Cases from the Consumer Information Website

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Cases from the Consumer Information Website
Cheryl Caskey Omega Diagnostics, L.L.C. Susan
Leclair University of Massachusetts at
Dartmouth Mary Ann McLane University of
Delaware Mary Beth Miele University of
Delaware Bernadette Rodak Indiana University,
Indianapolis
ASCLS Annual Meeting, Orlando, July 27, 2005
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What the CI is and how it works

• 1999 7 intrepid ASCLS member volunteers
• This is the first interactive, non-subscription-ba
  sed, international service for consumers
• http//www.ascls.org
• http//www.LabTestsOnLine.org
• Never publicized, but was findable by most
  browsers
• 2005 29 intrepid ASCLS member volunteers
• 24/7/365

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What the CI is and how it works

• 1999 fewer than 1 question per day
• 2005 average of 15 questions per day

We always need and welcome new volunteers.
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Workload by discipline
Assignment to a team Handle all of your
discipline questions in that 24 hour period Team
decides how to handle overlapping questions
Hematology 15 - 20
Chemistry 60 65
Immunology 20 - 30
Microbiology 0 5
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The efforts have been noticed

• Awards
• ASAE Summit Award, given to programs that
  significantly enhance American society
• eHealthCare Leadership Program Gold Award for
  Best Health/Healthcare Content

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Hematologymost common questions

• WBC low (most common) and high
• HCT low and high
• Diffs relative vs absolute values
• Indices
• MPV and RDW
• ESR the most diagnostic test of all

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Examples

• My hematocrit was 16 and I had to have an
  infusion, but I am still suffering with
  headaches. Is it normal to have headaches with a
  low hematocrit?
• My WBC is 3.2 and the range is 4.0 10.0.
• The doctor told me my lab tests were fine, but on
  my copy there is an H next to the MPV of 10.7.

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Just a little information, please

• I was wondering if you could answer a question
  about leukemia for me. I need to know what types
  of blood tests are done on what types of cells
  and possibly a few details on each of them to
  diagnose leukemia.

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Healthcare provider examples

• What is the quickest and most efficient way for a
  patient to increase their hematocrit level?
• I just had a routine physical exam. Im an RN
  and would like to know what a platelet count of
  700,000 and a WBC of 21,000 indicates. Why am I
  being sent to a hematologist?

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Worried mother

• My son is a 5 years and 3 month old Chinese boy.
  His segs is too low and his lymphs is too high.
  He did not have any symptoms when I brought him
  for the blood test. I am really concerned. Do
  you think he may be infected with HIV. Do you
  think he may have leukemia?

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Patients right to know

• I just finished treatment for dysgerminoma and
  had my follow up blood work. I am concerned about
  my eosinophil percentage of 34.0 when the range
  is 0-4. I called my oncologists office and the
  nurse told me that the only thing they look at is
  WBC, ANC and MONO and that patients should not
  receive copies of their blood work because they
  dont know the significance of anything and they
  would tell ME when I should be concerned.

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Frustrated daughter

• All I am trying to find out is what the effect on
  the body of someone having a very low (1,000)
  platelet count is. My mother has been
  receiving platelet infusions.
• Several messages later - diagnosis of RAEB
  trying to make decision to continue treatment I
  referred her to social services at her local
  university, mentioned hospice and sent her
  information on MDS.

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Long term friends

• Initial contacts can grow into a trusting
  relationship. We may become a source of support,
  comfort, inspiration, as well as technical
  information.
• Case of 2 CLLers
• ET?AMM

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Good teaching material

• RBC 3.69 x 109/L (4.1-5.1)
• HCT 24.1 (35-47)
• HGB 7.3 g/dL (10.9-15)
• MCV 66.2 fL (80-100)
• MCHC 30.3 g/dL (33-36)
• Fe 2.7mmol/L (6.6-26)
• Ferritin 3 µg/L (30-180)
• I have been very tired and all I want to do is to
  eat ice. What do you think my problem is?

