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Hematology/blood work question


QUESTION: Until two years ago, my blood work has been normal except for slightly elevated cholesterol and sporadic elevated sed rate. I have had a lot of blood work over the past 18 months ordered by ENT's, immunologists and rheumatologists to try to pin down a dx. The following possibilities have been discussed, undifferentiated connective tissue disease, mast cell activitation disorder and most recently Lupus. Does the blood work below point to any of these conditions?  

c-reactive protein, quant         
sedimentation rate-westergren
immunoglobulin e, total          elevated most of the time
complement, total (ch50)
complement 3 and 4
% nk (cd56/16)
bun/creatine ratio
anti-dna(ss)igg, ab, qn         119   0-19     Elevated One time 3/2013
        44   9-36
homogeneous pattern ANA         1:320   elevated one time 1/2014      

Mch          consistently  slightly low
vitamin D     consistently low
stiff fingers
mouth sores

Constant 18 months
Brain fog

since May 2013
pericardial effusion   
tachycardia and palpitations controlled by meds since effusion

7-8 years
shoulders, traps tight and painful

long standing   20 years plus
Frequent sinus infections
reactive airways
itchy skin

ANSWER: Hello Roxy,
Warm welcome to you!
Some tests and their elevation points towards certain diseases.
Constantly elvated IgE could mean mastocytosis(or mast cell activation disorder).
Elevated Anti-dna(ss)igg, Ab points towards Undifferentiated Connective Tissue Disorder and Lupus.
Many times these can co-exist.
The pericardial effusion can result from rheumatoid arthritis also.
I recommend further lab investigation and co-relating it with symptoms.
It would have been better if you had sent the complete report(including value observed).

Thanking you.

---------- FOLLOW-UP ----------

QUESTION: 1/23/2014
complement c4, serum         44   9-36
homogeneous pattern ANA         1:320      
vitamin d, 25-hydroxy   21.1         30.0-100.0

rheumatoid factor
rnp antibodies
 sjogren's ab, anti-ss-a/-ss-b         negative
anti-dsdna antibodies
smith antibodies
C reactive creatinine
sed rate

rdw         15.9   12.3-15.4

vitamin d, 25-hydroxy   17.1         30.0-100.0    ng/mL
mch   26.2         26.6-33.0   pg

immunoglobulin e, total         704   0-100
complement, total (ch50)         >63   22-60
rdw         19.3   12.3-15.4
% nk (cd56/16)         21.9   1.4-19.4   %
rbc         5.29   3.77-5.28   
mcv   76         79-97   
mch   25.0         26.6-33.0   

July 2013

  Test   Low   Normal   High   Reference Range   Units
antistreptolysin o ab         388.4   0.0-200.0   IU/mL

ab nk (cd56/16)         408   24-406   /uL
% nk (cd56/16)         20.4   1.4-19.4   
rdw         16.9   12.3-15.4   %
sedrate-         57   0-40   mm/h

  c-reactive protein, quant         6.3   0.0-4.9   mg/L

complement, total (ch50)         >60   22-60
vitamin d, 25-hydroxy   29.0         30.0-100.0
mcv   70         79-97   fL
mch   21.8         26.6-33.0   pg
mchc   31.1         31.5-35.7   g/dL

June 5, 2013
alt (sgpt)         55   0-32   IU/L
bun/creatinine ratio         28   9-23   1
eos         13   0-7   %
eos (absolute)         1.1   0.0-0.4   x10E3/uL
mchc   30.7         31.5-35.7   g/dL
mch   22.4         26.6-33.0   pg
mcv   73         79-97   fL

August 20 2013
IGE elevated

April 26 2013
% nk (cd56/16)         22.2   1.4-19.4   
Immunoglobulin e , total         3215   0-100   IU/mL

complement, total (ch50)         >60   22-60   

hemoglobin   9.9         11.1-15.9   g/dL
hematocrit   31.8         34.0-46.6   %
mcv   78         79-97   fL
mch   24.2         26.6-33.0   pg
mchc   31.1          

