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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: NAD but I've worked in potato warehouses for many years, and also spent days shovelling out rotten potatoes in enclosed spaces.. I've never had an issue so I found it kind of weird to have these symptoms without ingestionWhen were you near the rotten potatoes? At the beginning you said it was in the last few days but later on it said the last few weeks.Temperatures above 98.6 and below 100.4 are considered mild fevers. Ive had one for a few months now. Your temperature is nothing to worry about unless it goes to 103 or above or if it lasts longer than a week.Symptoms of solanine poisoning are mainly gastrointestinal and neurological. Symptoms usually appear in 8-12 hours and go away in 24-72 hours. It is also only considered to be toxic if it is ingested through food or drink.. ### Response: Temperatures below 100.4 are normal and not considered mild fevers. You are not having a mild fever for months, youre having a normal body temperature.Anything above 100.4 is considered a fever.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: This is just a question but my normal temp is 97.6. Would 100.4 not be considered a fever? Or does that 100.4 go from possible normal temps and not the average body temp? Usually if my body is 3 degrees warmer than normal I don't feel well etc.. ### Response: Hi friend, no that wouldn't be considered a fever. The body has a much greater range of normal temperature in general than people who use the empiric system believe. "98.6" is actually the direct translation of 37 C into fahrenheit. In celsius, (which is how medicine measures temperatures, even in the USA), fever starts at 38 degrees. That directly translates to 100.4. (That's why a temp of 99 is not actually a fever.) Though it appears higher than the 98.6 we're used to hearing, it's actually well within normal limits.The usual frame I'm used to is 36.5-38 as sort of the guidelines. Your temperature of 97.6 translates to 36.4444. My guess for that is just that temperatures taken outside the body can be less accurate. That's not a concerningly low temp to me; basically you fit well within the normal standards and you would not qualify as having a fever until you reached 38 (or 100.4).


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: High Hematocrit with Low iron. Should I see hematology ASAP or continue further investigations?Hematocrit peaked at 47.5 this year. (Normal high range is 44)Currently Ferritin is 9. (Normal range 16-165)37f. Af Am. 59. 140lbs.Problems.Persistent headache. Severe abdominal pain. Raynauds without spasm - hands stay cold. Severe chest pain. Abnormal EKG (compared to previous) w/t wave inversions. Intermittent claudication with 0.7 ABI post exercise. Paresthesias. Sudden high blood pressure since my hematocrit went out of range. Fatigue. Night sweats. Sudden high blood pressure when hematocrit went up to 46. 12 yrs ago, retinal detachment left and tears/holes both eyes retina surgeon can be signs of microvascular/hematology issues.Meds.Continuous BCP 12 years bc of heavy bleeding. Amlodopine off label for poor circulation in legs/hands.Saw a hematologist and they declined to test for JAK2 mutation for polycythemia Vera because hematocrit wasnt that high and EPO was low normal 3.2.Unlikely sleep apnea. Live at 100ft above sea level. Dont smoke. Changed houses since hematocrit started climbing years ago, so carbon monoxide unlikely. Drink a gallon of water daily. 3 cardiologists say I do not have a heart or cardiopulmonary problem. Entire body has been imaged neck down for large vessel blockages. Neurologist did EMG and entire spine has been imaged for paresthesias. All normal.Should I continue the endless investigations? I have GI, rheumatology appts scheduled.See hematology ASAP?Take an iron supplement and see if I feel better?. ### Response: I dont think you need workup at all.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Why is that? Does anything need to be done about my ferritin levels?Im at Stage 3 iron deficiency.https://maryannjacobsen.com/wp-content/uploads/2021/02/Stages-of-iron-deficiency.png. ### Response: I mean you need iron but there's no workup needed for your blood count.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: My hematocrit is 10% over the expected high range for African American women. So the equivalent in a white male would be 55 range.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4578165/table/T2/?report=objectonlyAt what percentage over the norm for my gender and race does it need workup?Or is the white male range the standard that has to be used for everyone?. ### Response: What's your hemoglobin? That isn't an abnormal hematocrit.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 15+ also above the 97.5 percentile for my gender and race according to the US National Institutes of Health.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4578165/table/T2/?report=objectonlyIm asking. If doctors dont trust the national institutes of health guidelines, what is the guideline I should expect them to use for abnormal?Do I need to be in the white male range for abnormal?Do I need to take iron supplements to pop my red blood cell counts into the abnormal for a white male range?. ### Response: Just fyi there's no such thing as a NIH guideline. You're just quoting a table in a very low impact journal. Pubmed is the central database where most publications are stored. Usually when a publication only makes it to a low impact journal, that's because there are significant flaws in the study.Every lab that runs these tests have slightly different results and their own reference range.It's somewhat futile to go on a endless journey for mildly abnormal tests because unless there's major clinical consequences, chances are it's nothing. As you said yourself, you're above the 97.5% but that means 2.5% of the population has hemoglobins higher than that which is you.Anyway good luck.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Is this some kind of blood cancer?25.Male.HIV undetectable. My HIV provider is very concerned regarding abnormalities found repeatedly on my labs since the start of the year. Previously, my CD4 Poz Lymph usually stayed in the 30s range. However this past year, that range has consistently been dropping. First 22; then 19, and 16... Since last summer, I have had a full workup related to abdominal pain, migraines and muscle weakness/discomfort and current severe rectal pain. My provider has expressed her concern regarding this and has now referred me out for a hematology/oncology consult. There is a history of blood disorders including blood related cancers on my dads side of the family. Can you give me any insight or advice on what I may be dealing with here? It would be greatly appreciated. Thank you.. ### Response: This is a murky situation because both resurgence of HIV as well as other infections could cause high lymphocytes. If HIV is still negative then Id worry more about another underlying viral infection. If lymphs remain high and keep going up then Id ask for hematology consult. Your ID doc might want to send off flow cytometry to rule out any ominous diagnoses in the meantime. I wouldnt be too concerned about percentage of CD4 cells. Just worry about absolute count which is fine. High lymphs is nothing concerning unless it keeps going up on repeat..