What is your assessment?
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A chance to educate patients

• My hemoglobin is 14.2 and my ferritin is 13.2
  (20-120). How can my ferritin be low when my
  hemoglobin is good. Dont they both involve iron
  in your blood?
• My father just had blood work done and his HGB
  was gt20.0. He has lung problems and is a heavy
  smoker. Can smoking and lung disease affect his
  hemoglobin?

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Hemostasis and ThrombosisCoagMost common
questions

• PT and INR by far the most common
• APTT
• Lupus anticoagulants
• Anti-phospholipid antibodies
• Protein C and Protein S

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Coag Examples

• I take Coumadin and I used to get my PT results
  in seconds. Now I get an answer called an INR.
  Is that a new test? Nobody can explain to me
  what it means just that it is the way the
  report is now given.
• What are the symptoms of an INR of 8.0?

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Scary, but with a happy ending

• I had been on coumadin for a month without any
  monitoring. I wanted to get off, so the doctor
  ordered an INR. It came back 11.1 and he called
  me at work to come right to his office for a shot
  of vitamin K.

• The doctor apologized. Three days after the
  vitamin K shot, my INR is 1.6. No one told me
  that I could not take fish oil or that there were
  any diet restrictions while taking coumadin.
  Thanks for all your information.

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This is a foreign language to me

• I was found to have an elevated APTT in pre-op
  screening. I have never had any bleeding
  problems. I was told that I have a lupus
  anticoagulant as evidenced by the positive hex
  phase study, elevated ACAs and inhibitory pattern
  in multiple factor levels. I was told that
  because of the lupus anticoagulant that I might
  be at increased risk of post-op thrombotic
  episodes. What does all this mean in plain
  English?

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Some questions are fairly easy- and some more
complicated

• FAIRLY EASY
• What is thrombosis?
• Why would my physician suggest that I take a baby
  aspirin every day??

• NOT SO EASY
• My daughter has been diagnosed with Klippel
  Trenaunay Syndrome. Her doctor wants to start
  her on Coumadin. How does that relate to KTS?
• My baby has been diagnosed with Kawasaki
  Syndrome. Is it usual for the platelet count to
  approach 1 million?

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And some require a hemostasis/thrombosis GURU

• I am homozygous for Factor V Leiden and
  heterozygous for MTHFR C677T. My two sons
  testing came back with 2 copies of the A1298C
  mutation and their factor V activity levels were
  approximately 126-140. Does that make me
  C677T/A1298C? What is the thrombotic risk for
  my sons?

And George Fritsma came through
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Chemistry scope of questions

• A recent test indicated my ALT was fine but my
  AST was 15 (the range being 16-40). What does a
  lower number mean? Is this dangerous?
• What is standard crininine level for a 67 yr. old
  male?
• What is the BCP cholesterol test?
• Hi, Can amas test for cancer ? can you do it?
  thanks

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A pharmacopeiaand the thick PDR

• I am on 1 mg of Primogyna dailyiron tablets,
  garlic, gelatin capsules, brewers' yeastGinko
  Biloba and NoniCozaarAllegra, Nasonex, and
  Atrovent.
• If taking a c-peptide test how would the drugs
  Amaryl (glimepiride) Avandia (Rosiglitazone
  Maleate) I am taking for diabetes affect the
  test?
• I am taking eltroxin since 1998. St.Johns
  WortDepakote, mebaral lipitor

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What could that possibly be???
O presente texto está na lingua portuguesa
(Brasil) e os exames são de minha filha Raquel
que apresenta icterícia, cefalopatia,
colecistopatia acalculosa e tem 21 anos de idade
e gozava de perfeita saúde. Não consome alcool ou
outra droga qualquer, exceto um remedio
recomendado pela dermatologista de nome
Flutamida. Eu ficaria muito grato com suas
explicações para os resultados dos exames que
transcrevi abaixo Bilirrubina direta 7,10 mg/dl
Bilirrubina indireta 4,90 mg/dl Bilirrubina
total 12,99 mg/dl Material sangu Método
Jendrassik mod.

