Instruction: High eosinophils anxiety or underlying issue?Age : 24Sex : MaleHeight : 61Weight : 190Race : CaucasianDuration of complaint : unknown how long persisted under radar.Location : North America / SoutheastAny existing relevant medical issues : none.Current medications : propranolol.Hey everyone, for any with experience in hematology, I went to the doc a month ago for routine work and a check up. After a blood test returned, it appeared that everything was normal, nearly in perfect ranges, with the exception of my eosinophil count.Normal ranges are between 0-500 per x value and comprise 0-6% roughly of all white blood cells. My white blood cell count alone was practically perfect (middle of range, if not slightly favoring lower end) and all individual white blood cells were in optimal ranges, however my eos was rated at 1500, nearly 3x the standard, and at 19%.For some context, I had just gotten back from a trip in California where I had a fairly massive reaction to poison ivy or oak or sumac, it covered a significant portion of my legs (60%) and it was streaked on my torso and my arms. I also, not even a week before, had been ill or had an allergic reaction to something in a house I stayed in that is suspected to have some mold in it and cats which im Allergic to. I was sick for probably 3 days.I have my second blood test tomorrow and am a bit stressed by this. Any direction, advice, anecdotal evidence etc is appreciated.

Output: Almost certainly due to your exposure to the plant.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: High eosinophils anxiety or underlying issue?Age : 24Sex : MaleHeight : 61Weight : 190Race : CaucasianDuration of complaint : unknown how long persisted under radar.Location : North America / SoutheastAny existing relevant medical issues : none.Current medications : propranolol.Hey everyone, for any with experience in hematology, I went to the doc a month ago for routine work and a check up. After a blood test returned, it appeared that everything was normal, nearly in perfect ranges, with the exception of my eosinophil count.Normal ranges are between 0-500 per x value and comprise 0-6% roughly of all white blood cells. My white blood cell count alone was practically perfect (middle of range, if not slightly favoring lower end) and all individual white blood cells were in optimal ranges, however my eos was rated at 1500, nearly 3x the standard, and at 19%.For some context, I had just gotten back from a trip in California where I had a fairly massive reaction to poison ivy or oak or sumac, it covered a significant portion of my legs (60%) and it was streaked on my torso and my arms. I also, not even a week before, had been ill or had an allergic reaction to something in a house I stayed in that is suspected to have some mold in it and cats which im Allergic to. I was sick for probably 3 days.I have my second blood test tomorrow and am a bit stressed by this. Any direction, advice, anecdotal evidence etc is appreciated.. ### Response: Almost certainly due to your exposure to the plant..


Instruction: Worried about a blood cancer but doctors aren't? Petechiae that come and go?25M, 6'0, White, 175lbs. Manual Labor Job, lifted weights until june 6th (mostly due to workload) No alcohol/smoking, only THC gummies. USA(Prior Health Concerns)-Rosacea-Late Dec 2020 I tested negative for covid, unbearable stomach pain/bloating whenever I ate. Lost 11lbs over 7 days until I could finally eat again. Saw GastroEnter early Jan '21. Gastroscopy, upper endo, colonoscopy. All biopsied, no inflammation. No blood in stool. Total mystery to them that resolved and never came back. Had remnant pains the next few months, tingles/tickles around torso, all resolved in time with no medications/treatments.-August 2nd, had knot under left armpit for two months ultrasounded, ruled benign, not pathologically enlarged(Current Health Issues)I've had issues the last few months. My hands felt cold/stiff in the fingers, no pain. This lasted only a few days before going away, (June 1st). GP said Raynaud's. Almost as soon as the finger issues stopped, I went to the ENT for a migratory feeling of fullness in my throat for multiple weeks that turned out to be acid reflux, and issue I have had off and on for the last handfuls of years (Maybe once a year), but never like this. I'm on omeprazole 20mg daily and that has been resolved. Back issues (now believed by trial/error to be caused by highly acidic food (Homemade hot sauces) have all but recently resolved. Migratory from spine to flanks, almost always symmetrical radiating irritation/tightness. Only two instances of sharp pains when eating spicy/acidic food, so I associate that with the acid reflux. These back issues never affected my mobility, and only ever had an issue like this when I had the moderna vaccines (Which kicked my ass for three days each)My biggest concerns have been my blood work. Initially my doctor was worried about my platelets on June 6th. (Still had back issues). I was on a plant based diet, and he recommended I go off it because he has no experience with it until we see what's happening. I resumed a traditional diet until follow up bloods and peripheral smear on June 22nd. Almost everything bounced back into normal range, or at the very least recovered significantly. No concerns on his end other than slightly low wbc, peripheral smear great. I felt better, and resumed a plant based diet until I felt started to have back/hand issues again.Aug 2nd - I also noticed some flat individual dots on my trunk/legs. Only about 5 at the time. Some of which are raised. He said they are petechiae, never go away, and that was that. Two of which I vaguely remember noticing a few years ago but cannot be certain. More bloodwork and smear done. Both smear results are of no concern to GP or hematologist (Facility requires all bloodwork reviewed by Hematology across the street as per policy)The last handful of days I noticed a cluster under my left armpit of petechiae, which had mostly faded before returning again today, but not as prominent. I have a hematology appointment on the 15th. Both doctors are not concerned of Leukemia, but Hematologist is still interested to see what's up and GP said all his resources are exhausted.I have no organ enlargements/lymph node enlargement/no fatigue/nightsweats/weight loss. No inflammatory markers, healthy kidneys/liver/spleen. No reduction in appetite (Quite the opposite) Only Low wbc and mild hand symptoms that come and go that had remedied when returning to traditional diet but dropped since returning to plant based. The last three days I have noticed minor "tickles" around my body. I wouldn't say itching. Similar to the tingles I would get when I had my stomach issues about 3 years ago. None of my symptoms ever got worse at night, quite the opposite.(Questions)Would cancer symptoms wane and reoccur? Would my bloods have recovered so fast if I it was? I honestly don't know what to think at this point. I feel like by now if it was leukemia it would have been caught in the blood smears or my conditions would have worsened, not (mostly) resolved?I understand my WBC is low, but would it be considered pathologically so? All abnormal labs are posted, everything else fell into normal rangeshttps://imgur.com/FZEIlnE (Bloodwork)https://imgur.com/Lhw9UC1 (Petechiae)

Output: Blood smears are diagnostic for blood cancers. If theyre normal, you dont have blood cancer.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Worried about a blood cancer but doctors aren't? Petechiae that come and go?25M, 6'0, White, 175lbs. Manual Labor Job, lifted weights until june 6th (mostly due to workload) No alcohol/smoking, only THC gummies. USA(Prior Health Concerns)-Rosacea-Late Dec 2020 I tested negative for covid, unbearable stomach pain/bloating whenever I ate. Lost 11lbs over 7 days until I could finally eat again. Saw GastroEnter early Jan '21. Gastroscopy, upper endo, colonoscopy. All biopsied, no inflammation. No blood in stool. Total mystery to them that resolved and never came back. Had remnant pains the next few months, tingles/tickles around torso, all resolved in time with no medications/treatments.-August 2nd, had knot under left armpit for two months ultrasounded, ruled benign, not pathologically enlarged(Current Health Issues)I've had issues the last few months. My hands felt cold/stiff in the fingers, no pain. This lasted only a few days before going away, (June 1st). GP said Raynaud's. Almost as soon as the finger issues stopped, I went to the ENT for a migratory feeling of fullness in my throat for multiple weeks that turned out to be acid reflux, and issue I have had off and on for the last handfuls of years (Maybe once a year), but never like this. I'm on omeprazole 20mg daily and that has been resolved. Back issues (now believed by trial/error to be caused by highly acidic food (Homemade hot sauces) have all but recently resolved. Migratory from spine to flanks, almost always symmetrical radiating irritation/tightness. Only two instances of sharp pains when eating spicy/acidic food, so I associate that with the acid reflux. These back issues never affected my mobility, and only ever had an issue like this when I had the moderna vaccines (Which kicked my ass for three days each)My biggest concerns have been my blood work. Initially my doctor was worried about my platelets on June 6th. (Still had back issues). I was on a plant based diet, and he recommended I go off it because he has no experience with it until we see what's happening. I resumed a traditional diet until follow up bloods and peripheral smear on June 22nd. Almost everything bounced back into normal range, or at the very least recovered significantly. No concerns on his end other than slightly low wbc, peripheral smear great. I felt better, and resumed a plant based diet until I felt started to have back/hand issues again.Aug 2nd - I also noticed some flat individual dots on my trunk/legs. Only about 5 at the time. Some of which are raised. He said they are petechiae, never go away, and that was that. Two of which I vaguely remember noticing a few years ago but cannot be certain. More bloodwork and smear done. Both smear results are of no concern to GP or hematologist (Facility requires all bloodwork reviewed by Hematology across the street as per policy)The last handful of days I noticed a cluster under my left armpit of petechiae, which had mostly faded before returning again today, but not as prominent. I have a hematology appointment on the 15th. Both doctors are not concerned of Leukemia, but Hematologist is still interested to see what's up and GP said all his resources are exhausted.I have no organ enlargements/lymph node enlargement/no fatigue/nightsweats/weight loss. No inflammatory markers, healthy kidneys/liver/spleen. No reduction in appetite (Quite the opposite) Only Low wbc and mild hand symptoms that come and go that had remedied when returning to traditional diet but dropped since returning to plant based. The last three days I have noticed minor "tickles" around my body. I wouldn't say itching. Similar to the tingles I would get when I had my stomach issues about 3 years ago. None of my symptoms ever got worse at night, quite the opposite.(Questions)Would cancer symptoms wane and reoccur? Would my bloods have recovered so fast if I it was? I honestly don't know what to think at this point. I feel like by now if it was leukemia it would have been caught in the blood smears or my conditions would have worsened, not (mostly) resolved?I understand my WBC is low, but would it be considered pathologically so? All abnormal labs are posted, everything else fell into normal rangeshttps://imgur.com/FZEIlnE (Bloodwork)https://imgur.com/Lhw9UC1 (Petechiae). ### Response: Blood smears are diagnostic for blood cancers. If theyre normal, you dont have blood cancer..


