It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Blood and Blood Vessel Message Board

  • Hematologist???

  • Post New Thread   Closed Thread
    Thread Tools Search this Thread
    Old 03-25-2009, 04:34 PM   #1
    krazy2day
    Senior Member
    (female)
     
    krazy2day's Avatar
     
    Join Date: Jan 2009
    Posts: 251
    krazy2day HB Userkrazy2day HB Userkrazy2day HB Userkrazy2day HB Userkrazy2day HB User
    Hematologist???

    Hematologists treat blood disorders, right? So, is vasculitis treated by hem's or should that be a rheumatologist?

    Initial labs showed
    HIGH: chloride, wbc, rdw, mpv, segs, and esr
    LOW: A/G Ratio, and HDL Chol
    NEAR HIGH: globulin & lymph absolutes
    NEAR LOW: carbon dioxide, and albumin

    Additional labs (checking for RA and B12)
    LOW: folic acid
    HIGH: CRP

    Nothing extremely high/low -just simply out of range or bordering high/low
    Folic acid was prescribed and Im assuming RA and B12 are now ruled out.

    I dunno what the Dr is thinking but he scheduled me with a hem and a head scan (all in same week)

    --- if vasculitis is apparent, does it make sense that my carbon dioxide levels are near low (because oxygen transfer in the blood is probably impaired)?
    --- MPV = platelet sz, right? So, increased platelets are being produced w/in bone marrow? Why does this happen? What does it really mean?
    --- are these labs indicative of any one thing? (Of course I wont mention this to the Dr but I considered giant cell arteritis (before the labs) and have since been looking at Polyarteritis nodosa (w/o rash) and Im thinkin he may have the same thoughts as he pushed me into the scan and hem dr.)

    Any thoughts are appreciated, thx.

     
    Sponsors Lightbulb
       
    Old 03-25-2009, 10:44 PM   #2
    harka
    Senior Veteran
    (male)
     
    harka's Avatar
     
    Join Date: Jul 2008
    Location: Canada
    Posts: 991
    harka HB Userharka HB Userharka HB Userharka HB Userharka HB Userharka HB Userharka HB Userharka HB User
    Re: Hematologist???

    Quote:
    Originally Posted by krazy2day View Post
    Hematologists treat blood disorders, right? So, is vasculitis treated by hem's or should that be a rheumatologist?

    Initial labs showed
    HIGH: chloride, wbc, rdw, mpv, segs, and esr
    LOW: A/G Ratio, and HDL Chol
    NEAR HIGH: globulin & lymph absolutes
    NEAR LOW: carbon dioxide, and albumin

    Additional labs (checking for RA and B12)
    LOW: folic acid
    HIGH: CRP

    Nothing extremely high/low -just simply out of range or bordering high/low
    Folic acid was prescribed and Im assuming RA and B12 are now ruled out.

    I dunno what the Dr is thinking but he scheduled me with a hem and a head scan (all in same week)

    --- if vasculitis is apparent, does it make sense that my carbon dioxide levels are near low (because oxygen transfer in the blood is probably impaired)?
    --- MPV = platelet sz, right? So, increased platelets are being produced w/in bone marrow? Why does this happen? What does it really mean?
    --- are these labs indicative of any one thing? (Of course I wont mention this to the Dr but I considered giant cell arteritis (before the labs) and have since been looking at Polyarteritis nodosa (w/o rash) and Im thinkin he may have the same thoughts as he pushed me into the scan and hem dr.)

    Any thoughts are appreciated, thx.
    Hi there!

    Yes you are right that hematologists treat blood disorders, and generally primary vasculitides are treated by rheumatologists, but depending on which vasculitis it is and which organ it affects and whether it's secondary to something (like an infection for example) multiple specialists may see a patient with presumed or confirmed vasculitis.

    The way you have presented the bloodwork doesn't really tell anyone anything. The problem with presenting the bloodwork like that is that, first of all, there are no values (high, low, near normal etc.) given and that doesn't really help delineate anything. Secondly, there are a bunch of things you have included which are not clinically relevant in most settings. First off, I guess you don't know why you're going to see a hematologist, but I guess a good question to ask is, why do you think you have vasculitis? Vasculitis is a fairly specific and rare condition which is something that most laypeople are not familiar with. Additionally, vasculitis is a very difficult concept for people without medical training (actually, even people WITH medical training who aren't trained in internal medicine) have trouble understanding. Did your doctor mention it to you? Or did you perhaps put your symptoms in to a search engine on the internet and vasculitis came up?

