Instruction: Some discussion on liver lesions? Hi guys!So I went to the ER a week ago with pain in RUQ after lager. The doctors thought it was gallstones or gastritis and wanted an ultrasound - it came back with a 5.4cm lesion on my liver. I then went for an MRI, the ER doc said it didnt look benign or a cyst and wanted to admit me for more investigation. I also had a CT scan and they don't have much information on it. My bloods are normal also. My symtpoms include; extreme fatigue, right shoulder pain, stomach bloating, 8 weeks PV bleeding with black blood(they are investigating this too), and severe itching on legs. I know due to my age its most likely not cancerous as I'm only 26. But there is cancer in the family too. I was meant to be there for a biopsy this morning but the consultant (gastro) wanted to cancel it and get a second opinion on my scans from a hematology clinic before a biopsy.I just wanted to bounce this off people for your thoughts. I'm not asking for anyone to diagnose me as I know its up to the medical professionals. But I just want to see what people think

Output: Much more information needed here - I'd suggest posting the radiologist report from all the imaging, all bloodwork results, etc.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Some discussion on liver lesions? Hi guys!So I went to the ER a week ago with pain in RUQ after lager. The doctors thought it was gallstones or gastritis and wanted an ultrasound - it came back with a 5.4cm lesion on my liver. I then went for an MRI, the ER doc said it didnt look benign or a cyst and wanted to admit me for more investigation. I also had a CT scan and they don't have much information on it. My bloods are normal also. My symtpoms include; extreme fatigue, right shoulder pain, stomach bloating, 8 weeks PV bleeding with black blood(they are investigating this too), and severe itching on legs. I know due to my age its most likely not cancerous as I'm only 26. But there is cancer in the family too. I was meant to be there for a biopsy this morning but the consultant (gastro) wanted to cancel it and get a second opinion on my scans from a hematology clinic before a biopsy.I just wanted to bounce this off people for your thoughts. I'm not asking for anyone to diagnose me as I know its up to the medical professionals. But I just want to see what people think. ### Response: Much more information needed here - I'd suggest posting the radiologist report from all the imaging, all bloodwork results, etc..


Instruction: 37M - MRI of Cervical Spine - "Diffusely low signal"Hi there,Having some MRIs done for some nerve issue i'm experiencing. Cervical spine MRI showed up fairly normal but I'm not entirely sure what this means."Diffusely low signal intensity marrow likely represents hematopoietic marrow. Hematological correlation is suggested."

Output: Usually adults have fatty bone marrow. Hematopoietic bone marrow can be an indirect sign of hematologic conditions. Hence the hematological correlation to make sure.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 37M - MRI of Cervical Spine - "Diffusely low signal"Hi there,Having some MRIs done for some nerve issue i'm experiencing. Cervical spine MRI showed up fairly normal but I'm not entirely sure what this means."Diffusely low signal intensity marrow likely represents hematopoietic marrow. Hematological correlation is suggested.". ### Response: Usually adults have fatty bone marrow. Hematopoietic bone marrow can be an indirect sign of hematologic conditions. Hence the hematological correlation to make sure..


Instruction: Thank you kindly. Hematopoietic is just various types of blood?

Output: Hematopoietic cells are the cells in our bone marrow that produce the blood cells

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you kindly. Hematopoietic is just various types of blood?. ### Response: Hematopoietic cells are the cells in our bone marrow that produce the blood cells.


Instruction: 68M Recurrent right sided nosebleeds resistant to treatment followed by respiratory infectionMy dad is a 68 year old Mexican (mestizo) male. At the time of his first nosebleed, he was diagnosed with diabetes, high cholesterol, and prehypertension. He's 5'6" and weights 180 pounds. He rarely drinks and doesn't smoke or use recreational drugs. He's prescribed metformin, insulin, aspirin, and lovastatin but refuses to use the last two. He also has arthritis in his elbows, for which his doctor tells him to use ibuprofen as needed. I don't know his cholesterol levels or A1C.About two weeks ago now, had a nosebleed (limited to the right nostril) for the first time in over 30 years while he was cleaning the garage. We asked him if he accidentally hit himself, scratched his nose, or sneezed but he insisted that it just started out of nowhere. Initially he was able to stop the bleeding but later that same day the bleeding resumed while he was moving some boxes (15-35lbs). We were unable to stop the bleeding and he went to the emergency room where they tried to stop the bleeding with Tranexamic acid and, after that failed, cocaine hydrochloride before ultimately applying an anterior nasal packing. His blood pressure was checked and it was high 143/83 but the doctor said it could be due to the stress of the situation and didn't warrant immediate treatment (side info, he had a heart rate of 85, low 60s seems to be normal for him). He was told to go back in two days to remove it and cauterize the affected area. He was also prescribed cephalexin (I'm assuming to prevent opportunistic infections). Apart from the nosebleed, he seemed fine. He was a little shook from the experience but was feeling good. No other symptoms.Two days later he went to get the nasal packing removed and the doctor determined nothing needed to be cauterized. My dad was told to be careful for a few days and to schedule an appointment with his PCP, which he did. He has that appointment later today. Two days after getting the nasal packing removed, he woke up with a bloody nose that he was unable to stop. He went to the ER again where they ended up cauterizing his nose. He had some minor discomfort from the procedure but was fine otherwise. He was also referred to an ENT doctor and was able to schedule an appointment, but it's a month from now.Since then, he's experienced 1 more severe nosebleeding episode. He went to the ER and got it treated with lidocaine and since his blood pressure was higher 153/89, he was prescribed blood pressure medication (something starting with an an L -- I don't have the documents on hand). He was also given a nose clip and finally had some lab work done (cbc, complete metabolic panel, and prothrombin time test -- those results will probably be discussed today). He's since experienced two minor nosebleeding episodes that have been effectively treated at home. In addition, starting the day his nasal pack was removed he started experiencing symptoms of what appears to be a respiratory infection. This will be explained in the next paragraph.The day my dad got his nasal pack removed, he complained of discomfort in the nose and sinuses. Some discomfort was to be expected but the day after he started developing a sore throat which eventually progressed to a dry cough, headache, coughing fits and nocturnal fever (no thermometer available to record temperature). He went to urgent care which prescribed him prednisone and azithromycin. It's been two days since and there's been no change on his condition on that front. The illness appears to be communicable since my mom started displaying symptoms about 4 days after my dad. It's possible that he caught the bug during Easter since we had a small gathering (<8 people) though no one else was displaying symptoms at the time or has displayed symptoms since. My dad has been tested for both covid and the flu, for which he has tested negative. It's also possible he caught it while seeking treatment for his nosebleed due to the area of treatment but I'm wondering if the two could be interrelated.It's concerning that after having no nosebleed or symptomatic medical issues for so long (other than the diabetes), one would present so abruptly and severely without any physical trauma or changes in medicine or lifestyle habits. My questions would be what would be some of the most likely causes of nosebleeds in someone with his medical history (hypertension seems to be a big one)? His visit with the PCP is today. What would be some good things to bring up or ask about in his upcoming visit that his doctor might overlook but could be important?

Output: Hypertension does not cause nosebleeds, not does it prolong them. Except very rarely and dramatically they are not from an artery.The most common cause is actually nosepicking, so grill him more about this. Dry air, a cold, allergies and exposure to dust in his garage are other likely causes. Once you start getting them they tend to persist for a while. He is not on a blood thinner.While waiting for ENT he can use saline nasal spray to keep it moist, use a humidifier at night, and learn how to apply effective pressure to stop the bleeding.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 68M Recurrent right sided nosebleeds resistant to treatment followed by respiratory infectionMy dad is a 68 year old Mexican (mestizo) male. At the time of his first nosebleed, he was diagnosed with diabetes, high cholesterol, and prehypertension. He's 5'6" and weights 180 pounds. He rarely drinks and doesn't smoke or use recreational drugs. He's prescribed metformin, insulin, aspirin, and lovastatin but refuses to use the last two. He also has arthritis in his elbows, for which his doctor tells him to use ibuprofen as needed. I don't know his cholesterol levels or A1C.About two weeks ago now, had a nosebleed (limited to the right nostril) for the first time in over 30 years while he was cleaning the garage. We asked him if he accidentally hit himself, scratched his nose, or sneezed but he insisted that it just started out of nowhere. Initially he was able to stop the bleeding but later that same day the bleeding resumed while he was moving some boxes (15-35lbs). We were unable to stop the bleeding and he went to the emergency room where they tried to stop the bleeding with Tranexamic acid and, after that failed, cocaine hydrochloride before ultimately applying an anterior nasal packing. His blood pressure was checked and it was high 143/83 but the doctor said it could be due to the stress of the situation and didn't warrant immediate treatment (side info, he had a heart rate of 85, low 60s seems to be normal for him). He was told to go back in two days to remove it and cauterize the affected area. He was also prescribed cephalexin (I'm assuming to prevent opportunistic infections). Apart from the nosebleed, he seemed fine. He was a little shook from the experience but was feeling good. No other symptoms.Two days later he went to get the nasal packing removed and the doctor determined nothing needed to be cauterized. My dad was told to be careful for a few days and to schedule an appointment with his PCP, which he did. He has that appointment later today. Two days after getting the nasal packing removed, he woke up with a bloody nose that he was unable to stop. He went to the ER again where they ended up cauterizing his nose. He had some minor discomfort from the procedure but was fine otherwise. He was also referred to an ENT doctor and was able to schedule an appointment, but it's a month from now.Since then, he's experienced 1 more severe nosebleeding episode. He went to the ER and got it treated with lidocaine and since his blood pressure was higher 153/89, he was prescribed blood pressure medication (something starting with an an L -- I don't have the documents on hand). He was also given a nose clip and finally had some lab work done (cbc, complete metabolic panel, and prothrombin time test -- those results will probably be discussed today). He's since experienced two minor nosebleeding episodes that have been effectively treated at home. In addition, starting the day his nasal pack was removed he started experiencing symptoms of what appears to be a respiratory infection. This will be explained in the next paragraph.The day my dad got his nasal pack removed, he complained of discomfort in the nose and sinuses. Some discomfort was to be expected but the day after he started developing a sore throat which eventually progressed to a dry cough, headache, coughing fits and nocturnal fever (no thermometer available to record temperature). He went to urgent care which prescribed him prednisone and azithromycin. It's been two days since and there's been no change on his condition on that front. The illness appears to be communicable since my mom started displaying symptoms about 4 days after my dad. It's possible that he caught the bug during Easter since we had a small gathering (<8 people) though no one else was displaying symptoms at the time or has displayed symptoms since. My dad has been tested for both covid and the flu, for which he has tested negative. It's also possible he caught it while seeking treatment for his nosebleed due to the area of treatment but I'm wondering if the two could be interrelated.It's concerning that after having no nosebleed or symptomatic medical issues for so long (other than the diabetes), one would present so abruptly and severely without any physical trauma or changes in medicine or lifestyle habits. My questions would be what would be some of the most likely causes of nosebleeds in someone with his medical history (hypertension seems to be a big one)? His visit with the PCP is today. What would be some good things to bring up or ask about in his upcoming visit that his doctor might overlook but could be important?. ### Response: Hypertension does not cause nosebleeds, not does it prolong them. Except very rarely and dramatically they are not from an artery.The most common cause is actually nosepicking, so grill him more about this. Dry air, a cold, allergies and exposure to dust in his garage are other likely causes. Once you start getting them they tend to persist for a while. He is not on a blood thinner.While waiting for ENT he can use saline nasal spray to keep it moist, use a humidifier at night, and learn how to apply effective pressure to stop the bleeding..