Instruction: Worried about a blood cancer but doctors aren't? Petechiae that come and go?25M, 6'0, White, 175lbs. Manual Labor Job, lifted weights until june 6th (mostly due to workload) No alcohol/smoking, only THC gummies. USA(Prior Health Concerns)-Rosacea-Late Dec 2020 I tested negative for covid, unbearable stomach pain/bloating whenever I ate. Lost 11lbs over 7 days until I could finally eat again. Saw GastroEnter early Jan '21. Gastroscopy, upper endo, colonoscopy. All biopsied, no inflammation. No blood in stool. Total mystery to them that resolved and never came back. Had remnant pains the next few months, tingles/tickles around torso, all resolved in time with no medications/treatments.-August 2nd, had knot under left armpit for two months ultrasounded, ruled benign, not pathologically enlarged(Current Health Issues)I've had issues the last few months. My hands felt cold/stiff in the fingers, no pain. This lasted only a few days before going away, (June 1st). GP said Raynaud's. Almost as soon as the finger issues stopped, I went to the ENT for a migratory feeling of fullness in my throat for multiple weeks that turned out to be acid reflux, and issue I have had off and on for the last handfuls of years (Maybe once a year), but never like this. I'm on omeprazole 20mg daily and that has been resolved. Back issues (now believed by trial/error to be caused by highly acidic food (Homemade hot sauces) have all but recently resolved. Migratory from spine to flanks, almost always symmetrical radiating irritation/tightness. Only two instances of sharp pains when eating spicy/acidic food, so I associate that with the acid reflux. These back issues never affected my mobility, and only ever had an issue like this when I had the moderna vaccines (Which kicked my ass for three days each)My biggest concerns have been my blood work. Initially my doctor was worried about my platelets on June 6th. (Still had back issues). I was on a plant based diet, and he recommended I go off it because he has no experience with it until we see what's happening. I resumed a traditional diet until follow up bloods and peripheral smear on June 22nd. Almost everything bounced back into normal range, or at the very least recovered significantly. No concerns on his end other than slightly low wbc, peripheral smear great. I felt better, and resumed a plant based diet until I felt started to have back/hand issues again.Aug 2nd - I also noticed some flat individual dots on my trunk/legs. Only about 5 at the time. Some of which are raised. He said they are petechiae, never go away, and that was that. Two of which I vaguely remember noticing a few years ago but cannot be certain. More bloodwork and smear done. Both smear results are of no concern to GP or hematologist (Facility requires all bloodwork reviewed by Hematology across the street as per policy)The last handful of days I noticed a cluster under my left armpit of petechiae, which had mostly faded before returning again today, but not as prominent. I have a hematology appointment on the 15th. Both doctors are not concerned of Leukemia, but Hematologist is still interested to see what's up and GP said all his resources are exhausted.I have no organ enlargements/lymph node enlargement/no fatigue/nightsweats/weight loss. No inflammatory markers, healthy kidneys/liver/spleen. No reduction in appetite (Quite the opposite) Only Low wbc and mild hand symptoms that come and go that had remedied when returning to traditional diet but dropped since returning to plant based. The last three days I have noticed minor "tickles" around my body. I wouldn't say itching. Similar to the tingles I would get when I had my stomach issues about 3 years ago. None of my symptoms ever got worse at night, quite the opposite.(Questions)Would cancer symptoms wane and reoccur? Would my bloods have recovered so fast if I it was? I honestly don't know what to think at this point. I feel like by now if it was leukemia it would have been caught in the blood smears or my conditions would have worsened, not (mostly) resolved?I understand my WBC is low, but would it be considered pathologically so? All abnormal labs are posted, everything else fell into normal rangeshttps://imgur.com/FZEIlnE (Bloodwork)https://imgur.com/Lhw9UC1 (Petechiae)

Output: Blood smears are diagnostic for blood cancers. If theyre normal, you dont have blood cancer.


Instruction: Can MCV go up by a few points over a month, still in normal range - should we be concerned? All levels listedMale -48 (my husband)WhiteWeight 163No signs/symptomsCan an MCV increase in one month by 3 points?Been seeing doctor since April 2022 for low WBC and neutrophils. Everything else was normal. (found on routine bloodwork)Followed by hematology. They aren't all that concerned, but I have a question.This latest test (50 days after last one) his WBC went back up to 4.3 (previous low 2.8) and neutrophils are 2.5 (previous low 1.4).Of course now I see that his MCV went up to 95.8 from 92,8, before that 93.8 (still normal, ref high is 100)MCH stayed same at 32.5 (norm)MCHC went down from 34.5 to 33.6 (normal, ref low is 31)RDW 12.6 stayed same (norm)RBC went from 4.64 to 4.53 (still normal, ref low is 4.2)Hemoglobin went from 14.9 to14.6 (still norm, ref low is 13)Platelets, all other counts normal for him.Normal B12, Folate normal at 29.4Are these counts any cause for concern? Can they go up and down within range?He's had 4 blood tests within 3 months so I can see the fluctuations. Also to note, he's having heel pain/inflammation starting last week (from running we think). They did test for RA due to strong family history (dad and brother) but negative. Although doctor said that doesn't mean he's not developing it.And he has been eating a lot less healthy this month and gained some weight.

Output: This change is within normal lab variation. Nothing to worry about.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Can MCV go up by a few points over a month, still in normal range - should we be concerned? All levels listedMale -48 (my husband)WhiteWeight 163No signs/symptomsCan an MCV increase in one month by 3 points?Been seeing doctor since April 2022 for low WBC and neutrophils. Everything else was normal. (found on routine bloodwork)Followed by hematology. They aren't all that concerned, but I have a question.This latest test (50 days after last one) his WBC went back up to 4.3 (previous low 2.8) and neutrophils are 2.5 (previous low 1.4).Of course now I see that his MCV went up to 95.8 from 92,8, before that 93.8 (still normal, ref high is 100)MCH stayed same at 32.5 (norm)MCHC went down from 34.5 to 33.6 (normal, ref low is 31)RDW 12.6 stayed same (norm)RBC went from 4.64 to 4.53 (still normal, ref low is 4.2)Hemoglobin went from 14.9 to14.6 (still norm, ref low is 13)Platelets, all other counts normal for him.Normal B12, Folate normal at 29.4Are these counts any cause for concern? Can they go up and down within range?He's had 4 blood tests within 3 months so I can see the fluctuations. Also to note, he's having heel pain/inflammation starting last week (from running we think). They did test for RA due to strong family history (dad and brother) but negative. Although doctor said that doesn't mean he's not developing it.And he has been eating a lot less healthy this month and gained some weight.. ### Response: This change is within normal lab variation. Nothing to worry about..


Instruction: Worsening Breath hunger with normal blood panel resultsMy doctor doesnt seem to think theres a problem here. Does anyone have an idea why I find it so hard to breath? Walking up the stairs is becoming more and more difficult. Im 33/f (I hope this makes sense, its translated from German)Material submitted: Whole blood or supplement, EDTA blood, GlucoExactinvestigationresultDimension reference areagraphicprevious valueCLINICAL CHEMICAL TESTSglucose10560-100The multiplication of the measurement result by a factor of 1.16 required for the GlucoExact tube was already 60-100 mg/dl (3.3-5.6 mmol) normal fasting glucose: 100-125 mg/dl (5.6-6.9 mmol) abnormal fasting glucose: >126 mmol/l) Diabetes mellitus (guidelines of the DDG from 10/2004, confirmed in Diabetologie 2010; 5: 109-112)performed.mg/dl (>7.0GOT (ASAT) GT29160.7<0.9Creatinine (Jaff)GFR (calculated, according to CKD-EPI)11460min/1.73m2COFIRON BUDGETferritin13-150LIPOS METABOLISM/ATHEROSCLEROSIS RISK DIAGNOSTICS45-23075cholesterol134triglycerides62mg/day20-150HDL cholesterol51mg/day48-83LDL cholesterolmg/day10-155LDL target values according to the ESC/EAS guideline: Diagnosis and therapy of dyslipidemia (2019 version): In the case of a low cardiovascular risk, an LDL cholesterol target value of <116 mg/dl (<3.0 mmol) should be set, and in the case of a moderately increased cardiovascular risk of <100 mg/dl (<2.6 mmol/l) should be aimed for. If the cardiovascular risk is high, the LDL. Cholesterol maintained at less than 50% of baseline and at least <70 mg/dl (<1.8 mmol/l) and very highcardiovascular to be sustained to less than 50% of baseline and at least to <55 mg/dL (<1.4 mmol/L).non-HDL8314-185Secondary non-HDL target values according to the ESC/EAS guideline: Diagnosis and therapy of dyslipidemia (2019 version): with a moderately increased cardiovascular risk <130 mg/dl (<3.4 mmol/l), with a high cardiovascular risk <100 mg/dl dl (<2.6 mmol). at very high cardiovascular risk <85 mg/dl (<2.2 mmol).VITAMIN DIAGNOSTICSVitamin B12197-771 1.8-9.0folic acidTHYROID DIAGNOSTICS TSH basal value1.250.4-4.0TSH in the reference range as an indication of a euthyroid SD functional position (assuming an intact HVL axis). Please note the changed reference range.Page 1/2amedes MVZ 1. Laboratory. and Microbiology Leipziger Chaussee 1911 06112 Halle/Saale Tel.:0345/44507-100 FAX:44507210amedeswithdrawal inputSurnamePIKE EMMAborn05/20/1989 (933 years)Payer checkout investigationYour number 7014147367 barcode number701414736707/26/2022 07/26/2022final resultlab noYPWG26 5414resultDimension reference areagraphicprevious valueHEMATOLOGICAL DIAGNOSTICSSMALL BLOOD COUNT5.44.0-9.0leukocyteserythrocyte hemoglobin4.2TA39-5313.0120-16.0hematocrit MCV3836-4789.880-9630.728-32MCHC34.230-36platelets150-400Commentary on findings: [1] Please note the changed reference range.This finding was medically validated by Dr. Biro, F for Laboratory Medicine

