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Medical Forum / General / Laboratory / October 2008Follow up: My FBG is now normal, but my RBCs are elevated
Well guys, my FBG came back normal at 90 mg/dL, but my RBCs are elevated: RBC count: 5.97 million cells/uL Hb: 17.9 g/dL Hct: 53.2% MCV: 89.2 fL MCH: 30.0 pg MCHC: 33.6 g/dL RDW: 13.7% Platlet count: 202000 cells/uL Absolute neutrophils: 4847 cells/uL Absolute lymphocytes: 2503 cells/uL Absolute monocytes: 806 cells/uL Absolute eosinophils: 235 cells/uL Absolute basophils: 8 cells/uL Neutrophils: 57.7% Lymphocytes: 29.8% Monocytes: 9.6% Eosinophils: 2.8% Basphils: 0.1% Erythropoietin: 8.1 mIU/mL My FP advise me to see a hematologist...should I? My RBC have been like this for at least 5 years, and no symptoms related to it, I think. Thanks! > Well guys, my FBG came back normal at 90 mg/dL, but my RBCs are > elevated: [quoted text clipped - 22 lines] > like this for at least 5 years, and no symptoms related to it, I > think. What's your local reference ranges for all these tests? I wouldn't call those results that abnormal. > > Well guys, my FBG came back normal at 90 mg/dL, but my RBCs are > > elevated: [quoted text clipped - 27 lines] > > - Show quoted text - I believe he uses labcorp and according to their reference range it is within the normal reference range and not elevated. The lab should credit all the additional testing pertaining to the follow up of that 37 mg/dl glucose. To quote from douglas's previous entry: "Actually, the lab report says that RBCs were present when they recieved it. , but then it says "verified by repeat analysis". What does this mean? The lab was Quest Diagnostics." Probably not a good idea to get into which lab is "better." If the preanalytical problem was due to mishandling at the doctor's office, I do not believe the lab owes anyone anything. Having worked for a reference lab, if credit was given for all the repeated work that was done due to doctor's office errors, the labs would have a hard time making any money at all. If anyone owes anyone, I would think it is the doc's office that possibly mishandled the specimen. That's obviously for Douglas and his insurance company to fight about. Douglas's results are high normal on the RBC, and the hematocrit is a bit over. Dr. Ed Uthman has a great discussion of CBC results here: http://web2.airmail.net/uthman/blood_cells.html Follow-up with a hematologist depends, obviously, on symptomatology, age, history, etc. Judy Dilworth, M.T. (ASCP) Microbiology I believe he uses labcorp and according to their reference range it is within the normal reference range and not elevated. The lab should credit all the additional testing pertaining to the follow up of that 37 mg/dl glucose. On Oct 5, 3:26 pm, "JEDilworth" <bactit...@nospamhortonsbay.com> wrote: > To quote from douglas's previous entry: > [quoted text clipped - 29 lines] > The lab should credit all the additional testing pertaining to the > follow up of that 37 mg/dl glucose. I've been getting headaches, occasional pain in the legs when walking, esp. when going up stairs, occasional orthostatic hypotension. I've been getting headaches, occasional pain in the legs when walking, esp. when going up stairs, occasional orthostatic hypotension. __________________________________________________________ Lots of people feel dizzy when they stand up suddenly. No patient ever in the history of medicine has ever had "orthostatic hypotension". Perhaps you should stop reading the medical books and hang out with people of your own age? > To quote from douglas's previous entry: > [quoted text clipped - 29 lines] > The lab should credit all the additional testing pertaining to the > follow up of that 37 mg/dl glucose. The preanalytical problem would not have been a problem if the lab had not accepted unpreserved glucose samples. This is a textbook example of why they should stop doing it. > > "douglas" <Protoman2...