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Old 08-28-2013, 01:14 PM   #1
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Confused on my ANA Titer results etc

Hello all,

I'm a 41 yo F. Been feeling "off" for about 9 years now, and every test I have had run comes back normal. Last fall, I noticed my ring finger on my right hand was popping in the mornings when I would wake up. Like when I would extend the fingers, it would snap to extension. I asked my chiro about it, and he said to get tested for RA. That came back with a normal range result of 9, but was positive for Epstein Barre and my ANA titer was 1:80 with a nucleolar pattern. Went to the rheumatologist and she said she wasn't concerned and just take some ibuprofen.

Still googling all my symptoms, I thought maybe my thyroid had finally kicked the bucket and got that tested. It couldn't have come back more normal, but the doctor also tested my ANA again, and this time it was 1:320. The ANA IFA screen was positive.

Nucleolar staining is indicative of scleroderma, but I show very few of the symptoms of it, so I'm not convinced that's what it is.

I had a cold sore the day my blood was drawn this last time, do you think that would affect the range and make it higher since I was systemically fighting something off?

Thanks!

 
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Old 08-28-2013, 02:29 PM   #2
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Re: Confused on my ANA Titer results etc

A cold sore should not affect your ANA results. I would see if the second ANA test showed a nucleolar pattern as well. as pattern determination is somewhat up to the lab tech performing the test, and it can change from one test to another. Having 2 positive ANA's and not feeling quite right for 9 years certainly could mean something in the autoimmune area. I would list all my symptoms that seem chronic and abnormal, take these new tests to your rheum. and ask if there is anything else that she would test to provide more information. There are lots of clues and supporting labs for autoimmune disease, but most are non-specific. For example a urine check might show blood or protein in lupus, anti-SCL70 may be positive in scleroderma, sed rate and CRP can be elevated, showing inflammation in many AI disorders, a CBC may show low white cells, anemia, low platelets, and there are other antibodies like dsDNA and Smith for lupus, anti CCP for rheumatoid arthritis, etc. It seems more of a workup is warranted in view of the length of time you have not felt right, and 2 positive ANA's with a titer high enough to be considered clinically significant. How far you pursue this is somewhat your call depennding on how sick you feel and how much you just need to know.

 
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Old 08-28-2013, 04:39 PM   #3
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Re: Confused on my ANA Titer results etc

Here are my labs from 9/12/2012:

Protein 6.6
Albumin 4.2
Globulin 2.4
AST 24
ALT 15
Hemoglobin A1c 5.7 (H)
Vitamin D3 52
Vitamin D2 <8
White Blood Cell Count 6.6
Red Blood Cell Count 3.56 (L)
Hematocrit 34.3 (L)
MCV 96.3
MCH 32.8
MCHC 34.1
RDW 15.3 (H)
Cardio CRP 0.3


ANA Screen, IFA Positive
Rheumatoid Factor 9
CCP AB (IGG) <16
ANA Pattern Nucleolar
ANA Titer 1:80

ANA Direct performed 8/17/2010 was negative.

ANA last week was:
ANA Pattern Nucleolar
ANA Titer 1:320

Last edited by memes; 08-28-2013 at 04:42 PM.

 
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Old 08-29-2013, 01:37 AM   #4
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Re: Confused on my ANA Titer results etc

Hi. Along with the ANA from last week, were your standard labs also run last week? I'm curious because some values from your (older) 9/12/12 standard labs may suggest some form of anemia---e.g., low red blood cell count and low hematocrit coupled with high RDW. (I say "may" b/c I'm just a dumb patient!) I'd ask to see & have explained my most recent standard labs, since any abnormalities in those may shed more light on last week's 1:320 ANA & thus suggest what doctor's next steps should be. So keep asking questions, OK? Looking forward to your updates, bye, Vee

P.S. Does diabetes run in your family? I'd ask about 9/12/12 elevated A1c, also make sure it's been run again recently. While I don't think that level is considered diagnostic of diabetes, it may be considered "pre-diabetes".

 
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Old 08-30-2013, 09:17 AM   #5
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Re: Confused on my ANA Titer results etc

ust spoke to the rheumy I saw in May and she sent over my results. Everything is normal, normal, normal. She said "Have you thought of trying antidepressants?"