Output: While your blood tests are normal, there isnt much of any investigation for shortness of breath (aside from demonstrating that youre not anemic). A typical workup for shortness of breath will include chest imaging (usually starting with a chest x-ray) and pulmonary function testing (breathing tests). If you doctor isnt comfortable working up your symptoms its always reasonable to ask about a referral to a pulmonologist.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Worsening Breath hunger with normal blood panel resultsMy doctor doesnt seem to think theres a problem here. Does anyone have an idea why I find it so hard to breath? Walking up the stairs is becoming more and more difficult. Im 33/f (I hope this makes sense, its translated from German)Material submitted: Whole blood or supplement, EDTA blood, GlucoExactinvestigationresultDimension reference areagraphicprevious valueCLINICAL CHEMICAL TESTSglucose10560-100The multiplication of the measurement result by a factor of 1.16 required for the GlucoExact tube was already 60-100 mg/dl (3.3-5.6 mmol) normal fasting glucose: 100-125 mg/dl (5.6-6.9 mmol) abnormal fasting glucose: >126 mmol/l) Diabetes mellitus (guidelines of the DDG from 10/2004, confirmed in Diabetologie 2010; 5: 109-112)performed.mg/dl (>7.0GOT (ASAT) GT29160.7<0.9Creatinine (Jaff)GFR (calculated, according to CKD-EPI)11460min/1.73m2COFIRON BUDGETferritin13-150LIPOS METABOLISM/ATHEROSCLEROSIS RISK DIAGNOSTICS45-23075cholesterol134triglycerides62mg/day20-150HDL cholesterol51mg/day48-83LDL cholesterolmg/day10-155LDL target values according to the ESC/EAS guideline: Diagnosis and therapy of dyslipidemia (2019 version): In the case of a low cardiovascular risk, an LDL cholesterol target value of <116 mg/dl (<3.0 mmol) should be set, and in the case of a moderately increased cardiovascular risk of <100 mg/dl (<2.6 mmol/l) should be aimed for. If the cardiovascular risk is high, the LDL. Cholesterol maintained at less than 50% of baseline and at least <70 mg/dl (<1.8 mmol/l) and very highcardiovascular to be sustained to less than 50% of baseline and at least to <55 mg/dL (<1.4 mmol/L).non-HDL8314-185Secondary non-HDL target values according to the ESC/EAS guideline: Diagnosis and therapy of dyslipidemia (2019 version): with a moderately increased cardiovascular risk <130 mg/dl (<3.4 mmol/l), with a high cardiovascular risk <100 mg/dl dl (<2.6 mmol). at very high cardiovascular risk <85 mg/dl (<2.2 mmol).VITAMIN DIAGNOSTICSVitamin B12197-771 1.8-9.0folic acidTHYROID DIAGNOSTICS TSH basal value1.250.4-4.0TSH in the reference range as an indication of a euthyroid SD functional position (assuming an intact HVL axis). Please note the changed reference range.Page 1/2amedes MVZ 1. Laboratory. and Microbiology Leipziger Chaussee 1911 06112 Halle/Saale Tel.:0345/44507-100 FAX:44507210amedeswithdrawal inputSurnamePIKE EMMAborn05/20/1989 (933 years)Payer checkout investigationYour number 7014147367 barcode number701414736707/26/2022 07/26/2022final resultlab noYPWG26 5414resultDimension reference areagraphicprevious valueHEMATOLOGICAL DIAGNOSTICSSMALL BLOOD COUNT5.44.0-9.0leukocyteserythrocyte hemoglobin4.2TA39-5313.0120-16.0hematocrit MCV3836-4789.880-9630.728-32MCHC34.230-36platelets150-400Commentary on findings: [1] Please note the changed reference range.This finding was medically validated by Dr. Biro, F for Laboratory Medicine. ### Response: While your blood tests are normal, there isnt much of any investigation for shortness of breath (aside from demonstrating that youre not anemic). A typical workup for shortness of breath will include chest imaging (usually starting with a chest x-ray) and pulmonary function testing (breathing tests). If you doctor isnt comfortable working up your symptoms its always reasonable to ask about a referral to a pulmonologist..


Instruction: 27F immunocompromised and sick for two weeks. Getting worse. Rheumatologist is out of town and ER doctor sent me home pending blood test results that are still processing. Insight?Demographics: 27 female. Height 5ft 6in, weight 190lbs. Married.Conditions: rheumatoid arthritis and lupus; SVT.Meds: 2000mg sulfasalazine, 400mg plaquenil, 200mg Cimzia injection every two weeks.Non-smoker, no alcohol, no caffeine.Duration of complaint: 2weeksI have four doses of pfizer covid vaccine.Currently negative for covid.Two weeks ago before my scheduled Cimzia injection I spiked a low-grade fever. It was about 37.8c. Since then, my temperatures have been 37.5c to 38.5c. Acetaminophen will not bring my temperature down. It initially started with fatigue and headache and fever.Last week I began to get a sore throat, sweating, clamminess, chills, mild sinus pressure, confusion, shortness of breath, and a slight cough.I went in for monthly rheumatology bloodwork on 7/28. Ill attach the results. Mildly decreased WBC and Neutrophils.On 7/29 I went to the emergency room as my primary doctor instructed me to because I was not improving. Many cultures were taken. WBC further decreased and neutrophils were more than half of the previous day. There is a WBC Morphology pending pathologist review.Sepsis cultures have not shown any growth over the day.X-ray of chest showed no abnormality.Im confused as to what could be causing this. The ER doctor also said he was confused and it could be a medication or a nasty virus (was not tested for these) and that I have neutropenia and I am quite immune compromised but left it at that.Today, 7/30, I have had more difficulty breathing, particularly with movement or talking. Im coughing green/yellow thick mucus. More fatigue. My lungs feel heavy.Im thinking of heading back to the ER tomorrow if symptoms get worse, but Im not sure it will do any good for me or provide me with more.Is there any insights?Ive reached out to my rheumatologists receptionist as well as my primary doctor. However, Monday here is a holiday so the offices are closed. The earliest I could see my primary is on Tuesday, and Im not sure how much further it will progress by then.here is the link to my imgur albumI understand that some of the blood work with the hematology panel is still pending.Also, what does it mean with the WBC morphology Reviewed by technologist Sent to Pathologist for review?

Output: I wouldn't wait a day more. Go to the ER. In my opinion you should be started on broad spectrum antibiotics asap, while waiting for results.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 27F immunocompromised and sick for two weeks. Getting worse. Rheumatologist is out of town and ER doctor sent me home pending blood test results that are still processing. Insight?Demographics: 27 female. Height 5ft 6in, weight 190lbs. Married.Conditions: rheumatoid arthritis and lupus; SVT.Meds: 2000mg sulfasalazine, 400mg plaquenil, 200mg Cimzia injection every two weeks.Non-smoker, no alcohol, no caffeine.Duration of complaint: 2weeksI have four doses of pfizer covid vaccine.Currently negative for covid.Two weeks ago before my scheduled Cimzia injection I spiked a low-grade fever. It was about 37.8c. Since then, my temperatures have been 37.5c to 38.5c. Acetaminophen will not bring my temperature down. It initially started with fatigue and headache and fever.Last week I began to get a sore throat, sweating, clamminess, chills, mild sinus pressure, confusion, shortness of breath, and a slight cough.I went in for monthly rheumatology bloodwork on 7/28. Ill attach the results. Mildly decreased WBC and Neutrophils.On 7/29 I went to the emergency room as my primary doctor instructed me to because I was not improving. Many cultures were taken. WBC further decreased and neutrophils were more than half of the previous day. There is a WBC Morphology pending pathologist review.Sepsis cultures have not shown any growth over the day.X-ray of chest showed no abnormality.Im confused as to what could be causing this. The ER doctor also said he was confused and it could be a medication or a nasty virus (was not tested for these) and that I have neutropenia and I am quite immune compromised but left it at that.Today, 7/30, I have had more difficulty breathing, particularly with movement or talking. Im coughing green/yellow thick mucus. More fatigue. My lungs feel heavy.Im thinking of heading back to the ER tomorrow if symptoms get worse, but Im not sure it will do any good for me or provide me with more.Is there any insights?Ive reached out to my rheumatologists receptionist as well as my primary doctor. However, Monday here is a holiday so the offices are closed. The earliest I could see my primary is on Tuesday, and Im not sure how much further it will progress by then.here is the link to my imgur albumI understand that some of the blood work with the hematology panel is still pending.Also, what does it mean with the WBC morphology Reviewed by technologist Sent to Pathologist for review?. ### Response: I wouldn't wait a day more. Go to the ER. In my opinion you should be started on broad spectrum antibiotics asap, while waiting for results..


Instruction: Any other possible causes of low WBC count? am hispanic 23F, 5'1, 105 lbs.Symptoms: some fatigue, occasional night sweats (maybe 1-2x/every 2wks for ~4-5 mo) that are drenching and wake me up, palpable non-tender L posterior auricular lymph node, submental, and R posterior cervical lymph nodes (but have been told by a otolaryngologist in a class these are probably just shotty/only palpable because I am thin), I mainly just saw a doctor to establish care after moving and for a physical because it had been a while.Medical hx: childhood asthma, internal hemorrhoids ongoing on/off for 4 yrs dx by colonoscopy, iron deficiency without anemia 2 yrs ago (likely d/t vegetarian diet)Current medication is Nuvaring. I drink max 2 drinks/wk, I do not smoke, and I do not use any drugs.Lab results:-CBC w/Diff: Repeated 3x over 2 months, same results. Results here of manual diff:WBC 3.1 10e3/uL 3.9 - 11.2 10e3/uL LRBC 4.9 10e6/uL 3.7 - 5.2 10e6/uLHemoglobin 12.1 g/dL 11.3 - 15.1 g/dLHematocrit 38 % 34 - 45 %MCH 24.8 pg 25.7 - 34.1 pg LMCHC 32 g/dL 32 - 36 g/dLMCV 78 fl 79 - 98 fl LRDW 13.7 % 11.0 - 14.9 %Platelet Count 180 10e3/uL 165 - 366 10e3/uLMPV 12.2 fl 9.0 - 11.8 fl HAutomated Nucleated RBC 0 %/100 WBCBand Neutrophil % 1 % 0 - 1 %Segmented Neutrophil % 43 % 43 - 74 %Lymphocyte % 49 % 17 - 46 % HMonocyte % 6 % 4 - 13 %Eosinophil % 1 % 0 - 6 %Basophil % 0 % 0 - 1 %Absolute Neutrophil (Segs and Bands) 1.36 10e3/uL 1.90 - 7.80 10e3/uL LAbsolute Lymphocyte 1.52 10e3/uL 0.90 - 3.20 10e3/uLAbsolute Monocyte 0.19 10e3/uL 0.26 - 0.86 10e3/uL LAbsolute Eosinophil 0.03 10e3/uL 0.03 - 0.52 10e3/uLAbsolute Basophil 0.00 10e3/uL 0.01 - 0.10 10e3/uL LRBC Morphology Comment Present RBC: Manual smear Review PerformedPoikilocytosis 1+ AOvalocytes Present ATarget Cells Present A-Other labs:normal CMP, negative ANA screen, negative rheumatoid factor, normal Vitamin D, normal B12, normal Folate, negative for hep B & hep C, negative TB skinMy question:My Dr. did an e-consult with hematology, and they were dismissive I think because I am young and relatively healthy and all of the above possible explanations were negative/normal. They said that it was likely just low WBC due to genetic variation. I have never had a low WBC count in the past (last cbc w/diff in 2020 was normal) and no one in my family has a low WBC count. I understand that it still could potentially be a "normal"/ genetic variant low wbc count, but are there any possible explanations for my results that have not been explored above and should I push to investigate or should I just wait and see if I start getting infections or other symptoms like they said I should? I am a student in a healthcare field and could just be over-analyzing and worried for no reason!

