Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Im not sure if this is the appropriate place to post, Ill delete if not.33F, Current diagnoses: anemia, bulging discs, arthritis. Im on slow release iron and vitamin B12 daily and mobic and skelaxin PRN. I see a PCP regularly. Ive always been an anxious person but lately its been significantly worse. I lost my sister at the end of 2021, she was at home recovering from covid and died unexpectedly. It was a very traumatic experience, I watched the paramedics perform CPR on her. Im also a nurse, worked a covid unit the first 2 years of the pandemic. Ive got a lot of negative feelings from that as well, like most hcw. I find myself crying more often than not. I find myself unable to sleep because Im reliving the night my sister died and the days that followed. Its not just when Im asleep though. Itll hit me when Im driving or at the store, just these intrusive memories replaying and I cant make them stop.I work third shift, I come home and stand next to my husband because Im convinced hes not breathing. I have to watch his chest rise and fall several times before I believe hes ok. I panic if he doesnt respond to a text, I almost left work one night because I was freaking out convinced he was dead, he was home with covid and had just fallen asleep.I now work a unit thats not technically critical care but our patients are very sick. (Post op, pressors, a lines ) I often feel so heavy in my chest by the end of the night sometimes until I get home because Im so anxious that I have forgotten something or done something wrong.When I did my physical I did discuss my grief with my PCP but told her I felt like I was ok. I do this thing were I like to say Im ok even though I know Im not. Its getting to a point though its obviously interfering with my life. Im just not sure who to turn to. Ive never sought care for my mental health so I was going to go through my employers EAP but its so overwhelming. Theres therapists, social workers all kinds of options. But theres no psychiatrists available. I dont really know if theres a reason I should be seeking one or if I should just start with a therapist. I think I just feel overwhelmed by all of it and need help in which direction I should go.If youve read all of my ramblings I greatly appreciate it. Any and all advice is welcomed. Thank you all for your time!. ### Response: I think you would benefit the most from having both psychological and pharmacological therapy together.It sounds like you're in a different country than mine, and your healthcare system may be slightly different, but I hope this largely applies.I think your first step ought to be going back to your primary care doctor and telling them what you've written here.Your primary care doctor should be able to signpost you towards the appropriate psychological service, who can do their own assessment and determine what type of psychological therapy is best suited for your needs.At the same time, I think you would benefit also from pharmacological therapy, but it's not necessary for you to see a psychiatrist immediately. Your primary care doctor is trained to assess and prescribe treatment for common and uncomplicated psychiatric conditions. If it later becomes clear that your illness is more complex than it first appeared, or if you don't respond to the first or second-line treatments, you could explore getting a referral to see a psychiatrist then.You should also look into seeing your employer's occupational health service, who can, I hope, help support you in your work and make any necessary adjustments. I would strongly recommend discussing your health with them especially if your mental state starts interfering with your ability to work.I hope things start getting easier for you soon..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What type of medical tests should I ask my doctor to perform to look at underlying medical issues or deficiencies that might be responsible for my hair loss. I have complained in the past and she only looked at iron.Im a 34F who has lost probably 60% of my hair over the past 3 years. I have no history or family members with hair loss. I am east European with light brown, fair hair. However, I have always been complimented with how full, soft, lush my hair is. Hair loss is all over rather than patterned.. ### Response: This post has very little information about your general health, no information about your medications, inadequate information about the alopecia distribution, and no quality images of your scalp. Meaningful comment is not appropriate..