Here are the results:

Hepatitis Panel: Non-reactive
She did A IGM, B Surface, B Core, C Antibody

Glucose: 79

Urea Nitrogen (Bun): 12
Creatinine: 0.74
Sodium: 139
Potassium: 4.4
Chloride: 105
Carbon Dioxide: 22
Calcium: 9.5
Total Protein: 6.4
Albumin: 4.2
Globulin 2.2
Albumin/Globulin Ratio: 1.9
Bilirubin total: 0.4
Alkaline Phosphatase: 34
AST 26
ALT 23
Vitamin D, 25-hydroxy: 24 (Low)
Uric Acid: 4.3
Creatine Kinase: 110
TSH w. Reflex to FT4: 1.24

SED rate Westergren: 11
Urine pH: 6.5

White Blood Cell count: 5.9
RBC: 3.46 (low)
Hemoglobin: 10.8 (low)
Hematocrit: 33.2(low)

MCV: 96.2
MCH: 31.1
MCHC 32.3
RDW 15.2 (high)

Platelet count: 274

ANA IFA Screen: Positive
ANA Pattern: Nucleolar
ANA Titer: 1:160

DNA DS Antibody: <1
Rheumatoid Factor: 9
C-Reactive Protein 9

SM & SM/RNP Antibodies <1.0

Sjogren's Antibodies SS-A <1.0
" " SS-B <1.0
CCP AB IGG <16

Vee, my father had diabetes, but it was self-inflicted (alcohol abuse, etc)

 
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Old 08-30-2013, 07:32 PM   #6
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Re: Confused on my ANA Titer results etc

Your results are not all normal. You are considerably anemic, have had 3 positive ANA's, and a low Vit D. These are 3 things that frequently occur in lupus. I don't understand why your rheum is just ignoring this. I would see a different rheum, especially with her advice to go on antidepressants. You should have a ferritin level done to see if your anemia is iron deficient or that from chronic disease, a Coombs test to see if it is hemolytic (also a sign of lupus), and be put on treatment for Vit D deficiency and anemia, once the cause is determined. A Vit B12 and folate would be helpful too as those are frequently low in lupus, and an anti SCL70 antibody would be helpful plus complement levels, antiphospholipid antibodies. She is dismissing your symptoms and your abnormal labs. Hopefully someone else would take more interest in your case and not tell you everything is normal. The degree of anemia alone is enough to make you feel horribly fatigued.

Last edited by ladybud; 08-30-2013 at 07:33 PM. Reason: typo

 
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Old 08-30-2013, 07:49 PM   #7
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Re: Confused on my ANA Titer results etc

Quote:
Originally Posted by ladybud View Post
Your results are not all normal. You are considerably anemic, have had 3 positive ANA's, and a low Vit D. These are 3 things that frequently occur in lupus. I don't understand why your rheum is just ignoring this. I would see a different rheum, especially with her advice to go on antidepressants. You should have a ferritin level done to see if your anemia is iron deficient or that from chronic disease, a Coombs test to see if it is hemolytic (also a sign of lupus), and be put on treatment for Vit D deficiency and anemia, once the cause is determined. A Vit B12 and folate would be helpful too as those are frequently low in lupus, and an anti SCL70 antibody would be helpful plus complement levels, antiphospholipid antibodies. She is dismissing your symptoms and your abnormal labs. Hopefully someone else would take more interest in your case and not tell you everything is normal. The degree of anemia alone is enough to make you feel horribly fatigued.
I agree with everything that ladybud says here. Please get your bloodwork looked in to, and hopefully followed up to see why you have anemia, the vitamin deficiencies and the positive ANA. She should do more labs such as the complement levels, and a urinalysis would be good to get as well.

 
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Old 08-30-2013, 09:02 PM   #8
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Re: Confused on my ANA Titer results etc

In a lupus hardcover I own, there's a section about anemia that speaks to the concepts Ladybug mentions. The "nonimmunologic" kind, also called "the anemia of chronic disease", is seen in various underlying diseases (including lupus, for one). This category includes iron-deficiency anemia, anemia from NSAID's, etc.

In the other kind, immunologic anemia, a/k/a autoimmune hemolytic anemia (abbreviation is AIHA), unwanted auto-antibodies are attacking the red blood cells themselves, causing them to die prematurely. (RBC's are supposed to live for 120 days.) Obviously this can cause low RBC. AIHA can occur standalone, or in conjunction with another autoimmune, like lupus.

I've had only the first kind of anemia (mine was B-12 deficiency) before I was diagnosed/treated for lupus, but my RBC stayed in-range. So I think the advice about needing those further tests to determine what's causing your anemia is excellent, and I hope you get those tests going ASAP, wth a rheumatologist or a hematologist. Good luck & let us know what happens next. Hugs, Vee

 
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Old 08-31-2013, 07:25 AM   #9
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Re: Confused on my ANA Titer results etc

Thanks!