@gmail.com> wrote in message > [quoted text clipped - 39 lines] > > - Show quoted text - I use Quest. http://www.emedicine.com/MED/topic1863.htm http://www.drkaslow.com/html/blood_cell_counts.html http://www.aafp.org/afp/20040501/2139.html Doc wants to rule out polycythemia vera. See the above articles for a lot more information. It is not good to have too high of a hematocrit. You can sustain blood clots and other symptoms. I would definitely see a hematologist if your counts have been running this way for a long time. "PV should be suspected when hemoglobin and/or hematocrit levels are elevated (i.e., hemoglobin level greater than 18 g per dL [180 g per L] in white men and 16 g per dL [160 g per L] in blacks and women; hematocrit level greater than 52 percent (0.52) in white men and 47 percent (0.47) in blacks and women).3 PV also should be suspected in patients with portal venous thrombosis and splenomegaly with or without thrombocytosis and leukocytosis." The fact that your Hematocrit (Hct) is >52% is a red flag. Are you an asthmatic? Do you live at a high altitude (>5000 feet)? These can also be causes of high hematocrits. Interesting that your blood glucose is now normal. I really think it was mishandling of the blood the first time. Judy Dilworth, M.T. (ASCP) Microbiology > Well guys, my FBG came back normal at 90 mg/dL, but my RBCs are > elevated: [quoted text clipped - 6 lines] > like this for at least 5 years, and no symptoms related to it, I > think. On Oct 4, 10:16 pm, "JEDilworth" <bactit...@nospamhortonsbay.com> wrote: > http://www.emedicine.com/MED/topic1863.htmhttp://www.drkaslow.com/html/blood_cel l_counts.htmlhttp://www.aafp.org/afp/20040501/2139.html > [quoted text clipped - 34 lines] > > - Show quoted text - I have been an asthmatic, but it's been a while since I've had an attack. No, I don't live in high altitudes. Being an asthmatic can cause your body to compensate by producing more RBC's, hence making your hematocrit go higher. Does your doc think your RBC's/Hct are elevated due to your asthmatic condition or something else? I would think once an asthmatic, always an asthmatic, regardless of attacks or not. If you're using an inhaler, you're considered an asthmatic, even if you are under good control. Big question - if your RBC's have been elevated for 5 years, have you had asthma for over 5 years??????? These are basic inquiries you should be making before you go trotting off to an expensive hematologist. This is part of the basic differential diagnosis. If your FP doc doesn't know this, perhaps you should be seeing an internist. If you are symptomatic, then that is another situation all together and you should see a specialist. Douglas, did you look over any of those links I posted???? Judy Dilworth, M.T. (ASCP) Microbiology > > RBC count: 5.97 million cells/uL > > Hb: 17.9 g/dL [quoted text clipped - 3 lines] > > like this for at least 5 years, and no symptoms related to it, I > > think. I have been an asthmatic, but it's been a while since I've had an attack. No, I don't live in high altitudes. On Oct 5, 10:35 pm, "JEDilworth" <bactit...@nospamhortonsbay.com> wrote: > Being an asthmatic can cause your body to compensate by producing more > RBC's, hence making your hematocrit go higher. [quoted text clipped - 27 lines] > I have been an asthmatic, but it's been a while since I've had an > attack. No, I don't live in high altitudes. I haven't had an attack in two years, or needed my inhaler, even my fluticasone one. He just said "go see a hematologist; here's ones in your area". So, are you going to do this? What do your parents think (assuming your <18 years old)? If this is "new patient" blood work, how do you know you've run a high RBC count for 5 years???? Douglas, getting information out of you is like pulling teeth! Judy Dilworth, M.T. (ASCP) Microbiology I haven't had an attack in two years, or needed my inhaler, even my fluticasone one. He just said "go see a hematologist; here's ones in your area". On Oct 6, 10:29 pm, "JEDilworth" <bactit...@nospamhortonsbay.com> wrote: > So, are you going to do this? What do your parents think (assuming your > <18 years old)? [quoted text clipped - 11 lines] > > He just said "go see a hematologist; here's ones in your area". B/c the last time I had a CBC, it was w/ my old pediatrician, who I saw 5 years ago, and my FP's group bought out his group, so they have those records. So, you're consistently running a high hematocrit/RBC count. This is obviously not a new event. However you are or not developing symptoms? Not quite sure with your vague answers. What prompted you to see the doc in the first place? Anything going on? What are you going to do about the hematologist?? Judy Dilworth, M.T. (ASCP) Microbiology > He just said "go see a hematologist; here's ones in your area". B/c the last time I had a CBC, it was w/ my old pediatrician, who I saw 5 years ago, and my FP's group bought out his group, so they have those records. On Oct 7, 10:02 pm, "JEDilworth" <bactit...