Lab results - looking for opinions [PLEASE READ 1ST POST]

Maria Fisher46 said:Look, lady,

you didn't really say why this testing was even ordered. What kind of symptoms is the patient dealing with?

Anyway, there are definitely some red flags here that need more digging—mainly the anemia. But honestly, these results are pretty incomplete. There's no differential blood count, yet we're seeing leukocytosis, so you definitely need a CBC with a diff. You also need to check ESR and CRP, and grab an LDH to round out the biochemistry; plus, bilirubin and ALP are missing from the panel. It’d also be smart to run a ferritin test and a serum protein electrophoresis.

When you see anemia paired with high urea, but creatinine is sitting right in the normal range, it could point toward GI bleeding (though, obviously, high urea can just be dehydration or other stuff going on), so the next logical step is to run three fecal occult blood tests.

Depending on how they feel and what those tests show, you'll need to send them off for more work—lab work, imaging, maybe seeing a specialist. I'm just listing things that can be handled at a primary care clinic before you bother sending them to a specialist.

Thanks for getting back to me... the blood work was just part of a routine physical... and there aren't any actual symptoms. The only thing is hemorrhoids, so I was wondering if those could actually cause issues like anemia too?

electricmarlin62 said:Thanks for the reply. This blood work was just part of a routine checkup... I don't actually have any symptoms. The only thing going on is hemorrhoids, so I was wondering if those could also be causing issues like anemia?

They can cause anemia, sure, but you always need to rule out other possibilities. Plus, there’s the leukocytosis mentioned, which wouldn't typically be linked to hemorrhoids.

Either way, you need to follow up. Reach out to your primary care physician for an evaluation; they'll determine the next steps.

Hey there!

If Anne, Enid, and anti-dsDNA all come back looking normal, is it still possible for someone to actually have Lupus?

Kimberly Morris said:Hi there.

If Anne, Enid, and anti-dsDNA all come back clear, is it still possible for someone to have Lupus?

Hello,

Medical literature describes something called seronegative Lupus, which aligns perfectly with what you’re describing—negative results for ANA, ENA, and anti-dsDNA. That said, we see fewer of these cases in practice now. As antibody detection technology improves, the number of patients previously labeled "negative" due to poor test quality or interpretation has dwindled.

Once you account for those technical discrepancies, you are left with a very small group of people who truly test negative across all those markers.

It is worth noting that modern diagnostic guidelines have expanded the immunological panels used to support a Lupus diagnosis. This now includes things like anti-Ro/SSA (which can be positive even when ANA is negative, so if suspicion is high, specific anti-Ro/SSA testing can be requested), antiphospholipid antibodies, C3, C4, CH50, and occasionally the direct Cummings test or an RPR test. When all those are performed and everything remains normal, we are looking at a tiny fraction of patients—practically isolated cases—who have Lupus despite clear results. Even then, these patients usually present with at least one clear objective indicator, such as significant abnormalities in urinalysis or kidney biopsy findings that point toward Lupus.

To put it simply: if you are dealing "only" with a cluster of non-specific symptoms—fatigue, general weakness, feeling unwell, loss of appetite, headaches, dizziness, or muscle and joint pain—without any objective clinical evidence, a Lupus diagnosis isn't justified. That doesn't mean the diagnosis won't crystallize over the next few years, but right now, there is nothing to anchor it.

The Cat, thanks a ton for such a massive, detailed breakdown.

I’ve been lurking on the forum and noticed you're actually a doctor.

Right now, things are looking pretty sketchy with Sjögren's or maybe Lupus, but I don't see my immunologist for another 10 days—and that's because I paid out of pocket to get seen faster.

Honestly, just the thought of a potential diagnosis has me spiraling, so I was thinking about hitting up a private lab to run those three specific tests. But then I started worrying if those results would even tell me anything definitive about Lupus. I tried posting over in the Lupus thread, but it's been total radio silence over there. Is it okay if I vent my symptoms here? Maybe someone can give me a hand while I'm stuck waiting for these labs to come back.

Kimberly Morris said:Nicholas Myers, thank you for such an exhaustive response.

I’ve been following this forum and noticed you're a physician.

There's some suspicion regarding Sjögren's syndrome or Lupus in my case. I have a private appointment with an immunologist in ten days.

The mere possibility of the diagnosis is triggering panic. I considered heading to a private lab to run those three specific tests, but I'm worried they won't be enough to confirm if it's actually Lupus. I reached out on the Lupus thread, but haven't received a response yet. Can I describe my symptoms here? Perhaps someone can offer some insight while I wait for my labs.

If there is suspicion, then yes, feel free to describe your symptoms on the Lupus thread.

But seriously, nobody’s even getting back to me. I posted a question a few days ago and... crickets.

Kimberly Morris said:The problem is, I’m getting radio silence over there. I posted a question a few days ago and haven't heard a word.

Just start a new thread. Briefly outline your symptoms and we'll get back to you with an answer.

Maria Fisher46 said:You should probably just start a fresh thread listing your symptoms so we can actually help you out with your question.

Fine, done. I already posted everything about my Lupus on the other thread. Thanks though.

Hi everyone, could someone please help me make sense of this? My results show dysmorphic erythrocytes in my urine at 55%.
I've been dealing with microhematuria for years now, and my primary care physician is only just realizing it might actually be something worth looking into.
She referred me to a urologist, who then requested a cytology report. Following that, they sent my samples off to investigate the origin of the red blood cells, which led to this specific finding. My follow-up appointment with the specialist isn't until nine months from now. Should I be worried?
My urine cultures always come back sterile. Thanks

ironsurfer10 said:Hi, could someone please explain what a 55% dysmorphic erythrocyte count in urine actually means?
I've been dealing with microhematuria for years, and my GP just realized it might actually be an issue.
She referred me to a urologist who requested cytology, and now they've sent me for testing to determine the origin of the erythrocytes—this was the result. My appointment with the specialist isn't until nine months from now. Should I be worried?
My urine cultures always come back sterile. Thanks.

