Posts by Nicholas Myers

Dennis Barnes2 said:Can someone explain these results?
http://img267.imageshack.us/img267/7248/nalaz.th.

Hello,

The initial post includes a note that is vital if we want to interpret these results correctly.

Specifically, why was toxoplasmosis serology ordered? (Is this a pregnant patient? If so, what week? A newborn? Someone with swollen lymph nodes? Any other symptoms?)

Based on this report, which shows high IgG antibody avidity, it points toward a toxoplasmosis infection that occurred in the past. Pinpointing the exact timing is difficult, but all signs suggest the infection happened more than 3-5 months ago. That said, more reliable data regarding the onset of infection can only be obtained by testing at least two separate samples at the same lab using the same methodology.

Timing of onset, clinical symptoms, age, pregnancy status, etc.—these are all critical factors in deciding whether treatment is necessary, how long it should last, and, in the case of pregnancy, what the risks are to the fetus.

Please provide more details so a more precise answer might be possible.

Best regards. 🙂

Since you mentioned there's a small blister at the center of the rash, we might be looking at an insect bite. You could try an over-the-counter antihistamine, similar to what Kyle Lee7 suggested. However, if the rash persists, spreads, or if your condition worsens, please consult a doctor immediately.

Let us know how things look in a few days.

Best regards. 🙂

What’s the status today? Are we seeing these patches start to recede, spread, change texture, or peel away? Or have they vanished entirely?

At first glance, they look like hives. But the timeline doesn't fit the profile. Typical hives usually clear up within 24 hours, often migrating to different spots on the body.

Are the other parameters—like MCV, MCH, MCHC, hemoglobin, and so on—all within the normal range? If they are, then the matter is settled. 🙂

redpilot37 said:I had my blood work done and everything looks fine, except my erythrocyte count is slightly elevated.
The range is 3.86-5.08, but mine came back at 5.20.
Does this have any diagnostic significance?
Thanks in advance for the help. 🙂

If that’s the only outlier in your results, there isn't much clinical significance to worry about. What prompted the labs in the first place—any specific symptoms, a routine checkup, or just a general physical?

Dear restlesscanyon48,

Since vividsailor7 hasn't chimed in yet, I’ll offer my own thoughts. Please don't take offense at my stepping in—I know you explicitly asked for his input, and I apologize to him for the uninvited intrusion.

There is indeed leukocytosis present. However, it's worth noting that a differential blood count—the breakdown of specific white blood cell types by percentage—wasn't provided. That data is crucial for getting an orientation on whether we should be looking toward a bacterial infection, a viral one, or something else entirely. If that part of the report exists, it would be helpful if you could share it.

Furthermore, it's a fact that estrogen levels during pregnancy typically cause a mild rise in leukocytes. In a complete blood count, we often see a percentage increase in neutrophils and a slight uptick in eosinophils. In clinical practice, a value up to 12.0 x 10^9/L is quite common for a pregnant patient, though even higher values (often up to 15.0 x 10^9/L) are frequently considered within the normal range. That said, we shouldn't ignore infection markers in pregnancy, such as existing symptoms (like discomfort during urination or a fever) and CRP levels. If there's any suspicion of an infection, a thorough patient history is necessary, along with a CRP test. I strongly suggest you get both a differential count and a CRP.

Looking at the urine dipstick results, there are ketones present. Given that your blood glucose levels are normal, this might suggest you've been vomiting. Essentially, seeing ketones in the urine alongside normal glucose can be caused by prolonged fasting or dehydration resulting from vomiting or diarrhea.

The urine sediment shows some leukocytes and erythrocytes along with a significant amount of bacteria. However, there is also plenty of mucous and squamous epithelial cells. This could indicate sample contamination—meaning the specimen wasn't collected properly (for instance, if the urine came into contact with skin or vaginal secretions during collection). Of course, a urinary tract infection remains a possibility. It is worth keeping in mind, however, that lower urinary tract infections (bladder or urethra) generally don't trigger changes in the blood count, such as elevated leukocytes.

So, before vividsailor7 weighs in, please clarify why these tests were ordered. Was this just a routine prenatal checkup, or have you been experiencing specific symptoms? If so, what are they? Also, was a differential count performed, and have you had any other tests done?