@nospamhortonsbay.com> wrote: > So, you're consistently running a high hematocrit/RBC count. This is > obviously not a new event. However you are or not developing symptoms? [quoted text clipped - 11 lines] > saw 5 years ago, and my FP's group bought out his group, so they have > those records. It was time for a checkup, and my Mom wanted some tests run. This was an incidental finding, but I guess my FP was concerned enough to run an erythropoietin level. The hematologist's office will be calling us back to schedule the appointment, after some strong-arming by the FP, b/c apparently, even though I'm 17 and ~200lbs, they considered me a child, notwithstanding the fact that my body is anatomically and physiologically an adult; any medications I needed would be titrated for an adult. But no, they want me to see a pediatric hematologist...apparently the MA doesn't know that pediatric and adult hematology is VASTLY different, esp. w/ regards to fellowships. But, hematologically, you are not quite an adult. Even though you are a big kid, your marrow status might be more pediatric than adult at this point. Bone plates don't fuse until your 20's, especially in boys, as they develop later than girls. Also, at 200 pounds, unless you are really tall, you should probably think about cutting out those sugary lattes... http://www.jamesline.com/news/publications/frontiers/archives/?ID=2416 You'll notice on this chart that cancer rates don't really drop until mid-20's, so, hematologically speaking, you're still more in the pediatric part of the graph. Hematologists also deal with cancers - that is the only reason I posted this. http://doctor.mcw.edu/clinic.php?75 - most of the pediatric hematologists/oncologists on this list give ages of 0-18 and some even go up to age 30. http://tinyurl.com/4onno3 - Lab Corp normals for Erythropoietin - please notice the different results for different age levels. Adult normals are different than for your age group. What was your result? Please realize different labs' normals may vary a bit. What does your appointment and health have to do with fellowships???? Who is the MA? Your mom? Judy Dilworth, M.T. (ASCP) Microbiology It was time for a checkup, and my Mom wanted some tests run. This was an incidental finding, but I guess my FP was concerned enough to run an erythropoietin level. The hematologist's office will be calling us back to schedule the appointment, after some strong-arming by the FP, b/c apparently, even though I'm 17 and ~200lbs, they considered me a child, notwithstanding the fact that my body is anatomically and physiologically an adult; any medications I needed would be titrated for an adult. But no, they want me to see a pediatric hematologist...apparently the MA doesn't know that pediatric and adult hematology is VASTLY different, esp. w/ regards to fellowships. On Oct 8, 9:37 pm, "JEDilworth" <bactit...@nospamhortonsbay.com> wrote: > But, hematologically, you are not quite an adult. Even though you are a big kid, your marrow status might be more pediatric than adult at this point. Bone plates don't fuse until your 20's, especially in boys, as they develop later than girls. Also, at 200 pounds, unless you are really tall, you should probably think about cutting out those sugary lattes... > [quoted text clipped - 21 lines] > hematologist...apparently the MA doesn't know that pediatric and adult > hematology is VASTLY different, esp. w/ regards to fellowships. I'm 6' 1", BTW. The MA was not my Mom. My Mom's an RN. My erythropoietin is 8.1 "douglas" <Protoman2050@gmail.com> wrote in message news:8d1cc419-ac3e-4afb-b356- My Mom's an RN. My erythropoietin is 8.1 _________________________________________ 8.1 what ? Meganewtons per cubic parsec? > "douglas" <Protoman2...@gmail.com> wrote in message > [quoted text clipped - 5 lines] > > 8.1 what ? Meganewtons per cubic parsec? mU/mL On Oct 9, 8:55 am, "Manky Badger" <you.m...@be.joking> wrote: > "douglas" <Protoman2...@gmail.com> wrote in message > [quoted text clipped - 5 lines] > > 8.1 what ? Meganewtons per cubic parsec? mU/mL __________________________________________ And the relevant age & gender related reference range is..... > On Oct 9, 8:55 am, "Manky Badger" <you.m...@be.joking> wrote: > [quoted text clipped - 12 lines] > > And the relevant age & gender related reference range is..... 4.1-15, if I remember. On Oct 9, 1:02 pm, "Manky Badger" <you.m...@be.joking> wrote: > "douglas" <Protoman2...