Blood counts are evaluated by a blood test called the complete blood count, or CBC. Let’s take a look at the components of the CBC:
White Blood Cell (WBC) Count
There are several types of white blood cells, which help your body fight infections. The most important infection fighters are white blood cells called “neutrophils.” With a CBC, your neutrophils will be counted and reported as the “absolute neutrophil count” or ANC. If your neutrophils are low, then you have what is called “neutropenia.”
Neutropenia (low white blood cell count) leaves you more susceptible to infections. The lower your ANC is, the more likely you are to have health problems:
• If your ANC is lower than 1,000, then you have a higher risk of getting an infection.
• If your ANC is lower than 500, then you have a higher risk of getting a more serious infection.
If you are diagnosed with neutropenia, it’s important to take steps to avoid germs and prevent opportunities for infection. (See Sidebar: Avoiding Infections)
Avoiding Infections
The following tips will help you steer clear of germs and stay safe while your white blood cell count is low:
• Wash your hands often, including before and after you eat, when using the bathroom, after coughing, sneezing and blowing your nose, after shaking someone’s hand or touching anything handled by others.
• Take a shower or bath every day.
• If your skin gets dry, use unscented lotion or oils. This will help prevent your skin from cracking, which can let in germs.
• If you cut or scrape yourself, clean the area with soap and warm water right away. Then cover it with a bandage.
• Always wear shoes in the hospital and around the house, and especially outdoors.
• Rinse your mouth out with water after you eat and before you go to bed.
• Use an ultra-soft toothbrush, and only floss your teeth if your ANC is higher than 500 and your platelet count is 50,000 and higher.
Avoiding Infections (Cont.)
• Use lip balm (like ChapStick) to prevent drying and cracking.
• If you wear dentures, make sure they fit well to avoid irritation.
• Check with your doctor before you see the dentist.
• Ask someone else to clean around the house, especially litter boxes, birdcages and fish tanks.
• Do not touch fresh flowers, houseplants, dirt or soil, or stagnant (still) water, and do not keep any plants in your home—not even dried flowers. Ask your doctor about when it is safe to have plants or flowers near you.
• Avoid crowded places and stay away from people who are sick.
• Never swim in lakes, ponds, rivers or oceans. If you want to swim, talk it over with your doctor or nurse first, and swim only in a pool that is treated with chlorine to kill germs. Also, stay out of hot tubs and Jacuzzis.
• Keep away from construction sites, since germs can hide in dirt and dust.
• Use an electric shaver instead of a razor, and do not get a manicure, pedicure or fake nails (or nail tips).
• Prevent cuts and tears in your rectum by avoiding enemas, rectal thermometers or suppositories (medicines that you put in your anus).
• Women need to avoid tampons, vaginal suppositories (like those used to treat a yeast infection), and douches.
• Be sure not to get any vaccines (like a flu shot) unless your doctor tells you to.
• Use a water-based lubricant during sex.
• Avoid anal sex. It is more likely than vaginal sex to cause cuts and tears.
Source: National Institute of Health – www.cc.nih.gov/ccc/patient_education/pepubs/cbc.pdf
Red Blood Cell (RBC) Count
Red blood cells carry oxygen and remove waste from your body. These cells also contain a protein called hemoglobin, which is what makes red blood cells the color red.
Hemoglobin (HGB) Value
Hemoglobin carries oxygen from your lungs to the rest of your body. It also moves carbon dioxide (waste) to your lungs so you can breathe it out.
Hematocrit (HCT) Value
The hematocrit value measures how much of your total blood count is made up of red blood cells.
Platelet Count
Platelets help stop bleeding by sticking together to form blood clots, which “plug” cuts and wounds.
Understanding the Bone Marrow Biopsy
The second major component used to monitor MPN is bone marrow. The bone marrow is the blood cell factory of the body, producing red cells (oxygen carrying cells), white blood cells (infection fighting cells), and platelets (blood clotting cells). As we’ve discussed, in MPN this “factory” malfunctions, producing too many cells or is hindered by scarring (fibrosis). Therefore, your healthcare team will likely want to look at your bone marrow under the microscope to better understand your disease.
To do this, the team will have to take a sample of your bone marrow. This process is called a “bone marrow biopsy.” Bone marrow biopsies are often performed when your disease is first being diagnosed to confirm the diagnosis and determine the severity of the disease. Later in the course of MPN, a bone marrow biopsy is often used to monitor and evaluate if your MPN is becoming more advanced.
The Bone Marrow Biopsy Procedure
A bone marrow biopsy can be done in a hospital or clinic by your healthcare team. It’s typically a short procedure, lasting only 10 minutes or so. Unless there are complications, which are rare, you will go home the same day. Many bone marrow biopsies are performed with only local numbing medications, which will not cause difficulty in driving. However, in some cases, your team may decide to use medication to decrease your anxiety of pain, and in that case, you will need someone to drive you home.
Before the Procedure:
• You will likely discuss the risks and benefits of the procedure and be required to sign an informed consent document that you understand these risks and benefits.
• Just prior to the procedure, the team will check your vital signs, and you may be given some medication to relax you.
• The area where the physician will insert the biopsy needle is marked and cleaned. The bone marrow fluid (aspirate) and tissue sample (biopsy) are usually collected from the top ridge of the back of a hipbone (posterior iliac crest). Sometimes the front of the hipbone may be used.
• You’ll be asked to lie on your abdomen or side, and your body will be draped with a cloth so that only the exam site is showing.
The Procedure
• The bone marrow aspiration is usually done first. The doctor makes a small incision, then inserts a hollow needle through the bone and into the bone marrow.
• Using a syringe attached to the needle, the doctor withdraws a sample of the liquid portion of the bone marrow. You may feel a brief sharp pain or stinging. The aspiration only takes a few minutes. In some cases, several samples may be taken.
• Next, the physician uses a needle to withdraw a sample of solid bone marrow tissue.
After the Procedure
• Pressure will be applied to the area where the needle was inserted to stop the bleeding. Then, a bandage will be placed on the site, and you will be asked to rest for a few minutes.
• If you received medications, a driver will take you home, and you