    HIGH: chloride, wbc, rdw, mpv, segs, and esr
    Starting with this...it's hard to glean anything because #1 there are no numerical values and #2 all of these values are completely non-specific. A high ESR suggests inflammation is going on, but it is so non-specific that it can be high even if you have the common cold. If it is >100 then it SUGGESTS other things going on, but otherwise not really. A high white count can also suggest inflammation/infection, but again, it depends on HOW high it is and other accompanying symptoms.

    LOW: A/G Ratio, and HDL Chol
    I don't know what an A/G ratio is. A low HDL is also very non-specific though it is associated with people who have a tendency to form plaques in their arteries.....I say it again though, HOW low?

    NEAR HIGH: globulin & lymph absolutes
    NEAR LOW: carbon dioxide, and albumin
    None of these have any clinical value if they are "near" high or low. The carbon dioxide (used as a surrogate for blood bicarbonate level) is deranged in certain acid/base disturbances, but that wouldn't apply to you.

    So your pattern of bloodwork (even if I had the numbers) wouldn't suggest anything because there are no values which are very specific.

    Vasculitis, again is a VERY complex disorder and because there are blood vessels everywhere in the body, it depends on which blood vessels are affected which dictate the types of symptoms you get. Certain vasculitides prefer the lung and kidneys, while others like nerves and others still are related to infections, and others like small vessels and others big vessels etc. etc. It is a HUGE HUGE topic. Vasculitis in itself doesn't derange the "carbon dioxide" level unless the kidneys or lungs are severely affected (among other things).

    MPV I think means mean platelet volume, and it is rarely clinically relevant. What is more relevant is the platelet COUNT. In inflammatory syndromes, there are certain things in the blood which react to the inflammation and end up increasing. These are called "acute phase reactants" and platelets are one of these. In inflammation, the bone marrow sometimes responds by churning out more platelets. In certain vasculitides, there can be severe inflammation in the tiny microscopic vessels which can result in destruction of blood cells, and one of the earliest signs of this is decreased platelets.

    So PAN was suggested by the doctor and you thought of GCA? What about your symptoms prompted your doctor to think about PAN? I have an inkling that your doctor is sending you to the hematologist for a completely different reason based on some other more specific abnormality in your bloodwork.

    Anyway, I'll await your response and see if I can help answer any more questions.

     
    Old 03-26-2009, 11:21 PM   #3
    krazy2day
    Senior Member
    (female)
     
    krazy2day's Avatar
     
    Join Date: Jan 2009
    Posts: 251
    krazy2day HB Userkrazy2day HB Userkrazy2day HB Userkrazy2day HB Userkrazy2day HB User
    Re: Hematologist???

    Thank you for your response.

    I know low/mild results aren't necessarily a concern but aren't labs used to compare with symptoms in order to distinguish an underlying cause? (Actually, my symptoms governed the labs I suppose.)

    I'm not sure what you mean when you say, "there are a bunch of things you have included which are not clinically relevant in most settings" but you go on to ask why I think I have vasculitis. My initial complaints were leg related. I was in an auto accident and have had low lumbar issues (and I have a spinal cord tumor). I ignored a few MRI's and was afraid the leg thing had something to do with one of those. I knew enough from treatment that the cauda equina could eventually be effected so I looked that up and stumbled upon claudication. The symptoms were exact, so the appt was to rule that out and catch up on my MRI. The dr asked me tons of questions and peripheral pitting edema came up. He mentions the elevated ESR and SEGS. During this visit he also talked a lot about my 'mild' headaches. I mentioned them not being part of the bigger problem (I didnt even bring them up) but he was interested and asked me tons more questions. Those questions led to my saying I get lines of soft spots that feel puffy and bruised. Not typical headaches that are in the front, on the left, right, etc.. On to the eyes (which I know is age degeneration, he mentions muscle control & deterioration) balance (kooky CNS functioning, side-stepping like a drunk), and leg pulses (hardly palpable). He says, I have significant things going on and wants to start with leg dopler ultrasound and head scan. He had them take my blood again b4 I left and said he wanted to check for RA and B12 deficiency as well.