Instruction: I guess one of the possible causes they explored during his first visit was nosebleed due to hypertensive crisis but yeah, it doesn't seem like the doctors think hypertension was the cause of his nosebleedsThe dust in the garage does seem like a likely culprit considering it had been two years since it had last been cleaned out. It's just alarming that a man that hasn't experienced a nosebleed in decades would suddenly have recurrent nosebleeds but it sounds like it's not too out of the ordinary to experience them in succession like that, so that's reassuringI'm sure his PCP will grill him about picking or rubbing his nose since he has a habit of doing that, though one would hope he'd be following the doctors' instructions to not touch the area after the first nosebleedWe'll get him a humidifier. Hopefully his visit with the PCP will provide answers or more specific questions

Output: It's usually from irritation in an area called Kiesselbach's plexus in the front of the nose. The ENT can cauterize this, usually helps. Noses bleed, it is very rarely a sign of cancer or hematologic disease.Rarely the sinus packing can cause a sinus infection. His symptoms sound more like a viral URI with the dry cough and sore throat plus infecting your mother.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I guess one of the possible causes they explored during his first visit was nosebleed due to hypertensive crisis but yeah, it doesn't seem like the doctors think hypertension was the cause of his nosebleedsThe dust in the garage does seem like a likely culprit considering it had been two years since it had last been cleaned out. It's just alarming that a man that hasn't experienced a nosebleed in decades would suddenly have recurrent nosebleeds but it sounds like it's not too out of the ordinary to experience them in succession like that, so that's reassuringI'm sure his PCP will grill him about picking or rubbing his nose since he has a habit of doing that, though one would hope he'd be following the doctors' instructions to not touch the area after the first nosebleedWe'll get him a humidifier. Hopefully his visit with the PCP will provide answers or more specific questions. ### Response: It's usually from irritation in an area called Kiesselbach's plexus in the front of the nose. The ENT can cauterize this, usually helps. Noses bleed, it is very rarely a sign of cancer or hematologic disease.Rarely the sinus packing can cause a sinus infection. His symptoms sound more like a viral URI with the dry cough and sore throat plus infecting your mother..


Instruction: 1: It really seems like he should have been diagnosed and started treatment for MDS after the bone marrow biopsy/aspiration in July 2021, not 11 months later given the fact he has tried so many therapies for ITP with no response. It also notes that patients "typically have mild-moderate thrombocytopenia." He has always been below 50K, surely that's not moderate?What is your opinion on his history/diagnosis?2: I believe the nurses screwed up with premedicating him for his tranfusions during his last hospital visit. He had negative reactions on the two days I know they deviated from what is clearly on his chart AND on the request from his hematologist/oncologist which tells them what medication he needs when. Then, units aren't even ordered for the following two days, a man who is recorded as transfusion-dependent in his chart. Prior to his hospital visit, the premeds were followed almost exactly with no negative reaction, and after noticing his head bleed, the nurse followed the premeds exactly with no negative reaction. I am going off of his medical history acquired from the hospital which notes exactly when the medication is administered (not being confused with when they charted it). His cause of death is noted as acute respiratory failure due to PNA, but its only because we took him off the oxygen due to the head bleed which I believe they caused.Am I looking at this wrong? Did they mess up?THANK YOUI know, it's a long one. I really appreciate it if you took the time to read through it and give your thoughts and opinions.I know he had a rough disease, and I believe I could accept his death, but something in these hospital notes stinks...

Output: Having treated many patients like this, these cases are often very difficult to manage. They sent off clonal hematopoiesis of indeterminate potential (CHIP) which is helpful in identifying mutations that may be causing cell abnormalities in MDS and sometimes garners targetable mutations eg IGH, del5q, ringed sideroblasts. However many of these we do not have detailed data given rarity so their effects on treatment are still unclear. In February 2023, that loss of chromosome 7 confers a very very poor prognosis along with refractory thrombocytopenia. I believe getting palliative care involved at this point may have been warranted. I do not believe any treatment wouldve changed his course by this time.I dont think a mistake was made by not treating him since signs of transformation to AML were not evident on the marrow from 2021. A score we use to predict transformation would also predict that prognosis was good with low chance of AML transformation in the next 10 yrs. Your father also has an extensive cardiac history and the drugs we use to treat MDS to AML have significant side effects including heart failure which Ive seen happen before from anthracycline. He had too many comorbidities so Vidaza was appropriate when it was given which is used to treat AML. Wed classify him as medically unfit but not frail and these patients are typically very hard to treat. Patients also become refractory to transfusions over time because their body starts making antibodies towards platelets. I do not think the mix up with premeds made a difference.Watching a loved one die from a hematologic malignancy is not easy, especially MDS. Please make sure you take care of yourself as well. I am very sorry for your loss. You did the right thing letting him go like you did. There was no meaningful way out of his situation where he would go on living a quality life. Please know that his medical team did everything they could.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 1: It really seems like he should have been diagnosed and started treatment for MDS after the bone marrow biopsy/aspiration in July 2021, not 11 months later given the fact he has tried so many therapies for ITP with no response. It also notes that patients "typically have mild-moderate thrombocytopenia." He has always been below 50K, surely that's not moderate?What is your opinion on his history/diagnosis?2: I believe the nurses screwed up with premedicating him for his tranfusions during his last hospital visit. He had negative reactions on the two days I know they deviated from what is clearly on his chart AND on the request from his hematologist/oncologist which tells them what medication he needs when. Then, units aren't even ordered for the following two days, a man who is recorded as transfusion-dependent in his chart. Prior to his hospital visit, the premeds were followed almost exactly with no negative reaction, and after noticing his head bleed, the nurse followed the premeds exactly with no negative reaction. I am going off of his medical history acquired from the hospital which notes exactly when the medication is administered (not being confused with when they charted it). His cause of death is noted as acute respiratory failure due to PNA, but its only because we took him off the oxygen due to the head bleed which I believe they caused.Am I looking at this wrong? Did they mess up?THANK YOUI know, it's a long one. I really appreciate it if you took the time to read through it and give your thoughts and opinions.I know he had a rough disease, and I believe I could accept his death, but something in these hospital notes stinks.... ### Response: Having treated many patients like this, these cases are often very difficult to manage. They sent off clonal hematopoiesis of indeterminate potential (CHIP) which is helpful in identifying mutations that may be causing cell abnormalities in MDS and sometimes garners targetable mutations eg IGH, del5q, ringed sideroblasts. However many of these we do not have detailed data given rarity so their effects on treatment are still unclear. In February 2023, that loss of chromosome 7 confers a very very poor prognosis along with refractory thrombocytopenia. I believe getting palliative care involved at this point may have been warranted. I do not believe any treatment wouldve changed his course by this time.I dont think a mistake was made by not treating him since signs of transformation to AML were not evident on the marrow from 2021. A score we use to predict transformation would also predict that prognosis was good with low chance of AML transformation in the next 10 yrs. Your father also has an extensive cardiac history and the drugs we use to treat MDS to AML have significant side effects including heart failure which Ive seen happen before from anthracycline. He had too many comorbidities so Vidaza was appropriate when it was given which is used to treat AML. Wed classify him as medically unfit but not frail and these patients are typically very hard to treat. Patients also become refractory to transfusions over time because their body starts making antibodies towards platelets. I do not think the mix up with premeds made a difference.Watching a loved one die from a hematologic malignancy is not easy, especially MDS. Please make sure you take care of yourself as well. I am very sorry for your loss. You did the right thing letting him go like you did. There was no meaningful way out of his situation where he would go on living a quality life. Please know that his medical team did everything they could..


Instruction: Hey yall My kiddo (3M, approx 42 pounds, 3.5 feet tall) (daily meds are nexium, senna, zyrtec, tenex, atarax, melatonin) got referred to hematology and I'm drawing a blank on what questions to ask. He had a blood smear that had "abnormal lymphocytes" and a high level of lymphocytes. He started seeing Immunology a few months ago because he's always had frequent infections and fevers just about daily for most of his life. Immunology doesn't have any diagnosis, but are thinking of referring him to rheumatology. Im just not really sure what questions to ask or what to say really. If there's a better sub for this, please point me in the right direction. Thanks y'all!

Output: Where does it say "abnormal lymphocytes"? That's unusual language. "Atypical" lymphocytes are seen with viral infections, classically mono. If the blood smear was the reason for referral, I would ask what the results mean. If the answer isn't clear, keep asking until you understand. They will tell you the differential diagnosis for the findings and what additional tests they recommend. There might be none.Frequent infections are the rule in childhood, not some weird immune deficiency. Is he really having fevers every single day for 3 years? Also, one of the most common findings with immune deficiencies is poor growth and your son is a tank :) Rheumatologic conditions in preschoolers often come with poor growth, rash, joint swelling, and very abnormal blood tests. But they can be more subtle and I can't say on the internet if that's a possibility in your case.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Hey yall My kiddo (3M, approx 42 pounds, 3.5 feet tall) (daily meds are nexium, senna, zyrtec, tenex, atarax, melatonin) got referred to hematology and I'm drawing a blank on what questions to ask. He had a blood smear that had "abnormal lymphocytes" and a high level of lymphocytes. He started seeing Immunology a few months ago because he's always had frequent infections and fevers just about daily for most of his life. Immunology doesn't have any diagnosis, but are thinking of referring him to rheumatology. Im just not really sure what questions to ask or what to say really. If there's a better sub for this, please point me in the right direction. Thanks y'all!. ### Response: Where does it say "abnormal lymphocytes"? That's unusual language. "Atypical" lymphocytes are seen with viral infections, classically mono. If the blood smear was the reason for referral, I would ask what the results mean. If the answer isn't clear, keep asking until you understand. They will tell you the differential diagnosis for the findings and what additional tests they recommend. There might be none.Frequent infections are the rule in childhood, not some weird immune deficiency. Is he really having fevers every single day for 3 years? Also, one of the most common findings with immune deficiencies is poor growth and your son is a tank :) Rheumatologic conditions in preschoolers often come with poor growth, rash, joint swelling, and very abnormal blood tests. But they can be more subtle and I can't say on the internet if that's a possibility in your case..