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: How concerned should I be regarding leukemia, lymphoma or some other blood related cancer. ### Response: Id have absolutely no concern for these things with these labs.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Just had new panel taken yesterday that just came back via Labcorp. Numbers are still wonky. Being referred to hematologist . Confused and terrified. ### Response: No reason to be terrified. Your lymphs might be high but they arent going up. Numbers are seemingly almost the exact same as last time within deviation. Heme will likely send flow cytometry off but your ID doc couldve done this to get the ball rolling. Still doesnt seem like anything ominous. Bad things come with really bad labs, multiple cell lines affected and usually metabolic abnormalities..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Is this Lymphoma/ some type of Blood cancer25.Male.HIV undetectable. My HIV provider is very concerned regarding abnormalities found repeatedly on my labs since the start of the year. Previously, my CD4 Poz Lymph usually stayed in the 30s range. However this past year, that range has consistently been dropping. First 22; then 19, and 16... Since last summer, I have had a full workup related to abdominal pain, migraines and muscle weakness/discomfort and current severe rectal pain. My provider has expressed her concern regarding this and has now referred me out for a hematology/oncology consult. There is a history of blood disorders including blood related cancers on my dads side of the family. Can you give me any insight or advice on what I may be dealing with here? It would be greatly appreciated. Thank you.. ### Response: See what the haematologists say but I wouldnt be particularly concerned if your CD4% is lower, because your absolute lymphocyte count is high. When your lymphocyte count comes down your CD4 % will increase. I dont know why your lymphocyte count is (a bit) higher than normal, but its not usually anything concerning.The most important thing is that you are continuously undetectable on HIV viral load..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Help with CBC results?Im a 30y/o white female, 52, 138lbs. I used to stay very active, workout consistently. I never drink or smoke, and the only meds Im on is Fluoxetine 60mg for clinical OCD diagnosed several years ago.For the past 8 months I have had severe fatigue, breathlessness, irritability, exercise intolerance, sleep disturbances, heart palpitations and it seems I am constantly ill from flus or colds.Bloodwork initially showed low ferritin so we assumed it was that and did iron infusions. My b12, folate and T4 and Vitamin D were all normal. My reticulocyte count was quite low previous to the infusions and after treatment, its still low. From what my doctor understands, the absolute reticulocyte count should have risen substantially (even elevated) in response to the iron infusions as it would help my bone marrow get stimulated to make more red blood cells.Why would this be? My doctor is sending me to Hematology Oncology because she doesnt like the blood work results either, but my appointment is 2 months out due to living in a remote region of the country (US). Can anyone help me decipher what all this means? (I will put link to pic of labs). ### Response: What date did you get an iron infusion..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I got the 2 dose formulation. Once on 9/23 and again on 9/28. ### Response: This seems like pretty acceptable/normal lab variations then for such a short interval between lab testing and iron treatment..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What are your thoughts as to the Retic count being low?. ### Response: I think it's likely appropriate given the timing. But, I'm not the specialist. I wouldn't stress.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: So sick Im afraid Ill die35F, white, 5'4" was generally healthy except for Ehlers Danlos and trauma-related mental health (being addressed) Was bitten several times by a mouse (no rash) and a month later, soon after having an operation of tubal ligation and IUD replacement (to stop periods) began having sporadic fevers. Thought it was due to surgical wound, took antibiotics, sporadic fevers continued. My surgical wounds are healing very slowly as in 6-8 weeks. This was October. December, elevated temp ranging from 99-101 every day. Shortness of breath, but chest CT showed healthy lungs. Nausea and weight loss but abdominal CT showed no problems. Persistent need to cough and clear throat and difficulty doing so, having to cough for a minute to clear it enough to talk.No one knows whats wrong. I now feel like Im dying. I dont say that to be cute, I feel like I need someone to watch me and Im scared. I have a hematology appt but its at the end of March and who knows if they can help me either.POSITIVE TESTS: mycoplasma hominis, ureaplasma urealyticum, SED rate 44 mm/hr and D-DIMER abnormal at 321 ng/mLIm taking doxycycline and am 2 days in and feel nothing.Negative tests done: CT scan of chest with contrast, ie no blood clots, Covid, CBC with platelet, mono, blood cx aer & an, urinalysis, panel hepatic function, lipase, cbc w pits/auto diff, chemistry labs, protein total serum, serum electrophoresis, TB test, ck total, rheumatoid factor, hiv, lactate, hs C-reactive protein, and sed rate ESR. All mostly within range.Help.EDIT some have said to add my meds, Im on a lot dont judge lolLexapro, Wellbutrin, Vraylar, Nuvigil, Provigil, Xywav, Glyco-whatever (the sweating pill), prazosin for nightmares, topamax, vit D, levothyroxine (thyroid just checked and normal), fiber, linzess, and I receive ketamine/lidocaine infusions but those started post-fevers. ### Response: Need clarification, the organisms that you listed, were they wound cultures, blood culture, sputum cultures?If wound cultures, were they superficial, deep, or tissue (in that they took a chunk of tissue to culture)D-dimer and ESR will both be elevated in infectious processes, although it would be odd for CRP to be normal.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: They were all blood tests! No wound cultures or sputum cultures. ### Response: Blood cultures? I'm still unsure how they got these organisms.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Oooo are you talking about the mycoplasma hominis? That was a vaginal swab (embarrassing). ### Response: Same with ureaplasma?Ok just wanted to check this wasn't in the blood or something, but given location this is not a big deal and likely normal Flora.Sorry unfortunately I don't have much to offer, but at least you can be assured these organisms are likely not related to what's going on.A lot of things don't really add up in your post. You say you're "generally healthy" but you're on over 13 medications. What's the Topamax for? Migraines or seizures? How about the cariprazine? Were any of these medications started recently? Glycopyrrolate that I am assuming you're taking as well as Topamax can cause elevated body temperatures and the combination of the both of them might be the cause of your symptoms..