    Those labs showed low folic acid and a high CRP. They phoned in vitamins, made me an appt with hematologist, and a follow up appt with him.

    So I looked up: elevated segs, esr and crp and found the GCA and PAN. One of these also included elevated wbc (prob PAN). I know I shouldn't look ANYTHING up but I did. Here's my perception.... Claudication is a symptom of vascular disease. (I'm pretty certain I have the intermittent claudication). It could be neurogenic (esp considering the spinal issues) but if it were, I wouldn't feel better after a short rest. Vascular claudication makes more sense and is also related to the circulatory system. I've had a def fluid imbalance, palpatations -triple beats- diaphoresis... Vascular Peripheral issues can be due to plaques; plaques are more apt to occur with low HDL. I did notice that PAN was rare and im probably over reacting on that one. The GCA is a tight fit though. I wonder the odds of having peripheral vascular disease AND the GCA. So, no, the dr mentioned nothing really. His interest in my head made for good reading once I found the GCA though. >>smile<<

    You said, "So your pattern of bloodwork (even if I had the numbers) wouldn't suggest anything because there are no values which are very specific." What do you mean by.. no values being very specific? I have the lab ranges but you mention those wouldn't help. Sorry, I'm not getting some of this. Do you mean ALL labs? I have the full CBC, lipid profile, BUN, etc.....

     
    Old 03-27-2009, 05:17 PM   #4
    harka
    Senior Veteran
    (male)
     
    harka's Avatar
     
    Join Date: Jul 2008
    Location: Canada
    Posts: 991
    harka HB Userharka HB Userharka HB Userharka HB Userharka HB Userharka HB Userharka HB Userharka HB User
    Re: Hematologist???

    Thank you for your response.
    ****My pleasure!

    I know low/mild results aren't necessarily a concern but aren't labs used to compare with symptoms in order to distinguish an underlying cause? (Actually, my symptoms governed the labs I suppose.)
    ******Not really actually. The labs you have provided don't really give a whole lot of information either way. If your hemoglobin was 60 or your platelets <50 then that tells you something, but the rest of the labs are relatively inconsequential. Far more important things would be labs indicative of renal/liver function, markers of inflammation OTHER than the non-specific CRP and ESR (such as ANA, ANCA, extractable nuclear antibodies etc.) In other words, you're right that certain things can be distinguished via labs, but not the ones you've provided.


    I'm not sure what you mean when you say, "there are a bunch of things you have included which are not clinically relevant in most settings" but you go on to ask why I think I have vasculitis.
    *******Oh, I was referring to the bloodwork you've provided--it's not overly informative. The reason I was asking about the vasculitis because you yourself mentioned it and I was wondering if it was something you found on the internet or a doctor mentioned to you.

    My initial complaints were leg related. I was in an auto accident and have had low lumbar issues (and I have a spinal cord tumor). I ignored a few MRI's and was afraid the leg thing had something to do with one of those. I knew enough from treatment that the cauda equina could eventually be effected so I looked that up and stumbled upon claudication. The symptoms were exact, so the appt was to rule that out and catch up on my
    The dr asked me tons of questions and peripheral pitting edema came up. He mentions the elevated ESR and SEGS. During this visit he also talked a lot about my 'mild' headaches. I mentioned them not being part of the bigger problem (I didnt even bring them up) but he was interested and asked me tons more questions. Those questions led to my saying I get lines of soft spots that feel puffy and bruised. Not typical headaches that are in the front, on the left, right, etc.. On to the eyes (which I know is age degeneration, he mentions muscle control & deterioration) balance (kooky CNS functioning, side-stepping like a drunk), and leg pulses (hardly palpable). He says, I have significant things going on and wants to start with leg dopler ultrasound and head scan. He had them take my blood again b4 I left and said he wanted to check for RA and B12 deficiency as well.
    *****Ahhh, okay so it seems like the doctor was asking all sorts of questions to see if there are any symptoms suggestive of vasculitis. Just remember that there are few symptoms which are SPECIFIC for vasculitis. To give an example: abdominal pain can be seen with certain types of vasculitis, but it's not specific to vasculitis because there are a TON of other things that have abdominal pain. What's important in vasculitis is to see a constellation of symptoms and put them together (almost like a jigsaw puzzle) and THEN you can confirm the diagnosis with either serology or a biopsy.

