###Input :When you sign a DNR it isnt just a genetic DNR. There are different sections to it. It asks if you are ok being on a vent if needed. It asks if you are ok having a feeding tube if needed.You can be ok with life support, just not CPR if it comes down to it. ###Output :This is a difficult question to answer without knowing the full clinical picture. What is his day to day ventilation settings? Just because he is down to 30% doesn't meet his PEEP is down. How has his spontaneous breathing trials go? What does his CXR show? What do you mean the blood work is great? What are his I/Os? How is his kidney function?


###Input :He's got a feeding tube because he's been sedated. But he's had bowel movements. Constant IV hydration drip but no urine in catheter.They had been doing breathing therapy with him that is when they lowered his sedation and oxygen. He seemed to be doing better with 30% and then bile in the tube then his condition worsened. He's now at 50% again. They have done several torso scans but they haven't given details on the scans diagnostics.That's most of what I have based on what I've been given. They said his kidney and pancreas are not necrotic. He did have an infection in his lungs when he was admitted but they cleared out several days ago. However since he had bile with the intubation he has liquid in the lungs again. ###Output :There's far too many details still being missed here to state that his care is hasty. You have an individual who has one kidney on continuous dialysis while having low blood pressure. He is making no urine at all. For some reason, he was intubated for pancreatitis, so I assume it was because of ARDs. He sounds critically ill.


###Input :To clarify, just because the organs aren't necrotic doesn't mean they are functioning. Also organ donation has nothing to do with DNR. The appropriateness of someone to donate only comes after they have died or are literally about to. In the US people self-declare at the DMV so the organ donation services already know their intent in most cases.He has multisystem organ failure, plus underlying conditions which will make his recovery harder than someone without those (alcoholism, solitary kidney) based on what you have written, so it is absolutely imperative to find out what his wishes might be regarding code status. In the absence of any clear directives from the patient in the past, the family is asked to predict what the patient would choose for themself if they were able to sit in on the discussion and weigh in--basing this off of past comments, how they engaged (or avoided) healthcare interventions on their own, etc.I suggest that his designated healthcare agent and any other family present, have a care conference with the intensivist. This is a time set aside in a nearby conference room, not at the bedside or in the hall. Include one of his nurses if possible, any specialists who can make it (often harder to arrange) and then the unit's social worker/case manager. The purpose is to outline exactly where he is on his trajectory, what the major challenges are, what the expected chances of recovery appear to be at this point, and then a discussion of next steps. Find out more about why the doctor was recommending DNR. Hear what they have to say about this based on their experience. It might be because they don't feel he will likely be resuscitated if they make attempts, therefore, to attempt shocks and compressions would be futile. If they feel it would be futile, then it would represent only harm to the patient and not comfort or cure. I cannot predict what they are thinking so you need to find out, but this has been my experience from working in ICU as an RN and Care Manager.If he cannot be weaned off of the vent shortly, he will need a trach and a PEG (feeding tube in his side). If he stabilizes enough to be discharged from ICU (off of CRRT, off of high vent settings, off of any vasopressors that are stabilizing his BP, only on X number of antibiotics, etc) then he will meet criteria to transfer to a ventilator rehabilitation hospital or LTACH (long term acute care hospital).If this happens, it is a long slog. Is it something he would want? Also, he might not survive it and could have a downturn at any time, heading back to the hospital. Knowing this, is this something the family would predict HE would want? If so, you have your answer. If not, then it is appropriate to consult hospice to make him comfortable. Another service to consult if you have it available is Palliative Care. In many hospitals they are consulted for complex cases like this who are taking a long time to recover. They are particularly helpful to the patient to improve quality of life while recovering, as well as provide support and guidance to family.At the end of this long post, I offer you two things. One-you are in my thoughts. I know how difficult this is and you are on a crash course of learning right now. Two, please use this resource that many families in your position find extremely helpful--patients let us know so often this has helped them in cases like yours: Hard Choices for Loving People booklet ###Output :If this was me I would want a DNR and a DNI signed. More importantly, I would want a MOLST form singed indicating exactly the care that I would want, the care that I don't want, and for how long. That is to say, give me antibiotics for one week and see how I do, if nothing's happening then stop all unnecessary treatments.What I like to see in patients is an end goal. What happens far too often, is patients will sit in an ICU for an extended period of time deconditioning and not getting better, but family does not want to do anything for fear of making the situation worse or feeling like they are murdering a family member by taking away care. Recognize that his pancreas is not well at all. His kidneys are not well at all. His liver is not well at all. Assumedly, his lungs aren't either.Let's say he is extubated. Now we have a burnt pancreas. And kidney. And liver. If you are this young and have liver dysfunction or failure, that's a life of slowly getting sicker and sicker until you can possibly but probably not get a liver transplant in the future. It's painful. If his kidneys are truly shot and he requires dialysis in the future, that's 50 years of spending 3 days a week going to get dialysis and sitting there having your blood cycled over and over for hours, just to go home and not feel well. Then you do it again. Then you do it again. That's a lot of stress for a 30-year-old. A 30-year-old that already has alcoholism. If your pancreas is constantly becoming inflamed, diabetes maybe in the future or at least insulin dependence. A 30-year-old diabetic will have a low quality of life.DNR and DNIs are to preserve a patient's dignity thinking about the long-term consequences to their health and quality of life. The idea that saving people is enough, is not enough. By stating do not resuscitate, You're saying to give a chance, but don't take it farther than he would like given all that has happened, and will happen in the future.The doctor sees this all the time. The doctor sees a family that holds on to hope that everything will be okay because their family member is " a fighter, " but neglects to see that the patient has already fought 25 rounds and has been knocked out three times. And also neglects to see that, if they come out of the fight, they essentially will have an agonizing future for the rest of their life.