April 11, 2013
aldolase         9.3   1.2-7.6   U/L
c-reactive protein, quant         20.8   0.0-4.9   mg/L
sedimentation rate-westergren         43   0-40
complement c3, serum         185   90-180
beta globulin         1.4   0.6-1.3   g/dL
monocytes         15   4-13   %
complement c4, serum         72   9-36   mg/dL Adult

bun/creatinine ratio         27   9-23   1
mcv   78         79-97   fL
mch   25.6         26.6-33.0   pg
vitamin d, 25-hydroxy   22.1         30.0-100.0   ng/mL

April 8 2013
bun/creatinine ratio         27   9-23   
monnocytes         15   4-13
complement c4, serum         72   9-36
beta globulin         1.4   0.6-1.3   g/dL
complement c3, serum         185   90-180   mg/dL Adult

sedimentation rate-westergren         43   0-40   mm/hr
c-reactive protein, quant         20.8   0.0-4.9   mg/L
ladolase         9.3   1.2-7.6   U/L

mcv   78         79-97   fL
mch   25.6         26.6-33.0   
vitamin d, 25-hydroxy   22.1         30.0-100.0   ng/mL

c-reactive protein, quant         5.6   0.0-4.9   mg/L
anti-dna(ss)igg, ab, qn         119   0-19   EU

ebv ab vca, igg         >8.0   0.0-0.8   
ebv nuclear antigen ab, igg         4.2   0.0-0.8

The blood reports suggest co-esistance of multiple disorders. As you had mentioned in october 2013, most tests which are positive indicate towards rheumatoid arthritis. There are also signs of liver inflammation. The serum is positive for antibodies of Lupus also. So we can conclude to say you have Mixed connective Tissue Disorder.   

Your reports say Sjogren's is negative. But you have also mentioned RNP antibodies and smith antibodies. So my question is whether these two tests are positive or negative? These two tests are very important for final diagnosis.

If you their reports pls send. What medications now you are taking for managing the condition?

Thanking you!

---------- FOLLOW-UP ----------

QUESTION: Thanks for your response

The following tests were negative

rheumatoid factor
rnp antibodies
  sjogren's ab, anti-ss-a/-ss-b         
 anti-dsdna antibodies
smith antibodies
 C reactive creatinine
sed rate

Could I still have rheumatiod arthritis event hough the rheumatoid factors are always normal?

I do have osteo arthritis.

I was told that tests point to undifferentiated connective tissue disease not mixed as there are not enough symptoms of any one disease to point the the dx of mixed.  The homogeneous ANA was elevated a few weeks ago for the first time ever.

I was just started on plaquinil.  The dr also suspects fibromyalgia and started me on lyrica. Which tests point to liver inflamation?  Could that inflamation be part of an underlying inflamatory process?  Could that have caused the large pericardialeffusion I had 7 months ago when 1 liter of blood was drained?

I am not saying you have rheumatoid arthritis. But some tests like Anti ssDNA antibodies are positive in rheumatoid arthritis also. So you may be experiencing some symptoms of Rheumatoid Arthritis also. In MCTD, patients will have overlapping symptoms of 2 or more conditions like, Rheumatoid arthritis, Lupus, scleroderma etc.

Yes your doctors are correct. Since none of the antibodies, specific to the diseases have come positive in lab results, we will have to call it undifferentiated only.

The pericardial effusion could be due to undifferentiated connective tissue disorder. But Aldolase test, ebv antibodies, low hematocrit, etc point towards liver inflammation.

Thanking you!


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Dr.Shrinidhi Kulkarni


I can answer all questions related to hematology. RBC, WBC, Platelet and blood forming organs etc and related questions. hematology also includes blood proteins, hemoglobin and disorders related to clotting abnormalities. So questions about all aspects of hematology are welcome!


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KIMS Banglore

MBBS, Internship in Internal Medicine

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