My recommendation would be: perform a CBC with differential (if not already done), check your CRP (sedimentation rates are physiologically elevated during pregnancy, making them unreliable for diagnosis), and repeat the urinalysis, ensuring the sample is collected correctly. If the repeat test still shows leukocytes and bacteria, a urine culture should be conducted, followed by targeted treatment if you are symptomatic.

That's all from me for now.

Best regards. 🙂

Megan Jones27 said:(...)

So, yeah. Given everything going on, it doesn't surprise me that they're flagging some kind of infection.
I was hoping to keep up with the beta-glucans and vitamins, but someone on this forum suggested I hold off for a bit because of that recent rash.

I'll move my response to that specific part over to the hives thread so we don't drift too far off-topic.

Emily Edwards19 said:Can someone please translate this diagnosis: Carrus tracti respiratori acc.virosa.
Thanks so much!!!

Ma'am,

Are you certain all the spelling is correct? Specifically regarding that first word, carrus!

Is it possible that instead of carrus, it should actually be catarrhus?

If so, it would refer to what we call catarrhal respiratory issues—essentially an acute upper respiratory infection caused by a virus, typically accompanied by a fever and other breathing symptoms.

melloworca6 said:Comment: hypergammaglobulinemia

So, could you explain what this actually means? It’s really the only thing in my results that I don't understand or why they even tested for it.

Ma'am,

If you'll allow me, I'd like to weigh in on this discussion as well.

The ANA/ANF test—that's what you've already covered here.

As for the hypergammaglobulinemia, it points toward a Sjogren diagnosis, given that the disease involves B-lymphocyte activation, which produces gamma globulins.

The critical factor is that there is no monoclonal protein in the electrophoresis results; that's important because its presence would raise suspicions of malignant changes (Non-Hodgkin lymphoma is more common in Sjogren patients than in the general population).

Regarding an SLE diagnosis, beyond just the serology, a thorough evaluation of various organ systems and careful attention to all symptoms is vital. Personally, I would lean toward following your immunologist's assessment rather than rushing to an SLE diagnosis.

That’s all from me for now. I'll let vividsailor7 add anything else he deems necessary.

Best regards. 🙂

Kimberly Edwards2 said:I’ve actually reached out before regarding elevated eosinophils. Most tests have been done; results show SE 42, E4.25, HB12LG/L, HTC 36%, MCV 86.1, 9.3 L9.3 /OE 10%, LY16%, TR 278, iron 17, UIBC 31.
The workup didn't show any infection or target organ damage, so for now, it’s being treated as hypereosinophilic syndrome...
I was prescribed Decortin as therapy. Given the values listed above, is it standard practice to start corticosteroid treatment? Is there perhaps a milder option, considering the diagnosis seems more like an assumption at this stage?
If Nicholas Myers happens to be reading this, I would appreciate his insight...

Dear lady,

If my memory serves, since we last spoke, your current results look better than those from April 2011. Your eosinophil percentage is currently 10%, compared to when it was 26%, and even touched nearly 30% once.

Therefore, assuming you transcribed the results correctly, your eosinophil percentage is now 10%, which translates to an absolute count of 0.93 x 10^9. That number is technically elevated, but it isn't alarming by any stretch.

Considering you mentioned having no symptoms—that this was just an incidental finding during a routine checkup (and I hope you're still feeling fine)—and seeing as the numbers are improving (meaning the eosinophil count is trending down), I'm not entirely sure why your doctor opted for medication.

Since I don't know the full clinical picture—every test you've undergone or the specific basis for the diagnosis (based on what you've shared, the criteria for hypereosinophilic syndrome don't all seem to be met)—I can't determine if the Decortin is necessary.

I'd also be curious about the infectious disease workup you underwent. If I recall your posts from April 2011, you mentioned seeing an infectious disease specialist, but you didn't specify which tests were run to rule out an infectious cause for the eosinophilia.

Taylor Hernandez37 said:I hope I can ask here without starting a whole new thread...

Can a brain CT scan (computed tomography, referral diagnosis: TIA) show signs of Alzheimer's disease?