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: No medications (aside from Advil as needed), not considered alopecia, images wouldnt be relevant considering to the average person, it just looks like I have thin hair, but I know what it was beforehand and the loss I experience showering daily.I have always had perfect health. Also, I have a very clean diet, eat white meat or fish daily, lots of organic produce, avoid fast food or junk food (besides chocolate). Dont smoke, drink maybe 2 glasses of wine per month. Active lifestyle.I do still experience cystic acne as an adult, and have oily skin.. ### Response: Hair loss is alopecia. If you choose not to share relevant information, meaningful comment is not appropriate..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: This response is a bit harsh, and repetitive. Perhaps you could assist the OP by describing what YOU consider to be meaningful and relevant, as it appears she is trying. Also, you are the one with the degree.. ### Response: Good suggestion. I need precise information on the anatomic distribution of the hair loss. Additionally, I need information on the appearance of the scalp and the hair follicle appearance in involved and uninvolved areas..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 26F, 57, 177lbs SLE Lupus, Ehlers Danlos syndrome, and pseudo tumor cerebriThis is the first post and I took the advice given and got medical help. Well the ER didnt do anything but, give me fluids they did another CT with contrast and told me the findings were most likely old. Plus I take blood thinners already and I should be fine ( I take blood thinners because I have a stent in my brain and I had heart surgery long story). The new CT showed  IMPRESSION:Tiny sliver of hyperdensity seen in the right frontal lobe along anterior aspect of the right superior frontal sulcus concerning for focus of subarachnoid hemorrhage.Proximal Jugular Veins: Diminutive on the right, normal on the left.I also got in contact with the on call doctor since my neurosurgeon is on vacation and he said the location of hemorrhage isnt concerning. Plus if all I have is an headache I should be fine. Just to note he did see the ct report or films.So I just want to be sure Im make a good decision to not do anything. I still have a terrible headache accompanied with nausea that doesnt seem to go away. My mom is worried and keeps insisting I need to take this seriously.I hope this is legible its hard to type with a terrible headache. Thanks again I appreciate you guys. ### Response: you're on a blood thinner and they said its okay to continue while you have a hemorrhage? what?! did you have an angiogram? i don't understand this. do you have a cereberal venous thrombus?Physician/NeurosurgeonWe get a huge number of consults for hemorrhage that are almost certainly not hemorrhages on our review. If a neurosurgeon already consulted and said this is nothing then that is reasonably likely to be true. It could be artifact, calcification, post-op change from a prior procedure, or any number of other things. I think OP should track down the on-call neurosurgeon again and get a better explanation.Physician, Emergency Medicine | Moderatorone would assume a radiologist would be a little more careful in hedging if they werent sure. lord knows they hedge when they need toPhysician/NeurosurgeonThat is a poor assumption. They call surface SAH all the time that arent. There is a lot of volume averaging on the hemispheric convexities and it makes little light spots appear pretty regularly..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Is this standard practice? Hematology question.Female, 50, Arizona. Too many ailments to list.I've been anemic for at least a couple of years. One of my Dr's asked me who was managing my anemia. Ummm, nobody? So she referred me to a hematologist. The next day, I received a seemingly random text from a cancer center. The Dr she referred me to is both an oncologist and hematologist. Thus the cancer center wanting to schedule me an appointment.. ### Response: Nope thats normal. Hematology and oncology often are done in the same fellowship. Doesnt mean you have cancer at all54ReplyShare.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Assistance for interpreting Ultrasound, Chemistry, Hematology, and Urinalysis resultsGood day everyone!! May i ask for assistance with interpreting/reading may mom's results (shown in pictures above) and her potential ailment, we're really suffering financially these past few days, i'm very sorry and thank you for those who would help!! Gender: F Age: 60. ### Response: Who ordered the tests for her? They need to be the one to interpret the tests because they know what they are looking for. Tests in isolation with no context really arent useful. The lab that processes tests also have parameters that are normal based on the sample processing, and none are listed..