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Topimax for weight loss, Vraylar+Lexapro+Wellbutrin for depression/anxiety/ptsd. When I said I was healthy I meant physically healthy? Guess I shouldve said fat. I do have narcolepsy, I forgot to say that but I view it as so separate. But ty for the info about the glyco and topamax! Ill bring that up with my doc and see if maybe that has to do with it. No new meds, latest one was Xywav in the summer.. ### Response: While Topiramate does induce weight loss it's not usually my first choice. In addition, it's usually contraindicated in people with mental health disorders and is known to increase the risk of suicide. It also causes drowsiness and you already have narcolepsy. Given the interraction with the glycopyrrolate as well I'd discuss with your physician about transitioning to another agent such as a GLP1 agonist if the goal is really just weight loss..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Platelets count of 2000, but sent home?I was in the emergency room for bruising and petechiae. They checked my blood and everything came back within normal range except my platelets which came back at 2. They said I need to see an expert so they sent me home and told me to follow up with hematology tomorrow. They gave me 40 mg of dexamethasone. When I was there they made it seem like no big deal, but now when Im researching it Im a bit concerned. Other stories say people were immediately hospitalized for levels of 5-10 and efforts were made to quickly increase their levels. Now I cant sleep because Im so worried and cant find any real answers. Should I be concerned that they sent me home? Is 2 a level that will cause me to die in my sleep or something?25 female 53 150 lbs Regularly Prescribed 150 mg lamictal and 50 mg Vyvanse Dont smoke or use any recreational drugs Only other health problem is possible PCOS (based on polycystic appearing ovaries and low SHBG) I also currently have a cold if thats relevant? COVID test negative.. ### Response: uhh... yeah not sure why they would've sent you home. Was it a community hospital? Is there a university hospital nearby?.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Yes, a community hospital. How would I go about transferring to a university hospital? Just call them and tell them whats going on?. ### Response: Or just go to another ED? Your platelet is 2,000 right?.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Yeah its 2 and the rage is 140-150 so Im pretty sure that translates to 2,000. Will a different ER do anything different? Even if its the same hospital network?I have an appointment with the hematologist around noon. Theyre being pretty casual about this. Should I push to be kept? Or to have them intervene some how like a transfusion?. ### Response: Just meet with them at noon.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Hypoferritinemia?Im 23 F. 53 and 125 pounds.I have severe gastroparesis (gj tube because of it), IBS, endometriosis, and now hypoferritinemia without anemia as well.I got a letter in the mail from my doctor saying hematology thinks I have hypoferritinemia without anemia due to a combination of malabsorption and losing a lot of blood from endometriosis issues. Im constantly dizzy and my joint pain baseline is never below a 7 anymore. They said it could possibly be because of this, but they arent sure.Other than a letter that said my ferritin levels were 4 & I also had low folate levels, so I was to schedule an iron infusion appointment a few weeks out, I havent heard anything else.My biggest questions are is this something that would likely be chronic, or fixed with a single iron infusion? & is there anything I can do to help correct this?. ### Response: If you have a GJ and bowel problems you'll probably have ongoing absorption problems anyway.Have you considered trying to stop the periods with contraception so you're not losing more blood at least? You should avoid the pill if absorption is an issue but depot, implant and coils would be good options..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Ive used the pill for 12 years to try and limit periods, but Ive always bled through it anyway. My gyn is hesitant about using any other hormonal birth control because of how rapidly the endometriosis grows back after being removed. They didnt want to use any IUDs because of level of cramping I already get. They said at this point my options are to either keep taking the pill and hope it helps or get pregnant and hope that helps.Ive been on over 20 medications for a year to try and help my symptoms, but I see no improvement from any of them whatsoever except sometimes the dissolving zofran helps my nausea. I dont know if this is another sign of an absorption issue.. ### Response: I'm surprised they are happy with the pill given your presumed absorption problems. A method that prevents ovulation eg the depot would be ideal and will make endometriosis better..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 2.5 year olds bloodwork. Concerned.My 2.5 year old daughter has been refusing food, tired and constipsted. I get picky eating is a thing but this is beyond picky. Shes losing weight. Her doctor didnt seem concerned but there are levels on her chart that are totally abnormal and Im at a loss as to what I can do.WBC Learn more about this 5.96 103/uL WBC Date: May 21, 2021 08:49 a.m. PDT Reference Range:4.80 103/uL - 13.50 103/uLRBC Learn more about this 5.07 106/uL RBC Date: May 21, 2021 08:49 a.m. PDT Reference Range:3.70 106/uL - 5.40 106/uLHemoglobin Learn more about this 13.7 g/dL Hemoglobin Date: May 21, 2021 08:49 a.m. PDT Reference Range:10.5 g/dL - 16.0 g/dLHematocrit Learn more about this 40.0 % Hematocrit Date: May 21, 2021 08:49 a.m. PDT Reference Range:29.0 % - 48.0 %MCV Learn more about this 78.9 fL MCV Date: May 21, 2021 08:49 a.m. PDT Reference Range:74.0 fL - 99.0 fLMCH Learn more about this 27.0 pg MCH Date: May 21, 2021 08:49 a.m. PDT Reference Range:25.0 pg - 32.2 pgMCHC Learn more about this 34.3 g/dL MCHC Date: May 21, 2021 08:49 a.m. PDT Reference Range:31.0 g/dL - 37.0 g/dLRDW Learn more about this 12.3 % RDW Date: May 21, 2021 08:49 a.m. PDT Reference Range:11.6 % - 14.4 %Platelets Learn more about this 370 103/uL Platelets Date: May 21, 2021 08:49 a.m. PDT Reference Range:150 103/uL - 450 103/uLMPV Learn more about this 8.4 fL MPV Date: May 21, 2021 08:49 a.m. PDT Reference Range:7.3 fL - 12.4 fLNeutrophil % Auto Learn more about this 33.8 % Neutrophil % Auto Date: May 21, 2021 08:49 a.m. PDT Reference Range:33.6 % - 77.5 %Lymphocyte % Auto Learn more about this 57.7 % Lymphocyte % Auto Date: May 21, 2021 08:49 a.m. PDT Reference Range:10.0 % - 59.0 %Monocyte % Auto Learn more about this 7.6 % Monocyte % Auto Date: May 21, 2021 08:49 a.m. PDT Reference Range:4.0 % - 12.5 %Eosinophil % Auto Learn more about this 0.70 % (Low) Eosinophil % Auto Date: May 21, 2021 08:49 a.m. PDT Reference Range:1.00 % - 4.00 %Basophil % Auto Learn more about this 0.2 % Basophil % Auto Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.0 % - 1.0 %Imm. Granulocyte % Learn more about this 0.0 % Imm. Granulocyte % Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.0 % - 0.4 %Neutro Absolute Learn more about this 2.02 103/uL Neutro Absolute Date: May 21, 2021 08:49 a.m. PDT Reference Range:1.50 103/uL - 8.60 103/uLLymph Absolute Learn more about this 3.44 103/uL Lymph Absolute Date: May 21, 2021 08:49 a.m. PDT Reference Range:1.00 103/uL - 7.30 103/uLMono Absolute Learn more about this 0.45 103/uL Mono Absolute Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.00 103/uL - 1.20 103/uLEos Absolute Learn more about this 0.04 103/uL Eos Absolute Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.00 103/uL - 0.50 103/uLBaso Absolute Learn more about this < 0.04 103/uL Baso Absolute Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.00 103/uL - 2.80 103/uLRetic Count.LC Learn more about this 1.3 % Retic Count.LC Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.6-2.6Imm. Granulocyte Absolute Learn more about this < 0.04 103/uL Imm. Granulocyte Absolute Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.00 103/uL - 0.10 103/uLMiscellaneous Hematology Sed Rate Learn more about this 16 Sed Rate Date: May 21, 2021 08:49 a.m. PDT Reference Range:0 - 20 Routine ChemistrySodium Learn more about this 137 mmol/L Sodium Date: May 21, 2021 08:49 a.m. PDT Reference Range:137 mmol/L - 145 mmol/LPotassium Lvl Learn more about this 4.2 mmol/L Potassium Lvl Date: May 21, 2021 08:49 a.m. PDT Reference Range:3.5 mmol/L - 5.1 mmol/LChloride Learn more about this 102 mmol/L Chloride Date: May 21, 2021 08:49 a.m. PDT Reference Range:98 mmol/L - 107 mmol/LCO2 Learn more about this 21 mmol/L (Low) CO2 Date: May 21, 2021 08:49 a.m. PDT Reference Range:22 mmol/L - 30 mmol/LAGAP Learn more about this 14 mmol/L AGAP Date: May 21, 2021 08:49 a.m. PDT Reference Range:7 mmol/L - 16 mmol/LBUN Learn more about this 16 mg/dL BUN Date: May 21, 2021 08:49 a.m. PDT Reference Range:7 mg/dL - 17 mg/dLCreatinine Level Learn more about this 0.30 mg/dL Creatinine Level Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.20 mg/dL - 0.70 mg/dLBUN/Creat Ratio Learn more about this 53.3 ratio (High) BUN/Creat Ratio Date: May 21, 2021 08:49 a.m. PDT Reference Range:6.0 ratio - 20.0 ratioGlucose Lvl Learn more about this 88 mg/dL Glucose Lvl Date: May 21, 2021 08:49 a.m. PDT Reference Range:74 mg/dL - 106 mg/dLCalcium Learn more about this 10.4 mg/dL (High) Calcium Date: May 21, 2021 08:49 a.m. PDT Reference Range:8.4 mg/dL - 10.2 mg/dLProtein Total Learn more about this 7.7 g/dL Protein Total Date: May 21, 2021 08:49 a.m. PDT Reference Range:6.3 g/dL - 8.2 g/dLAlbumin Learn more about this 4.8 g/dL Albumin Date: May 21, 2021 08:49 a.m. PDT Reference Range:3.5 g/dL - 5.0 g/dLA/G Ratio Learn more about this 1.7 ratio A/G Ratio Date: May 21, 2021 08:49 a.m. PDT Reference Range:1.0 ratio - 2.2 ratioBilirubin Total Learn more about this 0.30 mg/dL Bilirubin Total Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.20 mg/dL - 1.30 mg/dLBilirubin Direct Learn more about this 0.0 mg/dL Bilirubin Direct Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.0 mg/dL - 0.3 mg/dLAmylase Lvl Learn more about this 68 U/L Amylase Lvl Date: May 21, 2021 08:49 a.m. PDT Reference Range:30 U/L - 110 U/LLipase Lvl Learn more about this 55 U/L Lipase Lvl Date: May 21, 2021 08:49 a.m. PDT Reference Range:23 U/L - 300 U/LAlk Phos Learn more about this 215 U/L (High) Alk Phos Date: May 21, 2021 08:49 a.m. PDT Reference Range:38 U/L - 126 U/LALT Learn more about this 19 U/L ALT Date: May 21, 2021 08:49 a.m. PDT Reference Range:0 U/L - 34 U/LAST Learn more about this 57 U/L (High) AST Date: May 21, 2021 08:49 a.m. PDT Reference Range:14 U/L - 36 U/LCRP Learn more about this < 0.5 mg/dL CRP Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.0 mg/dL - 0.9 mg/dLGlobulin Learn more about this 2.9 g/dL Globulin Date: May 21, 2021 08:49 a.m. PDT Reference Range:2.2 g/dL - 3.7 g/dLImmunology/Serology Mono Screen Learn more about this Negative Mono Screen Date: May 21, 2021 08:49 a.m. PDT Reference Range:Negative. ### Response: All these results look very normal, with the exception of a mildly elevated AST and Alk phos (most likely from a virus). Nothing here gives much of an idea what may be going on.Children can also have elevated Alk Phos from simply growing, so absolutely no worries there. Agree about the AST potentially being viral in origin. At my place we'd recheck that (by itself) in a few months but not worry about it in the meantime..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Husband with osteonecrosis and little game plan besides narcotics- is he being managed appropriately?Just a HUGE thanks in advance to anybody who responds. I'm a talker and I'm livid right now, so I'm trying to keep this just to necessities but may fail and leave out key details and/or talk about things that aren't necessary. To preface- I come from a "medical family" but it's primarily neuro and psych rather than ortho. I devour medical literature, podcasts, etc, have worked as nursing staff in psych and derm, just got my master's in health sciences, and am planning to apply to med school this cycle- so basically, please feel free to talk to me in technical terms, link to articles, etc as appropriate.Now onto the issue.Husband is 28M, 5'8.5", 225lbs, white, occasionally smokes cigars (maybe a cigar or two a year?), and drinks moderately (down from heavy drinking a few years ago as part of work culture). About 5 weeks ago was diagnosed with osteonecrosis in both femoral heads. Started having pain just in his right hip in May, but really started to notice in June as it was limiting mobility. Got to the point in July where he couldn't go up and down the stairs- I was gone and he was texting me he had to army crawl back up the stairs to bed. Initially, he got an x-ray which had some "fringe" or something to that effect (I wasn't in the appointment so I don't really know what was said about it) but was concerning for possible osteonecrosis and MRI was recommended. While waiting, he went to PT, and the PT thought perhaps bursitis if not ON, but the pain kept worsening. Got an MRI at the end of August which showed osteonecrosis in both hips involving over 50% of both femoral heads. Right side had marked edema extending into the femoral neck and noted a "mild asphericity of the head consistent with mild depression," subchondral fluid cleft, and diffusive mildly thinned cartilage. Left side had edema as well extending into the neck.Husband was referred to ortho, which in itself was a headache as PCP had to send that referral FOUR times. As we're waiting, his pain is getting worse to the point where he was using a cane and then progressed to needing a full set of crutches. If you could see his gait- it's just awful and was placing stress on other joints and was leading to back pain too. PCP started him on Celebrex 1000mg QAM for two weeks and then 500mg QAM after as well as gabapentin (titrated up to 900mg QHS). Got several labs drawn to check for a cause- including autoimmune labs- and the only abnormality was low vitamin D (15 ng/mL), so he was also started on OTC D3 5000IU daily and a prescription weekly dose of D2 (I can't remember the dosing). . The Celebrex seemed to help him the most, but after about a week on that, it was still only "barely" helping. As time went on waiting for ortho, the way he described the pain and sensation also