@gmail.com> wrote in message > [quoted text clipped - 14 lines] > > And the relevant age & gender related reference range is..... 4.1-15, if I remember. ________________________________________________ So your red-cell related parameters are a tad to the top end of the reference range, but not excessively so, and your Epo is well within the expected range. I'm sorry Dougas, but I'm suspecting another of your wind-ups here. > On Oct 9, 1:02 pm, "Manky Badger" <you.m...@be.joking> wrote: > [quoted text clipped - 27 lines] > > - Show quoted text - It's not, trust me. I see the hematologist on Wednesday at 2pm. So, Douglas, for the SECOND time, who is the MA and what is all this to do with fellowships? If your mom is a nurse she should be asking some hard questions about the necessity for this referral at this point. Please realize that all of this stuff will go into your permanent medical record and will count towards your insurability as an adult. Do you want this stuff on the big medical insurance computer in Boston or not? That's where it will go and could possibly affect your buying life insurance AND/OR medical insurance in the near/far future. I would want a GOOD REASON for seeing a hematologist. This is not BS. My husband has high BP issues and I've been through this many times with him. Your EPO is normal, I guess. So, why the referral? Obviously I am not a doc or a hematologist, so just curious. Judy Dilworth, M.T. (ASCP) Microbiology On Oct 8, 9:37 pm, "JEDilworth" <bactit...@nospamhortonsbay.com> > hematologist...apparently the MA doesn't know that pediatric and adult > hematology is VASTLY different, esp. w/ regards to fellowships. I'm 6' 1", BTW. The MA was not my Mom. My Mom's an RN. My erythropoietin is 8.1 On Oct 10, 9:26 am, "JEDilworth" <bactit...@nospamhortonsbay.com> wrote: > So, Douglas, for the SECOND time, who is the MA and what is all this to > do with fellowships? If your mom is a nurse she should be asking some [quoted text clipped - 21 lines] > > The MA was not my Mom. My Mom's an RN. My erythropoietin is 8.1 My FP ordered the consult, and I was saying that adult hematologists get exposed to different diseases in their training than pediatric hematologists. The MA was the girl who answered the phone of the hematologist's office. My mom did ask the FP why, and she was also concerned about my headaches and leg pain. > my headaches and leg pain. Anything else you've not mentioned? > > my headaches and leg pain. > > Anything else you've not mentioned? No, just occasional itching of my skin. MA = Medical assistant. Now I get it. Hematologically, you are considered an adolescent, not quite an adult. You are going to the correct specialist. If you are having symptoms along with the high RBC/hematocrit, then you definitely have to get it checked out. Good luck. Judy Dilworth, M.T. (ASCP) Microbiology My FP ordered the consult, and I was saying that adult hematologists get exposed to different diseases in their training than pediatric hematologists. The MA was the girl who answered the phone of the hematologist's office. My mom did ask the FP why, and she was also concerned about my headaches and leg pain. On Oct 10, 9:46 pm, "JEDilworth" <bactit...@nospamhortonsbay.com> wrote: > MA = Medical assistant. Now I get it. > [quoted text clipped - 14 lines] > hematologist's office. My mom did ask the FP why, and she was also > concerned about my headaches and leg pain. So, what tests could I expect from Dr L, the hematologist? Flow- cytometry-analysed bone marrow aspiration, 2,3-DPG levels, sonogram of my legs to check for microthrombi? Think my erythrocytosis is causing PVD, b/c I've also noticed my toes tend to be paler then the rest of my body? Would I be put on clopidogrel+acetylsalicylic acid for the presumable PVD? > On Oct 10, 9:46 pm, "JEDilworth" <bactit...@nospamhortonsbay.com> > wrote: [quoted text clipped - 31 lines] > > - Show quoted text - You need to take a deep breathe there. It does bring up one important point and that is O2 saturation levels. If it less than 92% then one needs to look at cardiopulmonary disease or obesity. Sometimes sleep apnea can cause polycythemia. Also splenomegaly is also important and becomes more so as hematocrit raises. The normal erythropoietin sort of implies that it is not an increased red cell mass however. In secondary polycythemia EPO is increased and in primary EPO is decreased. One can measure red cell mass by Cr51 isotope studies. What it appears to be is relative erythrocytosis or a plasma volume being decreased rather than red cell mass increased. The most common cause is dehydration although some can be idiopathic. I take it you are not a smoker and so if one looks at the probability of etiology of polycythemia nonsmokers in adults one finds that P vera comprises 33% with Relative erythrocytosis comprising 65% and tumors and other causes yielding 1%. This would be for adults and so it probability breaks down different in peds for obvious reasons. The bone marrow exam is way down the list at the very end once everything else has been looked at. > > On Oct 10, 9:46 pm, "JEDilworth" <bactit...