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Urinalysis - Download Now PowerPoint

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					    Cases from the Consumer
    Information Website


Cheryl Caskey      Omega Diagnostics, L.L.C.
Susan Leclair      University of Massachusetts at Dartmouth
Mary Ann McLane    University of Delaware
Mary Beth Miele    University of Delaware
Bernadette Rodak   Indiana University, Indianapolis
      ASCLS Annual Meeting, Orlando, July 27, 2005            1
What the CI is and how it works
   1999: 7 intrepid ASCLS member volunteers
   This is the first interactive, non-subscription-
    based, international service for consumers
    – http://www.ascls.org
    – http://www.LabTestsOnLine.org
   Never publicized, but was ―findable‖ by most
    browsers
   2005: 29 intrepid ASCLS member volunteers
   24/7/365
                                                       2
What the CI is and how it works

   1999: fewer than 1 question per day
   2005: average of 15 questions per day


                                      Ye a rly Incr ea s es

                        700



                        600
                                                                   We always need
                        500


                                                                  and welcome new
    Nu b o Questi ons




                        400
      m er f




                        300



                        200
                                                                     volunteers.
                        100



                          0
                              1   2           3               4    5   6
                                                  years
                                                                                    3
Workload by discipline
    Hematology                    Assignment to a team
    15 - 20%
                                  Handle all of your
                      Chemistry   discipline questions in
                       60 – 65%   that 24 hour period
 Immunology
   20 - 30%
                                  Team decides how to
                                  handle “overlapping”
       Microbiology               questions
       0 – 5%


                                                        4
The efforts have been noticed

 Awards:
  –ASAE Summit Award, given to
   programs that significantly
   ―enhance American society‖
  –eHealthCare Leadership Program
   Gold Award for Best
   Health/Healthcare Content
                                5
              Hematology
         most common questions
   WBC – low (most common) and high
   HCT – low and high
   Diffs – relative vs absolute values
   Indices
   MPV and RDW
   ESR – the most diagnostic test of all

                                            6
                   Examples

   My hematocrit was 16 and I had to have an
    infusion, but I am still suffering with
    headaches. Is it normal to have headaches
    with a low hematocrit?
   My WBC is 3.2 and the range is 4.0 – 10.0.
   The doctor told me my lab tests were fine, but
    on my copy there is an ―H‖ next to the MPV of
    10.7.

                                                 7
Just a little information, please

   I was wondering if you could answer a
    question about leukemia for me. I need
    to know what types of blood tests are
    done on what types of cells and
    possibly a few details on each of them
    to diagnose leukemia.


                                             8
    Healthcare provider examples

   What is the quickest and most efficient
    way for a patient to increase their
    hematocrit level?
   I just had a routine physical exam. I‘m
    an RN and would like to know what a
    platelet count of 700,000 and a WBC of
    21,000 indicates. Why am I being sent
    to a hematologist?
                                              9
              Worried mother
   My son is a 5 years and 3 month old Chinese
    boy. His segs is too low and his lymphs is too
    high. He did not have any symptoms when I
    brought him for the blood test. I am really
    concerned. Do you think he may be infected
    with HIV. Do you think he may have
    leukemia?




                                                10
         Patients’ right to know
   I just finished treatment for dysgerminoma
    and had my follow up blood work. I am
    concerned about my eosinophil percentage of
    34.0 when the range is 0-4. I called my
    oncologist‘s office and the nurse told me that
    the only thing they look at is WBC, ANC and
    MONO and that patients should not receive
    copies of their blood work because they
    don’t know the significance of anything
    and they would tell ME when I should be
    concerned.
                                                11
            Frustrated daughter

   All I am trying to find out is what the effect on
    the body of someone having a very low
    (1,000) platelet count is. My mother has
    been receiving platelet infusions.
    – Several messages later - diagnosis of RAEB –
      trying to make decision to continue treatment – I
      referred her to social services at her local
      university, mentioned hospice and sent her
      information on MDS.

                                                          12
          Long term “friends”

   Initial contacts can grow into a trusting
    relationship. We may become a source
    of support, comfort, inspiration, as well
    as technical information.
   Case of 2 CLLers
   ETAMM


                                            13
          Good teaching material
   RBC        3.69 x 109/L (4.1-5.1)
   HCT        24.1% (35-47)
   HGB        7.3 g/dL (10.9-15)
                                              What is
   MCV        66.2 fL (80-100)                 your
   MCHC       30.3 g/dL (33-36)            assessment?
   Fe         2.7mmol/L (6.6-26)
   Ferritin   3 µg/L (30-180)
   I have been very tired and all I want to do is to eat
    ice. What do you think my problem is?

