Bone marrow, hemoglobin, and hep C

[mike716]

There's never a dull moment in Tango Town. No sooner did I start to calm down a little after getting hit last week with this jazz about having my gall bladder removed, than I am told by a hematologist that my high hemoglobin level (16 to 17) is weird and that I have to have a bone marrow puncture or something. Like, another biopsy only worse? On general anesthetic?

Oy! I'm getting punch-drunk from all this. I mean, are these people serious or are they using me to practice on because there's no one else around?

What the heck is a bone marrow puncture (or punction, or whatever), how is it done, does it hurt, and what are the nasty consequences that the MDs aren't telling me about?

Anyone know?

Mike
(on the verge of throwing in the towel and drinking myself to death with red wine)

[his3707]

Hi Mike, sorry to hear your having to deal with one thing and then another.  Is this the first time your hemogloblin has been high?  What are they going to be looking for?

[his3707]

•Normal hemoglobin level for men is 14-18 grams/100ml of blood.  This is what I just saw searching around... If that is how they measured yours wouldnt yours be normal?

[Trish77]

http://www.mayoclinic.com/health/high-hemoglobin-count/MY00112  

- turned up immediately among many others with a quick google search.  Seems to indicate your hgb level, while on the upper end, is normal as his3707 said.  

[mikesimon]

I assume they are referring to a bone marrow biopsy. A sample of your bone marrow is taken from a large bone, generally the pelvic bone. A needle is inserted into your bone and a sample of your marrow cells is retrieved. Then they go deeper and a core marrow sample is taken. I have never had one but I know several people who have and they say it's not comfortable but it's not unbearable either. I don't think any of them underwent general anesthesia for the procedure. I think they may have been injected with Versed or another twilight drug.

Your Hgb is within the reference range. I doubt your Hgb is the reason for the marrow biopsy - if it is I would question the procedure. Regardless I would question the physician about the reason for the bone marrow biopsy. I know that with some types of anemia/low red blood cell count a bone marrow biopsy is appropriate but, from what you say, that isn't the case. Significant elevations of some blood numbers can also warrant a marrow biopsy but an Hgb of 16 - 17 just doesn't "weird" to me.

Good luck,
Mike

[SPOON1212]

i would be asking questions after questions if dr wanted to a bone marrow bx for hgb as yours is not at a critical level.  are there any other problems going on? that dr's told you? just doesn't make any sense. as i said ask, ask ect!!!!!!!

let me know what's going on

julie

[mike716]

All my blood tests have shown my hemoglobin between 16 and 18 g/Dl. My hepatologist never said it was too high, but he sort of sloughs off everything as being unimportant. And according to a new test standard I found on the Net, normal for men after middle age is 12.4-14.9 gm/dl. So I guess mine is high.

Your guess is as good as mine what they are looking for. They don't tell me anything. But I've put my GP onto it. Maybe she can find out what it's all about.

M.

[mike716]

I clicked on the "Causes" link on that Mayoclinic site, and it gives "smoking" as one of them. That makes sense since smoking reduces the lungs' capacity to absorb oxygen. I'll bet that's why my hgb is high. Probably has nothing to do with my bone marrow at all.

M.

[mike716]

Thanks for the helpful info. I don't like the sound of this biopsy at all. And I agree that my hgb just isn't that high. I'm going to pester my GP to find out what the hematologist's reasons for ordering the biopsy are, and if it's just the hgb I think I'll cancel it. which I believe is my right. I'll check with my hepatologist, too, although he always says that everything is unimportant (like even when my transaminases went up from 40 to 100!).

This hospital is always either too concerned and ordering pointless tests, or else completely indifferent and doing nothing. Bunch of weirdo extremists.

Mike

[mike716]

I'll keep you posted. I've got my GP working on this, and I'm gonna query my hep MD, too, although his opinion is worth zip. If I can't get some reasonable explanation before the 17th, I'll cancel on general principles.

Mike

[newleaf09]

I imagine they are looking to verify iron overload, hemochromatosis.   Bone marrow aspiration is considered less invasive than another liver biopsy and gives them a look at the red blood cells as they are forming, to get better information than just seeing iron deposits in the liver.  Looks like you may be getting those phelbotomies after all.

[Diamond_Lil]

How is hemochromatosis diagnosed?

Blood tests can determine whether the amount of iron stored in the body is too high. The transferrin saturation test reveals how much iron is bound to the protein that carries iron in the blood. Transferrin saturation values higher than 45 percent are considered too high.

The total iron binding capacity test measures how well your blood can transport iron, and the serum ferritin test shows the level of iron in the liver. If either of these tests shows higher than normal levels of iron in the body, doctors can order a special blood test to detect the HFE mutation, which will confirm the diagnosis. If the mutation is not present, hereditary hemochromatosis is not the reason for the iron buildup and the doctor will look for other causes.

A liver biopsy may be needed, in which case a tiny piece of liver tissue is removed and examined with a microscope. The biopsy will show how much iron has accumulated in the liver and whether the liver is damaged.  

Iron overload in the liver must be determined by liver biopsy; not bone marrow biopsy.  It is not unusual to have elevated ferritin and hgb levels in people with hepatitis c.