Instruction: i meant atypical, im sorry! it was in the notes for the test result.He has fever just about every day, if its not fever, its right under fever (99.9-100.3) but most days its 100.4 or higher. He usually gets sick 1-3 times a month, and he stays sick and his pediatrician says thats too much especially for a kiddo not in day care or anything like that. Hes been hospitalized a few times and they havent been able to figure out what causes it. This is something weve been dealing with pretty much since he was born.

Output: Has he ever had a CRP or ferritin? What was the total WBC and neutrophils on the blood count?I think hematology is unlikely to solve this for you. Between immuno and rheum they may have some recommended tests for uncommon causes of recurrent fevers.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: i meant atypical, im sorry! it was in the notes for the test result.He has fever just about every day, if its not fever, its right under fever (99.9-100.3) but most days its 100.4 or higher. He usually gets sick 1-3 times a month, and he stays sick and his pediatrician says thats too much especially for a kiddo not in day care or anything like that. Hes been hospitalized a few times and they havent been able to figure out what causes it. This is something weve been dealing with pretty much since he was born.. ### Response: Has he ever had a CRP or ferritin? What was the total WBC and neutrophils on the blood count?I think hematology is unlikely to solve this for you. Between immuno and rheum they may have some recommended tests for uncommon causes of recurrent fevers..


Instruction: 3F with persistent nosebleeds, referred to hematologyMy daughter 3F has had persistent nosebleeds since she was 18m. We had a blood draw the other day for Von Willebrand screen and her Ag%, factor activity, and factor VIII numbers were normal. However, the lab still did show high Prothrombin time, INR, and aPTT. However, I have no clue what that means. We've been referred to pediatric hematology but the first appointment isn't until April. Can someone give me a run down of what these kinds of results potentially mean? Should I look for a hematologist with an earlier appointment?

Output: Could be platelet aggregation/functional disorder, a possible other factor deficiency like prothrombin, fibrinogen, factor V, or factor X or an acquired factor inhibitor (less likely at that age). These would all affect both PT and PTT times.We worry most about these folks with procedures or when she hits puberty and starts having menses. Its good that she is getting checked out by hematology. There is no urgency unless youre noticing other signs of spontaneous bleeding like bloody stools, large spontaneous bruises or joint swelling (common place to bleed for hemophiliacs).

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 3F with persistent nosebleeds, referred to hematologyMy daughter 3F has had persistent nosebleeds since she was 18m. We had a blood draw the other day for Von Willebrand screen and her Ag%, factor activity, and factor VIII numbers were normal. However, the lab still did show high Prothrombin time, INR, and aPTT. However, I have no clue what that means. We've been referred to pediatric hematology but the first appointment isn't until April. Can someone give me a run down of what these kinds of results potentially mean? Should I look for a hematologist with an earlier appointment?. ### Response: Could be platelet aggregation/functional disorder, a possible other factor deficiency like prothrombin, fibrinogen, factor V, or factor X or an acquired factor inhibitor (less likely at that age). These would all affect both PT and PTT times.We worry most about these folks with procedures or when she hits puberty and starts having menses. Its good that she is getting checked out by hematology. There is no urgency unless youre noticing other signs of spontaneous bleeding like bloody stools, large spontaneous bruises or joint swelling (common place to bleed for hemophiliacs)..


Instruction: Low MPV?Hey, just a quick question! My son (3M, 42lbs, 43 inches, daily meds are Tenex, Atarax, Nexium, Senna, Cetrizine, Albuterol) has always had a low MPV on every CBC since birth and I was just wondering if that meant anything. I know theres a lot of components when it comes to blood, but Im just curious about that one thing. He does have a hematology appointment coming up next month, I just wanted to know what yall thought.

Output: Low MPV (mean platelet volume) usually doesnt mean much. We worry moreso when they are enlarged. If MPV is actually low <7, it can indicate problem with production but we very rarely see this. Reduced production can happen for any number of reasons eg infection, medication effects or reduced bone marrow production. Usually we would review a blood smear to see exactly whats going on and heme can do this.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Low MPV?Hey, just a quick question! My son (3M, 42lbs, 43 inches, daily meds are Tenex, Atarax, Nexium, Senna, Cetrizine, Albuterol) has always had a low MPV on every CBC since birth and I was just wondering if that meant anything. I know theres a lot of components when it comes to blood, but Im just curious about that one thing. He does have a hematology appointment coming up next month, I just wanted to know what yall thought.. ### Response: Low MPV (mean platelet volume) usually doesnt mean much. We worry moreso when they are enlarged. If MPV is actually low <7, it can indicate problem with production but we very rarely see this. Reduced production can happen for any number of reasons eg infection, medication effects or reduced bone marrow production. Usually we would review a blood smear to see exactly whats going on and heme can do this..


Instruction: any heme docs who can interpret this CBC?24M, 5'10, 200 lbs, East-Asian.Elevated BP (usually around 140/90), No alcohol use, no drug use. not on any medications. Not diagnosed with any conditions. Family history of DM2, High Blood Pressure.No complaint and no symptoms of any kind, but I recently went to my PCP to get a checkup due to an older sibling being diagnosed with DM2 recently. The physician ordered a CBC with differential/platelet and CMP. CMP results were completetly normal, but many markers for the CBC were off from the reference values.I asked my PCP the significance of the results and he told me that he's not quite sure. Then, to make sure that the results are not due to lab error, he had me take a second blood test about 3 weeks after the results of the previous one. The test this time included Iron and TIBC as well as Ferritin. Results basically came back identical to the results of the first test.He basically asked me to schedule a visit with hematology because he's not sure how to interpret the results. I just scheduled a visit with a hematology group near me but it'll be mid august before i can see them. Seen as I just need someone to interpret my CBC results, i figured it might be quicker if one of the docs here on reddit can do a quick reading so i can have peace of mindThe results the second test (with comparision to the values of the initial test) are as follows:https://imgur.com/a/gxgM99T

Output: Low MCV like this with normal hemoglobin is likely a hemoglobinopathy like thalassemia. Could also be something like spherocytosis. Hematology should look at a blood smear, maybe run hemoglobin electrophoresis and can give you a more definite answer as to what is going on. Your RDW being elevated suggests that you're churning out new cells or possibly have a vitamin deficiency. Lots to discuss with hematology here but nothing that is ominous or emergent. Normal ferritin suggests that you aren't iron deficient which was tested because of low MCV.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: any heme docs who can interpret this CBC?24M, 5'10, 200 lbs, East-Asian.Elevated BP (usually around 140/90), No alcohol use, no drug use. not on any medications. Not diagnosed with any conditions. Family history of DM2, High Blood Pressure.No complaint and no symptoms of any kind, but I recently went to my PCP to get a checkup due to an older sibling being diagnosed with DM2 recently. The physician ordered a CBC with differential/platelet and CMP. CMP results were completetly normal, but many markers for the CBC were off from the reference values.I asked my PCP the significance of the results and he told me that he's not quite sure. Then, to make sure that the results are not due to lab error, he had me take a second blood test about 3 weeks after the results of the previous one. The test this time included Iron and TIBC as well as Ferritin. Results basically came back identical to the results of the first test.He basically asked me to schedule a visit with hematology because he's not sure how to interpret the results. I just scheduled a visit with a hematology group near me but it'll be mid august before i can see them. Seen as I just need someone to interpret my CBC results, i figured it might be quicker if one of the docs here on reddit can do a quick reading so i can have peace of mindThe results the second test (with comparision to the values of the initial test) are as follows:https://imgur.com/a/gxgM99T. ### Response: Low MCV like this with normal hemoglobin is likely a hemoglobinopathy like thalassemia. Could also be something like spherocytosis. Hematology should look at a blood smear, maybe run hemoglobin electrophoresis and can give you a more definite answer as to what is going on. Your RDW being elevated suggests that you're churning out new cells or possibly have a vitamin deficiency. Lots to discuss with hematology here but nothing that is ominous or emergent. Normal ferritin suggests that you aren't iron deficient which was tested because of low MCV..


Instruction: Should I be concerned with repeated abnormal CBC labs?For some background, Im a 35 year old female, relatively healthy, normal BMI, no major health events, Ive never smoked cigarettes, rarely drink, not taking any medications.During my most recent physical (3/23), my practitioner was slightly concerned about my CBC lab results from 2020. At that time, my platelets were low (81 103/uLtheir standard range is between 140-400 103/uL), but all other values were within normal range.After the physical, I had my labs drawn and everything was normal with the exception of my platelet count. The platelet count was inconclusive and there was a note stating that they were unable to give numerical value for the platelet count. My practitioner messaged me and said that she had never seen this before and advised me to have my labs redone. She also advised the nurse to collect my new sample in a sodium citrate tube.I had my labs redrawn last Friday (4/14), and as of yesterday I had not received my results. I typically get these results back in 1-2 days, so I decided to contact my physicians office. A nurse promptly replied and told me that my blood sample had spoiled before it made it to the main lab for processing, and that I needed to come back to redo the test.This morning a woke up to a message in my patient portal stating that the blood sample did not spoil, and hematology assumed that there was essentially an abnormality with the sample.Im going back to have my labs redrawn this morning.Im not quite sure what to make of all of this? Ive been trying not to dwell on it, but Im becoming concerned after all of these failed attempts to obtain my platelet count. I would greatly appreciate any suggestions or guidance!