                                                            14
     A chance to educate patients

   My hemoglobin is 14.2 and my ferritin is 13.2
    (20-120). How can my ferritin be low when
    my hemoglobin is good. Don‘t they both
    involve iron in your blood?
   My father just had blood work done and his
    HGB was >20.0. He has lung problems and
    is a heavy smoker. Can smoking and lung
    disease affect his hemoglobin?

                                                15
      Hemostasis and Thrombosis
                   “Coag”
           Most common questions

   PT and INR – by far the most common
   APTT
   Lupus anticoagulants
   Anti-phospholipid antibodies
   Protein C and Protein S

                                          16
             Coag Examples

   I take Coumadin and I used to get my
    PT results in seconds. Now I get an
    answer called an INR. Is that a new
    test? Nobody can explain to me what it
    means – just that it is the way the report
    is now given.
   What are the symptoms of an INR of
    8.0?
                                             17
Scary, but with a happy ending…
   I had been on coumadin        The doctor apologized.
    for a month without any        Three days after the
    monitoring. I wanted to        vitamin K shot, my INR
    get off, so the doctor         is 1.6. No one told me
    ordered an INR. It             that I could not take fish
    came back 11.1 and he          oil or that there were
    called me at work to           any diet restrictions
    come right to his office       while taking coumadin.
    for a shot of vitamin K.       Thanks for all your
                                   information.

                                                           18
    This is a foreign language to me
   I was found to have an elevated APTT in pre-
    op screening. I have never had any bleeding
    problems. I was told that I have a lupus
    anticoagulant as evidenced by the positive
    hex phase study, elevated ACAs and
    inhibitory pattern in multiple factor levels. I
    was told that because of the lupus
    anticoagulant that I might be at increased risk
    of post-op thrombotic episodes. What does
    all this mean in plain English?
                                                  19
Some questions are fairly easy- and
some more complicated
   FAIRLY EASY                   NOT SO EASY
   What is thrombosis?           My daughter has been
                                   diagnosed with Klippel
   Why would my                   Trenaunay Syndrome. Her
    physician suggest that I       doctor wants to start her on
    take a baby aspirin            Coumadin. How does that
    every day??                    relate to KTS?
                                  My baby has been
                                   diagnosed with Kawasaki
                                   Syndrome. Is it usual for the
                                   platelet count to approach 1
                                   million?

                                                              20
      And some require a
  hemostasis/thrombosis GURU
And George      I am homozygous for Factor V
 Fritsma         Leiden and heterozygous for
   came          MTHFR C677T. My two sons‘
 through         testing came back with 2 copies
                 of the A1298C mutation and
                 their factor V activity levels were
                 approximately 126-140%. Does
                 that make me C677T/A1298C?
                 What is the thrombotic risk for
                 my sons?


                                                   21
Chemistry scope of questions

   A recent test indicated my ALT was fine but my
    AST was 15 (the range being 16-40). What does
    a lower number mean? Is this dangerous?
   What is standard crininine level for a 67 yr. old
    male?
   What is the BCP cholesterol test?
   Hi, Can amas test for cancer ? can you do it?
    thanks
                                                        22
A pharmacopeia…and the thick PDR
   I am on 1 mg of Primogyna daily…iron tablets, garlic,
    gelatin capsules, brewers' yeast…Ginko Biloba and
    Noni…Cozaar…Allegra, Nasonex, and Atrovent.
   If taking a c-peptide test how would the drugs Amaryl
    (glimepiride) & Avandia (Rosiglitazone Maleate) I am
    taking for diabetes affect the test?
   I am taking eltroxin since 1998…. St.Johns
    Wort…Depakote, mebaral… lipitor




                                                            23
 What could that possibly be???
O presente texto está na lingua portuguesa (Brasil) e os
 The test is a HRP test. It's either related to my
exames são de minha filha Raquel que apresenta icterícia,
   heart disease or my acalculosa
cefalopatia, colecistopatia diabetes. e tem 21 anos de idade
e gozava de perfeita saúde. Não consome alcool ou outra
droga qualquer, exceto um remedio recomendado pela
 What is a gamma test? I have results but I don’t
dermatologista de nome Flutamida. Eu ficaria muito grato
   know what it is for. Is there a charge for this
com suas explicações para os resultados dos exames que
   service, if so
transcrevi abaixo: please disregard my message, thank
   you.
Bilirrubina direta 7,10 mg/dl; Bilirrubina indireta 4,90 mg/dl;
Bilirrubina total 12,99 mg/dl
Material: sangu; Método: Jendrassik mod.
   My 77-year-old father has been asked to have a
                     http://www.altavista.com
    "12/60 creatinine" test.                                      24
Do they really mean that?