Hello,

Regarding Alzheimer's dementia diagnoses and CT scans, generally speaking, a CT or MRI should be performed during the initial dementia assessment or whenever there's any shift in mental status. These methods (CT and MRI) serve a supportive role; they are just one link in the chain leading to a definitive diagnosis.

In cases where dementia is present, a CT might reveal brain atrophy (shrinkage). However, structural changes in the brain might not be visible until the disease reaches a more advanced stage. On the flip side, people without dementia can develop brain atrophy simply due to aging, so there is often significant overlap between these groups.

That’s why the clinical exam, specific testing, and gathering accurate data from the patient and their caregivers are vital for a diagnosis.

We insisted on this exam as a family because a few months ago, we found him early in the morning tossing things around. When we sat him down, he knew everything about himself and us... but it was as if he were hallucinating. He's a diabetic, and we checked his sugar immediately—it was at 26.

My father is 62. I personally want to ask about Alzheimer's because he forgets small things here and there. Nothing major, nothing like what I've read regarding symptoms, thank God, but it worries me because of that night with the hyperglycemia. Could there be a connection? Or is it just the blood sugar issue, as the doctors suggest?

Regarding the cause of your father's behavioral shifts, consciousness issues, and mental status changes, he needs a full neurological workup to determine exactly what is happening.

It is possible that glucose fluctuations caused those disruptions, but there could be other underlying reasons—especially since diabetes can affect blood vessels, including those in the brain.

Best regards. 🙂

Nancy Rivera57 said:Blood work, 15 weeks pregnant.

Erythrocytes 3.84 (3.86-5.08)
Hematocrit 0.345 (0.356-0.470)
RDW 16.7 (9.0-15.0)
Platelets 156 (158-424)
Glucose 3.3 (4.40-6.40)

Everything else is fine, Hb 119.

The doctor claims I have anemia and needs me to take folic acid, but I don't think that's the case since my Hb is okay. I've been taking vitamins with 800mcg of folic acid since the start of my pregnancy—that's the standard daily dose for Americans. I told the doctor this, and he basically just said "fine then," even though the results aren't technically normal.
I eat normally, frequently, and all sorts of things, but I haven't gained any weight for a month now; before that, I was actually losing it.
I’d like to get a second opinion.

Hello,

Looking over these lab results, here is my assessment:

1. Erythrocytes — It's quite common for erythrocyte counts to drop during pregnancy; by the third trimester, values can dip as low as 3.8 x 10^12/L. Based on that, your current count could still be considered within a functional range, but you are hitting the lower limit, which warrants attention.

2. Hematocrit — Hematocrit levels also tend to decrease during pregnancy. The lowest values generally considered normal (physiological) hover around 0.31. Therefore, this parameter could also be viewed as acceptable for now.

3. Hemoglobin — This also drops during pregnancy (usually around week 32 or 34), and the physiological floor is typically around 110 g/L. In my view, your hemoglobin value also seems acceptable at this stage.

Based on points 1, 2, and 3, we arrive at the same conclusion you reached: there isn't enough evidence for anemia right now. I'll repeat: *right now*.

Since a decline in these parameters is expected leading up to weeks 32/34, actual anemia could certainly develop later.

It would be wise to check your serum iron and Ferritin to evaluate your body's iron stores. Generally, an iron level below 12 µmol/l is an indicator of deficiency during pregnancy.

Anemia caused specifically by folic acid deficiency is usually characterized by an increased MCV. I assume that was tested—was the result normal?

I'm not entirely sure what clinical reasoning your doctor used to reach that conclusion.

Furthermore:

4. Platelets — Platelet counts often dip slightly during pregnancy, but nothing significant. Yours is still satisfactory, though it should be monitored.

5. Blood glucose is quite low; that is something you should pay attention to.

In summary: looking at these numbers, I don't see clear indicators of anemia yet, but your erythrocyte count is indeed sitting on the edge. You should determine your iron and Ferritin levels (if you haven't already). Additionally, you'll need to monitor your blood sugar and keep an eye on your platelets.

Regarding these results, as well as your other concerns (like the fact that you haven't gained weight in a month!), please make sure to consult with your medical team. If you aren't comfortable with your current OBGYN, seek out a second opinion.