Output: I wouldn't pursue anything further with this if you don't have frequent infections or any other symptoms. Some people just run on the lower end, and that's fine.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Any other possible causes of low WBC count? am hispanic 23F, 5'1, 105 lbs.Symptoms: some fatigue, occasional night sweats (maybe 1-2x/every 2wks for ~4-5 mo) that are drenching and wake me up, palpable non-tender L posterior auricular lymph node, submental, and R posterior cervical lymph nodes (but have been told by a otolaryngologist in a class these are probably just shotty/only palpable because I am thin), I mainly just saw a doctor to establish care after moving and for a physical because it had been a while.Medical hx: childhood asthma, internal hemorrhoids ongoing on/off for 4 yrs dx by colonoscopy, iron deficiency without anemia 2 yrs ago (likely d/t vegetarian diet)Current medication is Nuvaring. I drink max 2 drinks/wk, I do not smoke, and I do not use any drugs.Lab results:-CBC w/Diff: Repeated 3x over 2 months, same results. Results here of manual diff:WBC 3.1 10e3/uL 3.9 - 11.2 10e3/uL LRBC 4.9 10e6/uL 3.7 - 5.2 10e6/uLHemoglobin 12.1 g/dL 11.3 - 15.1 g/dLHematocrit 38 % 34 - 45 %MCH 24.8 pg 25.7 - 34.1 pg LMCHC 32 g/dL 32 - 36 g/dLMCV 78 fl 79 - 98 fl LRDW 13.7 % 11.0 - 14.9 %Platelet Count 180 10e3/uL 165 - 366 10e3/uLMPV 12.2 fl 9.0 - 11.8 fl HAutomated Nucleated RBC 0 %/100 WBCBand Neutrophil % 1 % 0 - 1 %Segmented Neutrophil % 43 % 43 - 74 %Lymphocyte % 49 % 17 - 46 % HMonocyte % 6 % 4 - 13 %Eosinophil % 1 % 0 - 6 %Basophil % 0 % 0 - 1 %Absolute Neutrophil (Segs and Bands) 1.36 10e3/uL 1.90 - 7.80 10e3/uL LAbsolute Lymphocyte 1.52 10e3/uL 0.90 - 3.20 10e3/uLAbsolute Monocyte 0.19 10e3/uL 0.26 - 0.86 10e3/uL LAbsolute Eosinophil 0.03 10e3/uL 0.03 - 0.52 10e3/uLAbsolute Basophil 0.00 10e3/uL 0.01 - 0.10 10e3/uL LRBC Morphology Comment Present RBC: Manual smear Review PerformedPoikilocytosis 1+ AOvalocytes Present ATarget Cells Present A-Other labs:normal CMP, negative ANA screen, negative rheumatoid factor, normal Vitamin D, normal B12, normal Folate, negative for hep B & hep C, negative TB skinMy question:My Dr. did an e-consult with hematology, and they were dismissive I think because I am young and relatively healthy and all of the above possible explanations were negative/normal. They said that it was likely just low WBC due to genetic variation. I have never had a low WBC count in the past (last cbc w/diff in 2020 was normal) and no one in my family has a low WBC count. I understand that it still could potentially be a "normal"/ genetic variant low wbc count, but are there any possible explanations for my results that have not been explored above and should I push to investigate or should I just wait and see if I start getting infections or other symptoms like they said I should? I am a student in a healthcare field and could just be over-analyzing and worried for no reason!. ### Response: I wouldn't pursue anything further with this if you don't have frequent infections or any other symptoms. Some people just run on the lower end, and that's fine..


Instruction: 29F. Low wbc and neutropenia. Referred to hematology. Stressed because it takes time to see specialistI just need some peace of mind, something that can calm me down my pcp called me after my cbc test and said that they want to refer me to Hematologist just to make sure they dont miss anything. The soonest appointment for hematologist is in the end of January! I dont know what to do because all I can think of is Cancer or HIV because what else can explain my low wbc 2.9k/UL (3.9-12 standard range) and neutrophils 34.8% (40-70%) high lymphocytes 52.4% (25-45%) and high basophil 2.1 (0-2%) I am absolutely terrified and cant wait that long to find out whats causing it Can PCP run other tests in a mean time?

Output: What else could cause it? A viral illness. Nutritional deficiencies. Drug induced neutropenia. Benign ethnic neutropenia. There's many potential causes besides what you jumped to. There are some tests your doctor could do, like a peripheral blood smear, folate and B12, some liver function testing and some screening panels depending on clinical suspicion from history and exam. Many of these may have been done or deemed not necessary.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 29F. Low wbc and neutropenia. Referred to hematology. Stressed because it takes time to see specialistI just need some peace of mind, something that can calm me down my pcp called me after my cbc test and said that they want to refer me to Hematologist just to make sure they dont miss anything. The soonest appointment for hematologist is in the end of January! I dont know what to do because all I can think of is Cancer or HIV because what else can explain my low wbc 2.9k/UL (3.9-12 standard range) and neutrophils 34.8% (40-70%) high lymphocytes 52.4% (25-45%) and high basophil 2.1 (0-2%) I am absolutely terrified and cant wait that long to find out whats causing it Can PCP run other tests in a mean time?. ### Response: What else could cause it? A viral illness. Nutritional deficiencies. Drug induced neutropenia. Benign ethnic neutropenia. There's many potential causes besides what you jumped to. There are some tests your doctor could do, like a peripheral blood smear, folate and B12, some liver function testing and some screening panels depending on clinical suspicion from history and exam. Many of these may have been done or deemed not necessary..


Instruction: Hereditary iron deficiency?Profile: 25, female, 58, 175lbs, active, Caucasian-Mediterranean, Complaint: -extreme fatigue despite adequate sleep -dizzy/ fainting spells -poor circulation -blood pressure and blood sugar fluctuations -severe brain fog -dissociative episodes -debilitating anxiety/ depression Has been going on for the past 5 years and steadily getting worse.Recent labs: Hemoglobin A1C: 5.6 Glucose fasting: 5.0 mmol/L Ferritin: 40 ug/L Hematology profile normal, electrolytes normal, kidney/ liver function tests (urine & blood) normal, B12: high 836 pmol/L Cholesterol: 4.82 mmol/L LDL: 3.01 mmol/L HDL: 1.51 mmol/L Non HDL: 3.31 mmol/LHello! So I (25F), my mother (50), and my grandma (74) all have iron deficiency. We all have no underlying illnesses, except that grandma and I are subclinical hypothyroid. No kidney or liver issues. No other inflammatory diseases, crohns, celiacs, etc.Recently I found out that ferritin is optimal at >100 ug/L. Pretty pissed because 5 months ago it was 54 and I was told it was normal and now its 40. all of my symptoms align with iron deficiency.Can anyone shed some light as to what the root of this may be? Is it possible its just hereditary?Thanks in advance for any responses.

Output: Well, you all (presumably) menstruate. So you lose iron monthly. That can cause iron deficiency.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Hereditary iron deficiency?Profile: 25, female, 58, 175lbs, active, Caucasian-Mediterranean, Complaint: -extreme fatigue despite adequate sleep -dizzy/ fainting spells -poor circulation -blood pressure and blood sugar fluctuations -severe brain fog -dissociative episodes -debilitating anxiety/ depression Has been going on for the past 5 years and steadily getting worse.Recent labs: Hemoglobin A1C: 5.6 Glucose fasting: 5.0 mmol/L Ferritin: 40 ug/L Hematology profile normal, electrolytes normal, kidney/ liver function tests (urine & blood) normal, B12: high 836 pmol/L Cholesterol: 4.82 mmol/L LDL: 3.01 mmol/L HDL: 1.51 mmol/L Non HDL: 3.31 mmol/LHello! So I (25F), my mother (50), and my grandma (74) all have iron deficiency. We all have no underlying illnesses, except that grandma and I are subclinical hypothyroid. No kidney or liver issues. No other inflammatory diseases, crohns, celiacs, etc.Recently I found out that ferritin is optimal at >100 ug/L. Pretty pissed because 5 months ago it was 54 and I was told it was normal and now its 40. all of my symptoms align with iron deficiency.Can anyone shed some light as to what the root of this may be? Is it possible its just hereditary?Thanks in advance for any responses.. ### Response: Well, you all (presumably) menstruate. So you lose iron monthly. That can cause iron deficiency..


Instruction: Yes. Thats what we assumed it is.. but it seems odd as we all eat meat. I know that certain foods like dairy can block iron absorption though.

Output: It's not uncommon at all. Many people who menstruate are iron deficient

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Yes. Thats what we assumed it is.. but it seems odd as we all eat meat. I know that certain foods like dairy can block iron absorption though.. ### Response: It's not uncommon at all. Many people who menstruate are iron deficient.


Instruction: Elevated liver enzymesI am a 29 YO male, 510, non-smoker (occasional marijuana smoker), there has been no symptoms or duration.So I made a doctor app because of high blood pressure, she sent me for bloodwork and the results showed elevated liver enzymes AL-something was 129 when normal is 9-65. After numerous questions it was noted that I chronically used extra strength liquid gel Advil 400mg (took 2-3 a day for a long time due to chronic neck pain). The doctor said this COULD be it but had to rule everything out and advised to immediately stop taking Advil. This was Monday June 20th. Extra bloodwork was taken (HIV, Hepatitis) but results only came back stating my enzyme levels got worse, now 165. So I got my third set of bloodwork today for more in-depth bloodwork under hematology. The doctor is still saying that she THINKS it COULD be the Advil use but they dont know for sure whats causing it or why its getting worse. I also have a ultrasound scheduled for July 11th.Im trying to remain calm but why is this suddenly happening when Ive NEVER been sick like this, I dont have pain in my liver, I dont have yellow eyes or skin (which the doctor asked). If it wasnt for routine bloodwork catching it I would never even know. The doctor says its still mild and its good we caught it when we did but we got to figure out whats causing it. She mentioned something about auto immune disease or gastro also but my mind is going to the darkest depths.. cancer. I have this sinking feeling like Im dying now. Please any insight or input. I know you guys wont have answers for me from a simple Reddit post but anything.