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: PLEASE help me figure out why my legs/feet are cyanotic and can't get oxygen when sitting down. No quality of life and at risk of further permanent damage. Every specialist and hospital is baffled :( Pic inside.'ve posted here before in the past (now deleted), but that was over a year ago. I got a lot of great suggestions and every one of them has now been ruled out.History:30 year old white female, thin, non-drinker, vapes nicotine, no drugs or medsHealth issues prior to this situation: POTS, heart arrhythmias, and EDSA year ago, after my post, I was hospitalized with a vast array of neurological symptoms. To make a long story short, I ended up having a severe B12 deficiency that went unnoticed for 2 years. Low serum B12, extremely high homocysteine and MMA.After getting on the B12 injections, all of my initial symptoms have resolved, except this leg thing which I've never been told is related to the deficiency and idk if it is.Leg Issue:Feet PictureDuration: 15 monthsOnset: Began with some numbness in my toes and transient foot pain when walking, also difficult to walk as if I couldn't feel where my feet were (although sensation was intact). Coloration starts looking funny. A month later, I was sitting at my desk working for about 4 hours and looked down and my feet/calves looked like corpse limbs. Saw a vascular surgeon and had a terrible result on ankle brachial index test. He had me admitted to a major hospital and warned me of risk of double amputation. After release from hospital with no answers, I saw about a million specialists.Symptoms: when in a dependent position (sitting, essentially), it takes about 10 minutes for my feet/calves to start turning colors. They became ice cold to the touch, mottled, dark purple/blue (and sometimes blackish), and there is no detectable pulse in the feet or ankles on doppler or otherwise during this state. The longer I sit, the worse they get. It also has begun to spread higher and higher, if I sit too long it will now go all the way up to my thighs. It is not painful when sitting, they simply feel freezing cold. When I stand up to walk, they are moderately painful (not nerve pain, achey), and walking is clumsy and difficult for a bit. Occasionally, they will become hot, swollen, and bright red but there is no identifiable trigger for this. It happens rarely and isn't related to sitting or elevating them, unsure if this is even related. This cyanosis issue has caused muscle and nerve damage in my feet. Also, lack of toenail growth and yellow thick toenail color.What helps: elevation, when I elevate them, eventually the color will return to normal (pale) and the temperature usually stays cold. Walking also can help the blood flow return to normal. That's it. Soaks in warm water will help the warmth return, but does not solve anything else.What we've ruled out and tests done:Raynaud's syndromeCardiac causesPAD - MRI of both legs showed no atherosclerosis or other signs of PAD. Doctor mentioned "the veins in that area are very narrow but no other findings". He didn't write that on the report and MRI was marked as normal.I had 2 venous doppler exams. Both were done while my legs were elevated and in their good state. Both exams were normal. I expressed again, when elevated they have good blood flow, can they please do the test while my legs are dependent? They said it isn't possible.POTS Blood Pooling - It's not blood pooling, it's a lack of blood flow or a lack of oxygenated bloodBurger's syndromeAll autoimmune conditionsHematologic conditionsDependent acrocyanosis caused by POTSPretty much everything else that I'm sure I'm forgetting hereWorking Diagnoses: PVD of unknown cause, Venous Insufficiency of Legs (Don't know how they got to any of these conclusions but they are also just guesses at Doctor's admission)Other Factors: I do have motor (distal axonal) neuropathy throughout my body, caused by the b12 deficiency, however I have been told this is not related, and the neuropathy is also present in my arms and hands which have no issues in dependent positions.So for one year now under advice of my doctors, I have my feet elevated pretty much at all times. I can not sit on a couch with someone, I can't sit at a desk to work, I can't sit ever. This is affecting all areas of my life, I am babying my feet and legs all day long. I can't do normal things without being able to sit like a normal person.I am out of options, and completely desperate to save my feet. They are already muscle atrophied and partially paralyzed. They are very painful at night when I'm lying in bed (but not usually during the day).Summation: Cyanotic, cold, pulseless feet and calves when sitting. Every time. Will spread up my entire legs if I sit long enough. Clinical damage to muscles