine), a new drug to treat MDS, a bone marrow disease that can occur  as a side effect of cancer treatment   FDA.org
	According to a recent article published in the Journal of Clinical Oncology, "mini"  allogeneic stem cell transplants may provide a chance for a cure for patients over 60 years of age with poor-prognosis myeloid (blood) malignancies.  cancerconsultants.com
	Specific Regimen [FND] Influences Risk of Myelodysplasia After Lymphoma Treatment Oncolink
	Review article on MDS  asheducationbook.org
	ASH 2007 report on MDS  Oral Glutathione Analogue TLK199 Safe and Effective in Patients With MDS

Neutrophils:
2-8 (x106/l)

Adult female:
4.2-5.4 (x1012/l)

Drugs: Neupogen, Leukine 
Also see bcccancer.bc

Drug: Erythropoietin

Drug: Neumega