Do chest bone pain and raised CRP point to a marrow cancer?

Question

Hello doctor,

My mom is 67 years old and has been a smoker for decades. Her symptoms began with fatigue and chest bone pain, which led to an emergency room visit. A chest CT scan was performed and came back clear. At the time, she was diagnosed with possible pneumonia and treated with antibiotics, which provided slight improvement for a few weeks. Since then, her condition has worsened; she now reports widespread body pain and is experiencing significant depression and health anxiety. She has seen multiple doctors, including general practitioners, internal medicine specialists, and a rheumatologist, but the ongoing uncertainty and lack of a clear diagnosis have left her feeling exhausted and reluctant to continue further evaluations.

Across several blood tests, there have been consistent abnormalities. Her C-reactive protein (CRP) levels have remained markedly elevated, ranging from 71.26 to 231.56 mg/L, and her erythrocyte sedimentation rate (ESR) has also stayed high, from 66 to 81 mm/hr. She has persistent anemia with low red blood cell count, hemoglobin, and hematocrit, along with elevated ferritin levels. Her monocyte and eosinophil counts are frequently elevated. Additionally, her carcinoembryonic antigen (CEA) and B-type natriuretic peptide (BNP) are mildly elevated. Autoimmune markers, including the full ENA panel and rheumatoid factor, have consistently been negative.

Initially, I considered whether this could be something manageable like polymyalgia rheumatica, given her age, elevated inflammatory markers, and negative autoantibodies. However, I am now increasingly concerned about the possibility of a bone marrow-related malignancy.

I can attach all the bloodwork from the four visits, and I would deeply appreciate your thoughts on this.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

I hope you and your mom are doing well. I have reviewed all her test results. She has mild anemia, which is not very concerning considering her age. However, she also has neutropenia and a low platelet count. If these low counts persist or continue to decline, especially along with symptoms like fatigue and bone pain, we should evaluate her for aplastic anemia, as her RBC (red blood cell) count is also low.

For now, I suggest monitoring her blood counts closely, provided she does not have significant symptoms. It is essential to check her reticulocyte count to assess bone marrow function. A bone marrow biopsy would be the next step if needed. The elevated CRP (C-reactive protein) indicates an ongoing infection or inflammation.

She should maintain a nutritious diet, and I recommend supplementing with folic acid and vitamin B12, along with an anxiolytic if needed. These symptoms seem mild at the moment. Polymyalgia is also a possibility, so it would be best to consult a rheumatologist. Please get the reticulocyte count done soon so we can better evaluate her bone marrow activity.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.