###Input :Hello Reddit,My younger brother was 27, Male, maybe 6 foot and 375 pounds, half white/asian, no drugs, no smoking, extremely rarely drinking (like less than once a month).I don't recall what his early symptoms were but I found a virtual chat that said he may of had "uncomplicated cystitis" and had antibiotics prescribed for it. He saw a urologist and eventually had a nephrostomy tube, then had surgery later and was noted with a failed kidney. They were unable to remove it due to his weight and having hemorrhage concerns, at least that was my understanding, and that's it for a his existing medical condition, with an exception.I'm first wondering how he developed this condition to begin with. Would the failed kidney have caused the infection? I wish I had the full records so I could paint a better picture, but ultimately I can only guess that his high blood pressure was a cause, plus having a high stress job.Ever since all this, he had to urinate every like hour and this caused issues with work and sleep. I really don't understand why this kept happening and nothing was given to him for it. Would having a failed kidney cause that? This started back at the end of 2020 and the tube and surgery may have been in Q2/3? I now can't remember what happened first.From that I'm mostly wondering about the reason for frequent urination and if he would have got infected some other way outside of high blood pressure. He almost never leaves the house, and I fear he'd only get sick if a family member came home with something.Fast forward to the bulk of my reason to post. On January 13, 2023 he mentioned some nasal congestion and some body aches. He didn't seem to get better on the 14th so I asked if he wanted to see a doctor and he said not yet. This eventually came with some headaches so we tried to go to an urgent care but the wait times were 3+ hours so we figured try a Teladoc (98point6 for this call) and get an appointment later. He mentions a head ache lasting 4-5 days, dull/sharp pains in waves from front to back, also going behind his eyes. He was taking ibuprofen, and was asked about a fever and he said he wasn't sure but his head seems warmer compared to his body. They basically said to take Afrin and Excedrin and go to urgent care if things don't get better. When he went to take the afrin that night, he blew his nose and had a nose bleed, and per our father he had nose bleeds from time to time, but not that super often.Come January 19 I take him to urgent care and I do have his visit summary. Blood pressure 174/89 (why the fuck didn't anyone talk about this), temporal temperature of 98.1 (maybe the medication lowered it?), pulse 90, respiration 18, oxygen saturation 97. They gave him Toradol and sent him home. I feel like a fucking asshole that I wasn't in there with him, I had to drop him off and attend a work meeting that I should of canceled, and our mother picked him up. This is all very local, like within 15 minute drives.He doesn't seem to get better and on the 22nd he talks about some vision issues so I immediately take him to the nearest ER, which is a satellite and not attached to a large hospital. He goes to a back room almost immediately after checking in - alone, and again I feel like a fucking loser as I should of gone there with him to help explain everything - who knows exactly what he said since he was dealing with headaches. I did come back and talk to one of the nurses, but that didn't seem to change anything they expected.He had the following lab tests done, CBC With Diff, CG4 PANEL POC, Comprehensive Metabolic Panel Poc, PCR Influenza A & B and Covid 19 (POCT). Also had a CT Head W/O Contrast and EKG. Done today was just the CG4 and Comprehensive Metabolic, guess the CBC was still processing? I don't recall any notes on this, and his MyChart is closed.They didn't seem to find anything, even though he had a 171/105 blood pressure, they did ask if he had history and I didn't have a full answer, but said it wouldn't be surprising since the rest of the family has medication for it, but he didn't have a primary care doctor to prescribe it. He had trouble finding one since COVID and it really pisses me off that I didn't help him find one somehow. He also had 100.1 temperature.They gave him .9% NaCl (NS), tylenol, benadryl, toradol and reglan, and sent him home.The next day I don't remember exactly what triggered this, maybe balance, but we took him to the ER attached to the hospital and the doctor almost immediately said he wasn't going home that night, he saw something. They put him in a gown and my brother was shivering mad, and he normally likes it cold. Sometime that night I believe he got a room and had some tests, and they said he had meningitis, and shortly after was uncertain of contagious so the room was adjusted and we had to wear N95 masks and a face shield / gown. This went for maybe 2-3 days, and it bothers me so much because this was the most critical time that I could of had talking to my brother and I minimized my time like a coward and asshole. I believe our mother was there the whole time though.After that 2-3 days it was cleared for bacterial and said likely viral (they never said what