@nospamhortonsbay.com> > > wrote: [quoted text clipped - 52 lines] > > - Show quoted text - I don't smoke, and my electrolytes --I had a CMP done at the same time as the CBC-- show I'm not dehydrated. I think Dr L will do a pulse oximetry on me. And I have other people confirming I don't have sleep apnea. Thanks for the great post, Robert. My Hematology days are WAY in the past, and there's lots of new stuff out there. I agree that a bone marrow exam is far down the list. Invasive testing is usually not the first thing docs do unless there's a huge suspicion of something bad going on. My mother-in-law was diagnosed with CLL (chronic lymphocytic leukemia) back in the mid-80's after two suspicious CBC's. She was in her early 60's at the time. She was referred to a hematologist and they did a marrow right away. She had no symptoms of a viral infection but her absolute lymphocyte count was very elevated and smudge cells were present. The slides had been reviewed by pathologists and her internist made the referral immediately. She lived another 12 years after that. Douglas, you need to take a deep breath and let the doctor do their job. They have spent years doing what they do. You can "internet" yourself to death on this stuff. They usually don't order the really expensive testing unless they have to do so. Insurance companies complain about overutilization if they do. This is what they do for a living and they deal with this stuff a lot. Judy Dilworth, M.T. (ASCP) Microbiology > - Show quoted text - You need to take a deep breathe there. On Oct 11, 10:18 am, "JEDilworth" <bactit...@nospamhortonsbay.com> wrote: > Thanks for the great post, Robert. My Hematology days are WAY in the > past, and there's lots of new stuff out there. I agree that a bone [quoted text clipped - 21 lines] > > You need to take a deep breathe there. The role of the hematological consult is to rule out primary hematological disease. They don't follow every led. The question they answer is it a hematologic disorder or is it reactive to some other disorder and they punt the ball back to the PCP. They aren't cardiologist or pulmonologist. Some of the issues people have already mentioned pertaining to PV, secondary polycemia pertaining to lung, heart and abdominal masses.The only other remote possibility is a high affinity hemoglobin but no family history or it being a congenital condition as it seems to be acquired and not present at birth. All of the specific tests have varying sensitivities and specificity with regards to all of the above possibilities and there is some overlap. At the heart of the question and a major branch in the flow diagnostics involves on determining if it is an increase red cell mas or not. If there isn't then it's a relative polycythemia. In males with a >60% HCT or in females with a > 55% HCT one can assume a 99% probability that the red cell mass is truly increased. In patients with a high hematocrit, splenomegaly is almost 100% specific for P. vera. There is a Criteria for diagnosis of PV. Category A Category B A1 Total RBC Mass increased B1 Thrombodytosis > 400K A2 Arterial saturation O2 > 92% B2 Leukocytosis > 12K A3 Spenomegaly B3 LAP score >100 B4 Serum B12 >900 PV: A1 + A2 + A3 or A1 + A2 + any two from category B A search for a renal mass or abdominal mass would involve IVP, ultrasound or CT in those suspected of having a tumor secreting EPO. Maybe the hematologist will see something pointing to a primary hematological disorder but the only thing so far is erythrocytosis. The info above came from "Reasoning and Decision making in Hematology", edited by Benjamin Djulbegovic. With regards to CLL, apart from the smudge cells and elevated lymphocytes, is the classic look of the cells themselves. I have seen them in relatively mildly elevated white counts of 12K. They have a unique chromatin pattern. Thanks again for all the good information on PV. If we covered that in our basic MT training at all, I've forgotten it all, as I only did hematology