Output: Was the low sample done in the new tube your PCP suggested? If not, she is correct in suggesting it get drawn in that tube. Sometimes the chemical in the normal CBC tube interacts with the platelets and gives a falsely low number.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Should I be concerned with repeated abnormal CBC labs?For some background, Im a 35 year old female, relatively healthy, normal BMI, no major health events, Ive never smoked cigarettes, rarely drink, not taking any medications.During my most recent physical (3/23), my practitioner was slightly concerned about my CBC lab results from 2020. At that time, my platelets were low (81 103/uLtheir standard range is between 140-400 103/uL), but all other values were within normal range.After the physical, I had my labs drawn and everything was normal with the exception of my platelet count. The platelet count was inconclusive and there was a note stating that they were unable to give numerical value for the platelet count. My practitioner messaged me and said that she had never seen this before and advised me to have my labs redone. She also advised the nurse to collect my new sample in a sodium citrate tube.I had my labs redrawn last Friday (4/14), and as of yesterday I had not received my results. I typically get these results back in 1-2 days, so I decided to contact my physicians office. A nurse promptly replied and told me that my blood sample had spoiled before it made it to the main lab for processing, and that I needed to come back to redo the test.This morning a woke up to a message in my patient portal stating that the blood sample did not spoil, and hematology assumed that there was essentially an abnormality with the sample.Im going back to have my labs redrawn this morning.Im not quite sure what to make of all of this? Ive been trying not to dwell on it, but Im becoming concerned after all of these failed attempts to obtain my platelet count. I would greatly appreciate any suggestions or guidance!. ### Response: Was the low sample done in the new tube your PCP suggested? If not, she is correct in suggesting it get drawn in that tube. Sometimes the chemical in the normal CBC tube interacts with the platelets and gives a falsely low number..


Instruction: Basically Im just a little nervous about all this, (Leukemia, Pulmonary Arterial Hypertension are my main concerns ). Can anyone offer any guidance or insight into these findings and help me understand my questions better? Thank you for reading this novel, I truly appreciate any help or guidance anyone could give me.

Output: Do you snore? Now you say you are sleeping better, are you having fewer of these nocturnal episodes?**Lab / Test results ** are normal. Almost completely normal. While the "normal ranges" for our lab tests may not match your bodies, being within 10-25% and stable is completely normal (for you). I do not see any abnormalities at all here really. Your ECG may show slightly tall P waves (maybe MAYBE slightly taller in May if I squint) but an ECG is not accurate enough to that degree. Also, there are other areas of the ECG with some variability, this likely means the positioning of the leads from May does not exactly match that of the prior.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Basically Im just a little nervous about all this, (Leukemia, Pulmonary Arterial Hypertension are my main concerns ). Can anyone offer any guidance or insight into these findings and help me understand my questions better? Thank you for reading this novel, I truly appreciate any help or guidance anyone could give me.. ### Response: Do you snore? Now you say you are sleeping better, are you having fewer of these nocturnal episodes?**Lab / Test results ** are normal. Almost completely normal. While the "normal ranges" for our lab tests may not match your bodies, being within 10-25% and stable is completely normal (for you). I do not see any abnormalities at all here really. Your ECG may show slightly tall P waves (maybe MAYBE slightly taller in May if I squint) but an ECG is not accurate enough to that degree. Also, there are other areas of the ECG with some variability, this likely means the positioning of the leads from May does not exactly match that of the prior..


Instruction: HANK YOU SO MUCH! What you said, I think you may have figured it out. Last year, I started grinding my teeth at night. I would wake up in the middle of the night because I would slam my teeth together, and started to develop TMJ pain. So, I had a custom night guard made, but then I found I would it would keep my lips slightly parted while I slept, which dried my mouth and throat while I slept. So, I bought a velcro anti-snoring head strap (https://www.amazon.com/gp/product/B081NJT3YF/ref=ppx_yo_dt_b_search_asin_title?ie=UTF8&psc=1 but an older model) but in order for it to keep my mouth shut, I had to get it pretty snug, which I now think may have been pressing on my airway.The last week or so, I've been only attaching it partially (the part on the front part of my jaw, and wearing a sleep mask to keep out light, which helps keep it from riding forward/backward and falling off my head, and I haven't had any significant episodes since. A little chest pain here and there, and a sensitivity to any form of anxiety or overstimulation (I think my body might just be in a very hypersensitive healing state right now to encourage rest, I was only getting about 4 hours of sleep during those episodes, and waking up several times a night).I am waiting on old ECG's from 10+ years ago, so if it shows the taller P-Waves, I guess it might just normal for me, probably precipitated by the head- strap airway obstruction. I've always had chemical sensitivities that manifest as chest-tightness/shortness of breath. I've had many doctors since childhood tell me that I might be considered borderline asthmatic, but I am a minimalist when it comes to pharmaceutical interventions unless I cannot get around it with diet/exercise/lifestyle changes.I will still go ahead with my doctors appointments for due diligence, but I think you have solved it and helped ease my anxiety enormously. Thank you again! : )

Output: That is very interesting! But yes that was interesting when you said you were sleeping better now. Demonstrating that you can tell when something is better. I would not worry about the old ECGs, I would not have really called that R Atrial Enlargement, it is mostly normal.Happy to help!

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: HANK YOU SO MUCH! What you said, I think you may have figured it out. Last year, I started grinding my teeth at night. I would wake up in the middle of the night because I would slam my teeth together, and started to develop TMJ pain. So, I had a custom night guard made, but then I found I would it would keep my lips slightly parted while I slept, which dried my mouth and throat while I slept. So, I bought a velcro anti-snoring head strap (https://www.amazon.com/gp/product/B081NJT3YF/ref=ppx_yo_dt_b_search_asin_title?ie=UTF8&psc=1 but an older model) but in order for it to keep my mouth shut, I had to get it pretty snug, which I now think may have been pressing on my airway.The last week or so, I've been only attaching it partially (the part on the front part of my jaw, and wearing a sleep mask to keep out light, which helps keep it from riding forward/backward and falling off my head, and I haven't had any significant episodes since. A little chest pain here and there, and a sensitivity to any form of anxiety or overstimulation (I think my body might just be in a very hypersensitive healing state right now to encourage rest, I was only getting about 4 hours of sleep during those episodes, and waking up several times a night).I am waiting on old ECG's from 10+ years ago, so if it shows the taller P-Waves, I guess it might just normal for me, probably precipitated by the head- strap airway obstruction. I've always had chemical sensitivities that manifest as chest-tightness/shortness of breath. I've had many doctors since childhood tell me that I might be considered borderline asthmatic, but I am a minimalist when it comes to pharmaceutical interventions unless I cannot get around it with diet/exercise/lifestyle changes.I will still go ahead with my doctors appointments for due diligence, but I think you have solved it and helped ease my anxiety enormously. Thank you again! : ). ### Response: That is very interesting! But yes that was interesting when you said you were sleeping better now. Demonstrating that you can tell when something is better. I would not worry about the old ECGs, I would not have really called that R Atrial Enlargement, it is mostly normal.Happy to help!.


Instruction: What does this mean? Need a set of eyesHi, I went to hematology/oncology for low WBC count that resolved on its own and I have had lymphnodes that are palpable in my neck for years which have already been checked by another oncologist/surgeon/2 GPs and they werent concerned. However the recent DR I seen took an ACE test and I was elevated. I waited 6 months went to another doctor to re-test and it was at 136 while the cut off was 80 at this particular lab. Im very concerned and I have an appointment with a pulmonologist in a week. I have been stressing because Google says that high ace levels either indicate Sarcoidosis or Lymphoma. Does ACE levels mean malignancy? Google has such limited information on ACE levels and I need some knowledge. Im very concerned with Lymphoma.

Output: Usually concerned about sarcoidosis more than lymphoma with a high ACE level. They both can be co-diagnosed but this is a very rare phenomena. Pulmonologist is exactly who you need to see next as the lungs are most affected in sarcoidosis. Given prior work up, Id have low suspicion for malignancy.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What does this mean? Need a set of eyesHi, I went to hematology/oncology for low WBC count that resolved on its own and I have had lymphnodes that are palpable in my neck for years which have already been checked by another oncologist/surgeon/2 GPs and they werent concerned. However the recent DR I seen took an ACE test and I was elevated. I waited 6 months went to another doctor to re-test and it was at 136 while the cut off was 80 at this particular lab. Im very concerned and I have an appointment with a pulmonologist in a week. I have been stressing because Google says that high ace levels either indicate Sarcoidosis or Lymphoma. Does ACE levels mean malignancy? Google has such limited information on ACE levels and I need some knowledge. Im very concerned with Lymphoma.. ### Response: Usually concerned about sarcoidosis more than lymphoma with a high ACE level. They both can be co-diagnosed but this is a very rare phenomena. Pulmonologist is exactly who you need to see next as the lungs are most affected in sarcoidosis. Given prior work up, Id have low suspicion for malignancy..


Instruction: Please help me understand this. Scared19, Male, 60, 180 lbs, Usually healthy, Works-out 5 days a weekHi there, I went to hematology for a low WBC count and while there I mentioned to them that I have had palpable lymph-nodes in my neck for 3.5 years and I have already been checked previously by 4 doctors including a pediatric oncologist and had multiple ultrasounds which suggest its non-concerning. However, she took an ACE level test and it came back elevated and she said something along the lines Youre ACE levels came back elevated and it could suggest sarcoidosis and if youre concerned go to a GP and get it measured again  ANYWAYS! I didnt think much of it and let it be for 6 months & I went to a Nurse Practitioner to repeat my CBC out of curiosity which showed everything was normal and my WBC was 5.6 which was great. I also asked for the ACE level test to be re-measured and they didnt know what that even was. They had me come back after they researched it and then they took a small vile of blood. They sent it off and it came back high at a 135 and cut off for that lab was 80. I am freaking out because he contacted the hematologist doc and they said I should go to a pulmonologist. I feel perfectly healthy and better than I ever have. I am freaking out because google keeps saying ACE levels being high indicates: Lymphoma, Multiple Myeloma AND Lung cancer. I am absolutely plummeting right now and nothing makes sense to me. Please give me some advice OR knowledge. Its hard to find stuff online speaking about ACE levels.

