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[ { "from": "human", "value": "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." }, { "from": "gpt", "value": "Hair loss is alopecia. If you choose not to share relevant information, meaningful comment is not appropriate." } ]

[ { "from": "human", "value": "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." }, { "from": "gpt", "value": "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." } ]

[ { "from": "human", "value": "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" }, { "from": "gpt", "value": "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." } ]

[ { "from": "human", "value": "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." }, { "from": "gpt", "value": "Nope thats normal. Hematology and oncology often are done in the same fellowship. Doesnt mean you have cancer at all54ReplyShare" } ]

[ { "from": "human", "value": "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" }, { "from": "gpt", "value": "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." } ]

[ { "from": "human", "value": "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." }, { "from": "gpt", "value": "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." } ]

[ { "from": "human", "value": "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?" }, { "from": "gpt", "value": "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?" } ]

[ { "from": "human", "value": "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." }, { "from": "gpt", "value": "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." } ]

[ { "from": "human", "value": "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." }, { "from": "gpt", "value": "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." } ]

[ { "from": "human", "value": "Did they ever do an angiogram while you were symptomatic? Or a mri or Ct with contrast while you had active symptoms?" }, { "from": "gpt", "value": "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." } ]

[ { "from": "human", "value": "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!" }, { "from": "gpt", "value": "Uh ignore the spinal reflex part, that is a lame joke" } ]

[ { "from": "human", "value": "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)" }, { "from": "gpt", "value": "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." } ]

[ { "from": "human", "value": "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)" }, { "from": "gpt", "value": "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." } ]

[ { "from": "human", "value": "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" }, { "from": "gpt", "value": "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." } ]

[ { "from": "human", "value": "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" }, { "from": "gpt", "value": "Thats a rather eccentric collection of lab results. What kind of doctor ordered these?" } ]

[ { "from": "human", "value": "Infectious disease specialists." }, { "from": "gpt", "value": "Oncology? You don't mention a history of cancer" } ]

[ { "from": "human", "value": "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." }, { "from": "gpt", "value": "These labs suggest your doctor(s) are not practicing modern, evidence-based medicine." } ]

[ { "from": "human", "value": "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" }, { "from": "gpt", "value": "Much more information needed here - I'd suggest posting the radiologist report from all the imaging, all bloodwork results, etc." } ]

[ { "from": "human", "value": "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.\"" }, { "from": "gpt", "value": "Usually adults have fatty bone marrow. Hematopoietic bone marrow can be an indirect sign of hematologic conditions. Hence the hematological correlation to make sure." } ]

[ { "from": "human", "value": "Thank you kindly. Hematopoietic is just various types of blood?" }, { "from": "gpt", "value": "Hematopoietic cells are the cells in our bone marrow that produce the blood cells" } ]

[ { "from": "human", "value": "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?" }, { "from": "gpt", "value": "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." } ]

[ { "from": "human", "value": "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" }, { "from": "gpt", "value": "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." } ]

[ { "from": "human", "value": "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..." }, { "from": "gpt", "value": "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." } ]

[ { "from": "human", "value": "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!" }, { "from": "gpt", "value": "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." } ]

[ { "from": "human", "value": "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." }, { "from": "gpt", "value": "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." } ]

[ { "from": "human", "value": "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?" }, { "from": "gpt", "value": "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)." } ]

[ { "from": "human", "value": "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." }, { "from": "gpt", "value": "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." } ]

[ { "from": "human", "value": "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" }, { "from": "gpt", "value": "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." } ]

[ { "from": "human", "value": "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!" }, { "from": "gpt", "value": "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." } ]

[ { "from": "human", "value": "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." }, { "from": "gpt", "value": "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." } ]

[ { "from": "human", "value": "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! : )" }, { "from": "gpt", "value": "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!" } ]

[ { "from": "human", "value": "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." }, { "from": "gpt", "value": "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." } ]

[ { "from": "human", "value": "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." }, { "from": "gpt", "value": "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." } ]

[ { "from": "human", "value": "okay thanks. ill meet up with a pulmonologist most likely. how likely would something malignant cause this?" }, { "from": "gpt", "value": "Very unlikely. We dont use it as a test to look for malignancy." } ]

[ { "from": "human", "value": "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" }, { "from": "gpt", "value": "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" } ]

[ { "from": "human", "value": "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" }, { "from": "gpt", "value": "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." } ]

[ { "from": "human", "value": "Hi, thank you for your response. Based on the work above what makes you rule out lymphoma? Once again thank you!" }, { "from": "gpt", "value": "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." } ]

[ { "from": "human", "value": "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?" }, { "from": "gpt", "value": "The standard is to report blasts if they are present." } ]

[ { "from": "human", "value": "Would an automated cbc report as well?" }, { "from": "gpt", "value": "You can really never know, sometimes it counts them as lymphocytes" } ]

[ { "from": "human", "value": "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" }, { "from": "gpt", "value": "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." } ]

[ { "from": "human", "value": "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." }, { "from": "gpt", "value": "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." } ]