• The test is a HRP test. It's either related to my
  heart disease or my diabetes.
• What is a gamma test? I have results but I dont
  know what it is for. Is there a charge for this
  service, if so please disregard my message, thank
  you.
• My 77-year-old father has been asked to have a
  "12/60 creatinine" test.

http//www.altavista.com
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Do they really mean that?

• What is the significance of elevated nitrates in
  the urine?
• I had a test to determine my blood glucose level
  since I have type 2 adult onset diabetes
  hemoglobin A1c 5.6 I was expecting a reading
  similar to the blood test results that I get
  daily on my glucometer. How can I interpret the
  lab results? Thank you.
• I am interesting to know the test for cinetic
  creatinine concernig to eliminate the cromogenous

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youre thinking of doing what?

• We are exploring this test in our ED. I am
  interested in getting information on the
  technique used to perform the test (I know the
  sample is placed in a cartridge which is placed
  in a portable meterwhat I dont know is whether
  the reading is by mass spectrometry,
  electrophoresis, or some other technique). Do you
  have any information? Thanks in advance for any
  assistance you can provide.

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Questions about Microbiology

• Center around infectious diseases
• Risk of transmission
• Include specimen collection
• Interpretation
• Culture results
• Antibody levels
• Treatment

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Interpreting laboratory jargon

• Subject   Urine cultureWhat does mixed
  urogenital flora, less than 10,000 colonies/mL
  effect the test results?

Google searching comes in handy
Question For information about Bilharziazis,
please visit http//www.cdc.gov/ncidod/dpd/paras
ites/schistosomiasis/factsht_schistosomiasis.htm
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Uh Oh!

• During an annual exam my docter advised me that I
  may be infected with chlamydia. I have been
  completely faithful to my boyfriend of three
  years, and have never had an issue with previous
  exams. Could I still have gotton this if my
  boyfriend has been faithful to me? I have heard
  that in some cases an STD can go undetected for
  some time is this true?
• I know that Trich is a STD but what causes it
  exactly?  Also who gets it first a man or a
  woman?

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Questions from physicians

• Question Patient was screened for HepB as part
  of pregnancy blood testing. No known risk
  factors.
• Wife Results Oct/04
• HepB-HBsAg positive
• HepB-HBeAg non reactive
• HepB-Anti-HBe Reactive

• Given results below were the husband and wife
  ever exposed to HepB, are they currently
  infectious (acute/carrier), is further testing
  required?
• Wife Retest Results Nov/04
• HepA-AB(IgGIgM) Negative
• HepB core IgM AB Negative
• HepBs Antibody lt10 Nonimmune
• Wife Second Retest Nov/04
• HepBs Antibody lt10 Nonimmune
• Husbands results Nov/04
• Surface Antibody (Anti-HBs) lt2.0
• Liver Markers Normal
• Antibody (Anti-HAV) Not detected

What do you think?
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Serology Testing for HBV
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HIV serology

• What are these numbers (ie. 0.30 etc) and why do
  they change? 
• If I am HIV Neg why is there a reading at all?
• This is very confusing and I asked the nurse at
  the clinic where I got the results who said the
  number is just something to do with the type of
  test but to me it seems to be some kind of
  measurement???

• Hi - I would just like to know what the numbers
  mean on my negative HIV test results.  My print
  out is as follows for 4 tests since May 2004.
• May 2004 AxSym HIV  0.30 HIVNG
• Jul 2004 AxSym HIV 0.29 HIVNG
• Oct 2004 AxSym HIV 0.40 HIVNG
• April 2005 AxSym HIV 0.30 HIVNG
• Test - AxSYM HIV 1/2 Ag/Ab MEIA

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Obsessed by HIV

• hi ascls,this is me againthere is something i
  still cant get convinced enough about the blood
  circulation of the eyes..well, does the blood
  from the eyes flow thru down the body..? but i
  just wonder does blood in the capillaries of the
  eyes flow back to the body..? this question is
  crucial to me as im afraid hiv virus might get
  into the eyes as for my past encounter of the
  semen gettin to my eyes..
• (And then, 7 e-mails later)i recently had a
  couple of dust particle from my shoe went into my
  coke drink..will i get any hiv disease drinking
  that lot of dust in the drink or pose any danger
  to my health?