Hello,

Dysmorphic erythrocytes are red blood cells with irregular membranes; they typically originate from the upper urinary tract, specifically the kidneys.

The goal of this test is to pinpoint where the bleeding in the urinary system is coming from. Broadly speaking, if the bleeding is from the upper tract, a nephrologist handles it. If it's from the lower tract, you see a urologist. That’s the simplified version.

For this classification to be definitive, we usually look for dysmorphic or smooth erythrocytes to exceed 70% or 80%. If dysmorphic cells make up more than 70-80%, the source is the upper urinary tract. If smooth erythrocytes account for more than 70-80%, the source is likely the lower tract.

In your case, the number of dysmorphic and smooth erythrocytes is essentially equal. This suggests bleeding may be occurring in both the upper and lower tracts—essentially a mixed erythrocyturia from the entire urinary system. One possibility for a result like this could be kidney stones, though other causes exist.

Regardless, further investigation is necessary.

Does anyone know what it means when a bronchoscopy report shows an increase in M. tuberculosis in the bronchial aspirate sample? The sensitivity test results should be following shortly.

neonfalcon99 said:Does anyone know what it means when a bronchoscopy report shows that M. tuberculosis grew from a bronchial aspirate sample? They said the sensitivity test results are coming next.

It means exactly what it says right there! They put that microbe on a specific culture medium designed for mycobacteria, and it actually grew. Period. You can't draw any other conclusions until you look at the entire clinical picture and how the patient is actually doing.

neonfalcon99 said:Does anyone know what it means when a bronchoscopy report shows an increase in M. tuberculosis in the bronchial aspirate sample? They said the sensitivity test results are coming next.

Hello,

That essentially confirms a case of TB in this patient. Whenever a Mycobacterium tuberculosis culture comes back positive, the Centers for Disease Control and Prevention runs a drug sensitivity test. It takes about four weeks. The goal is to identify any resistant strains, which would require a different treatment approach.

Thanks so much. How exactly is that sensitivity test performed? We're looking at a healthy individual who had a cough but experienced no other symptoms. In a case like that, is antibiotic treatment an option, or is hospitalization required regardless? There are currently no symptoms present. That coughing fit happened about two and a half to three months ago, and the tests back in May and June were just routine checkups.

neonfalcon99 said:Thank you all so much. But how exactly is that sensitivity test performed? We're talking about a perfectly healthy individual who was coughing, but didn't have any other symptoms. In a case like that, is antibiotic treatment an option, or is hospital admission mandatory regardless? There aren't any symptoms right now—that coughing happened about 2.5 to 3 months ago, and the tests back in May/June were just routine check-ups.

Put simply, the test is conducted just like any other antibiogram. What’s really interesting to consider here, though, is whether that person received the BCG vaccine as a child or not.

As for everything else, personally, I am a firm believer that you need to consult the attending physician. That doctor has the full clinical picture right in front of them! Besides, they ordered the bronchoscopy with lavage and microbiological sampling, so if there was even a slight suspicion of TB, they had a legitimate reason to go that route.

Thanks everyone.

He received his TB vaccine as a child, but from what I’ve read, adults can still contract it since the shot isn't 100% effective. The pulmonologist found some minor shadows at the top of his left lung and ordered a full battery of tests just to rule everything out. I'm wondering what happens if the results come back positive. Is he allowed to work? Can he take antibiotics? Initially, we were told treatment might be manageable from home, but my research suggests a six-month regimen. Since he isn't showing any symptoms, they suspect it's likely just the latent form.

Look, if someone actually involved in the entire diagnostic and treatment process tells you that it’s a possibility, then it’s a possibility. Period.
Someone else might have a different take on it, sure, but personally, I can't weigh in on something this specific since I don't know the details of the case—I'm not actively part of it.

Dear Madam,

In the US, both the diagnosis and treatment of TB are strictly regulated by law. There are very specific protocols governing how we manage patients with this condition.

Since the culture from the bronchoscopy sample came back positive, we aren't talking about latent TB here. In cases of latent TB—where the individual isn't infectious to those around them—you won't find Mycobacterium present in respiratory samples*.

Furthermore, according to the CDC Tuberculosis Guidelines, a confirmed case is defined as a patient where the causative agent of TB is isolated via microbiological culture from any clinical specimen.

Based on that, this person does have TB.

It appears to be pulmonary TB that is microscopically negative (positive results usually arrive within 1 to 2 days, so you likely would have known immediately if that were the case and mentioned it in your inquiry). Given your description, they likely fall into category III under standard treatment regimens.

As for treatment, the rule of thumb is that it begins in a hospital setting. However, per the legal guidelines, there are exceptions. To quote:

newly diagnosed patients whose sputum is smear-negative, who are not in severe general health or suffering from major comorbidities, and who are willing to cooperate with their physician, live in stable social conditions, and do not reside in a household with individuals at high risk of contracting TB.

If the person you are asking about meets all these criteria, outpatient treatment outside of a hospital is an option.

Regarding work: under no circumstances should this person be working right now. Temporary disability lasts, as defined by the aforementioned regulations, until the sputum tests return negative and the patient stabilizes.

_______________________________________
*Note that some TB specialists might debate this point if the sample was taken directly from dormant granulomatous foci within the lung parenchyma.

Thanks a lot

What happens if someone refuses antibiotics? Does Medicare cover it, or is the patient responsible for the cost?