Nucelated Red Blood Cells Concern!

[Elsaria]

I'm 53 with some health issues (heart murmur, HBP, Acid Reflux and Asthma); I know that sounds like a lot but after so many years I'm still her.  Anyway, I was recently diagnosed with NRBC; however, attempts to extract bone marrow were unsuccessful.  I am currently seeing a hematologist but she doesn't want to give me, or able to give me a defined answer and the wait for an answer is extremely stressful.  Blood work has been done that has ruled out Sickle Cell and Lups, and some other anemias. I would like to know if Leukemia or Lymphoma are the only other major blood diseases that can cause NRBC or is there something less serious.  I have search the Internet but can only find references to infants or critically ill patients - I feel tired but I'm working, working out, doing all the things I usually do.

I'm looking for answers and not afraid of the what those answers would be so you reply would be greatly appreciated.

Thanks - North Texas

[Ken_PA]

The sense that I get, Mocha, is that when lymphoma is suspected then both aspiration and the biopsy are both typically done.

[Mochadelicious]

Thanks Ken,
I'm thinking I must have had a dry tap and a BMB as it was a two step procedure, much how you described, but I thought the whole two step procedure was called a BMB.  See...I'm still learning stuff about this cancer years later.  

Elsaria: Did they do a BMB on you...where they used a larger bore needle that takes a piece of your marrow?  If not, you may need to inquire about that with your doctor.

[Ken_PA]

Mocha, it turns out that it's called a "dry tap" bone aspiration. (An aspiration uses a thinner needle to get 'liquid narrow', while a BMB uses a bigger needle and gets a string of tissue.) They could/should have done a BMB after the dry tap, in order to see what was wrong in the marrow.

I'll post these for the record:
http://www.pathology.vcu.edu/education/PathLab/pages/hematopath/bm.html
"An Illustrated Guide to Performing the Bone Marrow Aspiration and Biopsy"

and

http://www.ncbi.nlm.nih.gov/pubmed/2239919
"Dry tap bone marrow aspiration: clinical significance"

"The presence of peripheral blood nucleated red blood cells, thrombocytopenia, and elevation of the serum lactate dehydrogenase were frequent findings in patients who experienced dry taps."

A dry tap could be from faulty technique. But the presence of the nucleated RBCs tends to indicate that's not the case. "Extramedullary hematopoiesis" (blood cells abnormally being produced outside the marrow) can result because the marrow is damaged and that in turn can produce nRBCs. An enlarged spleen or liver would be a clue.

Sorry to say, there are associations with a dry tap and malignancies in the marrow. But another possibility is that the marrow was poisoned by some medication.

[Ken_PA]

Mocha's question to you was a good one and the answer could have been a big clue as to why the nRBCs are there.

[Ken_PA]

maybe chronic hypoxia

[Mochadelicious]

Hello Elsaria,
Welcome to the forum.  I'm not sure if you will get an answer for your question on this forum as most of us here are Lymhoma/Leukemia survivors or caregivers and not physicians.  I personally have never even heard of NRBC, but perhaps someone else here does know (Ken)?  You might have better luck posting your question over on the doctor forums.  That said, it may be a good idea to get a second opinion if your current hematologist isn't giving you any answers.  May I ask why the bone marrow extraction was unsuccessful?