    Those labs showed low folic acid and a high CRP. They phoned in vitamins, made me an appt with hematologist, and a follow up appt with him.
    *****A high CRP suggests ongoing inflammation, but it doesn't necessarily mean vasculitis--you can get a high CRP with even pneumonia.

    So I looked up: elevated segs, esr and crp and found the GCA and PAN. One of these also included elevated wbc (prob PAN). I know I shouldn't look ANYTHING up but I did.
    *****Heehee, you're right. Maybe you shouldn't have gone and scared yourself! The problem with what you've done is that you have put three VERY VERY non-specific things in to a google search and come up with ONE thing that seems to fit, but the problem is there are TONS of other things that also fit.

    You can see high ESR/CRP in:

    osteomyelitis
    lymphoma
    pneumonia
    temporal arteritis
    renal cell carcinoma
    bacterial endocarditis
    still's disease

    and the list goes on and on and on. It may seem like it fits, but there are probably plenty of things in your history that do NOT go along with Giant cell arteritis or polyarteritis nodosa.

    Here's my perception.... Claudication is a symptom of vascular disease. (I'm pretty certain I have the intermittent claudication). It could be neurogenic (esp considering the spinal issues) but if it were, I wouldn't feel better after a short rest.
    *****This is not necessarily true. Neurogenic claudication is classically described as getting better when the person bends over, yes, but just because it gets better with rest doesn't mean it's not neurogenic. Plus, if you have a spinal cord tumour and previous trauma to the lower back, it's much more likely to be neurogenic rather than vascular....and for you to have vascular claudication, you are suggesting either accelerated atherosclerosis (which is rare) or vasculitis (which is even more rare)...not saying it's impossible, but unlikely given another possible explanation; however, young people are the ones who get these weird vasculitides, so it's great you're getting checked out.

    Vascular claudication makes more sense and is also related to the circulatory system. I've had a def fluid imbalance, palpatations -triple beats- diaphoresis...
    *****Why do you think you have a fluid imbalance? Also, again, all of these things you mention are very non-specific.

    Vascular Peripheral issues can be due to plaques; plaques are more apt to occur with low HDL.
    *****This is absolutely not true. You can NOT use a low HDL to suggest the presence of plaques or to refute their existence. Not saying you have plaque, just saying that plaque formation is multifactorial and there are many factors which contribute. The combination of high triglycerides, high LDL and low HDL is a risk factor, but you can have that WITHOUT having plaques and you can be free of it and have LOTS of plaques.

    I did notice that PAN was rare and im probably over reacting on that one. The GCA is a tight fit though. I wonder the odds of having peripheral vascular disease AND the GCA.
    ******Well, to address the question of peripheral vascular disease and GCA...well, GCA can result in peripheral vascular disease not because of plaques, but because it likes to involve large arteries (especially the aorta and its primary branches) and after the inflammation settles down, the arteries are often scarred and narrowed. If this happens in your femoral or iliac artery, it can result in vascular claudication. PAN and GCA are both rare things.

    So, no, the dr mentioned nothing really. His interest in my head made for good reading once I found the GCA though. >>smile<<

    You said, "So your pattern of bloodwork (even if I had the numbers) wouldn't suggest anything because there are no values which are very specific." What do you mean by.. no values being very specific? I have the lab ranges but you mention those wouldn't help. Sorry, I'm not getting some of this. Do you mean ALL labs? I have the full CBC, lipid profile, BUN,
    *****So I guess like I mentioned above, specificity talks about how well a test will help you determine a condition. Certain tests are more powerful than others just by their nature. So for example:

    Creatinine is a rough measure of kidney function. The higher it is, the worse the renal function is. A normal creatinine (in SI units) is around 80. If someone comes in to hospital with a creatinine of 900, well, that is very SPECIFIC for renal disease. There is not much else that can cause a creatinine that high, and that means the doctor can confidently focus his vision on the kidneys.

    Now take for example a NON-specific test like the ESR. A normal ESR is anywhere from 0-5 (10 if you're generous) If someone comes in with an ESR of 100, well, even though it's so abnormal, it still doesn't point you towards a single diagnosis. There are many things which can have an ESR that high. So unlike the creatinine in the previous example, with a high ESR, the doctor can't point his vision in any one direction. All he can say is that there is inflammation going on, and I have to find it.