Output: ACE level is a very nonspecific test. It is not recommended for exactly this reason. Positive tests have <25% chance of having sarcoid, especially if they aren't sent for a good reason.I would followup to make sure but this is a good example of why we don't just send off a bunch of tests for no good reason - you end up with anxiety and chasing down a number of things that are not real.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Please help me understand this. Scared19, Male, 60, 180 lbs, Usually healthy, Works-out 5 days a weekHi there, I went to hematology for a low WBC count and while there I mentioned to them that I have had palpable lymph-nodes in my neck for 3.5 years and I have already been checked previously by 4 doctors including a pediatric oncologist and had multiple ultrasounds which suggest its non-concerning. However, she took an ACE level test and it came back elevated and she said something along the lines Youre ACE levels came back elevated and it could suggest sarcoidosis and if youre concerned go to a GP and get it measured again  ANYWAYS! I didnt think much of it and let it be for 6 months & I went to a Nurse Practitioner to repeat my CBC out of curiosity which showed everything was normal and my WBC was 5.6 which was great. I also asked for the ACE level test to be re-measured and they didnt know what that even was. They had me come back after they researched it and then they took a small vile of blood. They sent it off and it came back high at a 135 and cut off for that lab was 80. I am freaking out because he contacted the hematologist doc and they said I should go to a pulmonologist. I feel perfectly healthy and better than I ever have. I am freaking out because google keeps saying ACE levels being high indicates: Lymphoma, Multiple Myeloma AND Lung cancer. I am absolutely plummeting right now and nothing makes sense to me. Please give me some advice OR knowledge. Its hard to find stuff online speaking about ACE levels.. ### Response: ACE level is a very nonspecific test. It is not recommended for exactly this reason. Positive tests have <25% chance of having sarcoid, especially if they aren't sent for a good reason.I would followup to make sure but this is a good example of why we don't just send off a bunch of tests for no good reason - you end up with anxiety and chasing down a number of things that are not real..


Instruction: okay thanks. ill meet up with a pulmonologist most likely. how likely would something malignant cause this?

Output: Very unlikely. We dont use it as a test to look for malignancy.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: okay thanks. ill meet up with a pulmonologist most likely. how likely would something malignant cause this?. ### Response: Very unlikely. We dont use it as a test to look for malignancy..


Instruction: okay thanks for the responses. my NP i seen doesnt even know what the ACE levels mean and has no knowledge on it. think i should go back and see my actual GP? or is this something i can just let be elevated

Output: I would be hard-pressed to know how to deal with this nonspecific test without seeing you and your lab records and getting a full medical history. So again I would followup. Depending on the level of suspicion a chest x-ray, chest CT or even biopsy might be warranted.It is generally more productive to wait until there are some symptoms but I can't reassure you that you definitely don't have sarcoid or a different autoimmune disease. It does not seem like you have cancer based on the lymph node surveillance

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: okay thanks for the responses. my NP i seen doesnt even know what the ACE levels mean and has no knowledge on it. think i should go back and see my actual GP? or is this something i can just let be elevated. ### Response: I would be hard-pressed to know how to deal with this nonspecific test without seeing you and your lab records and getting a full medical history. So again I would followup. Depending on the level of suspicion a chest x-ray, chest CT or even biopsy might be warranted.It is generally more productive to wait until there are some symptoms but I can't reassure you that you definitely don't have sarcoid or a different autoimmune disease. It does not seem like you have cancer based on the lymph node surveillance.


Instruction: Scared to death - Possibly cancer (leukemia/lymphoma)Hi, my husband is a 26-year-old M. He is 510 and weighs 190 pounds. No medical history beside hypothyroidism and takes 100 mcg of Levothryoxine. His mother has hypothryoroidism and his brother had a condition as a small child where his body attacked the collagen in his skin (scleordermia??). He had Covid in June and recovered in 3-4 days. He had routine blood work done because he has never had blood work done, and I encouraged him to do that. He works out regularly, and never gets sick. He does not have enlarged lymph nodes, no night sweats, no pain, or fatigue, weight loss, ect.He initially received a call from a local family doctor towards the end of January about abnormal blood work. His neutrophils were coming in at 0.1 as well as low WBC and high lymphocytes, and they wanted us to follow up with hematology/oncology. We were told that this blood work did have a bad blood smear that could affect the results. We found a hematologist/oncologist with a major hospital nearby and the lab work down below has been done by her office.We met with her today, and she said that his lab work on the 1st was not significant, and she would have not accepted him as a client had this been his initial labs. However, since he had the initial 0.1 neutrophils with the other small practice, she took him on. She said the blood work was not too off on the 1st, but that she wanted repeat lab work done. The CBC from the 14th was done after our appointment. She said during our appointment that if the lab work looked similar or was trending outside of the ranges more so then she wanted to do a bone marrow biopsy.We are scared shitless, and this has flipped our world upside down. Any insight or advice would be greatly appreciated. What is your take from these test results? Has anyone experienced this and its not been something as serious as cancer? Thank you in advance.February 14th 2023L : WBC (3.6-10.6) : 2.7RBC (4.5-5.9) : 5.17Hemoglobin (13.5-17.5) : 14.8Hematocrit (41-53) : 43.4%MCV (80-100) : 83.9MCH (26-34) : 28.6MCHC (32-36) : 34.1RDW SD (36.7-47.2) : 37.9RDW (11.3-15.6) : 12.4Platelets (150-400) : 236MPV (8.6-12.4) : 9.9L : Neutrophil % Auto (42-72) : 34.6%H : Lymphocytes % Auto (18-45) : 50.4%Monocyte % Auto (2-12) : 10.9%Eosinophil % Auto (0-5) : 2.6%Basophil % Auto (0-2) : 1.1%Immature Granulocytes (0-0.5) : 0.4%L : Neutrophil, Abs (1.8-6.8) : 1Lymphocytes, Abs (1.2-3.4) : 1.4Monocytes, Abs (0.2-0.9) : 0.3Eosinophil, Abs (0-0.5) : 0.1Basophil, Abs (0-0.1) : 0Immature Granulocyte, Abs (0-0.04) : 0Feburary 1st 2023L : WBC (3.6-10.6) : 3.1RBC (4.5-5.9) : 4.9Hemoglobin (13.5-17.5) : 14.1L : Hematocrit (41-53) : 40.8MCV (80-100) : 83.3MCH (26-34) : 28.8MCHC (32-36) : 34.6RDW SD (36.7-47.2) : 37.1RDW (11.3-15.6) : 12.2%Platelets (150-400) : 235MPV (8.6-12.4) : 9.7Neutrophil % Auto (42-72) 42.9%H : Lymphocytes % Auto (18-45) : 45.2%Monocyte % Auto (2-12) : 8.7%Eosinophil % Auto (0-5) : 2.2%Basophil % Auto (0-2) : 1%Immature Granulocytes (0-0.5) : NoneL : Neutrophil, Abs (1.8-6.8) : 1.3Lymphocytes, Abs (1.2-3.4) : 1.4Monocytes, Abs (0.2-0.9) : 0.3Eosinophil, Abs (0-0.5) : 0.1Basophil, Abs (0-0.1) : 0Immature Granulocyte, Abs (0-0.04) : 0February 1st 2023CMP All within normal limits.02/01/23 Pathology review blood smear report : Surgical Pathology ReportFinal Diagnosis : Neutropenia, rare circulating plasma cells  The concurrent flow cytometric analysis is negative for abnormal lymphocyte population  There are no significant hemolytic changes, dysplastic changes, or circulating blastsHistologic EvaluationPeripheral Blood MorphologyLeukocyte differential : Cells counted (100) : Bands/segmented neutrophil 54, eosinophil 1, basophil 0, monocyte 7, lymphocyte 37, plasma cell 1.Leukocytes : Neutropenia. Neutrophils are mostly mature and without dyspoiesis. Lymphocytes are mature and without over atypia. Occasional circulate plasma cells are present.Erythrocytes : Adequate with normal morphologyPlatelets : Adequate with normal morphology02/01/23 Leukemia/lymphoma phenotyping report by Flow Cytometry ReportComment : There is no evidence for increased blasts, increased plasma cells or abnormal lymphoid population. A negative flow cytometry does not exclude malignancy.Leukocyte DifferentialCD45 Dim Area : 1%Lymphoid Area : 59%-T Cells : 78%----CD4:CD8 ratio 1.5NK Cells : 12%B Cells : 8%----Kappa : Lambda ration 1.8Monocytoid Area : 3%--The monocytoid population has typical antigen expressionMyeloid area : 34%--The Myeloid population has typical antigen expressionANA Hep2 IFA w/ Reflex ENAANA IFA Screen : NegativeCMt1 : ANA IFA : NegativeFolate Level : 11.4Hep B Surface AntigenHep Bs Ag : NonreactiveCMT : Hepatitis B Surface AgHep B Core Antibody (Total) (ARUP)Hepatitis B Core Ab TotalHep B Core Ab Total : NonreactiveVitamin B12 Level (345-1485)  427HIV Av/Ab Combo  ScreenHIV  Ag/Ab Combo by CMIA : NonreactiveHep B Surface AntibodyHep B Surface Ab : NonreactiveESR, Westergren (0-15)  5TSH : (0.46-4.88)  2.54Hep C AntibodyNonreactiveHCV Signal to Cutoff Ratio : 0.05LDH (125-265) : 139

