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Cases from the Consumer Information Website

ASCLS Annual Meeting, Orlando, July 27, 2005

Cheryl Caskey Omega Diagnostics, L.L.C.Susan Leclair University of Massachusetts at DartmouthMary Ann McLane University of DelawareMary Beth Miele University of DelawareBernadette Rodak Indiana University, Indianapolis

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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-

based, 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

Yearly Increases

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We always need and welcome new

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Workload by discipline

Chemistry60 – 65%

Microbiology0 – 5%

Immunology20 - 30%

Hematology15 - 20%

Assignment to a team

Handle all of your discipline questions in that 24 hour period

Team decides how to handle “overlapping” questions

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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. I’m 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 oncologist’s 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 don’t 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 ETAMM

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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) MCHC30.3 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. Don’t they both involve iron in your blood?

My father just had blood work done and his HGB was >20.0. He has lung problems and is a heavy smoker. Can smoking and lung disease affect his hemoglobin?

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Hemostasis and Thrombosis“Coag”

Most 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 pharmacopeia…and the thick PDR

I am on 1 mg of Primogyna daily…iron tablets, garlic, gelatin capsules, brewers' yeast…Ginko Biloba and Noni…Cozaar…Allegra, 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 Wort…Depakote, mebaral… lipitor

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What could that possibly be???

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 don’t 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.

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/dlMaterial: sangu; Método: Jendrassik mod.

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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…you’re 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 meter—what I don’t 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

STD

Hepatitis

Resp

GI-UTI

Skin

Misc

40%

15%14%

17%

6%8%

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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/parasites/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(IgG+IgM) Negative HepB core IgM AB Negative HepBs Antibody <10 Nonimmune Wife Second Retest Nov/04 HepBs Antibody <10 Nonimmune

Husbands results Nov/04 Surface Antibody (Anti-HBs) <2.0 Liver Markers Normal Antibody (Anti-HAV) Not detected

What do you think?What do you think?

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Serology Testing for HBV

HBsAg Anti-HBs Anti-HBc

Total

Anti-HBc IgM

Susceptible Neg Neg Neg (neg)

Acute infection

POS Neg POS POS

Chronic infection

POS Neg POS Neg

Immune -

Past inf.Neg POS POS Neg

Immune -

VaccinatedNeg POS Neg Neg

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HIV serology 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

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???

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Obsessed by HIV hi ascls,this is me again…there 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 1:320 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........130.03

complement component C4.......mg/dl..........10.71

are 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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(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.

Some Questions Require Team Discussion

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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 we’d 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 don’t 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 there’s 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/consequences 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. It‘’s 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!!!! I’m so glad that I could FINALLY get an answer (couldn’t 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 mother’s 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!