Best regards. 🙂

stormyviper20 said:ANA positive at a titer of 1 : 40960

From what I gather, this is extremely high. What could this mean? I've been ordered to go to the hospital in 10 days for further testing, specifically immunology.

Dear lady,

Finding ANA antibodies at such a significant titer warrants serious suspicion of an underlying autoimmune condition. However, this single result alone doesn't pinpoint a specific diagnosis.

As you mentioned, you have already been diagnosed with one such condition, Sjögren. It’s not uncommon for patients with Sjögren to present with high ANA titers.

That said, since Sjögren can overlap with other autoimmune disorders—such as systemic lupus erythematosus, rheumatoid arthritis, or mixed connective tissue disease, among others—additional testing is necessary. They will likely look for specific markers like anti-dsDNA, Sm, U1-RNP, SS-A, SS-B, and Scl-70. These tests, combined with your clinical symptoms, should help clarify the exact diagnosis.

Best regards. 🙂

coastalpuma14 said:I’ve been diagnosed with mono. Along with my standard labs, I had some special tests done that I waited 20 days for—honestly, I didn't even realize what they were for. If anyone could help me make sense of these results (my follow-up isn't for about 10 days, so I'd rather not wait), I'd appreciate it:
VIDAS EBV VCA IgM (bioMérieux) - positive
VIDAS EBV/EA VCA IgG (bioMérieux) - positive
VIDAS EBV EBNA IgG (bioMérieux) - negative
Anti-CMV IgM (Abbott Architect i2000sr) - negative
Anti-CMV IgG (Abbott Architect i200sr) - negative

Thanks in advance. 🙂

Hello,

Here is the breakdown of your results:

1. Yes, you have infectious mononucleosis; your doctors hit the nail on the head with the diagnosis.

2. This is an acute (recent/newly developed) infection. We can tell because the antibodies against early antigens came back positive.

3. The culprit here is the Epstein-Barr virus (EBV). It’s worth noting that cytomegalovirus can also cause symptoms similar to mono, but your tests for that were negative.

Your labs are essentially a textbook case of an acute EBV infection presenting as infectious mononucleosis.

Just stick to your doctor's orders: rest, stay hydrated, skip the alcohol, and so on.

Best regards. 🙂

The dizziness you're feeling when standing up doesn't seem linked to low iron levels. I’d be more inclined to attribute those symptoms to low blood pressure or perhaps orthostatic hypotension—that sudden drop in pressure when you change positions.

Your assessment is spot on: with those hemoglobin, erythrocyte, and MCV numbers, you aren't technically anemic. If you want a real look at your iron stores, Ferritin is the metric to watch. When you schedule your next blood draw, make sure your doctor includes Ferritin, Iron, and TIBC on the lab order.

You're also right about the underlying cause. Between a diet lower in meat and the monthly iron loss that comes with being a woman, your reserves are clearly running low, putting you at a higher risk for iron deficiency.

Dear Kyle Lee7,

1. Regarding the urine results, you hit the nail on the head: the sample wasn't collected properly. Because the stream was caught too early, the final part of the urethra wasn't "flushed," leaving the sample contaminated. It’s essentially dirty, making it unreliable for any real analysis.

2. Contamination can easily produce these kinds of results. In other words, this doesn't necessarily point to a urinary tract infection. In fact, given your situation—zero symptoms, improper collection technique, and a high presence of epithelial cells—it looks much more like a contaminated sample than an actual infection. Furthermore, your leukocyte count isn't particularly high; strictly speaking, up to 5 leukocytes per field is standard, though many labs consider 5–10 to be the upper limit of normal.

Be sure to mention your own observations to your doctor—specifically the lack of symptoms and the issue with how the sample was taken.

Whether you need a urine culture to rule out an infection is entirely up to your primary care physician's discretion.

3. Iron was not tested this time. Looking at the results you provided, there is no mention of iron; you correctly noted its absence.

4. In your differential blood count, they have specified neutrophils and lymphocytes, but the remaining cells (including monocytes) are tucked away under the "MID" category. That is where the monocytes are hiding.