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Why me?

• I have bugs-yes bugs- in my urine. I noticed in
  the toilet little things floating upon closer
  inspection with magnifying glass there were
  lots...of them swimming. I went to my doctor who
  did a urine test, said
• I had infection gave me 30 cephalexin caps.
  I've taken all of them which has been 10 days but
  I still see some bugs lots lots of eggs in
  all different stages of development.
• I think the bugs I pass now are not alive
• but why are there still so many eggs
• when will they be gone?

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Typical Immunology Question Mix

• ANA 35
• RF/RA 16
• Celiac Disease 4
• Complement 2
• Miscellaneous 43
• Mono
• Rast, IgE
• Cardiolipin Antibodies
• Immunoglobulins
• Other antibodies

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Immunology

• Typical questions include
• ANA
• My ANA came back positive. the Titer was
  1320 and speckled what does this mean?
• RF or RA
• I had been tested for RA 6 years ago. I have
  my medical records and I don't know how to ead
  it. What test would hev been ordered and how
  is it abbreviated? Also what would the test
  results look like? Lab test ordered under what
  heading would I find the info? thanks very much

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Other Questions

• am a 49 y/o female, my lab results are the
  following
• complement component C3.......mg/dl.......
  .130.03complement component C4.......mg/dl...
  .......10.71are these within the normal range
• Is this (antiphospholipids) the same as
  anticardiolipin antibodies?

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Some Questions Are Different...

• Can you tell me how many serological celiac tests
  are done annually in the US? Thank you.

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And My Personal Favorite Question

• Can you get pregnant from oral sex?

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Ongoing Dialogue

• Happy Holidays! I have to ask another question.
  Does ANA, speck patt and Anti-nRNP happen in
  about 5 of the population when nothing is wrong
  with them? As always I look forward to hearing
  from you. Respectfully Yours

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Help Needed at Times

• Follow up questions after the initial answers are
  sent.
• Original question sometimes requires help
• How old does a baby have to be to have a RAST
  test?

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Some Questions Require Team Discussion

• My sister has been suffering from severe attacks
  for the last couple of years and does not seem to
  be getting anywhere with her doctors. Her normal
  symptoms are hives (a bad attack looks like
  severe burns as the hives all merge together),
  shivering, occasional loss of sight, weakness,
  low blood pressure, fainting, weeing herself and
  crying (fear). She finds an antihistamine calms
  the attack down but very rarely has enough
  warning an attack is looming until it hits her.
  She has recently performed a home test on her
  blood which shows a high level of Ige anti-bodies
  and really wants to push on to get some help from
  her doctors

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Some Questions Require Team Discussion
(cont.). Our mother attracted anti-bodies after
she gave birth to my sister 30 years ago and at
that time there were only 3 people out of a
population of 35,000 with these anti-bodies
diagnosed. Any advice you can give us to help my
sister would be appreciated as I worry about her
driving in case she takes an attack on a busy
road and harms herself. The only factors we can
identify as common are the change in body
temperature (i.e. gym then walking into cold
air), cheese, vodka, white wine and bread and she
has tried eliminating and also combining but
cannot make an obvious connection to her attacks.
I look forward to your reply in the hope you can
shed some light on what she could be going
through.
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Answers.

• Often similar for common questions
• Resources used
• Texts
• PDR
• Reference laboratory web sites
• Internet
• Colleagues

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And there are times wed rather not know

• I am a 17 year old male and i have a 2 inch
  penis.  I am emailing you to find out will my
  penis grow any more.  If no, is there some type
  of medication (that works) and is to increase my
  penis.  It is kind of embarrising not to have a
  girlfriend or take a shower at school.

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Truly legal implications

• How does one test for the presence of semen in a
  sample of womans underware? I have several
  samples I have collected, but dont know what to
  do with them. Please help. Thank you.

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Unique outside research needed to answer some

• do you think that if doc ock used amylase and
  starch hydrolysis he could defeat spider man?
  (listed as a health care provider!)

then theres always back to square one

• what does protective mean on the green level

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And what do our healthcare colleagues ask?