for a bit as a generalist over 20 years ago and never got into anything abnormal. It makes sense what you are telling me about hematologists in their consultant roles. As I recall, my MIL's white count was not particularly elevated when she presented with CLL. She came to the lab draw station I was working at then (a two year stint as a generalist) and I decided (good thing) not to do her CBC and send it up to the main lab. When it came back abnormal and she was calling about results (in the days before HIPAA) I didn't know what to do. The hematology department at our main lab had a real sharp supervisor, and her diff had been referred to her due to the abnormalities in absolute lymph count. She ultimately referred it to the pathologist for review, but she picked up on "the look" of the cells immediately and hit the diagnosis. The pathologist just confirmed it. After being referred to the hematologist, my MIL was told she had probably had CLL for a couple of years before it was discovered via the blood count, which would make the onset somewhere around 1983. She died of complications from a stroke in 1997, which was probably caused by her platelet problems that she developed years later, althoug when first diagnosed her platelets were low but not extremely so. She needed heart valve surgery in 1995 (due to deterioration from rheumatic fever in the 1930's) and needed platelet transfusions before the surgery because of the CLL. Afterwards, she stroked out the day before she was to go home when they were weaning her from heparin to coumadin. She lived another year and a half without being able to walk or talk due to right-sided paralysis and went to a nursing home. She developed a bowel obstruction after going to live with her son in another state, and no surgeon would take on the surgery due to her extremely complicated health issues of stroke, atrial fibrillation, CLL issues (platelets up and down, white count up and down, etc.), paralysis, inability to communicate, etc. and she died from this. It was 12 years after she was diagnosed with CLL. Thanks again Robert. Are you a technologist, doctor, ?? You give great explanations :-). Judy Dilworth, M.T. (ASCP) Microbiology The role of the hematological consult is to rule out primary hematological disease. They don't follow every led. The question they answer is it a hematologic disorder or is it reactive to some other disorder and they punt the ball back to the PCP. They aren't cardiologist or pulmonologist. On Oct 11, 7:51 pm, "JEDilworth" <bactit...@nospamhortonsbay.com> wrote: > Thanks again for all the good information on PV. If we covered that in > our basic MT training at all, I've forgotten it all, as I only did [quoted text clipped - 43 lines] > disorder and they punt the ball back to the PCP. They aren't > cardiologist or pulmonologist. Thanks Judy no I am a MT in a large teaching hospital. I get called in on difficult cases because of my all around experience and years of put in which I have seen some rare cases some of which includes basic micro, gram stains, wet preps, malaria, etc. I have seen Borrelia on blood smears, and even Capnocytophaga from a dog bite on a blood smear. So I do get involved in teaching including answering interns questions. I did take the week long hematology ASCP workshop for hematologist and pathologist which was more clinical than the MT workshops. Actual microscope slides included rare blood disorders but that was a few years back and like anything else things continually change. It really is hard to keep up with all areas of the lab as a generalist and not miss anything. It's sad to be the bearer of bad news and to see how such a diagnosis can impact a person and it just isn't a laboratory finding and go home and forget it. We have to go on code blues also. It is emotionally draining especially seeing the family. That is especially true of difficult cases that cause the person to stay in the hospital for months or for major trauma cases requiring massive transfusions. We aren't at the beside but we fight for our patients. When we win one it feels so good and when we lose one then there is always hope for the next one. On Oct 11, 10:18 am, "JEDilworth" <bactit...@nospamhortonsbay.com> wrote: > Thanks for the great post, Robert. My Hematology days are WAY in the > past, and there's lots of new stuff out there. I agree that a bone [quoted text clipped - 21 lines] > > You need to take a deep breathe there. I'm letting them do their job; is it wrong to be an informed patient? Not at all. You just seem to be enamored with complicated expensive lab testing, that's all. Let us know what happens. Judy Dilworth, M.T. (ASCP) Microbiology I'm letting them do their job; is it wrong to be an informed patient? On Oct 7, 10:02 pm, "JEDilworth" <bactit...