It's a matter of how the machinery works. Some analyzers split white blood cells into three groups: granulocytes, lymphocytes, and MID. Others use five groups: granulocytes, lymphocytes, monocytes, eosinophils, and basophils—which is the breakdown we are more accustomed to seeing.

Based on your report, your neutrophil and lymphocyte counts look normal, but since the monocytes aren't listed separately, we can't determine their specific value.

On a final note, I should mention that you seem very well-informed on these matters and your conclusions are spot on.

Best regards. 🙂

bluebadger12 said:Thanks to both of you for staying on top of my case! Looking at the results as the eighth one mentioned, there’s presence of Bilirubin and ketones, though maybe the amount is small enough that according to the reference range, both should be considered negative. (It's that thing with the plus signs—up to +++ counts as negative, and I have ++, which feels a bit silly, but okay.)

Aside from that, everything else in the sediment is negative, except for Leukocytes at 20 and quite a few bacteria... everything else is negative, doesn't even have those silly plus signs... And yeah, I’m feeling some pressure in my lower abdomen even though I don't have trouble urinating. But since most of my issues stem from my own head and hypochondria, suddenly my kidneys hurt and this and that... alright, fine, it's just my head, but then I start thinking I have some severe disease involving my testes, kidneys, bladder... it's awful... getting a urine culture tomorrow...

No, we interpreted the urine results correctly. To be clear, a Bilirubin result of "++" is not a normal finding. A normal result would be "neg." That is how it should appear on the report.

The notation "neg to +++" simply indicates that the possible results can be: neg, +, ++, or +++. Only the "neg" label represents a normal finding, and that label is located in the final column (that column specifies what the normal result should be).

Your result falls into the first column and is marked as "++", which is not a normal finding.

However, we have already concluded that these are likely false elevations since your blood Bilirubin levels are normal.

Therefore, our previous advice stands (repeat the qualitative urine test and proceed with the urine culture).

Best regards. 🙂

Olivia Hayes89 said:I have no idea which lab ran this test or what specific methodology they used. However, in the lab where I work, the machines frequently flag positive Bilirubin, so we always double-check manually—alongside proteins, Urobilinogen, glucose, and nitrites. It’s entirely possible the machine threw a false positive here.
Since the blood work came back normal, I doubt the urine results carry much weight...
And from what I know, a urine culture usually takes about 2-3 days...

bluebadger12, does your urine sediment show nothing but leukocytes and bacteria?

I agree with you that the Bilirubin reading is likely a false positive; that's actually what I noted in my previous reply. Still, given that the ketones were also quite high, I’d suggest re-running the test just to be certain. Just to clear the air.

Considering that bluebadger12—based on what I gathered from his inquiry—was also dealing with bladder pain, and seeing these sediment results, a urine culture seems necessary. That’s why the doctor decided to order one.

Preliminary results can sometimes be available within 24 hours (a doctor might even get them over the phone), though final results typically take 48 to 72 hours in most cases.

bluebadger12 said:Thanks again! Everything looks solid on my blood work—bilirubin is normal, blood sugar is fine, and my liver enzymes (AST, ALT, GGT) are all perfectly centered. CRP is normal too. It’s just that urine test that has me worried, because I went ahead and did a full panel including liver function, CRP, triglycerides, and everything else, and they all came back completely normal. AST 19 (11-38)
ALT 19 (12-48) GGT 31 (11-55) glucose 5.5 (4.4 - 6.4) total bilirubin 18 (3-20)

In that case, you should re-test the urine for ketones, bilirubin, and urobilinogen.

Ketones could show up if you were fasting, for instance. As for the bilirubin, it might be a false positive; a confirmatory test would be wise.

velvetowl16 said:And how do I cure this dermatitis?

Hello,

Just as the pathologist noted, your results aren't specific. In other words, you can't pin down the exact cause of your symptoms based solely on this report.

The findings show that the outer layer of the skin has thickened and there is some inflammation present.

What’s needed now is matching these pathology results with your actual clinical presentation. That falls on the dermatologist—they need to look at the physical changes, listen to your symptoms, and weigh them against this report to reach a diagnosis.

Once that diagnosis is set, the appropriate treatment plan will follow.

Best regards. 🙂