he had) and the additional PPE was stopped. I remember he texted me to bring apple juice, yogurt, and fruit cups, which I did, but asked if it was okay because I thought hospitals didn't want outside food. They said it was okay as long as it conformed to a low sodium diet, which those did.During this I know he had a lumbar puncture, which is likely how they found the meningitis, and had a CT/MRI that they said was clear. Then suddenly the next day he developed delirium. He was able to answer our questions and knew who we were, but it was like he was living in a video game or something. He'd also spring up very quickly pulling wires to urinate (and frequently) which caused concerns for the monitoring and fall prevention, since he was a little wobbly and I think bumped his side one day because of the bar being down for the accessibility access for the toilet.The doctors believed the delirium was due to his lowered sodium levels, which could have been to the frequent urination and low sodium diet. He was drinking a ton of Gatorade at home back home, probably around the 16th I was buying him multi-packs as I felt those helped me recover. Eventually they put him on a EEG and because of the frequent getting up and sometimes he'd just try to rip the things off, they restrained him. I wasn't there when it happened but our mom was there and it sounded a little traumatic, like saying "why are you doing this mommy, and then attempting to bite her". Not sure if that's exactly what happened but he was restrained. Either at that point or shortly after he did have a nurse assigned to be next to him 24/7 to monitor, and help him pee as he'd be responsive if he had to go and the nurses asked.During this delirium he'd talk about random stuff, sounded like he was in a game, he couldn't explain where he was, but he was still answering questions. Everyday I visited I'd ask if he knew who I was and he'd start by laughing and saying of course, and I had to be more specific with him and he'd confirm my name and that I'm his brother. During this time we had a family member with him 24/7, but would occasionally talk to him, I know I'd hold his hand and he'd squeeze back, but we'd end up sitting to the side talking to each or reading a book, etc.Finally on the 30th I was coming in to swap out with our father, who said that my brother was a bit quieter today, maybe he was finally getting some much needed sleep as it seemed like he wasn't getting any. I also noticed that he had an oxygen tube under his nose, which wasn't there before. I didn't want to wake him so I didn't do much, and this was the first day I decided to pop up my switch and play some yoshi crafted world, and I kept one ear bud out just in case.I know he had a lumbar puncture done either before I came or just as I came, and an MRI earlier (might have been the previous day, it's becoming a blur now and I hate it) and the neurologist said they see a lesion, and it looked like one of the quadrants of the brain. I honestly can't remember but it felt like a sizable portion. I also looked at the EEG from time to time as I assume they were looking for seizures and I swear I saw alerts on the machine detecting them.This was the first time that I was going to pull the all nighter, and it was normally our mother that would do that and I offered to stay but she wanted to get some rest which I understood. A bit after I was there I noticed they swapped the tube with an oxygen mask, and I regret to this day that I did not look at that monitor better, seeing if oxygen was dropping, etc. There was a nurse there but I don't know how well they were watching, I swear one of the guys before was on his phone most of the time. I remember there was a night shift change, and I don't recall how long after before the most traumatic part happens. I did ask if my brother snored normally to our parents, as I never really heard him sleep and our father said yes, and he should get a sleep study done. It reminded me of our father's sleep apnea when napping on the couch during movie night. I don't remember how long this went on for, but I think they adjusted the bed height or something, don't remember... yet another thing to add to my list of regrets.That night after playing a bit I remember my arms getting tired so I pulled the little side table near me to prop my switch up on so I could just use the remotes, and all of a sudden a bunch of nurses come rushing into the room and one of the nurses checks his neck and says no pulse, then a code blue is called. I am escorted out of the room and just panicking. I don't remember hearing the monitor beeping prior (remember 1 ear bud and I had the volume at like 1 tick), and I don't recall him snoring just before either. For all I know the sensors were faulted and he was out for awhile, I have no idea how immediate it was, or if maybe the table pulled/squeezed the oxygen tube (this all happened in like 10 seconds). I know that his monitor was beeping a lot earlier due to his blood pressure, and I don't know if they gave him medication, but I don't remember that monitor beeping at all that day. Maybe the last nurse silenced it? I don't know. I also don't know how well the nurse