@nospamhortonsbay.com> wrote: > So, you're consistently running a high hematocrit/RBC count. This is > obviously not a new event. However you are or not developing symptoms? [quoted text clipped - 15 lines] > saw 5 years ago, and my FP's group bought out his group, so they have > those records. It was time for a checkup, and my Mom wanted some tests run. ___________________________________________________________ Why are you having a checkup? Why does your mother want tests running? A healthy person is a person who has not been thoroughly examined. We do not all lie in the middle of the "normal range" - that is why we call it reference range. I don't think there is much to be alarmed over in those figures. yes - the hct and the RBC is a bit high - and to be on the safe side, your doc will probably dig into that (defensive practice)- but what about your diurese? what if you are just a bit dehydrated for one or more reasons? looking at the figures for MCV and MCHC does not suggest that your blood pattern is disturbed - and your WBC looks quite ok as well - and eosinophils are low suggesting that you are not suffering an allergic response. You say in one letter that you suffer headaches and orthostatic hypotension - first of all this is not unusual for a teenager (as you claim to be, n'est ce pas?), secondly it could also suggest a tendency to be a little dehydrated - eat and eat with a bit of sense (living on coffee and coke and sugar is suicide - however slow it may be), and drink - water! - a couple of liters per day. Occasional pain during walking a stairs climbing - well well, get off the computer and start exercising - loose some weight if you are too fat, gain some muscle if you are too skinny. Discussing your health by judging lab work only is impossible. Remember - most doctors rely on the fact that many, many diseases are of the kind that if it doesn't kill you it'll probably diappear by itself. - And one last thing - you are not in a hospital setting, so most probably you are a healthy individual - I seem to have lost track - why did you have the blood work done in the first place? > I seem to have lost track - why did you have the blood work done in the > first place? At the risk of appearing cynical, it's either hypochondria or attention seeking. > A healthy person is a person who has not been thoroughly examined. We do not > all lie in the middle of the "normal range" - that is why we call it [quoted text clipped - 27 lines] > I seem to have lost track - why did you have the blood work done in the > first place? Yes, I would like to see the sodium level along with the questions you pose about diuresis. > A healthy person is a person who has not been thoroughly examined. We do not > all lie in the middle of the "normal range" - that is why we call it [quoted text clipped - 27 lines] > I seem to have lost track - why did you have the blood work done in the > first place? My electrolytes are fine, according to the CMP. And my urine is dilute. The labwork was routine, new patient stuff. > > A healthy person is a person who has not been thoroughly examined. We do not > > all lie in the middle of the "normal range" - that is why we call it [quoted text clipped - 34 lines] > > - Show quoted text - I take it no history of heart disease in which a BNP would detect an ineffective circulating blood volume? One would usually see and increased urine specific gravity along with prerenal azotemia involving increased hylaine casts and elevated BUN and sodium levels with dehydration. The other possibility again can be drawing artifacts of leaving the tourniquet on too long with hemostasis (hemoconcentration) showing up. One should not squeeze hard or make a hard fist as it can also elevate the potassium levels. I take it you are not a difficult draw. > > > A healthy person is a person who has not been thoroughly examined. We do not > > > all lie in the middle of the "normal range" - that is why we call it [quoted text clipped - 48 lines] > > - Show quoted text - Haven't done a urinalysis. I did have a congenital PFO which self- corrected. Is that heart disease? Refresh my memory...what's a BNP? > > > > A healthy person is a person who has not been thoroughly