     
    Old 03-28-2009, 03:11 AM   #5
    krazy2day
    Senior Member
    (female)
     
    krazy2day's Avatar
     
    Join Date: Jan 2009
    Posts: 251
    krazy2day HB Userkrazy2day HB Userkrazy2day HB Userkrazy2day HB Userkrazy2day HB User
    Re: Hematologist???

    Thanks again for your response. I'll see what the dr says and post back in a few days.

     
    Old 04-03-2009, 09:18 AM   #6
    emmom
    Newbie
    (female)
     
    emmom's Avatar
     
    Join Date: Apr 2009
    Location: meriden CT
    Posts: 1
    emmom HB User
    Re: Hematologist???

    I am new to this website so I am not sure how whether this is the right way to post this. My 12 year old has an eatting disorder that started in January. She has a few weeks of bad eating but has been getting 1300-1500 calories for the last few weeks. She has blood work every week and everything looks fine except the white blood count. On 3/19 it was 3.8 and yesterday it was 2.73. The normal scale is 4.5-13.5. I am worried that there could be something medically going on here and its being missed because of the eating disorder. Any suggestions would be appreciated.

     
    Old 04-03-2009, 01:17 PM   #7
    newbies
    Newbie
    (female)
     
    newbies's Avatar
     
    Join Date: Apr 2009
    Location: GA, USA
    Posts: 5
    newbies HB User
    Re: Hematologist???

    Quote:
    Originally Posted by emmom View Post
    I am new to this website so I am not sure how whether this is the right way to post this. My 12 year old has an eatting disorder that started in January. She has a few weeks of bad eating but has been getting 1300-1500 calories for the last few weeks. She has blood work every week and everything looks fine except the white blood count. On 3/19 it was 3.8 and yesterday it was 2.73. The normal scale is 4.5-13.5. I am worried that there could be something medically going on here and its being missed because of the eating disorder. Any suggestions would be appreciated.
    You should ask to see a haematologist. My WBC is low (2.1) too and was just asked to see a haematologist

     
    Old 04-04-2009, 10:32 AM   #8
    harka
    Senior Veteran
    (male)
     
    harka's Avatar
     
    Join Date: Jul 2008
    Location: Canada
    Posts: 991
    harka HB Userharka HB Userharka HB Userharka HB Userharka HB Userharka HB Userharka HB Userharka HB User
    Re: Hematologist???

    Hi Emmom,

    One of the most profoundly affected "organs" in severe eating disorders is the bone marrow so often when a person is sick with an eating disorder or else recovering from one, there are often longlasting abnormalities in the blood counts. As long as everything else is going in the right direction, the doctors will just keep an eye on it and intervene only if they have to.

     
    Closed Thread

    Related Topics
    Thread Thread Starter Board Replies Last Post
    why am I being sent to a hematologist? nutmeg22 Anemia 6 09-28-2009 03:02 PM
    Doc wants me to see a hematologist sophie56 Cancer 6 03-12-2009 02:46 PM
    I have an appt with a Hematologist jann71 Blood and Blood Vessel 11 02-24-2009 03:09 PM
    Saw hematologist nancyjo Anemia 9 02-12-2009 02:24 PM
    New here, seeing hematologist next week nancyjo Anemia 4 01-29-2009 07:46 AM
    Consult with Hematologist? susieq14 Anemia 12 11-17-2008 08:21 PM
    When do you see a hematologist? gabby6 Anemia 1 01-21-2008 04:43 PM
    Frustrating Appointment with the Hematologist LEJ79 Blood and Blood Vessel 4 05-11-2005 01:52 PM
    Why to see a Hematologist fkissam Blood and Blood Vessel 1 12-13-2003 07:38 PM

    Tags
    vasculitis



    Thread Tools Search this Thread
    Search this Thread:

    Advanced Search

    Posting Rules
    You may not post new threads
    You may not post replies
    You may not post attachments
    You may not edit your posts

    BB code is On
    Smilies are On
    [IMG] code is Off
    HTML code is Off
    Trackbacks are Off
    Pingbacks are Off
    Refbacks are Off




    Sign Up Today!

    Ask our community of thousands of members your health questions, and learn from others experiences. Join the conversation!

    I want my free account

    All times are GMT -7. The time now is 08:11 PM.





    © 2021 MH Sub I, LLC dba Internet Brands. All rights reserved.
    Do not copy or redistribute in any form!