was watching. One of the nurses in the morning/afternoon was great and I know she was looking at his face and the monitor with great focus, and I fear the night nurses not so much. I know the nurse that night was from newborns, and just helping out.I don't understand why or how he code blued, how quick it was, or anything, but I know it took them over 20 minutes to bring him back and he was on a ventilator. They did the 24 hour thermal treatment of going cold then normal, and after that for the next few days they'd do an eye test and pain test with no responses. On February 1 they did some test with a dye to see blood movement in the brain and I saw the results that night saying there was little blood flow but not clinically brain dead. I had a spark of hope but knew I wasn't a doctor. The next day we talked to the neurologist and confirmed that he was indeed brain dead and I felt like I lost my brother for the 3rd time in that hospital. Once during delirium, then the cardiac arrest, and now. We had to decide when to pull the life support, and I watched him officially die, for what felt like the 4th time.Having to find the courage to join our father for the funeral arrangements, then the funeral which was a visitation before cremation, then picking up the urn a week later, it's been waves of trauma and it still feels like yesterday a month later. Everyday I've gone home to see my parents, and touch the urn and cry. I don't understand why he's in there and not at our house playing video games with his friends.I don't understand how he got sick to begin with, he moved in with me back in May and I tried to make things as comfortable for him as possible. This was his first winter with me and I think this house is a bit drier than the parents he lived with, but I wouldn't think that'd cause the issue. He almost never leaves, he works from home and plays games. If he caught anything it'd be from me, and I know I got sick at the end of June with COVID and he caught that from me, what a fucking loser I am. I did another trade show in September and got sick, not sure if he got it then, he didn't report time off to work (and he tries to take every time off he can).I don't understand why the teladoc didn't ask other questions, or the urgent care to find anything. Then later the first ER only commented on the high blood pressure, and it wasn't until the second ER that they knew something was up.Why did he get delirium, why did they let sodium levels drop? What was going on with the oxygen? With the monitoring he had, how did they let a cardiac arrest happen?I have so many questions and it pains me knowing that even if I get knew, it doesn't change that my baby brother is gone. We had so many plans this year, such as cooking better for ourselves, working out to lose weight, and most critically spending more time outside of his room to try new things like restaurants and take vacations. The last vacation I had with him was 2007, and he was in Hawaii with the parents in 2008 where I was rejected from going because I didn't have a job after high school.Before his delirium I remember one big ask, which was to get a hug, and that he was ready and wanting to go on adventures with me. I hadn't seen my brother much outside of a quick dinner talk from time to time, and when he moved in I was glad to be bonding with him again, and we didn't even get 1 year. We had so many plans, and the world robbed him of that.During the visitation I played the Halo song "Never Forget". He was a big Halo fan and that song always gave me the feels. I hugged his cold body for that entire song, wishing I could give him more.This is a long post and I apologize, I just needed to write, and I wonder if anyone knows what may have caused things. I fear that my lack of knowledge and experience failed to get him to the ER sooner, but it didn't seem like that even helped, they may have just done the same as they did on the first visit and turned him around.I failed to protect you brother, I am so sorry. This world is just not fair and you deserved so much more. You were the nicest person anyone would of met and you made those around you happier. I miss you so much brother, and I love you even more.I will see you again one day. ###Output :I'm sorry for your loss.Delirium can be caused by many factors including infections, metabolic imbalances, medications, and underlying medical conditions. In your brother's case, the low sodium levels may have played a role, but it is also possible that there were other contributing factors such as an underlying infection or a reaction to medications.His low sodium could be due to frequent urination, or due to his low sodium diet, or it could be due to an underlying medical condition such as adrenal insufficiency or kidney disease.Don't know about the oxygen - but, changes in oxygen levels can occur due to changes in respiratory function, changes in blood pressure, or changes in heart function.The fact that he was on monitoring does not guarantee that a cardiac arrest could not occur. It is possible that the cardiac arrest was due to an underlying medical condition or a sudden event such as an arrhythmia. But, ultimately I don't know.