[ { "from": "human", "value": "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?" }, { "from": "gpt", "value": "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." } ]

[ { "from": "human", "value": "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)" }, { "from": "gpt", "value": "No. By definition it's not anemia." } ]

[ { "from": "human", "value": "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." }, { "from": "gpt", "value": "Holy shit at that ER work up. Seems.. thorough.Could be the bruise or a muscle strain causing swelling as well" } ]

[ { "from": "human", "value": "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!" }, { "from": "gpt", "value": "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." } ]

[ { "from": "human", "value": "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." }, { "from": "gpt", "value": "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." } ]

[ { "from": "human", "value": "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." }, { "from": "gpt", "value": "Where are the liver labs? And how did CLL get brought up?" } ]

[ { "from": "human", "value": "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." }, { "from": "gpt", "value": "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." } ]

[ { "from": "human", "value": "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" }, { "from": "gpt", "value": "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." } ]

[ { "from": "human", "value": "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" }, { "from": "gpt", "value": "Best to call your GP and discuss this. Those cells are usually indeed found in the bone marrow instead, not in the blood." } ]

[ { "from": "human", "value": "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." }, { "from": "gpt", "value": "Almost certainly due to your exposure to the plant." } ]

[ { "from": "human", "value": "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)" }, { "from": "gpt", "value": "Blood smears are diagnostic for blood cancers. If theyre normal, you dont have blood cancer." } ]

[ { "from": "human", "value": "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." }, { "from": "gpt", "value": "This change is within normal lab variation. Nothing to worry about." } ]

[ { "from": "human", "value": "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" }, { "from": "gpt", "value": "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." } ]

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

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

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

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

[ { "from": "human", "value": "Yes. Thats what we assumed it is.. but it seems odd as we all eat meat. I know that certain foods like dairy can block iron absorption though." }, { "from": "gpt", "value": "It's not uncommon at all. Many people who menstruate are iron deficient" } ]

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

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

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

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

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

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

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

[ { "from": "human", "value": "Sorry, I forgot to include this information! They are non itchy and non blanching." }, { "from": "gpt", "value": "Are they flat, or can you feel them.They're totally flat; not raised or bumpy." } ]

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

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

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

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

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

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

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

[ { "from": "human", "value": "Why is that? Does anything need to be done about my ferritin levels?Im at Stage 3 iron deficiency.https://maryannjacobsen.com/wp-content/uploads/2021/02/Stages-of-iron-deficiency.png" }, { "from": "gpt", "value": "I mean you need iron but there's no workup needed for your blood count" } ]

[ { "from": "human", "value": "My hematocrit is 10% over the expected high range for African American women. So the equivalent in a white male would be 55 range.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4578165/table/T2/?report=objectonlyAt what percentage over the norm for my gender and race does it need workup?Or is the white male range the standard that has to be used for everyone?" }, { "from": "gpt", "value": "What's your hemoglobin? That isn't an abnormal hematocrit" } ]

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

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

[ { "from": "human", "value": "How concerned should I be regarding leukemia, lymphoma or some other blood related cancer" }, { "from": "gpt", "value": "Id have absolutely no concern for these things with these labs" } ]

[ { "from": "human", "value": "Just had new panel taken yesterday that just came back via Labcorp. Numbers are still wonky. Being referred to hematologist . Confused and terrified" }, { "from": "gpt", "value": "No reason to be terrified. Your lymphs might be high but they arent going up. Numbers are seemingly almost the exact same as last time within deviation. Heme will likely send flow cytometry off but your ID doc couldve done this to get the ball rolling. Still doesnt seem like anything ominous. Bad things come with really bad labs, multiple cell lines affected and usually metabolic abnormalities." } ]

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

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

[ { "from": "human", "value": "I got the 2 dose formulation. Once on 9/23 and again on 9/28" }, { "from": "gpt", "value": "This seems like pretty acceptable/normal lab variations then for such a short interval between lab testing and iron treatment." } ]

[ { "from": "human", "value": "What are your thoughts as to the Retic count being low?" }, { "from": "gpt", "value": "I think it's likely appropriate given the timing. But, I'm not the specialist. I wouldn't stress" } ]

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

[ { "from": "human", "value": "They were all blood tests! No wound cultures or sputum cultures" }, { "from": "gpt", "value": "Blood cultures? I'm still unsure how they got these organisms" } ]

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

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

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

[ { "from": "human", "value": "Yes, a community hospital. How would I go about transferring to a university hospital? Just call them and tell them whats going on?" }, { "from": "gpt", "value": "Or just go to another ED? Your platelet is 2,000 right?" } ]

[ { "from": "human", "value": "Yeah its 2 and the rage is 140-150 so Im pretty sure that translates to 2,000. Will a different ER do anything different? Even if its the same hospital network?I have an appointment with the hematologist around noon. Theyre being pretty casual about this. Should I push to be kept? Or to have them intervene some how like a transfusion?" }, { "from": "gpt", "value": "Just meet with them at noon" } ]

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

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

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

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

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

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

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

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

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