changed, with more "grinding" pain.In what I've been able to read, it seems there are treatments that can help the pain (narcotics, staying off the joint, fluid aspiration for edema) and may treat earlier stages of disease (eg, core decompression, treating underlying cause to get blood flow back to the bone), but once the femoral head collapses, hip replacement becomes standard of care.When we were finally able to meet with ortho, the doc, while personable and nice, didn't really give us a lot of info. He didn't stage the disease at time of MRI, but kept saying "mild." This annoys me because with the amount of pain he is in and asphericity of the femoral head, I wouldn't classify anything he's experiencing as "mild" myself, and surely not "caught early/in early disease stage." We tried to impress the pain aspect and how limited his mobility is because of the pain. Doc kept hinting at "something stronger" to manage the pain and said we could schedule for aspiration for the edema. Also mentioned that he needed to stay off the joint as much as possible and should be using the crutches for any walking. Husband is terrified of needles (aspiration is done fully conscious and may need to be done every week or two to control pain from the edema), and with a history of SUDs in his family, being on narcotics for longer than a few days is also terrifying and he prefers not to. We asked about hip replacement, and he seemed not to want to do it, citing Husband's age. ORtho requested workup for potential coagulation disorder because we could "save the hips" if this was caused by a treatable clotting disorder, and he referred to hematology. No further discussion about replacement or why he didn't want to pursue it- just the age and potential for a clotting disorder.Neither one of us was thrilled with this. I wasn't convinced that restoring blood flow would magically re-shape his femoral head, especially with how he is now describing grinding pain. His half sister also does have a clotting disorder, but it's Factor V deficiency, so it's that she doesn't clot appropriately. But fine. Took them a week to get the referral to hematology, and a few days later, we have to call hematology and essentially was told he is a "low priority" patient and they wouldn't see him (they were rude, but I do get it because oncology patients need to take priority). Ortho refused to order the tests because "we don't really order tests" and said they'd send it to PCP. No follow-up scheduled with ortho until after the coag tests. This was about two weeks ago.About 10 days ago, his pain advanced so much that he finally did call in to the ortho clinic to as he was unable to sleep he was in so much pain. I picked up a script for 5mg oxycodone for him, and he's been taking this before bed reliably since and sometimes needs it during the day due to the pain. He hates it, and it barely touches the pain anyway. He called again last week because he is still in so much pain and essentially demanded to see the surgeon himself so we can get real answers about how we are not just going to "manage" the pain but resolve it. Thankfully, we see the surgeon tomorrow.Anyway, so today, we were able to meet with his PCP via telemedicine (he couldn't get to the actual hospital due to his limited mobility right now and still make it to the ortho appointment tomorrow). His PCP essentially said they a) weren't going to order any of the coag tests ortho wanted (they didn't have any notes from ortho and "it isn't standard of care") and if they wanted coag tests, they'd have to order themselves, and b) my husband "needs" to be more active, going to PT, walking, swimming if he can't put weight on it (note: the only pools here this time of year are at expensive gyms we cannot afford to go to), etc. My husband literally cannot do that. If he goes up and down the stairs more than once in a day, he's knocked on his ass in pain for the next 24 hours. He tried to impress this upon her, but she just kept saying how he needs to move it to avoid muscle atrophy, and if he can't, then the pain isn't managed appropriately. I don't disagree about his pain- it's not managed well at all- but her solution was to increase the gabapentin which tbh I don't think is helping him at all anyway. The bit about moving the joint more though directly goes against everything I've read about the disease, what the ortho told us, and what he experiences- he can manage his pain by being totally 100% sedentary, but that's not a lifestyle he wants (nor what is good long-term).So, wonderful docs of reddit, is he being managed appropriately so far? Is there something more I can do to ensure he has good care? I don't go into telemed visits with him since he takes him on headphones, but I do have to go with him when he goes in to the clinic since he cannot get around with me. I asked my older sis to send me some of the info on UpToDate so I can read more about what is actual standard of care. I cannot for the life of me feel good about it, and I feel like nobody is listening to him and his pain and what HE wants (solution, not management). Our world has radically shifted very rapidly, as he cannot do much at all or engage in hobbies or household chores or even the fun parts of a relationship most of the time. We are seeing a therapist to help manage it, even, but all the medical teams seem to be doing is throwing narcotics and giving him mixed messages and refusing to actually give us real insight into the disease process or why they don't want to resolve it. And yeah, I'm really mad about it all.Thanks again to anybody that can give me any insight into this.. ### Response: Osteonecrosis / avascular necrosis of the hip, it can be bad. I kinda agree with the ortho - be as reluctant as possible with a hip prosthesis. I don't like the term "hip replacement", cause it makes it sound like you change the hip with an equivalent. It's not. A metal prosthesis has a limited life span - 10 - 20 years. Given enough time, the prosthesis will eventually fail. He's young, so he'll be doomed to have a failure while still in prime age. Then he'll have a bigger problem, since replacing a replacement is a much bigger surgery, sometimes it may not be possible at all, and there's a chance he'll have to remove a hip joint altogether while still only 40-some years old.There's a chance his osteonecrosis may dwindle, without completely destroying the femoral head. Sometimes it just leaves a small irregularity in the top joint surface, and it can be usable. I often see that the "acute" inflammation like necrosis dies out. It would be wise to wait and see how things progress. Hopefully, he can have pain relief with medications temporarily.So, I think the treatment right now seems wise. You want the problem to be solved right now with a hip replacement, but the ortho know that will bite you back in a few decades. When he says it's mild, he's probably referring to how it looks on xray, and mild there is a good thing..