and nerves in affected area. MRI and venous doppler are normal. Feet are fine when I'm standing, walking around, or have them elevated. There are NO triggers to this except sitting. (Not triggered by temperature, stress, foods, anything but sitting). There is NOTHING that alleviates this situation except for elevation or walking.I have no idea what is happening but I can not live like this anymore. I have no quality of life. No doctor can give me any answer.I have lost all faith in solving this, but maybe a reddit miracle can happen. You never know. If you read this far, thanks for reading.. ### Response: How was Buerger disease ruled out? Biopsy?This is clearly severe peripheral arterial or venular disease - either medium vessel or small vessel.You ABSOLUTELY should not be using any nicotine products. This is in all likelihood driving the process..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you so much for replying.I don't actually remember how they ruled it out, but I brought it up to multiple specialists who had various reasons why it wasn't. But even still, I did quit vaping/nicotine for 9 months during this and the condition continued to worsen. I started using my vape lightly again recently, but I will stop 100%.Is it possibly reversible if I stop immediately? (I'm stopping regardless after reading your message).And just one more question, I also thought obvious PAD but they say it's ruled out because no atherosclerosis and normal doppler. Is that inaccurate?. ### Response: You can still have an inflammatory/autoimmune process causing similar symptoms.I dont know what workup youve had, but ruling out all autoimmune conditions is a pretty significant claim, though with the right lab work you can estimate a likelihood.Id consider some of the vasculitides/rheumatic conditions such as anti phospholipid syndrome, cryoglobulunemic vasculitis, etc. they often come with other manifestations but there is obviously not a full history and physical exam above.Many of these are associated with autoimmune diseases such as lupus, but they are not pathognomonic by any means.Have they done a biopsy?.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: No biopsy due to concerns about infection/wound not healing with the blood flow issues.You're right, I have no idea if they truly ruled out all autoimmune diseases. But I did have significant testing for it. The main hospital did all their own testing and when I was negative for everything, the doctor worked with Mayo Clinic and used their full autoimmune testing panel or whatever and was still negative for everything.I do remember some reasons coming up: no inflammation markers, negative ANA multiple times, 3 rheumatologists cleared me and told me it was vascular not rheumatological in origin. I was tested for and all the types of vasculitis (without biopsy just blood work).And these are some of the reasons I can remember for saying no to Buerger's:- My symptoms only come on in the dependent position and at no other time, all their tests showed no blockages or clogging or weird patterns of veins, no claudication, no blood clots, no change in symptoms when exposed to cold, and I think some more stuff. I know my vascular surgeon sent images and case history to some massive network of vascular specialists and the consensus was that it was not buergers (but again, who knows).My neurologist is absolutely convinced that I have Marfan syndrome but I did not get the genetic testing for it yet. And I'm not aware if that can cause this but it's the only other thing I can think of.EDIT: I just went through my mega document of all my labs and tests, and anti phospholipid syndrome could fit, because I do have a history of blood clots and also recurrent miscarriages (5 by the time I was 29). I am trying to find the exact lab names of the tests for this right now to confirm (that's always hard lol). (I found the names, I was tested for aCL IgG and IgM antibodies and results say<10 GPL<10 MPLThey also looked at regular IgA = 288.9, IgM = 50There's a bunch of other IgA and IgM and IgG tests in there too with other words in front of them that I don't understand but all seem normal.. ### Response: Did they do lupus anticoagulant (LA) or anti-beta2 glycoprotein 1 (a(beta)2GPI) with those antibody tests? It sounds likely that those will have been covered in the workup described. If so then its unlikely to be anti phospholipid syndrome, at least from initial workup. Given the description of symptoms there is still a possibility of antibodies to other things such as anti prothrombin, anti-annexin, anti-phosphatidylserine, etc, but the clinical correlation is weak at this time and testing is not routinely performed since there is much uncertainty about their significance. It may