Output: Many causes. Looks like good appropriate workup is being done. If you're overweight, fatty liver is a possible cause

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Elevated liver enzymesI am a 29 YO male, 510, non-smoker (occasional marijuana smoker), there has been no symptoms or duration.So I made a doctor app because of high blood pressure, she sent me for bloodwork and the results showed elevated liver enzymes AL-something was 129 when normal is 9-65. After numerous questions it was noted that I chronically used extra strength liquid gel Advil 400mg (took 2-3 a day for a long time due to chronic neck pain). The doctor said this COULD be it but had to rule everything out and advised to immediately stop taking Advil. This was Monday June 20th. Extra bloodwork was taken (HIV, Hepatitis) but results only came back stating my enzyme levels got worse, now 165. So I got my third set of bloodwork today for more in-depth bloodwork under hematology. The doctor is still saying that she THINKS it COULD be the Advil use but they dont know for sure whats causing it or why its getting worse. I also have a ultrasound scheduled for July 11th.Im trying to remain calm but why is this suddenly happening when Ive NEVER been sick like this, I dont have pain in my liver, I dont have yellow eyes or skin (which the doctor asked). If it wasnt for routine bloodwork catching it I would never even know. The doctor says its still mild and its good we caught it when we did but we got to figure out whats causing it. She mentioned something about auto immune disease or gastro also but my mind is going to the darkest depths.. cancer. I have this sinking feeling like Im dying now. Please any insight or input. I know you guys wont have answers for me from a simple Reddit post but anything.. ### Response: Many causes. Looks like good appropriate workup is being done. If you're overweight, fatty liver is a possible cause.


Instruction: Referred to hematologist at a cancer center for chronic leukopenia, thrombocytopenia, and anemia, wondering if my bloodwork could be indicative of anything serious?TLDR; I'm wondering if my bloodwork could be indicative of any serious issues besides iron deficiency anemia. Screenshots of my results are at the link at the bottom.23F, 52, 113lbs, dont smoke, rarely drink. I take Vitamin D3 supplements.I have iron deficiency anemia. Im a lacto-ovo vegetarian, so Ive always assumed that my anemia is related to my vegetarianism. Last April, I was prescribed iron supplements by my doctor. I took them for awhile and my iron levels had improved as of October and I wasnt anemic anymore. Around the same time I started slacking off taking my supplements (havent taken many since October) and as of last weeks bloodwood, Im anemic again. Im not surprised about that. My physician said she was going to refer me to hematologist to see what their recommendations would be as far whether supplementation alone is fine or if they'd suggest an iron infusion.The past three times Ive had my bloodwork done Ive noticed that my WBC and platelet count was low and would think Huh thats weird, but assumed it had something to do with my anemia. The doctor never mentioned a problem with it so I figured it wasnt really anything to worry about. At the end of our appointment I asked if my anemia is related to my vegetarianism or if its hereditary. She said she wasnt sure because of my low WBC and platelet count, so thats why shes sending me to the hematologist so they can look into it further. This was slightly off-putting to me because I expected the answer to be my vegetarianism because thats what Ive always assumed. It possibly being related to another underlying issue has been bothering me a little bit. On the appointment details, she noted: Thrombocytopenia (chronic), Leukopenia (chronic), and iron deficiency anemia secondary to inadequate dietary iron intake.Fast forward to today and I get an update from my doctors office that theyre still in the process of making the referral to the hematologist. They let me know the referral request was sent to our local cancer center. Normally, I dont really worry about stuff like this unless given reason to worry. Im aware that hematologists often work at cancer centers so Im assuming thats why she referred me there. It just has me slightly on edge because my dad goes there for his chemotherapy. The type of cancer he has isnt hereditary, but its still a little concerning to get referred to the same place where your dad got diagnosed with cancer and is getting treatment. My grandma has leukemia and also goes there to have it monitored. Im not sure if hers is hereditary or not.When I was researching leukopenia a little bit more and its possible causes, another thing thats bothered me a little bit is that I dont really see much of a link to iron deficiency anemia like I originally thought. So I'm not sure what could be causing it. I saw that low B12 can, but my B12 levels were checked last year and they were pretty good. My WBC was even on the low side then. Other details is that Im African American on my moms side and Mexican on my dads. I haven't had folate or copper tested, so maybe a deficiency? I also recently found out that my paternal great grandfather was a hemophiliac. Several people in my family have had cancer.Anyway, heres my recent bloodwork. I was wondering if anyone has any input on what this could mean to put my mind at ease while I wait for my hematology appointment.https://imgur.com/a/63OzoXP

Output: Your physician did the exact correct thing to refer you to hematology. The low platelets and white blood cells could be from many things. I agree that anemia is most certainly from iron deficiency. Given your ethnicity, low WBCs can sometimes be familial and we do see this more in the Black and Hispanic population. I am unsure why your platelets are low and this needs to be worked up. Leukemia is not hereditary. Hemophilia is hereditary and sometimes acquired but usually the former. Please let hematology know about this family history. You may also want to ask your mother if there is any history of sickle cell in her family given race.There is testing that can be done for folate and b12 deficiency but these levels (even when low) rarely affect WBC or platelet count. Based on your labs, there isn't anything that screams something ominous like cancer. Maybe autoimmune if anything as we see chronic non-life threatening low cell counts in these patients often

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Referred to hematologist at a cancer center for chronic leukopenia, thrombocytopenia, and anemia, wondering if my bloodwork could be indicative of anything serious?TLDR; I'm wondering if my bloodwork could be indicative of any serious issues besides iron deficiency anemia. Screenshots of my results are at the link at the bottom.23F, 52, 113lbs, dont smoke, rarely drink. I take Vitamin D3 supplements.I have iron deficiency anemia. Im a lacto-ovo vegetarian, so Ive always assumed that my anemia is related to my vegetarianism. Last April, I was prescribed iron supplements by my doctor. I took them for awhile and my iron levels had improved as of October and I wasnt anemic anymore. Around the same time I started slacking off taking my supplements (havent taken many since October) and as of last weeks bloodwood, Im anemic again. Im not surprised about that. My physician said she was going to refer me to hematologist to see what their recommendations would be as far whether supplementation alone is fine or if they'd suggest an iron infusion.The past three times Ive had my bloodwork done Ive noticed that my WBC and platelet count was low and would think Huh thats weird, but assumed it had something to do with my anemia. The doctor never mentioned a problem with it so I figured it wasnt really anything to worry about. At the end of our appointment I asked if my anemia is related to my vegetarianism or if its hereditary. She said she wasnt sure because of my low WBC and platelet count, so thats why shes sending me to the hematologist so they can look into it further. This was slightly off-putting to me because I expected the answer to be my vegetarianism because thats what Ive always assumed. It possibly being related to another underlying issue has been bothering me a little bit. On the appointment details, she noted: Thrombocytopenia (chronic), Leukopenia (chronic), and iron deficiency anemia secondary to inadequate dietary iron intake.Fast forward to today and I get an update from my doctors office that theyre still in the process of making the referral to the hematologist. They let me know the referral request was sent to our local cancer center. Normally, I dont really worry about stuff like this unless given reason to worry. Im aware that hematologists often work at cancer centers so Im assuming thats why she referred me there. It just has me slightly on edge because my dad goes there for his chemotherapy. The type of cancer he has isnt hereditary, but its still a little concerning to get referred to the same place where your dad got diagnosed with cancer and is getting treatment. My grandma has leukemia and also goes there to have it monitored. Im not sure if hers is hereditary or not.When I was researching leukopenia a little bit more and its possible causes, another thing thats bothered me a little bit is that I dont really see much of a link to iron deficiency anemia like I originally thought. So I'm not sure what could be causing it. I saw that low B12 can, but my B12 levels were checked last year and they were pretty good. My WBC was even on the low side then. Other details is that Im African American on my moms side and Mexican on my dads. I haven't had folate or copper tested, so maybe a deficiency? I also recently found out that my paternal great grandfather was a hemophiliac. Several people in my family have had cancer.Anyway, heres my recent bloodwork. I was wondering if anyone has any input on what this could mean to put my mind at ease while I wait for my hematology appointment.https://imgur.com/a/63OzoXP. ### Response: Your physician did the exact correct thing to refer you to hematology. The low platelets and white blood cells could be from many things. I agree that anemia is most certainly from iron deficiency. Given your ethnicity, low WBCs can sometimes be familial and we do see this more in the Black and Hispanic population. I am unsure why your platelets are low and this needs to be worked up. Leukemia is not hereditary. Hemophilia is hereditary and sometimes acquired but usually the former. Please let hematology know about this family history. You may also want to ask your mother if there is any history of sickle cell in her family given race.There is testing that can be done for folate and b12 deficiency but these levels (even when low) rarely affect WBC or platelet count. Based on your labs, there isn't anything that screams something ominous like cancer. Maybe autoimmune if anything as we see chronic non-life threatening low cell counts in these patients often.


Instruction: 32F, Fatigue, Migraines, Mild Bradycardia, Mild Anemia,Hi Reddit,My girlfriend has chronic fatigue, migraines, weakness, dizziness, and occasional stomach pains which cause her to be unable to work or leave the home somewhere around 1 in 4 days. She has been to several doctors who all use a very compartmentalized approach that simply finds nothing. Getting her to go to more doctors is a challenge, partly because of the fatigue but also because it seems to go nowhere (and I can't blame her). Here's the medical history as we've found it so far:Basic InfoWhite female32 years oldBorn Russia living in United States5'2", 95 lbs.No tobacco, vape user, moderate drinkerLittle useful family historySymptomsMigraines and other headaches, 1-2x/wk, varying in response to NSAIDs and triptans (sometimes helps, sometimes doesn't)Often feels dizzy or says room goes black when she "stands up too fast"Can also black out under substantial stressCold hands/feet that she sometimes complains are numbLast year had several instances of extremely severe stomach pain, once resulting in hospitalization (has no reoccurred this year), no cause foundFatigue 3-5x/month severe enough to not leave home even without complaints of headacheDepression, PTSD-like symptoms from childhood traumaRecently measured heart rate of 57 bpm in eveningDiagnostics AttemptedHead and abdomen CT & MRI, negativeColonoscopy, Dx: gastritis, recommended treat with PPI and dietBloodwork, positive results: mild anemia (says all bloodwork since childhood was same), mild vitamin D defBloodwork, negative results: CBC and other basic hematology, thyroid issues, Lyme diseaseRx / TreatmentNexplanon implant (~2 years)J&J corona vax, 3/2020, no boost (previous infection: Delta)Bupropion + psychotherapy for depressionVitamin DIbuprofen and/or triptans for migrainesAdd'l InfoOften has trouble sleeping at night, ends up sleeping in morning until early afternoonDiet could be better (eats at random times, often not the healthiest foods)Does not exercise (dislikes running, weight lifting, outdoor activities in sun/heat)Stress seems to trigger episodes but can happen even without stress triggerAnyone have any idea what to try next for diagnostics? The reading of 57 bpm is a newer symptom and was contemporaneous with the cold/numb extremities, so perhaps some kind of cardiology workup? Having a partner that is constantly sick with no idea what's going on is stressing us and our relationship, but more importantly worries me that something significant may be being missed.