Output: This is a slight neutropenia, without symptoms and with these blood tests the likelihood of leukemia is incredibly low.Also, this is not a lymphoma.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Scared to death - Possibly cancer (leukemia/lymphoma)Hi, my husband is a 26-year-old M. He is 510 and weighs 190 pounds. No medical history beside hypothyroidism and takes 100 mcg of Levothryoxine. His mother has hypothryoroidism and his brother had a condition as a small child where his body attacked the collagen in his skin (scleordermia??). He had Covid in June and recovered in 3-4 days. He had routine blood work done because he has never had blood work done, and I encouraged him to do that. He works out regularly, and never gets sick. He does not have enlarged lymph nodes, no night sweats, no pain, or fatigue, weight loss, ect.He initially received a call from a local family doctor towards the end of January about abnormal blood work. His neutrophils were coming in at 0.1 as well as low WBC and high lymphocytes, and they wanted us to follow up with hematology/oncology. We were told that this blood work did have a bad blood smear that could affect the results. We found a hematologist/oncologist with a major hospital nearby and the lab work down below has been done by her office.We met with her today, and she said that his lab work on the 1st was not significant, and she would have not accepted him as a client had this been his initial labs. However, since he had the initial 0.1 neutrophils with the other small practice, she took him on. She said the blood work was not too off on the 1st, but that she wanted repeat lab work done. The CBC from the 14th was done after our appointment. She said during our appointment that if the lab work looked similar or was trending outside of the ranges more so then she wanted to do a bone marrow biopsy.We are scared shitless, and this has flipped our world upside down. Any insight or advice would be greatly appreciated. What is your take from these test results? Has anyone experienced this and its not been something as serious as cancer? Thank you in advance.February 14th 2023L : WBC (3.6-10.6) : 2.7RBC (4.5-5.9) : 5.17Hemoglobin (13.5-17.5) : 14.8Hematocrit (41-53) : 43.4%MCV (80-100) : 83.9MCH (26-34) : 28.6MCHC (32-36) : 34.1RDW SD (36.7-47.2) : 37.9RDW (11.3-15.6) : 12.4Platelets (150-400) : 236MPV (8.6-12.4) : 9.9L : Neutrophil % Auto (42-72) : 34.6%H : Lymphocytes % Auto (18-45) : 50.4%Monocyte % Auto (2-12) : 10.9%Eosinophil % Auto (0-5) : 2.6%Basophil % Auto (0-2) : 1.1%Immature Granulocytes (0-0.5) : 0.4%L : Neutrophil, Abs (1.8-6.8) : 1Lymphocytes, Abs (1.2-3.4) : 1.4Monocytes, Abs (0.2-0.9) : 0.3Eosinophil, Abs (0-0.5) : 0.1Basophil, Abs (0-0.1) : 0Immature Granulocyte, Abs (0-0.04) : 0Feburary 1st 2023L : WBC (3.6-10.6) : 3.1RBC (4.5-5.9) : 4.9Hemoglobin (13.5-17.5) : 14.1L : Hematocrit (41-53) : 40.8MCV (80-100) : 83.3MCH (26-34) : 28.8MCHC (32-36) : 34.6RDW SD (36.7-47.2) : 37.1RDW (11.3-15.6) : 12.2%Platelets (150-400) : 235MPV (8.6-12.4) : 9.7Neutrophil % Auto (42-72) 42.9%H : Lymphocytes % Auto (18-45) : 45.2%Monocyte % Auto (2-12) : 8.7%Eosinophil % Auto (0-5) : 2.2%Basophil % Auto (0-2) : 1%Immature Granulocytes (0-0.5) : NoneL : Neutrophil, Abs (1.8-6.8) : 1.3Lymphocytes, Abs (1.2-3.4) : 1.4Monocytes, Abs (0.2-0.9) : 0.3Eosinophil, Abs (0-0.5) : 0.1Basophil, Abs (0-0.1) : 0Immature Granulocyte, Abs (0-0.04) : 0February 1st 2023CMP All within normal limits.02/01/23 Pathology review blood smear report : Surgical Pathology ReportFinal Diagnosis : Neutropenia, rare circulating plasma cells  The concurrent flow cytometric analysis is negative for abnormal lymphocyte population  There are no significant hemolytic changes, dysplastic changes, or circulating blastsHistologic EvaluationPeripheral Blood MorphologyLeukocyte differential : Cells counted (100) : Bands/segmented neutrophil 54, eosinophil 1, basophil 0, monocyte 7, lymphocyte 37, plasma cell 1.Leukocytes : Neutropenia. Neutrophils are mostly mature and without dyspoiesis. Lymphocytes are mature and without over atypia. Occasional circulate plasma cells are present.Erythrocytes : Adequate with normal morphologyPlatelets : Adequate with normal morphology02/01/23 Leukemia/lymphoma phenotyping report by Flow Cytometry ReportComment : There is no evidence for increased blasts, increased plasma cells or abnormal lymphoid population. A negative flow cytometry does not exclude malignancy.Leukocyte DifferentialCD45 Dim Area : 1%Lymphoid Area : 59%-T Cells : 78%----CD4:CD8 ratio 1.5NK Cells : 12%B Cells : 8%----Kappa : Lambda ration 1.8Monocytoid Area : 3%--The monocytoid population has typical antigen expressionMyeloid area : 34%--The Myeloid population has typical antigen expressionANA Hep2 IFA w/ Reflex ENAANA IFA Screen : NegativeCMt1 : ANA IFA : NegativeFolate Level : 11.4Hep B Surface AntigenHep Bs Ag : NonreactiveCMT : Hepatitis B Surface AgHep B Core Antibody (Total) (ARUP)Hepatitis B Core Ab TotalHep B Core Ab Total : NonreactiveVitamin B12 Level (345-1485)  427HIV Av/Ab Combo  ScreenHIV  Ag/Ab Combo by CMIA : NonreactiveHep B Surface AntibodyHep B Surface Ab : NonreactiveESR, Westergren (0-15)  5TSH : (0.46-4.88)  2.54Hep C AntibodyNonreactiveHCV Signal to Cutoff Ratio : 0.05LDH (125-265) : 139. ### Response: This is a slight neutropenia, without symptoms and with these blood tests the likelihood of leukemia is incredibly low.Also, this is not a lymphoma..


Instruction: Hi, thank you for your response. Based on the work above what makes you rule out lymphoma? Once again thank you!

Output: From history: No enlarged glands, no night sweat,no weight loss and no fatigue. No description of splenomegaly or hepatomegaly.From differential: No clonal phenotype, no abnormal peripheral lymphocytes. No blasts.From biochemistry: Normal LDH, normal ESR, no anemia.Basically, none of the warning signs for lymphoma, neutropenia isn't even common in a lymphoma unless there is lymphocytosis or infiltration of the marrow. And ALL infiltration of the marrow should give more symptoms.Edit: I understand this is stressful, so I'm not trying to dismiss you, but I am trying to calm you.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Hi, thank you for your response. Based on the work above what makes you rule out lymphoma? Once again thank you!. ### Response: From history: No enlarged glands, no night sweat,no weight loss and no fatigue. No description of splenomegaly or hepatomegaly.From differential: No clonal phenotype, no abnormal peripheral lymphocytes. No blasts.From biochemistry: Normal LDH, normal ESR, no anemia.Basically, none of the warning signs for lymphoma, neutropenia isn't even common in a lymphoma unless there is lymphocytosis or infiltration of the marrow. And ALL infiltration of the marrow should give more symptoms.Edit: I understand this is stressful, so I'm not trying to dismiss you, but I am trying to calm you..


Instruction: Would a cbc with differential show blasts if they are present? I got a cbc recently and it didn't even have a line item for blasts. Just neutrophil, lymphocyte, monocyte, eosonophil and basophil?

Output: The standard is to report blasts if they are present.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Would a cbc with differential show blasts if they are present? I got a cbc recently and it didn't even have a line item for blasts. Just neutrophil, lymphocyte, monocyte, eosonophil and basophil?. ### Response: The standard is to report blasts if they are present..


Instruction: Would an automated cbc report as well?

Output: You can really never know, sometimes it counts them as lymphocytes

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Would an automated cbc report as well?. ### Response: You can really never know, sometimes it counts them as lymphocytes.


Instruction: What could it be?16 year old male , 61, 105 lb, doesnt take meds, balanced diet, teenager so not a ton of exercise. Complains a lot about bone pain (legs and arms) and is always tired. Referred to hematology after standard labs, these are all labs the Hematologist pulled.These are the labs: Cd8% Tcells : 14 Cd8 absolute :204 Cd 16 + cd 56 (nk cells) : 64 Bilirubin direct: .30 Neutrophils : 28.6 Lymphocytes: 57.1 Monocytes 8.2 Basophils : 4.1 Absolute neutrophils : .9 Manuel nrbc : 2.0 Igm : 37 Wbc: 3.0 Mcv : 79.5 Mch: 25.5 Mchc : 32.2 Rdw: 16.6 Mpv:10.7 ANC .9 Segs % 28.6 Iron 223 Calculated TIBC 438 Iron saturation 51 Creatine .66 Ferritin 8

Output: Hard to say. Lots of info missing but cd8 cells are low. Absolute neutrophils are mildly decreased. Possible signs of iron deficiency.Guessing some sort of immunodeficiency. Best evaluated by both heme and immunology.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What could it be?16 year old male , 61, 105 lb, doesnt take meds, balanced diet, teenager so not a ton of exercise. Complains a lot about bone pain (legs and arms) and is always tired. Referred to hematology after standard labs, these are all labs the Hematologist pulled.These are the labs: Cd8% Tcells : 14 Cd8 absolute :204 Cd 16 + cd 56 (nk cells) : 64 Bilirubin direct: .30 Neutrophils : 28.6 Lymphocytes: 57.1 Monocytes 8.2 Basophils : 4.1 Absolute neutrophils : .9 Manuel nrbc : 2.0 Igm : 37 Wbc: 3.0 Mcv : 79.5 Mch: 25.5 Mchc : 32.2 Rdw: 16.6 Mpv:10.7 ANC .9 Segs % 28.6 Iron 223 Calculated TIBC 438 Iron saturation 51 Creatine .66 Ferritin 8. ### Response: Hard to say. Lots of info missing but cd8 cells are low. Absolute neutrophils are mildly decreased. Possible signs of iron deficiency.Guessing some sort of immunodeficiency. Best evaluated by both heme and immunology..


Instruction: 26, F. Slightly elevated RBC and high absolute lymphocytes.I [26,F] just got blood work done yesterday - routine chemistry and hematology tests. I weigh 120 lbs and Im 54. I do not smoke but used to vape. Everything under the routine chemistry test came back normal. My RBC shows as high (5.17). The reference range is 3.80-5.10. My lymphocytes were also high (4301 cells/mcL). The reference range for this is 850-3900 cells/mcL. My wbc, MCH, MCV, neutrophils, hemoglobin, and hematocrit are all normal.I got cbc tests done a year ago and they came back normal. I was sick all last week with either a cold or the flu. The doctor said my throat looked red. He used the stethoscope to listen to my heart and lungs and said everything sounded good. Could being sick last week cause the RBC and lymphocytes to be high? I have pretty bad health anxiety. Doctor didnt call me with the results yet but I can see them online.

Output: High lymphocytes are likely from infection. RBC count is only ever so slightly high and normal by most standards. Nothing to worry about. Simply being dehydrated could also cause both counts to be falsely elevated.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 26, F. Slightly elevated RBC and high absolute lymphocytes.I [26,F] just got blood work done yesterday - routine chemistry and hematology tests. I weigh 120 lbs and Im 54. I do not smoke but used to vape. Everything under the routine chemistry test came back normal. My RBC shows as high (5.17). The reference range is 3.80-5.10. My lymphocytes were also high (4301 cells/mcL). The reference range for this is 850-3900 cells/mcL. My wbc, MCH, MCV, neutrophils, hemoglobin, and hematocrit are all normal.I got cbc tests done a year ago and they came back normal. I was sick all last week with either a cold or the flu. The doctor said my throat looked red. He used the stethoscope to listen to my heart and lungs and said everything sounded good. Could being sick last week cause the RBC and lymphocytes to be high? I have pretty bad health anxiety. Doctor didnt call me with the results yet but I can see them online.. ### Response: High lymphocytes are likely from infection. RBC count is only ever so slightly high and normal by most standards. Nothing to worry about. Simply being dehydrated could also cause both counts to be falsely elevated..