be something a rheumatologist could speak to in more detail.One of the key criteria with testing though is that testing should occur within a short period of time from any event such as blood clots or miscarriage if I remember correctly. If it is not done within a short period of time it may not show up on testing (I dont routinely deal with APS so I dont know the timing recommendations). I could not say if the current cutaneous and vascular manifestations would be included, but a rheumatologist may be able advise further.I do agree it is worth another follow up and discussion with a rheumatologist again to discuss the possibility of the diagnoses in this thread, multiple good differentials on the list from other physicians as well. It sounds like youve already had an extensive workup, but at the end of the day if you have a progressive pathology and no answers, you have to keep searching and discussing it. Best of luck..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Huh, that's very interesting.I was told they tested for all lupus stuff but I don't see LA or the other antibody tests in my records, unless they're using different acronyms for it or something. They did do a bunch of prothrombin tests which were normal.Thank you so much for your help here. I think I need to go to a different state to see a rheumatologist, I've seen all the best where I live and after looking at my labs they tell me they can't do anything for me. But I'll keep trying.. ### Response: Lupus anticoagulant is actually not associated with lupus, rather it is associated with APS, as is the anti beta 2 one mentioned previously.They are part of the testing for the Sapporo criteria in APS diagnosis..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Did they ever do an angiogram while you were symptomatic? Or a mri or Ct with contrast while you had active symptoms?. ### Response: The problem with the studies you received such as the MRI and CTA is they dont have the resolution to see smaller blood vessels. This would require a biopsy. Some medium and small vessel diseases respond to immune suppression with steroids etc, the treatment for Buergers is not smoking. Others such as livedoid vasculopathy (a vein disease) require anticoagulation.So again not vaping is essential to save your legs. Wouldnt recommend other nicotine containing products such as patch or gum, but bupropion and varenicline are effective smoking cessation aids.Personally if smoking cessation isnt effective and the symptoms progress I would want the biopsy despite the admittedly very high wound healing risk. There may be a proximal area with less advanced disease that is amenable, and your symptoms are end-stage.Can PM me if you have specific questions..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you so much.I did not have that spinal reflex test done. And I understand now about the biopsy. I am quitting cold turkey, I don't react well to bupropion or most medications honestly.I will ask for the biopsy and I do have a referral right now to a new hematologist, only problem is all the new specialists I see just keep telling me everything has already been ruled out. I'll still go though of course!. ### Response: Uh ignore the spinal reflex part, that is a lame joke.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: LOL and I was sitting here googling that, confused as hell. So now you've made me laugh and you've terrified me with the end-stage comment :OI guess it's time to submit my application for Dignitas. Can you pls write me my physician recommendation? It would also be lovely if you could attend my death, Switzerland is beautiful. (and maybe write a eulogy about me too, I think you'd be very good at that). ### Response: No no end-stage vascular disease not end-stage you.Stop vaping (done). Advocate for a biopsy in an area that has a little better blood flow but might provide an adequate specimen. Followup with the specialists and try your best to stay positive even though it's a shitty situation..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Hematology questions. (mother with acquired aplastic anemia)Obligatory info so the bot doesn't eat me: 69F , 5'3 ", 185lb , White , USA , Former smoker but 20 years totally off, no drinking or illicit drugs, full list of prescriptions is further down the post, duration of about 6 months (2 pre-diagnosis, 4 post-diagnosis) location of complaint is... blood?First, thanks for looking. I know my questions here are going to be weird and kind of specific. My mother was diagnosed with acquired severe aplastic anemia this past July. For those who don't know it is a disease of bone marrow failure which means the creation of different types of blood cells is severely limited.I'll try to be short about it - my