Actually I have had ferritin tested, back in 2010, and it was 29. Granted, my ANA titer showed up negative until 2012, so I don't know if that would change. I'll have it rechecked, though. Back then, my sed rate was 6, now it's 11. And I see B12 was 585, Total Iron was 35 (low), and Iron Binding Capacity was 208 (low). That doctor *also* told me to go on an antidepressant. Actually, that's what they have ALL suggested, and I did go on Celexa for about 2 months in early 2010 but only because my grandmother was in the hospital, dying, and I could not get out of bed. A few weeks after she passed, and I hadn't shed a tear, the doctor added Wellbutrin and that gave me a rash, so he took me off both and suggested Zoloft, to which I refused and just stayed in bed for about a month until my husband practically dragged me out of the house. Spring came, and I got better.

I had a u/a done in May from the rheumy, and here are the results (I didn't think a u/a held much info, but I guess I was wrong!):

Color: Yellow
Appearance: Clear
Spec Gravity: 1.006
pH: 6.5
Glucose: Neg
Bilirubin: Neg
Ketones: Neg
Occult Blood: Neg (I'm not part of an occult, so this was a good thing! HAHAHAH!)
Protein: Neg
Nitrite: Neg (surprising, because I love bacon)
Leukocyte Esterase: Neg
WBC: None seen
RBC: None seen
Squamous Epithelial Cells: None seen
Bacteria: None seen
Hyaline Cast: None seen

May 2013:
Tissue Transglutaminase: 1
Immunoglobulin A: 209


I think I may make an excel sheet and compare all tests over the years, soo how they seem to run. I know at one point, my Vit D was in range, but it was the end of the summer, and I spend a lot of time in the sun in the summer.

I really appreciate you all looking at all these labs...to me it is a lot of fun to figure things out (except when you're worried you're going to die of scleroderma...)

 
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Old 08-31-2013, 08:16 AM   #10
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Re: Confused on my ANA Titer results etc

Well your urine looks great. Yes, an ANA can become positive over time, so a yearly check is reasonable or sooner if new symptoms appear. Since your iron was low before, that could be part of the anemia cause, but there may be more to it. In pure iron def. anemia, the iron binding capacity is high, and yours was low. Also your cell size is normal not small, so there may be other reasons for the anemia. I think a hematology consult is really your best bet, and would do that so you get the best work-up to figure this out.

 
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Old 08-31-2013, 09:09 AM   #11
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Re: Confused on my ANA Titer results etc

So, you suggest I see a straight up hematologist? Or another rheumatologist?

 
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Old 08-31-2013, 09:18 AM   #12
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Re: Confused on my ANA Titer results etc

Think I'd tilt to hematologist, too, as I'd expect them to be the best at sorting out the values that are off... which all seem to be in the RBC-anemia arena. Also, I believe ANA elevates in AIHA, so that may fit the picture, too.

...not to mention that your rheum suggested an antidepressant, so I hope when you DO get it all figured out, you write her a cool but entirely civil note announcing your findings! I wrote a few such notes, and sending them to the especially RUDE doctors I'd seen gave me great pleasure. GOOD LUCK.

 
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Old 08-31-2013, 10:31 AM   #13
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Re: Confused on my ANA Titer results etc

Quote:
Originally Posted by VeeJ View Post
Think I'd tilt to hematologist, too, as I'd expect them to be the best at sorting out the values that are off... which all seem to be in the RBC-anemia arena. Also, I believe ANA elevates in AIHA, so that may fit the picture, too.

...not to mention that your rheum suggested an antidepressant, so I hope when you DO get it all figured out, you write her a cool but entirely civil note announcing your findings! I wrote a few such notes, and sending them to the especially RUDE doctors I'd seen gave me great pleasure. GOOD LUCK.
AIHA still points to the possibility of scleroderma! Plus the nucleolar ANA pattern...

After looking at all this, I would probably guess that the inflammation/autoimmunity is stress-related, but my cortisol comes back normal, so it's not affecting my adrenals. That makes me scratch my head, because adrenals, to me, would show up as screaming if it really was stress-induced, wouldn't you think?

Oh, I definitely WILL send a letter to ALL the doctors who blew me off with an anti-depressant prescription. If I am *truly* depressed, I am the most controlled, happy depressed person I have ever seen. Sure, I have my moments, but any one of my friends and family would tell you I am not depressed. Stressed? Yes, but I'm also a control freak.

Again, thank you, thank you, thank you, and I will be making a hematology appointment Tuesday!

 
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Old 08-31-2013, 11:53 AM   #14
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Re: Confused on my ANA Titer results etc

But AIHA can also occur "standalone" (meaning without another AI), plus ANA pattern doesn't diagnose anything---so please don't overworry. Looking forward to your updates, Vee

 
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Old 08-31-2013, 12:58 PM   #15
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Re: Confused on my ANA Titer results etc

One more thing...

And this is really "out there"...

Could an allergy to cats trigger an autoimmune response such as this? Most of my troubles started when my daughter was born, but they got significantly worse around the time we got cats...not sure if there is any correlation...

 
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