Instruction: Hematology investigation; can anyone please translate?Age: 36Gender: MaleWeight: 88kgs, Height, 175cmsLocation: CanadaEthnicity: SE AsianMeds: 40mg Pantaprazole 2x a dayAbout 2 weeks ago I posted asking what the docs here thoughts my hematology panel results meant (post below)https://www.reddit.com/r/AskDocs/comments/dis3kq/can_someone_decipher_my_hematology_panel/Following the results, my GP sent me to get a hematology investigation done. Below are the results.results: https://imgur.com/EINgINCCurrently my GP is away, but I will follow up in a week or so. In the meantime, would any docs here be kind enough to shed some light on what the terms mean?

Output: Homozygous Hb E likely fully explains your CBC which has a pretty low MCV (ie your cells are small) but otherwise is normal. This in and of itself should not cause any real problems, though as noted there could be implications if you plan on having children. The most common scenario would be if a child inherits HbE from you and a beta thalassemia mutation from mom, which could result in the child having a form of thalassemia.A single alpha thalassemia gene deletion = you have 3 out of 4 functioning alpha hemoglobin chains. This also has no real significance in and of itself - people who have this and nothing else (including no HbE) would have totally normal labs. Again, your MCV is low because of the HbE and not the single alpha deletion.Hope htis helps.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Hematology investigation; can anyone please translate?Age: 36Gender: MaleWeight: 88kgs, Height, 175cmsLocation: CanadaEthnicity: SE AsianMeds: 40mg Pantaprazole 2x a dayAbout 2 weeks ago I posted asking what the docs here thoughts my hematology panel results meant (post below)https://www.reddit.com/r/AskDocs/comments/dis3kq/can_someone_decipher_my_hematology_panel/Following the results, my GP sent me to get a hematology investigation done. Below are the results.results: https://imgur.com/EINgINCCurrently my GP is away, but I will follow up in a week or so. In the meantime, would any docs here be kind enough to shed some light on what the terms mean?. ### Response: Homozygous Hb E likely fully explains your CBC which has a pretty low MCV (ie your cells are small) but otherwise is normal. This in and of itself should not cause any real problems, though as noted there could be implications if you plan on having children. The most common scenario would be if a child inherits HbE from you and a beta thalassemia mutation from mom, which could result in the child having a form of thalassemia.A single alpha thalassemia gene deletion = you have 3 out of 4 functioning alpha hemoglobin chains. This also has no real significance in and of itself - people who have this and nothing else (including no HbE) would have totally normal labs. Again, your MCV is low because of the HbE and not the single alpha deletion.Hope htis helps..


Instruction: reading my hematology results does it look like anemia?im female, 20 years old and i have graves disease, recently getting these results back im wondering if any of them point to anemia.(Hematology WBC 5.3 4.0 - 11.0 x E9/L RBC LO 3.96 4.00 - 5.10 x E12/L Hemoglobin 126 120 - 160 g/L Hematocrit LO 0.348 0.350 - 0.450 L/L MCV 88 80 - 100 fL MCH 31.8 27.5 - 33.0 pg MCHC HI 362 305 - 360 g/L RDW 12.0 11.5 - 14.5 % Platelet Count)

Output: No. By definition it's not anemia.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: reading my hematology results does it look like anemia?im female, 20 years old and i have graves disease, recently getting these results back im wondering if any of them point to anemia.(Hematology WBC 5.3 4.0 - 11.0 x E9/L RBC LO 3.96 4.00 - 5.10 x E12/L Hemoglobin 126 120 - 160 g/L Hematocrit LO 0.348 0.350 - 0.450 L/L MCV 88 80 - 100 fL MCH 31.8 27.5 - 33.0 pg MCHC HI 362 305 - 360 g/L RDW 12.0 11.5 - 14.5 % Platelet Count). ### Response: No. By definition it's not anemia..


Instruction: 15 y/o male, R arm swellingHello doctors of Reddit,My brother is a 15 yo male with 1 week of R arm swelling and mild/dull pain on shoulder abduction . He is an avid basketball player who trains very hard and he uses his right arm to shoot the ball. 3 days prior to onset of swelling someone hit him hard on the right shoulder. He didnt think much of it, but has mild ecchymosis on the shoulder.1 day after symptom onset he went to the ER. Ultrasound negative for DVT and echogenic material. CT scan of arm and chest negative for blood clots and mass. CT scan did not see a cervical rib but noted minor thoracic inlet narrowing. CBC normal PT/INR normal CPK elevated D dimer positive (ER physicians were unconcerned due to imaging) Protein C/S normal factor Leiden V normal Normal radial pulseHe was sent home with hematology and vascular surgeon follow up. The ER physicians suspect this is an overuse injury causing some type of impingement that resulted in the swelling of the arm.So far his arm circumference has dropped by 1 inch and his arm feels less tight, as in you can pinch the fat, which was difficult to do before. His pain has improved. We will follow up with the specialists but also a sports medicine doctor.Could this really be an overuse injury? Can such an injury really cause the whole arm to swell?Thank you all.

Output: Holy shit at that ER work up. Seems.. thorough.Could be the bruise or a muscle strain causing swelling as well

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 15 y/o male, R arm swellingHello doctors of Reddit,My brother is a 15 yo male with 1 week of R arm swelling and mild/dull pain on shoulder abduction . He is an avid basketball player who trains very hard and he uses his right arm to shoot the ball. 3 days prior to onset of swelling someone hit him hard on the right shoulder. He didnt think much of it, but has mild ecchymosis on the shoulder.1 day after symptom onset he went to the ER. Ultrasound negative for DVT and echogenic material. CT scan of arm and chest negative for blood clots and mass. CT scan did not see a cervical rib but noted minor thoracic inlet narrowing. CBC normal PT/INR normal CPK elevated D dimer positive (ER physicians were unconcerned due to imaging) Protein C/S normal factor Leiden V normal Normal radial pulseHe was sent home with hematology and vascular surgeon follow up. The ER physicians suspect this is an overuse injury causing some type of impingement that resulted in the swelling of the arm.So far his arm circumference has dropped by 1 inch and his arm feels less tight, as in you can pinch the fat, which was difficult to do before. His pain has improved. We will follow up with the specialists but also a sports medicine doctor.Could this really be an overuse injury? Can such an injury really cause the whole arm to swell?Thank you all.. ### Response: Holy shit at that ER work up. Seems.. thorough.Could be the bruise or a muscle strain causing swelling as well.


Instruction: Protein electrophoresis and Lambda/Kappa Chain ResultsHello guys,Context: 23 year old M with most likely beta thallessemia based on other results who also presented with elevated wbc of 13.9 and lymphocytes of 5100. Doctor did some thalassemia and protein electrophoresis tests to confirm thalassemia.Thalassemia results came back consistent with beta thalassemia however my doctor does not know how to interpret the SPEP results and will send me the hematology. Wanted some input before my hematology appointmentProtein: 8.2 H (reference 6.1-8.1)Beta 2 Globulin: 0.7 H (ref 0.2 - 0.5)Kappa: 444 H (ref 176-443)Lambda: 269 H (ref 91-240)Kappa/Lambda ratio: 1.65 ( ref 1.29-2.55)CMP: WNLCBC: besides the ones listed above and other values typically associated with beta thalassemia is WNLSymptoms/Problems: noneAny inputs would be appreciated. Thank you!

Output: Could be consistent w/ beta thalassemia, which affects hemoglobin (the protein in RBC responsible for carrying oxygen) and this can lead to anemia. The elevated beta-2 globulin might be the body's response to increased red blood cell breakdown, common in beta thalassemia. But the SPEP test isn't the main diagnostic tool for beta thalassemia; other tests like hemoglobin electrophoresis and genetic testing are more specific.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Protein electrophoresis and Lambda/Kappa Chain ResultsHello guys,Context: 23 year old M with most likely beta thallessemia based on other results who also presented with elevated wbc of 13.9 and lymphocytes of 5100. Doctor did some thalassemia and protein electrophoresis tests to confirm thalassemia.Thalassemia results came back consistent with beta thalassemia however my doctor does not know how to interpret the SPEP results and will send me the hematology. Wanted some input before my hematology appointmentProtein: 8.2 H (reference 6.1-8.1)Beta 2 Globulin: 0.7 H (ref 0.2 - 0.5)Kappa: 444 H (ref 176-443)Lambda: 269 H (ref 91-240)Kappa/Lambda ratio: 1.65 ( ref 1.29-2.55)CMP: WNLCBC: besides the ones listed above and other values typically associated with beta thalassemia is WNLSymptoms/Problems: noneAny inputs would be appreciated. Thank you!. ### Response: Could be consistent w/ beta thalassemia, which affects hemoglobin (the protein in RBC responsible for carrying oxygen) and this can lead to anemia. The elevated beta-2 globulin might be the body's response to increased red blood cell breakdown, common in beta thalassemia. But the SPEP test isn't the main diagnostic tool for beta thalassemia; other tests like hemoglobin electrophoresis and genetic testing are more specific..


Instruction: please help. 2 low wbc in a row, now seeing hematologyMy husband. Male, 48. Healthy.First wbc 3.5, no differential was done. Everything else normal.3 weeks later wbc 2.8 and neutrophils 1.4 with 1.5 being the lowest level for norm. Says 50.4%. All other levels still normal, monocytes normal but higher end. 0 immature granulocytes.Doctor said he knows we are scared, but really, really doesn't think it's cancer. Thinks most likely was fighting some kind of virus, but sending to hematology to be sure. Also has 2 immediate family members with rheumatoid arthritis.I'm very scared.

Output: When just the WBC is low, your doctor is right, it's usually recovery from an infection. Cancer tends to cause more than one type of blood cell to be low, which doesn't seem to be the case.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: please help. 2 low wbc in a row, now seeing hematologyMy husband. Male, 48. Healthy.First wbc 3.5, no differential was done. Everything else normal.3 weeks later wbc 2.8 and neutrophils 1.4 with 1.5 being the lowest level for norm. Says 50.4%. All other levels still normal, monocytes normal but higher end. 0 immature granulocytes.Doctor said he knows we are scared, but really, really doesn't think it's cancer. Thinks most likely was fighting some kind of virus, but sending to hematology to be sure. Also has 2 immediate family members with rheumatoid arthritis.I'm very scared.. ### Response: When just the WBC is low, your doctor is right, it's usually recovery from an infection. Cancer tends to cause more than one type of blood cell to be low, which doesn't seem to be the case..