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: hanks for the reply. We know he would need another replacement in his life time (or multiple replacements of the hardware) if he were to have it replaced now, although the rate of failure of that THA is what is unknown to me and what nobody seems to have discussed with us. My best friends mother had bilateral THA in her teens and is in her 50s now with an additional 3 replacements, and is still healthy, so I may have some rose colored glasses with the n=1 sample size there. I think I will look up the data about revisions.I worry so much because I see his QOL just deteriorating in front of me. He doesnt want to die, but I know he doesnt want to live like this. Not just the pain but being unable to do what he finds meaningful. Pain management is great when theres a positive end in sight, but if its going to be a long-term that has a very high likelihood of ending in THA anyway, I cant imagine he would want to live like that. The trajectory hasnt been good so far, and Im somebody that needs hard data and numbers to reconcile any differences between patterns I see and what I am told might happen. As a radiologist, you may not have an answer, but how often do you see patients actually improving without hip prosthesis once their MRI looks like my husbands (or, can be described like my husbands)? Do you get to know who is symptomatic and how symptomatic? Previously I was trying to find studies or case studies and just couldnt find anything promising myself, and I was also focused on the quality of his pain, since there seems to be a different type of pain now.Along the same vein, how often is common to repeat images while waiting? How quickly have you seen deterioration? Its only been 5 weeks since the MRI and just shy of 3 months since the X-ray, but I am worried about how its progressing and wondering if it may not be as early or mild now as it was then.. ### Response: how often do you see patients actually improving without hip prosthesis once their MRI looks like my husbands (or, can be described like my husbands)Don't have an exact number, but it's not uncommon to improve, and I'm often amazed of how well some seemingly terrible looking hips can end up, given time. Conditions with bone marrow edema are generally painful. I believe bone marrow edema in itself is causing much of the pain. The edema will usually / eventually resolve in time. A few months at least. Sometimes more than half a year. When / if the edema is gone, remaining pain will often depend on how damaged the joint surfaces are, and degree of osteoarthritis. From the description you quoted, it's not too damaged now. "Mild depression of the joint surface, mild cartilage thinning", I have an image in my head how that looks, and it's not too bad. As long as the joint surface isn't completely destroyed - and it isn't on those exams he's taken - there is a chance yet he could avoid THA.There is a chance it may develop into further joint destruction, but can only wait and see for that. Follow-up MRI 3-6 months after the first, maybe, depends on the clinical situation. Regular xray is often enough to assess damage to the joint surface.Also - while I'm not really questioning the diagnosis he's given, there are different conditions that causes bone marrow edema in the femoral head. "Transient migratory osteoporosis" is self limiting, and possible to mix up with osteonecrosis..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Help with hematology analysisIm a male 39 years old, 78 kg, 173 cm. I use CBD for anxiety daily, no other medication. My MCV seems to be a bit high in the analysis.MCV 98.1 Hemoglobin 9.3 mmol/l Erithrocytes 4.8 / pl Hematocrit 0.47 l/l Thrombocytes 214 NL Leukocytes 6.4 NLAll other parameters, including thyroid TSA and liver ALAT are good, also glucoses, glycosilated hg, cholesterol and triglycerides are good. I drink almost daily, but no more that a couple of beers, smoke socially, and dont do other drugs. Red meat consumption is very low but Im not vegetarian. My diet is (I think) good, but probably too much bread. Should I worry about the MCV? What does it mean? What could be the consequences?Edit: I should also say that I do boxing 2/3 times a week, and bike 10km 5 days a week.. ### Response: The most likely cause is your alcohol use. Alcohol is a well known cause of macrocytosis.Other possible etiologies include B12 deficiency (worth checking a B12 level but unlikely in your case), hemolytic anemia (very unlikely in your case as your hemoglobin is normal), liver disease, certain bone marrow disorders such as genetic conditions or MDS (those are very unlikely in your case).The macrocytosis itself is not concerning but it does mean that you have significant alcohol use. I would try to cut down.It's helps determine the cause of your anemia (low hemoglobin). You shouldn't worry, but you should follow up with your doctor to go through the next steps to work up your anemia with a high MCV. This is a common thing that has a pretty well trod diagnostic pathway that you and your doctor can work through.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Diagnosed with Chronic Myeloid Leukemia in November, fired from oncology office, 2 months without chemon September went to the ER for feeling under the weather and some blood work came back abnormal and I was referred to a hematology oncologist a month later. Went in and did the biopsy and everything. The doctor said that she calculated the risk from all the numbers and I'm in the intermediate risk stage but hopefully with the oral chemo for life, I should be able to keep it from turning into AML or the least, extend the quality of life.Come to find out that the doctor I was rushed in to see was actually a traveling doctor and she'd be leaving at the end of November. I then was forced to see a male doctor in the practice instead of the other female due to scheduling conflicts and bad weather. I felt very uncomfortable with the doctors bedside manner, the way he implied that I somehow forced a surgeon to take my thyroid out instead of trying medications first, didn't let me talk and explain that I was experiencing bad side effects from the chemo and also experiencing pain. This all happened and came to a head in March.He basically said that I was seeking drugs and that he wouldn't make any changes to my treatment (which was Bosulif 400mg/once a day). I was given a prescription and 5 refills. I then tried to speak to the director about being switched back to the female doctor and she said that the male Dr wouldn't sign off on that and if I was unhappy with the decision I can seek treatment elsewhere.I got my last refill in February and so have been off chemo since Feb 22nd. I tried to get into another oncology office but after the previous cancer center sent over my records, I've been told 4 times now that they have the referral and will contact me by end of day or the next day, for the last 3ish weeks.I can feel the pain in my thighs, hip/pelvic bone is growing and starting to get to effecting my daily routine.Does anyone have any advice on what I can do from here?Edit in case it's relevant: I also have Addisons and Graves Disease (well I had my thyroid taken out last June), Idiopathic Intracranial Hypertension, Thyroid Eye Disease, Ulcers, Gastritis, and gastroperisis.. ### Response: So what you have been taking is a -tinib drug which inhibits/blocks a growth hormone receptor (called tyrosine kinase). It really isn't classified as chemotherapy. That said, I would see a primary care doctor for now, to have the prescription renewed, while you wait to establish with a new oncologist..