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S Discussed In 2017 Oct,abt My Mother, Now Again She

Posted on Wed, 26 Feb 2020

Question: s discussed in 2017 oct,abt my mother, now again she is facing problem,on dec 2019 her homoglobin suddenly drop to 5.9,then infuse2 umit of red blood her homoglobin increse to 9 but after 25 days again its drop to 6 then again infuse 2 units and did flowvymtry in mac XXXXXXX its shows cd5

Follow up: Dr. dr. Jawahar Ticku (3 hours later)

My mother had splean removed in 2003 due to enlarged spleen but in biopsy no cause deducted,but in 2010 she diagonsed with DLBCL STAGE 4 and treated with RCHOP 8 CYCLES and in remission from 2012, but in 2017 routine blood shows lymphostis and homoglobin @ 10 for that we adviced to do flowcytomtry and pet ct,in pet ct no fdg uptake is found but in flow found cd20 ,cd19 ,cd79b ,igm ,lambda ,cd23 ,cd45 ,cd200

Answered by Dr. dr. Jawahar Ticku (10 hours later)

Brief Answer:
DLBC Lymphoma

Detailed Answer:
Dear MK
Thanks for your query.
Since your mother is a known case of DLBCL having achieved remission after chemo there must be now recurrence of the disease. The usual process of this disease is to get transformed into leukaemia. This can only be confirmed by Bone Marrow Examination. PET will not depict any thing. Of course other causes of anaemia need to be ruled out.
Regards.
Dr. Ticku

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. dr. Jawahar Ticku (59 minutes later)

already did examination reports attched, bone marrow two times,flow cytometry two times, both Reports attached kinsly sew and guide there is confusion between mzl/mcl/cll after so many extensive examanitaion from last one month but nothing is ruled out specifically. kindly check reports and guide further

Answered by Dr. dr. Jawahar Ticku (35 minutes later)

Brief Answer:
Lymphoma

Detailed Answer:
I have checked the reports. I do not find the bone marrow examination report. Mzl/mcl/cll are all variants and transformation of lymphoma. as per the reports she is harboring the disease and needs further treatment. There is not much variation in the treatment protocols. Even if these variants of disease are described they are comparatively less aggressive. i still apprehend the bone marrow inflitration leading to such severe anemia.This can be determined by bone marrow examination only.
Dr. Ticku

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. dr. Jawahar Ticku (11 hours later)

hi i am sendung again in this message bone marrow aspration,biopsy and flow,kindly advice the best treatment and further plan, sevond major question is it require chemo now or we can wait and follow up with fortnighly cbc test because on 1 dec her homoglobin drop to 5.9 and infuse 2 units and after25 days again drop to 5.5 then doctor given wyslone 100 mg for 5 days then in full month homoglobin maintain and even improve 10.2 (homoglobin),platlated 225 and lymphostis also improve kindly advice is treatment required or no ,if yes then what choice of treament is best

Answered by Dr. dr. Jawahar Ticku (9 hours later)

Brief Answer:
DLBCL

Detailed Answer:
Dear Sir,
If the blood counts have improved and are in normal range and there is no sudden fall in haemoglobin and platelet count and TLC is in normal range then need for active management or chemo is not there. Remain on follow up only and have periodic check ups only. Bone marrow was only needed to rule out remission or fall of haemoglobin due to unknown other cause.
Truly,
Dr. Ticku

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Above answer was peer-reviewed by : Dr. Vaishalee Punj