Instruction: Asking on behalf of my sister. Liver lab levels insane, among other strange things.Because the leukemia/lymphoma lab is taking forever to come back yet we have a ton others, her pcp isnt giving her much more info. Wonky highs and lows.36F, overall healthy, non-drinker and never smoked. Had 2 successful pregnancies and birth. Eats and maintains healthy diet and exercise. 57 145. All vaccines.3 weeks ago she started feeling achey. No upper respiratory stuff but general aches, fatigue and headache. Took several covid tests and negative. Ended up going to Hawaii where she thought she actually had covid there and those were also negative. She was complaining of the same thing. At one point, thought it was sun poisoning. Shes seemed to get worse and worse. A week later, which was 2 days after returning home she went to the ER for what she thought was severe dehydration. It wasnt that but they werent sure what it was. Said to see her pcp.ER doc did a handful of labs. Initially told her to see her pcp for follow up labs for mono or leukemia. Her joints ache, a weird floaty face feeling, no fever, no upper respiratory, majority of joint pain is in her legs and toes feel strange. Headaches here and there. Otherwise, she feels okay. No notice of brushing, bloody noses, rapid weight loss.Labs below. If a number is in here more than once its because it was the second lab test when increased. Nothing of concern went down, but only up. Only test we are waiting on, of course, is the leukemia one. Mono all came back negative and no antibodies.Sediment rate 4 - normal, Smudge cells - mild, C reactive - higher at 12, Polychrom, platelet morph and others in category this tests were all few or normal, WBC 8.02, Rbc 5.1, Hemagblobin 14, Hematrocit 41, MCV 83, Mch 29, Mchc 35, Rdw sd. 40, Mpv 9 - low., Nrbc 0 , Neutrophils 23.5% low, Lymphocyte 70% high, Mono 3.9%, Eos 1.0 % bordering, Baso 1.2%, Ig .1, Neutrophil # 1.8, Lymphocyte # 5.64, Mono # .08, Eos .08, Baso # 10,Edited and added below AST -57, ALT 61,Others I missed: Anion gap 2, Globulin 3.5, Albumin/gobulin ratio 1All plasma levels seem in range besides glucose bordering high.Can anyone share if youve seen a blood work up look like this? The overall sickness has been going on for 3 weeks now and is increasingly getting worse.If its not CLL like our minds are nervously going towards, do you recommend she ask for a referral to hematology or rheumatology? Weve heard a virus already thrown in there and Im just wondering what virus out there does this to your body bc even tho Im not a dr her liver numbers arent ideal with some other markers showing some poor function Any comment to give insight would be great! Thanks.

Output: Where are the liver labs? And how did CLL get brought up?

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Asking on behalf of my sister. Liver lab levels insane, among other strange things.Because the leukemia/lymphoma lab is taking forever to come back yet we have a ton others, her pcp isnt giving her much more info. Wonky highs and lows.36F, overall healthy, non-drinker and never smoked. Had 2 successful pregnancies and birth. Eats and maintains healthy diet and exercise. 57 145. All vaccines.3 weeks ago she started feeling achey. No upper respiratory stuff but general aches, fatigue and headache. Took several covid tests and negative. Ended up going to Hawaii where she thought she actually had covid there and those were also negative. She was complaining of the same thing. At one point, thought it was sun poisoning. Shes seemed to get worse and worse. A week later, which was 2 days after returning home she went to the ER for what she thought was severe dehydration. It wasnt that but they werent sure what it was. Said to see her pcp.ER doc did a handful of labs. Initially told her to see her pcp for follow up labs for mono or leukemia. Her joints ache, a weird floaty face feeling, no fever, no upper respiratory, majority of joint pain is in her legs and toes feel strange. Headaches here and there. Otherwise, she feels okay. No notice of brushing, bloody noses, rapid weight loss.Labs below. If a number is in here more than once its because it was the second lab test when increased. Nothing of concern went down, but only up. Only test we are waiting on, of course, is the leukemia one. Mono all came back negative and no antibodies.Sediment rate 4 - normal, Smudge cells - mild, C reactive - higher at 12, Polychrom, platelet morph and others in category this tests were all few or normal, WBC 8.02, Rbc 5.1, Hemagblobin 14, Hematrocit 41, MCV 83, Mch 29, Mchc 35, Rdw sd. 40, Mpv 9 - low., Nrbc 0 , Neutrophils 23.5% low, Lymphocyte 70% high, Mono 3.9%, Eos 1.0 % bordering, Baso 1.2%, Ig .1, Neutrophil # 1.8, Lymphocyte # 5.64, Mono # .08, Eos .08, Baso # 10,Edited and added below AST -57, ALT 61,Others I missed: Anion gap 2, Globulin 3.5, Albumin/gobulin ratio 1All plasma levels seem in range besides glucose bordering high.Can anyone share if youve seen a blood work up look like this? The overall sickness has been going on for 3 weeks now and is increasingly getting worse.If its not CLL like our minds are nervously going towards, do you recommend she ask for a referral to hematology or rheumatology? Weve heard a virus already thrown in there and Im just wondering what virus out there does this to your body bc even tho Im not a dr her liver numbers arent ideal with some other markers showing some poor function Any comment to give insight would be great! Thanks.. ### Response: Where are the liver labs? And how did CLL get brought up?.


Instruction: CLL was brought up bc of the higher absolute lympho count and the moderated smudge cell. The ER doc wrote it on discharge to pcp.

Output: I'm a ED physician, and this...sounds unusual. In CLL, the white count should be significantly elevated which in this case, it is not. Furthermore, the presence of smudge cells is not necessarily indicative of CLL. I be surprised if this was CLL. This is likely some sort of viral infection if I had to guess.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: CLL was brought up bc of the higher absolute lympho count and the moderated smudge cell. The ER doc wrote it on discharge to pcp.. ### Response: I'm a ED physician, and this...sounds unusual. In CLL, the white count should be significantly elevated which in this case, it is not. Furthermore, the presence of smudge cells is not necessarily indicative of CLL. I be surprised if this was CLL. This is likely some sort of viral infection if I had to guess..


Instruction: Post-Stroke Pneumovax?47f, hx of PCOS and gerd, overweight.I had an ischemic cerebellar/medullary stroke in 2021. It occurred 3 days after my second Pfizer vax, but no providers have really considered a link other than hematology, who saw me once and ruled out clotting disorders. He thought there could be a correlation, but said that there was no existing evidence. They never found a real cause. I was Covid negative at the time of my stroke but had a moderate case in April of 2020, so it had been 10+months. My cholesterol was elevated at the time of the stroke, so Ive been on a statin since then, and its remained in the normal range.Im an RN and am definitely pro-vaccine and pro-science, but Ive been hesitant to get my Covid boosters since the stroke. Also, I have Kaiser and my stroke has triggered a recommendation for the pneumonia vaccine. My own PCP wont advise me. When I asked her the risks of the pneumonia vaccine and named my fear of further stroke, she told me to speak to my family.Has anyone seen any discussion or research regarding this, or can anyone offer recommendation regarding both the boosters and other vax? Thanks so muchDont inbox me if youre an anti vaxxer because Im not interested

Output: In massive datasets there has been no correlation between Pfizer and stroke, although there has been risk of cavernous sinus thrombosis with the AstraZeneca vaccine.Pneumococcal vaccination hasnt had quite the sudden pileup of data, but thats been studied and no link to strokes.Prior COVID infection raises cardiovascular and cerebrovascular risks even up to a year later, even after mild illness. That and bad luck are the most likely culprits for you.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Post-Stroke Pneumovax?47f, hx of PCOS and gerd, overweight.I had an ischemic cerebellar/medullary stroke in 2021. It occurred 3 days after my second Pfizer vax, but no providers have really considered a link other than hematology, who saw me once and ruled out clotting disorders. He thought there could be a correlation, but said that there was no existing evidence. They never found a real cause. I was Covid negative at the time of my stroke but had a moderate case in April of 2020, so it had been 10+months. My cholesterol was elevated at the time of the stroke, so Ive been on a statin since then, and its remained in the normal range.Im an RN and am definitely pro-vaccine and pro-science, but Ive been hesitant to get my Covid boosters since the stroke. Also, I have Kaiser and my stroke has triggered a recommendation for the pneumonia vaccine. My own PCP wont advise me. When I asked her the risks of the pneumonia vaccine and named my fear of further stroke, she told me to speak to my family.Has anyone seen any discussion or research regarding this, or can anyone offer recommendation regarding both the boosters and other vax? Thanks so muchDont inbox me if youre an anti vaxxer because Im not interested. ### Response: In massive datasets there has been no correlation between Pfizer and stroke, although there has been risk of cavernous sinus thrombosis with the AstraZeneca vaccine.Pneumococcal vaccination hasnt had quite the sudden pileup of data, but thats been studied and no link to strokes.Prior COVID infection raises cardiovascular and cerebrovascular risks even up to a year later, even after mild illness. That and bad luck are the most likely culprits for you..


Instruction: Are promyelocytes showing on blood test normal?M 27, 6'1'', 150 pounds. I recently had bloodwork done due to low energy levels/pale skin. RBC was 4.0 and WBC was 3.4, both low but I guess not far enough outside the range to be a red flag yet. Hematology is having me retest in 4 weeks.What is concerning me is I have promyelocytes of 0.06 when this should be at zero, and everything I've read says this is never a good sign. My doctor and hematology didn't mention this at all in their notes, should I be concerned?Really appreciate the help.EOSINOPHILS,MANUAL COUNT0.16 x1000/mcLBASOPHILS, MANUAL COUNT0.03 x1000/mcLPROMYELOCYTES, MANUAL COUNT0.06 x1000/mcL

Output: Best to call your GP and discuss this. Those cells are usually indeed found in the bone marrow instead, not in the blood.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Are promyelocytes showing on blood test normal?M 27, 6'1'', 150 pounds. I recently had bloodwork done due to low energy levels/pale skin. RBC was 4.0 and WBC was 3.4, both low but I guess not far enough outside the range to be a red flag yet. Hematology is having me retest in 4 weeks.What is concerning me is I have promyelocytes of 0.06 when this should be at zero, and everything I've read says this is never a good sign. My doctor and hematology didn't mention this at all in their notes, should I be concerned?Really appreciate the help.EOSINOPHILS,MANUAL COUNT0.16 x1000/mcLBASOPHILS, MANUAL COUNT0.03 x1000/mcLPROMYELOCYTES, MANUAL COUNT0.06 x1000/mcL. ### Response: Best to call your GP and discuss this. Those cells are usually indeed found in the bone marrow instead, not in the blood..