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


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


###Input :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. ###Output :Hair loss is alopecia. If you choose not to share relevant information, meaningful comment is not appropriate.


###Input :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. ###Output :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.


###Input :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 ###Output :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.


###Input :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. ###Output :Nope thats normal. Hematology and oncology often are done in the same fellowship. Doesnt mean you have cancer at all54ReplyShare


###Input :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 ###Output :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.


###Input :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. ###Output :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.


###Input :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? ###Output :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?


###Input :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. ###Output :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.


###Input :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. ###Output :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.


###Input :Did they ever do an angiogram while you were symptomatic? Or a mri or Ct with contrast while you had active symptoms? ###Output :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.


###Input :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! ###Output :Uh ignore the spinal reflex part, that is a lame joke


###Input :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) ###Output :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.


###Input :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) ###Output :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.


###Input :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 ###Output :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.


###Input :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 ###Output :Thats a rather eccentric collection of lab results. What kind of doctor ordered these?


###Input :Infectious disease specialists. ###Output :Oncology? You don't mention a history of cancer


###Input :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. ###Output :These labs suggest your doctor(s) are not practicing modern, evidence-based medicine.


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


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


###Input :Thank you kindly. Hematopoietic is just various types of blood? ###Output :Hematopoietic cells are the cells in our bone marrow that produce the blood cells


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


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


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


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


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


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


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


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


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


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


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


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


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


###Input :okay thanks. ill meet up with a pulmonologist most likely. how likely would something malignant cause this? ###Output :Very unlikely. We dont use it as a test to look for malignancy.


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


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


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


###Input :Would a cbc with differential show blasts if they are present? I got a cbc recently and it didn't even have a line item for blasts. Just neutrophil, lymphocyte, monocyte, eosonophil and basophil? ###Output :The standard is to report blasts if they are present.


###Input :Would an automated cbc report as well? ###Output :You can really never know, sometimes it counts them as lymphocytes


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


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


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


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


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


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


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