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Ah, okay, was oddly explained to me in the beginning.But, I have gone to my primary care and they basically said that they can't prescribe the medication or treat the leukemia and that I need to try to work with the cancer center to find a new oncologist office. I've reached out to a few and had my referrals sent over but the days are just passing and no calls though a few have confirmed receiving the referrals.. ### Response: This is odd. I fail to see why a MD/DO would not prescribe at least 30 days of this medication. It isn't really a chemo drug and most physicians learn about it in medical school..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Donating Blood with Fatty Liver / NASH42 White Male, 510, 181 PoundsMedications: Wellbutrin, Pepcid, Prilosec, AdderallI currently have Fatty Liver / NASH with F2 Fibrosis. I keep seeing things asking for blood donors due to a current shortage, but my local blood bank lists "Liver Disease" as a disqualifying condition.Over the past 7 months, I've lost 50 pounds due to diet and daily exercise. At my last hematology visit, all of my liver blood tests were in the "normal" range. So is there really a reason that I shouldn't give blood? Or do they really mean that cirrhosis is the disqualifier for blood donation?. ### Response: Fatty liver is not an exclusion to blood donation. When they list "liver disease", they mean problems that can be transmitted via the donated blood products. That means viruses, like hepatitis B or C. Cirrhosis does not exclude anyone from donating blood, but the person may be taking medications or have abnormal blood counts or have abnormal vital signs that would prevent the donation..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Juvenile Xanthogranuloma22m with two skin lesions that were biopsied and turned out to be "Juvenile Xanthogranuloma" (adult type).The PA who did the biopsy didn't seem too concerned. I'm a little confused as it seems that it normally happens to infants and I can't find much other information about this online except in medical journals.Some research says it's rare, while other research says as many as 1% of children can be affected and that it's usually underdiagnosed. One study says the average dermatologist sees 1-2 cases per year, which doesn't seem too rare to me. It seems that 10-20% of cases occur in the third decade of life (people my age).I am also slightly concerned about an association between multiple juvenile xanthogranuloma and "hematologic malignancies."What has been your experience with this as a dermatologist/GP/etc.? Is this rare? Do you ever see it in adults in their early 20s or teenagers? Would having two lesions count as "multiple JXG"? Do I need to be getting bloodwork done? It's been months since they first appeared and no other ones have appeared.These developed after I got the COVID vax's. Apparently JXG results from a "proliferation of histiocytes". Could this be due to the immune response caused by the vax? I have not found anything about this link in VAERS.. ### Response: 2=multipleThese are very uncommon in adults. Feel free to have a thorough investigation if you feel it is needed. The yield is very low.Your theory on pathogenesis is interesting and unprovable..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Polycythemia Vera?For the last ~10 years, I've had multiple CBCs done and regularly had slightly elevated hemoglobin and HCT%. My pediatrician and then primary care (until about age 25) never thought twice about it, as they were at the very top range of normal. Then, when I switched doctors in 2019 due to a move, I had a CBC done and my current PCP is much more concerned.The last three CBCs showed: Hemoglobin: 17.4, 17.5, 17.5 HCT%: 49.6, 49.4, 49.8, all taken within the last year. All other labs are normal (RBC slightly elevated too, understandably). I even have a CBC from 2011 with HGB 17.5 and HCT 49%, and 2016 at 17.4 and 50% respectively. The institution they were taken at consider those within normal ranges (though at the upper bound). The most common JAK2 mutation is negative, and so is the EPO testing (as in its normal). I don't have any noticeable symptoms, other than some occasional moderate fatigue and malaise that may or may not be related.I was referred to hematology and the doctor was moderately concerned. She would like to order additional gene mutation testing for less common mutations, and some other more basic labs. The former of which is likely to be pretty expensive. She also was clear in saying that PV is technically cancer, and could lead to stroke etcetc. I am what I would consider highly medically literate, but still found the latter comments fairly scary. At the same time, she mentioned dehydration and sleep apnea as other causes. I find both to be somewhat unlikely given that a. being dehydrated at every blood test seems unlikely and b. i don't snore (though i know you can still have sleep apnear regardless, its far more rare).My real question is: from all of my research, the lab values I'm seeing are really just above normal and may even be within normal ranges at some institutions. To what extent is it worth continuing to pursue the root cause? What do I have to worry about most? If one of those other gene mutations comes back positive, what's my prognosis?. ### Response: I would defer to your hematologist for a real discussion, but your hematocrit at or below 50% is pretty non-concerning for primary polycythemia vera. Based on my reading you wouldn't even phlebotomize unless you HCT is >54%. There are plenty of other causes of secondary polycythemia beyond sleep apnea, including just simply having a higher than normal hematocrit.But to be sure, take your hematologists recommendations are far higher value than my thoughts. I deal with the secondary causes a lot more that primary PV..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: This makes a lot of sense to me, appreciate you answering. I agree and defer mostly to the hematologist.It becomes a challenging question when the labs that were ordered (myeloid NGS panel) are quoted at $1K+ and I have to decide if I want to follow through on that.. ### Response: A good question to your hematologist is what she's going to do with a positive result. If there would be a treatment that would significantly reduce your risks and improve your life, the $1000 might be worth it. If she would just monitor your blood counts the testing might not be worthwhile. agree with the original physician response.Just wanted to comment on whether or not to do NGS for $1k. I think this is a little excessive if only for high Hgb. Id maybe try CALR mutation first. This is the second most common cause of high Hgb or platelets. Maybe do MPL. Also how are your platelets? And do you smoke by any chance or live at a high altitude?While PV can transition into a cancer, it is also easily controlled with things like hydroxyurea and therapeutic phlebotomy to keep your Hct down. Its not as scary as say full blown myeloid leukemia. Its something that is treatable.Just my 2 cents as someone who works in the field. Maybe bring these issues or questions up the next time you speak with your hematologist. I think the Pulm MD above also had a good thought about if any of these mutations come back positive, what does it do for your future monitoring and treatment?.