mom had increasing weakness and bruising until ending up in the ER with Hgb of 4.6, platelets of 4, WBC 3.2, ANC 1, ALC 2; she spent a week in the hospital where they did a bone marrow biopsy and a million other tests to figure out the cause. (previous to this she had no other health issues)July 12th she was diagnosed with aplastic anemia, with bone marrow cellularity of 20%, reticulocytes between 0.02-0.03 (range 0.018 - 0.158 x10E+12/L), very tiny PNH clone (<1%) was given a PICC line and started horse ATG on July 14th in combination with cyclosporine 600mg + Promacta 150mg. Had almost no issues with the ATG treatment but became refractory to platelets pretty quickly and thankfully HLA matched ones were found. She was released once they found the appropriate dosing for the cyclosporine to not be at toxic levels.My mom is still going twice a week to the heme/onc clinic for blood tests and receiving blood if Hgb dips below 8 (approximately every 3/4 weeks) and platelets if they dip below 20 (approximately every 7-11 days). The tests are monitoring the need for transfusions, monitoring for blood cell lineage response, as well as checking for liver and kidney function.Currently taking 125mg x2 a day of Cyclosporine, 150mg Promacta, 20mg prednisone, along with 400mg acyclovir, levofloxacin, fluconazole, B12, Folic Acid, Vitamin D3/Calcium, 20mg x 2 Famotidine and 25mg metoprolol (for heart palpitations, the only med she was on previous to this) I'm sorry I don't remember offhand the exact dosings of the preventative antimicrobials and for the vitamins.I was asked to post the full lab values, so I am only going to post the most recent ones which were taken 11/29.Of note: Last blood transfusion 11/11, last platelet transfusion 11/26 (HLA matched, I guess they work really well)ComponentYour ValueStandard RangeFlagWBC3.8 X10E+09/L3.8 - 10.6 X10E+09/LRBC2.44 X10E+12/L3.73 - 4.89 X10E+12/LLHgb8.2 g/dL11.6 - 14.6 g/dLLHematocrit(HCT)23.2 %34.1 - 43.3 %LMCV95.0 fL82.6 - 97.4 fLMCH33.7 pg27.8 - 33.4 pgHMCHC35.5 g/dL32.7 - 35.5 g/dLRDW25.9 %11.8 - 15.2 % HPlatelets143 X10E+09/L156 - 369 X10E+09/LLMean Platelet Volume8.1 fL6.8 - 10.4 fLNEUTROPHILS %46.1 %44 - 77 %LYMPHS %44.6 %13 - 44 %HMONOS %8.8 %4 - 13 %EOS %0.1 %0 - 6 %BASO %0.4 %0 - 1 %ABS Neutrophils1.8 X10E+09/L2.24 - 7.68 X10E+09/LLABS Lymphocytes1.7 X10E+09/L0.80 - 3.65 X10E+09/LABS Monocytes0.3 X10E+09/L0.30 - 0.90 X10E+09/LABSOLUTE EOS0.0 X10E+09/L0.00 - 0.40 X10E+09/LABS Basophils0.0 X10E+09/L0.00 - 0.06 X10E+09/LTYPE OF DIFFERENTIAL | Auto diff performed RBC Morphology 1+ PolychromasiaOnto the questionsAfter all that, my questions are mainly about what certain things in the blood values mean and also things I have heard from other patients with this disease that I want to confirm if they are real or not. There isn't really time to discuss any of this when my mom sees the hematologist at the clinic and I don't want to be a bother acting like I know anything about blood or medicine and asking a million dumb questions.1.) What does +1 polychromasia mean here? From what I understand it's off-color red blood cells, usually very young ones. It has shown up on almost every CBC since treatment began.2.) What does the elevated RDW mean here? It has been elevated since treatment.3.) How does getting transfusions of red blood cells affect these numbers? I asked once about the most recent reticulocyte count (3.2%, ARC 0.084 x10E+12/L) hoping that it was indicating some response to the immune suppression, but was told that donor blood will also have reticulocytes in it so the count doesn't matter.4.) Things such as nucleated red blood cells and ovalocytes have also occasionally popped up on the reports alongside the polychromasia. What do they mean in this context?5.) Is it correct to understand that on diagnosis her bone marrow could only make enough cells for a Hgb of 4.6, but that it may have improved since then, but still be under the transfusion threshold? (ie if it improved to 6.5 or so but they wouldn't know if she continues to get transfused <8)6.) My mother's doctor is a hematologist/oncologist but does not seem to have any specialty in treating aplastic anemia, tho he seems to be doing things mostly right. I have been trying to find someone in the city that does have some specialty in aplastic anemia but it has been very hard. I have been through the AAMDSIF listings for her city and not come up with much. I am surprised because there is a major medical school and center there with a full heme/onc division and also sections for benign hematology and rare blood diseases. Is it weird to try and contact these sections for help finding a hematologist with an interest or specialty in treating this?I think that's all I have for now - feel free to ask for any more