examined. We do not > > > > all lie in the middle of the "normal range" - that is why we call it [quoted text clipped - 55 lines] > > - Show quoted text - Don't worry about it as the other poster noted that the clinical situation takes precedence over lab stuff. BNP info is here http://www.labtestsonline.org/understanding/analytes/bnp/glance.html I just wondering what else you have up your sleeve as we were talking about hypoglycemia and then see an EPO result out of nowhere. I just wondering what else you have up your sleeve as we were talking about hypoglycemia and then see an EPO result out of nowhere. Exactly - - "new patient stuff" - routine my ... > Well guys, my FBG came back normal at 90 mg/dL, but my RBCs are > elevated: [quoted text clipped - 24 lines] > > Thanks! Perhaps we should rename this thread much ado about nothing. From my limited pespective you are a teenage male with rbc/hgb/hct at the top end or slightly above normal. If anyone is likely to run at the top of the reference range for these measurements, I would think it would be teenage boys. It seems like a slightly abberent measurment which has led to a lot of speculation. Have you had a repeat CBC? > > Well guys, my FBG came back normal at 90 mg/dL, but my RBCs are > > elevated: [quoted text clipped - 33 lines] > > - Show quoted text - This WAS my repeat CBC. Perhaps we should rename this thread much ado about nothing. ____________________________________________________ What he said !!!! > Perhaps we should rename this thread much ado about nothing. > ____________________________________________________ > > What he said !!!! I'll inform you tomorrow what the hematologist said. On Oct 14, 3:00 pm, "Manky Badger" <you.m...@be.joking> wrote: > "rickh" <harrison6...@rogers.com> wrote in message > [quoted text clipped - 4 lines] > > What he said !!!! I'll inform you tomorrow what the hematologist said. ____________________________________________ Like we don't know already. I'd also be interested to know what his opinion cost you (or your mother) > On Oct 14, 3:00 pm, "Manky Badger" <you.m...@be.joking> wrote: > [quoted text clipped - 13 lines] > > I'd also be interested to know what his opinion cost you (or your mother) He ordered an ABG, CXR, and US of my spleen and kidneys, as well as a pulse oximetry, CBC, ferritin, uric acid, JAX2, LAP, one I can't remember, and a blood film. e wants to see me again in a month. On Oct 15, 9:31 am, "Manky Badger" <you.m...@be.joking> wrote: > I'd also be interested to know what his opinion cost you (or your mother) He ordered an ABG, CXR, and US of my spleen and kidneys, as well as a pulse oximetry, CBC, ferritin, uric acid, JAX2, LAP, one I can't remember, and a blood film. e wants to see me again in a month. ______________________________________________________________ Of course he did. He loves patients like you. He'll want to see you for evermore. You've found out all about these big words and you are saying "why not do this, why not do that". From the symptoms yuo've disclosed (so far) there's very little (if anything) wrong with you so he's not got to actually *do* anything. However you're asking for all these uttlerly unececsary tests and so he's laughing all the way to the bank. > On Oct 15, 9:31 am, "Manky Badger" <you.m...@be.joking> wrote: > [quoted text clipped - 14 lines] > However you're asking for all these uttlerly unececsary tests and so he's > laughing all the way to the bank. Actually, he said the tests I wanted were overkill, let's start here first; my Mom wanted him to do some of them to. I didn't disclose EVERYTHING now did I? Headaches, joint pain, ad some balance problems are the main ones. "douglas" <Protoman2050@gmail.com> wrote in message news:70e1725c-e99b-4287-b1f8- Actually, he said the tests I wanted were overkill, let's start here first; my Mom wanted him to do some of them to. I didn't disclose EVERYTHING now did I? Headaches, joint pain, ad some balance problems are the main ones. __________________________________________________________ So you've got him struggling trying to make sense of your games with only a fraction of the required information too. > "douglas" <Protoman2...@gmail.com> wrote in message > [quoted text clipped - 9 lines] > So you've got him struggling trying to make sense of your games with only a > fraction of the required information too. I said I didn't disclose everything to you...I did disclose everything to my physicians. |
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