Output: HR of 57 is normal.I know you said doctors have used a very compartmentalised approach, but I would actually use the term thorough.Incredibly so. While I appreciate how frustrating it can be for all of these things to come back negative, it is reassuring that theres no gross medical abnormality.The tests she has had are all incredibly sensitive and have even been repeated in different modalities, so the chance something has been missed is slim to none.I strongly suspect that what youre seeing is the effects of a functional disorder. With a functional disorder, there is no physical pathology resulting in symptoms. Rather, the symptoms are a manifestation of psychological trauma and/or psychiatric issues; two things that we know your partner unfortunately has.It is important to note that these symptoms are incredible real for the individual, even in the absence of physical pathology. This is not faking in any way.Your partners history is highly typical of this: general, multi-system symptoms with normal investigations.The management of these conditions is challenging. When theres a physical pathology, we can target it. When there isnt, theres nothing physical for us to target.That leaves us with the non-physical targets, which in this case is psychology/psychiatry. The most effective treatment for functional disorders with a known mental health history is treatment of said mental health history through a combination of medical and talking therapies.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 32F, Fatigue, Migraines, Mild Bradycardia, Mild Anemia,Hi Reddit,My girlfriend has chronic fatigue, migraines, weakness, dizziness, and occasional stomach pains which cause her to be unable to work or leave the home somewhere around 1 in 4 days. She has been to several doctors who all use a very compartmentalized approach that simply finds nothing. Getting her to go to more doctors is a challenge, partly because of the fatigue but also because it seems to go nowhere (and I can't blame her). Here's the medical history as we've found it so far:Basic InfoWhite female32 years oldBorn Russia living in United States5'2", 95 lbs.No tobacco, vape user, moderate drinkerLittle useful family historySymptomsMigraines and other headaches, 1-2x/wk, varying in response to NSAIDs and triptans (sometimes helps, sometimes doesn't)Often feels dizzy or says room goes black when she "stands up too fast"Can also black out under substantial stressCold hands/feet that she sometimes complains are numbLast year had several instances of extremely severe stomach pain, once resulting in hospitalization (has no reoccurred this year), no cause foundFatigue 3-5x/month severe enough to not leave home even without complaints of headacheDepression, PTSD-like symptoms from childhood traumaRecently measured heart rate of 57 bpm in eveningDiagnostics AttemptedHead and abdomen CT & MRI, negativeColonoscopy, Dx: gastritis, recommended treat with PPI and dietBloodwork, positive results: mild anemia (says all bloodwork since childhood was same), mild vitamin D defBloodwork, negative results: CBC and other basic hematology, thyroid issues, Lyme diseaseRx / TreatmentNexplanon implant (~2 years)J&J corona vax, 3/2020, no boost (previous infection: Delta)Bupropion + psychotherapy for depressionVitamin DIbuprofen and/or triptans for migrainesAdd'l InfoOften has trouble sleeping at night, ends up sleeping in morning until early afternoonDiet could be better (eats at random times, often not the healthiest foods)Does not exercise (dislikes running, weight lifting, outdoor activities in sun/heat)Stress seems to trigger episodes but can happen even without stress triggerAnyone have any idea what to try next for diagnostics? The reading of 57 bpm is a newer symptom and was contemporaneous with the cold/numb extremities, so perhaps some kind of cardiology workup? Having a partner that is constantly sick with no idea what's going on is stressing us and our relationship, but more importantly worries me that something significant may be being missed.. ### Response: HR of 57 is normal.I know you said doctors have used a very compartmentalised approach, but I would actually use the term thorough.Incredibly so. While I appreciate how frustrating it can be for all of these things to come back negative, it is reassuring that theres no gross medical abnormality.The tests she has had are all incredibly sensitive and have even been repeated in different modalities, so the chance something has been missed is slim to none.I strongly suspect that what youre seeing is the effects of a functional disorder. With a functional disorder, there is no physical pathology resulting in symptoms. Rather, the symptoms are a manifestation of psychological trauma and/or psychiatric issues; two things that we know your partner unfortunately has.It is important to note that these symptoms are incredible real for the individual, even in the absence of physical pathology. This is not faking in any way.Your partners history is highly typical of this: general, multi-system symptoms with normal investigations.The management of these conditions is challenging. When theres a physical pathology, we can target it. When there isnt, theres nothing physical for us to target.That leaves us with the non-physical targets, which in this case is psychology/psychiatry. The most effective treatment for functional disorders with a known mental health history is treatment of said mental health history through a combination of medical and talking therapies..


Instruction: Psoriatic Arthritis and Taking Methotrexate: Blood Work Comments[31][F], 5'2" 90 lbs, white and Hispanic, biologic taken, no longer taking Methotrexate with psoriatic arthritis. No drinking or smoking.My rheumatologist is taking me off Methotrexate due to my blood work, in conjunction with me feeling absolutely awful.Can a doctor please explain why those comments on the two blood results were written? Is it that serious? Meaning--my doctor wants me to take a repeat. What is concerning?I attached the photos w/ Imgur:https://imgur.com/a/FDmJ7A0"RBC01 3.49 Low 3.62 07/23/2021 x10E6/uL 3.77-5.28 Macrocytes present. Anisocytosis present."" Neutrophils (Absolute) 01 1.0 Low "" Alkaline Phosphatase01 128 High 76* 07/23/2021 IU/L 44-121 AST (SGOT) 01 70 High 29 07/23/2021 IU/L 0-4 ": Hematology Comments: Verified by microscopic examination"

Output: Youve got a macrocytic anemia, likely due to the methotrexate causing a folate deficiency basically the blood cells are bigger than normal and not developing properly.The anisocytosis just means you have a variety of different sized RBCs, meaning its likely that you are within 90 days of when the assumed folate deficiency started - blood cells live on average about 90 days so you either have a mild deficiency or its somewhat new.Neutrophils can be low for many reasons, its not at a super worrisome level but couple with the anemia its likely partially due to one of the multiple mechanisms of immune suppression from methotrexate.Alk phos/ALT/AST are liver function tests, its just saying theyre slightly elevated. Overall not super worrisome levels but again likely due to cytotoxic effects from methotrexate.Its more so they dont want you to GET bad rather than the labs ARE bad. They are borderline right now but when you have a known drug causing it, you want to stop it sooner than later. They are likely just recheckingnit to make sure they dont need to do further intervention to prevent worsening effects and ensure your body is recovering before they would try an alternative therapy or restart the current therapy if absolutely needed.Definitely a conversation to have with them for more details, not a rheumatologist so I dont know all the cytotoxic effects of methotrexate off the top of my head.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Psoriatic Arthritis and Taking Methotrexate: Blood Work Comments[31][F], 5'2" 90 lbs, white and Hispanic, biologic taken, no longer taking Methotrexate with psoriatic arthritis. No drinking or smoking.My rheumatologist is taking me off Methotrexate due to my blood work, in conjunction with me feeling absolutely awful.Can a doctor please explain why those comments on the two blood results were written? Is it that serious? Meaning--my doctor wants me to take a repeat. What is concerning?I attached the photos w/ Imgur:https://imgur.com/a/FDmJ7A0"RBC01 3.49 Low 3.62 07/23/2021 x10E6/uL 3.77-5.28 Macrocytes present. Anisocytosis present."" Neutrophils (Absolute) 01 1.0 Low "" Alkaline Phosphatase01 128 High 76* 07/23/2021 IU/L 44-121 AST (SGOT) 01 70 High 29 07/23/2021 IU/L 0-4 ": Hematology Comments: Verified by microscopic examination". ### Response: Youve got a macrocytic anemia, likely due to the methotrexate causing a folate deficiency basically the blood cells are bigger than normal and not developing properly.The anisocytosis just means you have a variety of different sized RBCs, meaning its likely that you are within 90 days of when the assumed folate deficiency started - blood cells live on average about 90 days so you either have a mild deficiency or its somewhat new.Neutrophils can be low for many reasons, its not at a super worrisome level but couple with the anemia its likely partially due to one of the multiple mechanisms of immune suppression from methotrexate.Alk phos/ALT/AST are liver function tests, its just saying theyre slightly elevated. Overall not super worrisome levels but again likely due to cytotoxic effects from methotrexate.Its more so they dont want you to GET bad rather than the labs ARE bad. They are borderline right now but when you have a known drug causing it, you want to stop it sooner than later. They are likely just recheckingnit to make sure they dont need to do further intervention to prevent worsening effects and ensure your body is recovering before they would try an alternative therapy or restart the current therapy if absolutely needed.Definitely a conversation to have with them for more details, not a rheumatologist so I dont know all the cytotoxic effects of methotrexate off the top of my head..


Instruction: Persistent elevated platelets35F, I have had platelet counts consistently ~500 for the past several months, on multiple repeat test. No other abnormalities on CBC. I have seen a hematologist and done several followup tests: no iron deficiency, no JAK2, CALR, MPL or BCR-ABL mutations. I had an abdominal ultrasound which showed normal spleen (incidentally found some gallstones). I take Wellbutrin 150mg and Lamotrigine 200mg. My last normal platelet count was in 2017, at 375.My question is like....do I need to pursue this further, and how? My hematologist wants to do a bone marrow biopsy but is unclear on what she expects it might find given my other results. My primary care doctor seems completely unconcerned (I checked back in after hematology and he just said "I think that is all.") I, of course, have done a thorough google and read all about the association with cancer, and given that no more benign cause has come up I've gotten pretty worried, but I don't know how much that's something I need to think about at my age/without any other specific symptoms. Can you just have higher platelets for no reason, or is it something I need to keep looking into?

Output: Hematology could go either way - biopsy or no biopsy. Without symptoms, many would opt for no biopsy and monitor. Some would be more aggressive and do the biopsy because 10% of those with thrombocytosis secondary to a myeloproliferative disorder lack mutations. So theyd essentially be looking for an MPN. You could go either way and set a limit eg do a bone marrow if they keep rising or hit a certain number, you develop symptoms or other cell counts are abnormal.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Persistent elevated platelets35F, I have had platelet counts consistently ~500 for the past several months, on multiple repeat test. No other abnormalities on CBC. I have seen a hematologist and done several followup tests: no iron deficiency, no JAK2, CALR, MPL or BCR-ABL mutations. I had an abdominal ultrasound which showed normal spleen (incidentally found some gallstones). I take Wellbutrin 150mg and Lamotrigine 200mg. My last normal platelet count was in 2017, at 375.My question is like....do I need to pursue this further, and how? My hematologist wants to do a bone marrow biopsy but is unclear on what she expects it might find given my other results. My primary care doctor seems completely unconcerned (I checked back in after hematology and he just said "I think that is all.") I, of course, have done a thorough google and read all about the association with cancer, and given that no more benign cause has come up I've gotten pretty worried, but I don't know how much that's something I need to think about at my age/without any other specific symptoms. Can you just have higher platelets for no reason, or is it something I need to keep looking into?. ### Response: Hematology could go either way - biopsy or no biopsy. Without symptoms, many would opt for no biopsy and monitor. Some would be more aggressive and do the biopsy because 10% of those with thrombocytosis secondary to a myeloproliferative disorder lack mutations. So theyd essentially be looking for an MPN. You could go either way and set a limit eg do a bone marrow if they keep rising or hit a certain number, you develop symptoms or other cell counts are abnormal..