information needed, I've got piles of it. If you're wondering why I'm so rabid about this, my father had leukemia and I was too young to understand why they were doing the things to him they did, or why they didn't do other things, and it seemed like he was adrift in a sea of complicated medical situations and opinions and unusual symptoms. This time, I want to know as much as possible, to be able to advocate and educate. I am also very interested in medicine and anatomy (but I'm too dumb for something like medical school, so it's just a weird special interest). ### Response: Agree with answers from /u/Spicy_Antigen.Regarding her doctor, he certainly has treated aplastic anemia before. I don't know if there are really enough aplastic anemia patient for any hematologist to have a "specialty" in it. If you want a second opinion, I'd reach out to the major medical center in her city..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Iron vs Iron Saturation? [Hematology]Can anyone explain the practical difference between these two test values (not just the technical definition), and what it would mean if someone had normal Iron but low Iron Saturation?i.e. How could the saturation end up low but the iron level itself stay normal, physiologically?The numbers are 63 mcg and 18%, respectively, in case you're wondering, with the range listed at 50->180 for Iron and 20->48% for the Iron sat.tyvm!Age: 30, Height: 180cm, Sex: M, Non Smoker. ### Response: It's not easy to ELI5 this. Iron level basically just measures the amount of "free" iron released by your body into your bloodstream at the very second that your blood was drawn. It will change from hour to hour and day to day. The iron level is basically meaningless because it doesn't tell you anything about how much iron you actually have in your body. For example, your body needs a certain amount of iron in your blood at any given point. Even if you're iron deficient, you could have 63 on your lab and you could be iron overloaded, and it could still be 63 on your lab.The iron sat tells you indirectly how much iron is stored in your body. A low saturation means your body stores are low..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What can these blood tests indicate? (Infectious doctors? hematology doctors? Nuerologists? )Male, 28, 68 kg, 183 cm. White. Sweden. Previously diagnosed with Lyme Disease. One major event of disease progression was food poisoning from eating raw fish.Symptomatic presentation:Numbness in body and limbs, and in skinDecreased body awarenessAnhedoniaDecreased sense of smellDecreased sense of touchDecreased hearing quality, level and resolutionLost access to brain areas and higher functionsBrain fogShort term memory affectedAffected bodily, space and time perceptionTingling in skinFloaters in eyesWeight lossMuscle lossDepersonalizationDerealizationAn altered mental state described as a conscious comaChronic fatigueNauseaSexual dysfunction, loss of sexuality, anorgasmiaGeneral weaknessVery dry skinNot able to have a feverTESTS DONE IN JUNE: VEGF-A 114 pg/ml, reference: >42,6 pg/ml. Candida glabrata 1,6 x 10^6 KBE / g Stool, reference <1.0 x 10^3 (<----*>Streptococcus Sp. ELISPOT 4.1 (ref > 3).**[**U75] ASO (streptolizyna)  255,03 u/ml < 200.Tryptophan Metabolism in urineSerotonin PathwayKynurenine Pathway IgG subcategory Type 4 1, 14 g/l, 0,004-0,86 Zonulin 71,88 ng/ml <55 Lactate / pyruvate 13,7 Quotient <12,9 Adrenaline 6,20 ug/g Crea 2,0 - 5,5 Dopamine 126,81 ug/g Crea 130 - 240Histamine in stool 1419,7 ng/ml <959Blod Analysis Cabinet of Medical AnalystBabesia sp 2.9% (out of 500 assessed erythrocytes) other detected co-infections: - Bartonella spFound in the analyzed fields of view: Pathological erythrocytes: anisocytosis (defense mechanism?)misshapen blood cells: - ovalocytes, lacrimocytes, dacrocytes - it may indicate an infection of the haematopoietic systemInternal cell structures : rod-shaped, branched, ring-shaped, grainy, - may indicate a multispecies parasitic infection. ### Response: Thats a rather eccentric collection of lab results. What kind of doctor ordered these?.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Infectious disease specialists.. ### Response: Oncology? You don't mention a history of cancer.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: My bad. It wasn't specialist in oncology. The doctor works and conducts research with supportive therapies for cancer, hyperthermia.Only labs that are off are being posted of course. 50+ more tests have been done. Including 2 MRIs of the brain and spine.. ### Response: These labs suggest your doctor(s) are not practicing modern, evidence-based medicine..


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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