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Elevated white blood countAge: 41 Height: 5' Weight: 175 Conditions: hidradenitisHi. I've sat chronically at 12 as my white blood count for several years. I've had issues with fatigue and feeling weak but it's recently increased with the addition of excessive sweating while asleep and at times during the day. my gp sent me for a routine workup where I have spiked to 15 without any illness(ie no colds etc). She repeated the test the following week and I was at 15.66. She's referred me to hematology. I'm overweight and do smoke a half a pack a day. I've been a chef for 20 years so I'm very active despite these lingering habits(sober now for 6 years). So I'm curious what to expect at the appointment if it's even necessary or if I just need to change my lifestyle? Thanks very much. ### Response: Smoking, overweight and hidradenitis could all contribute to an elevated white blood cell count. The sweating stuff is non specific, only sustained drenching night sweats are particularly concerning, and they are not subtle at all. Do you have the differential on the CBC?.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I don't, she hadn't uploaded my tests to my portal. She's been my gp for a few years so she knows my conditions etc. The night sweats only cause me to pause because I haven't had them like this since before I quit abusing alcohol. I guess I'm just wondering if I actually need to see a hematologist or if it's something I can try to manage on my own? She ordered a chest x-ray as well, I have no idea what that has to do with any of it!. ### Response: The Hematologist can at least look at your differential, maybe do a couple tests to rule out uncommon chronic leukemias and similar disorders and give you the all clear so the matter doesnt need to be addressed again. If youve got an appt, may as well go to it at this point. 15 is high enough that we wouldnt resent having to see you hehe. Now if you were sent when it was 12, that would suck, and we get a lot of those referrals as well. Its reasonable to get a once over by a blood doctor for a WBC if 15, but most likely to be fine from that perspective..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: M-Spike. How concerned should I be?My allergy doctor somehow decided to test me for some antibodies & some other things due to some unusual symptoms and I had an M-Spike result. She was quite concerned.Specifically, the test was "Protein Immunofix Electrophoresis, Serum Details" and the result was "abnormal band identified as monoclonal IgG kappa."I went to my primary care provider who ordered some follow-up tests, which I just got back. The results are in the table below. Most are normal, but the first one is presumably a repeat test (and same result) of the igG kappa.On Wednesday I'm meeting with a Hematology/Medical Oncology doctor. In the meantime I'm wondering if I should be losing sleep over this. Because I am.I'm 50 yrs old, 5' 9", 150 lbs., male, I take pepcid, non-smoker. I've been having some strange symptoms for five years (balance, adult onset scoliosis, right sided fatigue, bone pain on the right side).Thank you.. ### Response: Note: I am not a hematologistLooks like monoclonal gammopathy of uncertain significance (MGUS). A small percentage of people with this condition will progress each year to a low-grade malignancy called smoldering multiple myeloma or to overt multiple myeloma. Some people may develop other malignancy of the plasma cells (mature B cells that produce memory antibodies). Most people are simply monitored for rising amounts of the monoclonal protein over many years, and don't require treatment.Monoclonal proteins may be associated with elevated Factor VIII, which can predispose patients to blood clots. If you have a history of DVT or pulmonary embolism, the presence of these proteins could be a reason to consider ongoing anticoagulation medication long-term. If you haven't had a blood clot, it may be a reason to consider DVT prophylaxis when in high-risk situations, such as surgery or long periods of travel or prolonged bedrest.Your hematologist will probably tell you to have blood tests periodically to monitor the level of monoclonal protein. Based on the data that you gave, it doesn't look like you have a large amount of abnormal protein, so you are unlikely to require treatment..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I have experienced a change in bowl habits and I have been seen by a gastroenterology who diagnosed me with IBS. My primary recently ran a total bilirubin test and found my direct bilirubin was elevated (direct = 0.3 indirect = 2.0. He wants me to see a hematologist. Is this common?Hello and thank you for reading. I am a 25 year old male, no prior medical history, non smoker, non drinker, very active (run 20 miles a week). I started to have increased bowl movements (5-7 a day on bad days), very lose stools. Its been pretty frustrating. I made an appointment with my GP, he ran standard blood work (CMP/CBC) and the only thing there was elevated bilirubin of 2.0 which he said was just Gilbert's syndrome.. He referred me to gastroenterology.The gastroenterologist ran a C-reactive test, calprotectin stool test, whatever the celiac marker test is, and all were normal. His assessment was that it is IBS and no treatment is needed. I went back to my GP per a followup. He felt it was worth doing an ultrasound of my abdomen and a total bilirubin test. Ultrasound was normal, bilirubin test was 2.0 indirect and 0.3 direct. The normal direct is suppose to be < 0.2.The direct bilirubin test was done on November 4th. I'd seen the results and assumed they were not remarkable. On November 22nd, I get the following e-message from his RMA:"Your recent labs indicate your direct bilirubin is high which could indicate hemolyis. You need to follow up with hematology as soon as possible. Feel free to contact us as soon as possible"I was pretty irked to get this message 20 days after I'd already seen the lab results myself. I also felt like more context would be helpful on what as soon as possible meant... does it mean in the next few days or next few weeks or next few months...Ultimately, all I was wanting to know is if this is common practice for that lab result... could that elevation of direct bilirubin be related to Gilbert's? I appreciate the insight.. ### Response: It's probably going to be Gilbert's. But who knows, sometimes it's not..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you for your time and thoughts. I imagine that is what it will be and perhaps he is just being thorough. It struck me as odd that he wanted me to see a hematologist. What are the most common other things one would be concerned about if it isn't gilberts? His RMA wrote about hemolysis concern given the very mildly elevated direct bilirubin, but wouldn't I have abnormal rbc (anemia) blood work if that was happening.I haven't been able to hear back again given the holidays and have been a bit worried by the message.. ### Response: Hemolysis is the only other common thing.