Diamond_Lil

[newleaf09]

P.S. My 87 year old mother had this done by her hematologist, so I imagine it is not too bad.  I wasn't with her that day but don't think it was too big of a deal and did not involve general anesthesia (they don't like knocking out people that old).  They were looking for a form of leukemia (did not find) and use it to diagnose all kinds of other things, too.

[Bobby1952]

Mike
   My hgb is always 16-17 and my GI told me not to worry it's cause is  because I used to be a smoker.  

Bobby

[JennyPenny2009]

I'll take the bone marrow biopsy over the liver biopsy. It wasn't bad at all. But you do need a doc who is very experienced at doing it. They inject the area with a local, no twilight or general is used, and you feel pressure. It isn't really pain.

Newleaf gave you good advice. There are many things that cause high levels of hemoglobin and it is important to know which one is causing those slightly elevated levels.

[mike716]

I don't know what they're looking for, maybe it is iron overload, but does that cause high hemoglobin? It's all Greek to me, frankly. I don't even know if it's got anything to do with my request for a phlebotomy, re the trial. A bone marrow puncture sure doesn't sound like a lot of fun.

[mike716]

Hi, Lil. One of my many blood analyses, around a year ago, showed high serum ferretin (around 280 ng/mL) and saturation of 60, which I guess is pretty high. My hep MD said not to worry about it, but he says that about everything.

I did have a liver biopsy, and they did a staining for iron, but it came out negative. How do you figure that? Maybe the specimen was too small, or not representative of the whole liver, huh?

If it's normal for a hepatitic like me to have elevated hgb, why would they want to do a bone marrow puncture? Any idea?

Mike

[mike716]

Oh, well that doesn't sound so bad, if they did it to your grandma. Maybe it's a good idea, then. They might find something.

I waiting to see what my GP and hep MD have to say.

M.

[mike716]

Thanks for the comforting words, Jenny. I'm starting to feel less freaked out about it. Although i have the sneaking suspicion they're not going to find anything at all, and that it's from smoking, just like Bobby said above.

M.

[Diamond_Lil]

Mike,

I wouldn't begin to know what they are looking for specifically.  The bone marrow is responsible for so many things.  I wanted you to know that if your docs are concerned about Hemochromatosis it can be determined by blood test.  If the HFE mutation is not present than you don't have it.  Since the biopsy sample used to determine hepatic iron index showed no iron accumulation I would take that as a positive indicator your liver is not experiencing additional damage from iron overload and no further biopsy is necessary.
Your doctor should have at least given you full reasoning for wanting a bone marrow biopsy.  Your hgb levels are not that high.  I'm a female and mine are 15-16 and my doctor has no concerns.  As I had previously said, it is not unusual for hepatics to have higher ferritin levels because the liver does not process the iron properly, fibrosis being one of the reasons.  And yes, with higher ferritin levels comes higher hgb but because you don't know what your doctors are looking for none of what I have said may apply.

Good luck and hope the Argentine docs get if figured out.
Diamond_Lil

[mike716]

Thanks again for your helpful and informative comments. I appreciate them. You sound very knowledgable. Are you a health-care provider, or have you studied biology and/or medicine?

M.

[Diamond_Lil]

Mike,
I am not in the heath care profession.  I'm another lost soul with hepatitis c who has failed treatment twice and because of that I have done a fair amount of research and asked many many questions of my doctors.  

There are some constants in the approach and treatment of hepatitis c but not everything holds true for all.  It is a very individual process and there are doctors who will push the envelope and others who administer treatment by the book.  What I have learned from failing treatment is that when the time is right to treat again my knowledge and understanding of this virus will make me better prepared to ask the right questions and that may be pivotal in achieving a sustained virological response.  

That is what we all want, no matter how we get there.

Diamond_Lil

[mike716]

Thanks again. I don't know what I would do without you and the other kind folks in this forum.

Mike

[tashka]

I accompanied my father in law to several bone marrow biopsies. I was in the room when the doctor performed it. It is a simple procedure that doesn't hurt. Local anesthetic is used. The bone marrow is taken from pelvic bone while you lie on your stomach.

But I would not undergo it if the reason is just slightly elevated hemoglobin. If that is the ONLY reason it is suggested, I would just monitor your numbers. No matter how simple this procedure is, it is like a mini-surgery. It should not be done without valid reasons. Some people have higher values than others. My mom has high hemoglobin for her age. But she is doing fine and never had bone marrow biopsy.

[mike716]

What you say makes sense, the problem is that I don't really know why the hematologist ordered it. Some MDs don't tell you what they are doing. But several people have told me that doing pathology of the bone marrow can give indications of lots of body functions, and that sometimes things show up there that wouldn't have become symptomatic for a long time. So maybe it's a good idea just on general principles.

I'm still waiting to hear what my GP says about it. My hep MD had no comment (as usual).

Ho-hum, it's all a big roller coaster ride, and maybe you've gotta just go with the flow. I usually protest about any intrusion, even medicines I don't know. But this time I'm sorta curious myself to see what they find. So, if it doesn't hurt a lot and won't keep me out of the gym for too long, I think I'll do it.

Thanks for your perceptions.

Cheers!

Mike