Instruction: Thanks for this! My hematologist wants to do the biposy, but the only thing she's talking about finding at this point is essential thrombocytosis, and if I had that we would just be doing regular labs to monitor it since I'm young and low risk. I'm already doing labs frequently to monitor the unexplained result, so for my money I'd rather put it off unless something more suspicious does come up. Glad to hear that's not insane

Output: Just want to say that this advice shouldnt be substituted for your hematologists recommendations. Id discuss some of the suggestions mentioned and see if she is amenable to monitoring. She may have more information than I do about your situation as well eg low cell counts etc. that I am not privy to and this may change course of care.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thanks for this! My hematologist wants to do the biposy, but the only thing she's talking about finding at this point is essential thrombocytosis, and if I had that we would just be doing regular labs to monitor it since I'm young and low risk. I'm already doing labs frequently to monitor the unexplained result, so for my money I'd rather put it off unless something more suspicious does come up. Glad to hear that's not insane. ### Response: Just want to say that this advice shouldnt be substituted for your hematologists recommendations. Id discuss some of the suggestions mentioned and see if she is amenable to monitoring. She may have more information than I do about your situation as well eg low cell counts etc. that I am not privy to and this may change course of care..


Instruction: Recurring severe petechiae on 5f, multiple doctors confusedMy daughter 5F Caucasian. No significant medical history. She has had recurring petechiae on her elbows and occasionally knees for approximately 3 months. She is otherwise very healthy and full of energy. The petechiae occur mostly while she is at school, always on predominantly left elbow with occasional right elbow and knees. They do not occur every single school day, but most days with varying severity.She has visited multiple GPs and a pediatric hematology specialist; none of these have been able to find an explanation. She has had multiple complete blood counts, clotting factor tests, and other bloodwork taken. Platelets, red blood cells, white blood cells completely within good normal ranges. All other tests returned completely normal findings aside from marginally low ferritin and fibrinogen. The hematologist said neither of these were of concern to her.Some images of the petechiae on various days recently:https://imgur.com/a/OHKjDtlAny ideas would be very much appreciated.EDIT: Sorry, I forgot to include this information! They are non blanching and totally flat. Non itchy. They go away within about 24 to 48 hours, only for new ones to appear.The doctors have generally identified them as petechiae, but can't determine a cause.

Output: Sometimes skin biopsy can help with to diagnose conditions such as this.They looks raised and scaly. Can you run your finger over them with your eyes closed and feel them?Petechiae are generally considered to be less than 2 mm, and these are larger than that. I wouldn't describe it as petechial. Maybe purpura, but I can't tell if it's blanching.Does it itch?Pediatric psoriasis can look similar to this and occur on the extensor surfaces.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Recurring severe petechiae on 5f, multiple doctors confusedMy daughter 5F Caucasian. No significant medical history. She has had recurring petechiae on her elbows and occasionally knees for approximately 3 months. She is otherwise very healthy and full of energy. The petechiae occur mostly while she is at school, always on predominantly left elbow with occasional right elbow and knees. They do not occur every single school day, but most days with varying severity.She has visited multiple GPs and a pediatric hematology specialist; none of these have been able to find an explanation. She has had multiple complete blood counts, clotting factor tests, and other bloodwork taken. Platelets, red blood cells, white blood cells completely within good normal ranges. All other tests returned completely normal findings aside from marginally low ferritin and fibrinogen. The hematologist said neither of these were of concern to her.Some images of the petechiae on various days recently:https://imgur.com/a/OHKjDtlAny ideas would be very much appreciated.EDIT: Sorry, I forgot to include this information! They are non blanching and totally flat. Non itchy. They go away within about 24 to 48 hours, only for new ones to appear.The doctors have generally identified them as petechiae, but can't determine a cause.. ### Response: Sometimes skin biopsy can help with to diagnose conditions such as this.They looks raised and scaly. Can you run your finger over them with your eyes closed and feel them?Petechiae are generally considered to be less than 2 mm, and these are larger than that. I wouldn't describe it as petechial. Maybe purpura, but I can't tell if it's blanching.Does it itch?Pediatric psoriasis can look similar to this and occur on the extensor surfaces..


Instruction: Sorry, I forgot to include this information! They are non itchy and non blanching.

Output: Are they flat, or can you feel them.They're totally flat; not raised or bumpy.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Sorry, I forgot to include this information! They are non itchy and non blanching.. ### Response: Are they flat, or can you feel them.They're totally flat; not raised or bumpy..


Instruction: Iron/vitamin D low even when supplementing?26F, 133lbs, 56 Non-smoker, no recreational or pharmaceutical drugs.I recently had my ferritin retested as Im supplementing to raise my levels. Around a year ago it was 44 (ug/L) and now after taking supplements every other day its gone down to 26. My vitamin D (I take between 2000 to 4000 daily depending on the weather) is the exact same at 92 (nmol/L).Additionally looking at my blood work results my TSH went from 2.62 mIU/L to 1.29. My hematology/differentials are also all on the lower side and my MCH was flagged by the lab.All this being said, my doctor assured me my bloodwork is fine (I dont feel fine hence the bloodwork). Hoping to gain some insight into what could be causing this please.

Output: Make sure you take Iron with OJ/Vitamin C and Vitamin D with food.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Iron/vitamin D low even when supplementing?26F, 133lbs, 56 Non-smoker, no recreational or pharmaceutical drugs.I recently had my ferritin retested as Im supplementing to raise my levels. Around a year ago it was 44 (ug/L) and now after taking supplements every other day its gone down to 26. My vitamin D (I take between 2000 to 4000 daily depending on the weather) is the exact same at 92 (nmol/L).Additionally looking at my blood work results my TSH went from 2.62 mIU/L to 1.29. My hematology/differentials are also all on the lower side and my MCH was flagged by the lab.All this being said, my doctor assured me my bloodwork is fine (I dont feel fine hence the bloodwork). Hoping to gain some insight into what could be causing this please.. ### Response: Make sure you take Iron with OJ/Vitamin C and Vitamin D with food..


Instruction: I do both these things!

Output: Hey there. Lots to unpack so I'm gonna do this in bullet points.You didn't post your hemoglobin. Your hemoglobin should be going up with iron supplementation. Ferritin too, but I guess as an interested third party I wonder what it is, and what it was.your differentials are allowed to be all over the place, it's just the population breakdown of your white blood cells. It's constantly in flux as cells die and are born. I suggest paying less attention to this.your TSH is still within normal. Secondly a low TSH generally means your thyroid is not needing any more stimulation. I suggest paying less attention to this.vitamin d can be supplemented more aggressively I suppose. It is near normal.MCH is a completely and totally irrelevant lab valueI'm not really sure what symptoms you're having. From where I sit this feels like we're treating numbers that are irrelevant. I'd humbly suggest you stop looking at the labs so closely as I don't think they're holding the answers you seek. I'm not saying that your symptoms are irrelevant, but I am saying that these tests hold no explanation for any symptomatology.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I do both these things!. ### Response: Hey there. Lots to unpack so I'm gonna do this in bullet points.You didn't post your hemoglobin. Your hemoglobin should be going up with iron supplementation. Ferritin too, but I guess as an interested third party I wonder what it is, and what it was.your differentials are allowed to be all over the place, it's just the population breakdown of your white blood cells. It's constantly in flux as cells die and are born. I suggest paying less attention to this.your TSH is still within normal. Secondly a low TSH generally means your thyroid is not needing any more stimulation. I suggest paying less attention to this.vitamin d can be supplemented more aggressively I suppose. It is near normal.MCH is a completely and totally irrelevant lab valueI'm not really sure what symptoms you're having. From where I sit this feels like we're treating numbers that are irrelevant. I'd humbly suggest you stop looking at the labs so closely as I don't think they're holding the answers you seek. I'm not saying that your symptoms are irrelevant, but I am saying that these tests hold no explanation for any symptomatology..


Instruction: Sorry about that - hemoglobin was 126 g/L exactly a year ago, 124 g/L now.Happy to expand on the rest. I deal with near constant fatigue and hormonal issues like hair loss, hirsutism, abdominal pain, and digestive issues.