• I am a pharmacist and would like to know what
  electrolytes testing tells a doctor. Also, is
  there a web site that would tell tell me what lab
  testing reveals to a doctor? What is so
  important about a relation between Sodium and
  Potassium?

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And what do our healthcare colleagues ask?

• I am a physician. What are the effects/consequence
  s of pancreas removal?
• As a nurse, I am curious if you can tell the
  difference between inherited and acquired osmotic
  fragility?

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Time to challenge the clinician!

• I am 28 years old from the philippines. I had
  this bad headache at the back of my head. Its
  agonizing. for almost a month its attacking once
  in a while but lately more thank a week now the
  headache is getting worst. So, i had an ESR test
  and it say there the normal range is 0-20 but my
  result is 40. But the doctor ask my age and I
  said 28 and he added 14 into it that makes it
  normal he said. so, am not really sure if what he
  said is correct. so, pls. let me know so they're
  be light into this matter.

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Words of Thanks

• Thank you very much... you are a big help, you
  heaved me from depression...
• WELL YOU WERE RIGHT (CA19-9)

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Words of Thanks

• THANK YOU THANK YOU THANK YOU!!!! Im so glad
  that I could FINALLY get an answer (couldnt even
  get one from the Doc!)
• dear sirs, i have gratefully received your prompt
  response , and would like to thank you for your
  concern and for taking the trouble to examine my
  test and send me a reply. (saudi arabia)

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Words of Thanks

• thank you for avverything, I appreciate.  P.S.
  Send an email should you ever visit Greece )
• Thank you for your prompt reply. That was
  awesome.
• I just wanted to thank you for your prompt
  response, and I want to congratulate all of you
  for this wonderful site.
• You are providing an invaluable service!  Thanks
  again.

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Words of Thanks mothers HDL

• Thank you very much for your prompt reply The
  service your profession provides is truly
  remarkable the fact that you work 'behind the
  scenes' is immaterial to a person who has
  received correct treatment due to the initial
  accurate work done by professionals like
  yourself. God bless you all.

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Words of Thanks

• I am humbled and impressed by the fact that you
  actually answered my dog questions.
• I graduated from Harvard Public Health School. I
  have worked in Shanghai for almost 3 years. I am
  confused most of the time when I go to hospital.
  Now I will re-evaluate what those doctors say
  before I take any medical action.

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Words of Thanks

• Wow, thank you so much! What a great service you
  provide, isn't the Internet just great? Well,
  sometimes ) In this case for sure, GREAT! Thanks
  for sharing your knowledge.
• Bernadette, you guys are awesome. I found this
  site about two years ago and have used it about
  four times. For those of us that seek knowledge,
  since knowledge is power, I love this site

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Words of Thanks

• Am I impressed or what! Here I was, alarmed at
  home, and there you are ---right on time with
  reassurance that nothing that is happening inside
  my body should keep me pacing the floor at
  night. What a service! I send you my gratitude. I
  must tell everyone I know about this service. I
  have already e-mailed my own physician. Here in
  Toronto one now waits twelve hours to be seen,
  and can count on another six or seven hours
  before anything is said. Whoever is funding you
  may I just say Money well spent. Keep up the
  good work. Canadian blessings

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Words of Thanks

• Thank you so much for your information.  You are
  the first person to speak to me about this in an
  intelligent, non-layman way.  I find that though
  I do my own research and bring my ideas to the
  doctor's office for discussion, I never get a
  straightforward and intellectually elevated
  answer.  Thanks for clearing up some of my
  questions and for digging into this issue for
  me. 

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Getting interested?

• What is it worth to you?
• You get 1 CEU towards your NCA requirement every
  year.
• You join a unique group of people who are
• Creating a new awareness of clinical laboratory
  science across the world
• Actually, really, honestly saving lives
• Some of the best friends you will ever have

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Want to get involved?

• Talk to me.
• I will send you a copy of an orientation manual
  and hook you up with a current member. (I happen
  to have a few with me right now.)
• They will guide you through the manual and get
  you up and running.
• Thanks for coming! We look forward to talking
  with you!