Output: Awesome, thanks for posting. Unfortunately, your symptoms are not very specific for one thing. This means they can be explained by a lot of different conditions. That's what makes them so frustrating-- they're not obvious and that can sometimes get your team challenged. I think that's sometimes why young otherwise healthy women get told it's anxiety. I'm sorry in advance if that's happened. You mention hair loss, abdominal pain, and digestive issues. These together make me think about vitamin deficiencies and malabsorption syndromes. Hair loss alone can also be autoimmune in nature. You'd need to expand more on the GI issues for me to say something meaningful. I think all my recommendations are going to be low quality because I can't have a sit down session to discuss all your symptoms at length (eg what type of GI symptoms, any other autoimmune symptoms).Most vitamins are not on routine labs, and you need to test specific vitamin levels based on the disease you suspect is afoot (which is why we usually start with the history of the disease before we go to look at labs). Do you have any history of abnormal eating patterns, like eating disorders in your past (or present)? If so, that's where to start. If not, I think we might need to go down the route of testing for malabsorption. Fat in the stool (steatorrhea, you can google that, NSFW obvs) is usually a good clue for malabsorption to start with. There are some skin rashes that people get from certain malabsorptions as well, so it might be worth doing a skin check.As a random doc on a computer I'd probably send you to a GI doc to discuss your gi issues at length and evaluate for malabsorption. Even if we are sure that's the issue, though, there are still many conditions that can cause it. If it's not the issue (and again, sorry, these symptoms are not too specific so sometimes a lot of trial and error is involved) it may be worth discussing with a rheumatologist. Your primary doctor can also evaluate generally for rheumatic diseases.On the note of your primary doc, it sounds like you may not have a working relationship. I'm an advocate of switching docs until you find one who seems to be listening and has good open lines of communication with you.Iron itself is kinda a tricky one to get right. Bodies generally don't love iron (in fact we make a concerted effort to not absorb it). You could try taking your dose every 48 hours as one trick (when your body sees oral iron daily it gets more resistant to iron absorption). However, I don't know that is the answer for any of your issues, which is why I first suggested against looking at these labs too closely.Sorry to be long winded - internal medicine people usually are. As a first step, I'd go to a GI specialist to discuss these gi symptoms, stomach pain, and hair loss together as a possible malabsorption phenomenon.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Sorry about that - hemoglobin was 126 g/L exactly a year ago, 124 g/L now.Happy to expand on the rest. I deal with near constant fatigue and hormonal issues like hair loss, hirsutism, abdominal pain, and digestive issues.. ### Response: Awesome, thanks for posting. Unfortunately, your symptoms are not very specific for one thing. This means they can be explained by a lot of different conditions. That's what makes them so frustrating-- they're not obvious and that can sometimes get your team challenged. I think that's sometimes why young otherwise healthy women get told it's anxiety. I'm sorry in advance if that's happened. You mention hair loss, abdominal pain, and digestive issues. These together make me think about vitamin deficiencies and malabsorption syndromes. Hair loss alone can also be autoimmune in nature. You'd need to expand more on the GI issues for me to say something meaningful. I think all my recommendations are going to be low quality because I can't have a sit down session to discuss all your symptoms at length (eg what type of GI symptoms, any other autoimmune symptoms).Most vitamins are not on routine labs, and you need to test specific vitamin levels based on the disease you suspect is afoot (which is why we usually start with the history of the disease before we go to look at labs). Do you have any history of abnormal eating patterns, like eating disorders in your past (or present)? If so, that's where to start. If not, I think we might need to go down the route of testing for malabsorption. Fat in the stool (steatorrhea, you can google that, NSFW obvs) is usually a good clue for malabsorption to start with. There are some skin rashes that people get from certain malabsorptions as well, so it might be worth doing a skin check.As a random doc on a computer I'd probably send you to a GI doc to discuss your gi issues at length and evaluate for malabsorption. Even if we are sure that's the issue, though, there are still many conditions that can cause it. If it's not the issue (and again, sorry, these symptoms are not too specific so sometimes a lot of trial and error is involved) it may be worth discussing with a rheumatologist. Your primary doctor can also evaluate generally for rheumatic diseases.On the note of your primary doc, it sounds like you may not have a working relationship. I'm an advocate of switching docs until you find one who seems to be listening and has good open lines of communication with you.Iron itself is kinda a tricky one to get right. Bodies generally don't love iron (in fact we make a concerted effort to not absorb it). You could try taking your dose every 48 hours as one trick (when your body sees oral iron daily it gets more resistant to iron absorption). However, I don't know that is the answer for any of your issues, which is why I first suggested against looking at these labs too closely.Sorry to be long winded - internal medicine people usually are. As a first step, I'd go to a GI specialist to discuss these gi symptoms, stomach pain, and hair loss together as a possible malabsorption phenomenon..


Instruction: 24F, feeling very sick after accidentally inhaling a lot of fumes from rotten potatoes. Could I have solanine poisoning?24F, 56, 111 pounds, Caucasian, never smoked, almost never drink, no recreational drugs, located in Charleston, SC. History of Ehlers-Danlos Syndrome type III along with a number of comorbidities, including cardiovascular and gastrointestinal issues. More details on medical history at end of post.There has been a smell coming from my pantry for the last several days that I havent been able to identify. Today, I opened the door and just got hit with this wall of fumes, and I decided enough was enough. I spent about half an hour tearing it apart and smelling every single thing in it. By the time I identified the potatoes and threw them out, I was feeling pretty terrible. My head kills, Im super nauseous, and Im having chest pains.I looked it up online and read that rotten potato fumes can be extremely toxic, but its hard to tell if Im feeling awful because of toxins or because the smell and activity triggered flares of my pre-existing conditions (see below). Its not uncommon for me to experience chest pains just from walking around the kitchen for a while, and I have a headache and nausea for the better part of most days as it is. It feels worse than normal, but not so much worse that it couldnt be a heightened version of the regular stuff.That being said, I have been experiencing some other unexplained symptoms over the last few weeks that I wonder might have been caused by inhaling the fumes before they were as noticeable. Ive been experiencing random spikes in temperature (99.6-100) that last for about 12-18 hours, go away, and then pop back up again a few days later. Ive also lost weight (from 122 to 111 in less than a month) with no changes in diet, and Ive had pretty bad diarrhea and abdominal pain too (mostly upper right, but it kinda moves around). Ive also had really bad dry eyes and dry mouth. (My rheumatologist has suspected Sjogrens for a while and ordered a lip biopsy recently, so thats happening soon.) I also have had a sore throat (kinda burns, probably related to dry mouth) and swollen glands.I have an unrelated diagnostic laparoscopy scheduled for next month, and theyre going to test me for covid before that. I dont think I have covid, and neither does my doctor. Mostly because the fever has been so off-and-on, and Ive had no cough at all. But Ill be tested in the next few weeks regardless.I just dont know how to tell whether the worsened symptoms Im experiencing should be worrying me or not. I sent a message to my doctor, but the office doesnt open for several hours, and she probably wont see my message until the end of the work day anyway (thats the time of day she usually sends me messages). If theres a chance Im experiencing poisoning, what steps should I take to manage it until I hear from my doctor?Health issues: EDS (type III), POTS, mitral valve prolapse, MCAS, pernicious anemia, gastroparesis, IBD, GERD, interstitial cystitis, idiopathic hypersomnolence, small fiber neuropathy, cervical instability, scoliosis, kyphosis, tortuous colon, vestibular adenitis (two past surgeries for this), and unexplained eosinophilia (pending hematology referral). Suspected esophageal dysmotility (doctor wanted to do a manometry, but I declined because it sounds awful, so this is unconfirmed). Suspected endometriosis (pending laparoscopy). Suspected Sjogrens (pending lip biopsy).Meds:Ditropan (10 mg/day), Metoprolol (75 mg/day), Nexium (80 mg/day), Sunosi (150 mg/day), B12 (1000 mg/day), Nexplanon birth control implantI have had no recent changes in meds apart from my cardiologist upping my metoprolol from 50 to 75 mg/day because Ive been dealing with shortness of breath, presyncope, and chest pains more often than normal lately due to inactivity (thanks, quarantine).Any advice would be greatly appreciated. Thank you!

Output: You didnt ingest these? Typically large amounts in children of old potatoes could cause GI symptoms and some central nervous system issues. I would be surprised if the smell alone caused your symptoms and I doubt its connection to your undulating fevers. I am doubtful your symptoms are directly caused by the cleaning and smell. Perhaps it was irritating and triggering nausea, but without ingestion youre unlikely to be poisoned from potatoes.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 24F, feeling very sick after accidentally inhaling a lot of fumes from rotten potatoes. Could I have solanine poisoning?24F, 56, 111 pounds, Caucasian, never smoked, almost never drink, no recreational drugs, located in Charleston, SC. History of Ehlers-Danlos Syndrome type III along with a number of comorbidities, including cardiovascular and gastrointestinal issues. More details on medical history at end of post.There has been a smell coming from my pantry for the last several days that I havent been able to identify. Today, I opened the door and just got hit with this wall of fumes, and I decided enough was enough. I spent about half an hour tearing it apart and smelling every single thing in it. By the time I identified the potatoes and threw them out, I was feeling pretty terrible. My head kills, Im super nauseous, and Im having chest pains.I looked it up online and read that rotten potato fumes can be extremely toxic, but its hard to tell if Im feeling awful because of toxins or because the smell and activity triggered flares of my pre-existing conditions (see below). Its not uncommon for me to experience chest pains just from walking around the kitchen for a while, and I have a headache and nausea for the better part of most days as it is. It feels worse than normal, but not so much worse that it couldnt be a heightened version of the regular stuff.That being said, I have been experiencing some other unexplained symptoms over the last few weeks that I wonder might have been caused by inhaling the fumes before they were as noticeable. Ive been experiencing random spikes in temperature (99.6-100) that last for about 12-18 hours, go away, and then pop back up again a few days later. Ive also lost weight (from 122 to 111 in less than a month) with no changes in diet, and Ive had pretty bad diarrhea and abdominal pain too (mostly upper right, but it kinda moves around). Ive also had really bad dry eyes and dry mouth. (My rheumatologist has suspected Sjogrens for a while and ordered a lip biopsy recently, so thats happening soon.) I also have had a sore throat (kinda burns, probably related to dry mouth) and swollen glands.I have an unrelated diagnostic laparoscopy scheduled for next month, and theyre going to test me for covid before that. I dont think I have covid, and neither does my doctor. Mostly because the fever has been so off-and-on, and Ive had no cough at all. But Ill be tested in the next few weeks regardless.I just dont know how to tell whether the worsened symptoms Im experiencing should be worrying me or not. I sent a message to my doctor, but the office doesnt open for several hours, and she probably wont see my message until the end of the work day anyway (thats the time of day she usually sends me messages). If theres a chance Im experiencing poisoning, what steps should I take to manage it until I hear from my doctor?Health issues: EDS (type III), POTS, mitral valve prolapse, MCAS, pernicious anemia, gastroparesis, IBD, GERD, interstitial cystitis, idiopathic hypersomnolence, small fiber neuropathy, cervical instability, scoliosis, kyphosis, tortuous colon, vestibular adenitis (two past surgeries for this), and unexplained eosinophilia (pending hematology referral). Suspected esophageal dysmotility (doctor wanted to do a manometry, but I declined because it sounds awful, so this is unconfirmed). Suspected endometriosis (pending laparoscopy). Suspected Sjogrens (pending lip biopsy).Meds:Ditropan (10 mg/day), Metoprolol (75 mg/day), Nexium (80 mg/day), Sunosi (150 mg/day), B12 (1000 mg/day), Nexplanon birth control implantI have had no recent changes in meds apart from my cardiologist upping my metoprolol from 50 to 75 mg/day because Ive been dealing with shortness of breath, presyncope, and chest pains more often than normal lately due to inactivity (thanks, quarantine).Any advice would be greatly appreciated. Thank you!. ### Response: You didnt ingest these? Typically large amounts in children of old potatoes could cause GI symptoms and some central nervous system issues. I would be surprised if the smell alone caused your symptoms and I doubt its connection to your undulating fevers. I am doubtful your symptoms are directly caused by the cleaning and smell. Perhaps it was irritating and triggering nausea, but without ingestion youre unlikely to be poisoned from potatoes..