   What is the significance of elevated nitrates in the urine?

   I had a test to determine my blood glucose level since I have type 2
    adult onset diabetes… hemoglobin A1c 5.6… I was expecting a
    reading similar to the blood test results that I get daily on my
    glucometer. How can I interpret the lab results? Thank you.

   I am interesting to know the test for cinetic creatinine concernig to
    eliminate the cromogenous



                                                                            25
…you’re thinking of doing what?
We are exploring this test in our ED. I am interested
 in getting information on the technique used to
 perform the test (I know the sample is placed in a
 cartridge which is placed in a portable meter—
 what I don‘t know is whether the reading is by
 mass spectrometry, electrophoresis, or some
 other technique). Do you have any information?
 Thanks in advance for any assistance you can
 provide.


                                                        26
Questions about Microbiology
   Center around
    infectious diseases
    – Risk of
      transmission                        STD
                               8%
                          6%
   Include specimen                      Hepatitis
                                          Resp
    collection          17%         40%
                                          GI-UTI
   Interpretation        14% 15%         Skin
    – Culture results                     Misc
    – Antibody levels
   Treatment
                                                      27
Interpreting laboratory jargon
   Subject: Urine culture
    What does mixed urogenital flora, less than
    10,000 colonies/mL effect the test results?



Google searching comes in handy
Question:
For information about Bilharziazis, please visit –
http://www.cdc.gov/ncidod/dpd/parasites/schistosomiasis/
factsht_schistosomiasis.htm
                                                           28
Uh Oh!
   During an annual exam my docter advised me
    that I may be infected with chlamydia. I have been
    completely faithful to my boyfriend of three years,
    and have never had an issue with previous
    exams. Could I still have gotton this if my
    boyfriend has been faithful to me? I have heard
    that in some cases an STD can go undetected for
    some time is this true?

   I know that Trich is a STD but what causes it
    exactly? Also who gets it first a man or a woman?


                                                          29
  Questions from physicians
     Question: Patient was             Given results below were the
      screened for HepB as part of       husband and wife ever exposed to
      pregnancy blood testing. No        HepB, are they currently
      known risk factors.                infectious (acute/carrier), is
                                         further testing required?

     Wife Results Oct/04               Wife Retest Results Nov/04
     HepB-HBsAg positive               HepA-AB(IgG+IgM)        Negative
     HepB-HBeAg non reactive           HepB core IgM AB        Negative
     HepB-Anti-HBe Reactive            HepBs Antibody <10 Nonimmune
                                        Wife Second Retest Nov/04
                                        HepBs Antibody <10 Nonimmune

                                        Husbands results Nov/04
                                        Surface Antibody (Anti-HBs) <2.0
                                        Liver Markers Normal
What do you think?                      Antibody (Anti-HAV) Not detected


                                                                            30
  Serology Testing for HBV
              HBsAg Anti-HBs Anti-HBc Anti-HBc
                              Total     IgM
Susceptible
               Neg    Neg      Neg     (neg)
Acute         POS      Neg     POS      POS
infection
Chronic       POS      Neg     POS      Neg
infection
Immune -       Neg     POS     POS      Neg
Past inf.
Immune -       Neg     POS      Neg     Neg
Vaccinated
                                                 31
    HIV serology
                                                What are these numbers
   Hi - I would just like to know what the      (ie. 0.30 etc) and why do
    numbers mean on my negative HIV
    test results. My print out is as follows     they change?
    for 4 tests since May 2004.
   May 2004
                                                If I am HIV Neg why is
    AxSym HIV 0.30                               there a reading at all?
    HIVNG
   Jul 2004
    AxSym HIV 0.29
    HIVNG
                                                This is very confusing and
   Oct 2004                                     I asked the nurse at the
    AxSym HIV 0.40
    HIVNG
                                                 clinic where I got the
   April 2005                                   results who said ―the
    AxSym HIV 0.30
    HIVNG
                                                 number is just something
                                                 to do with the type of test‖
   Test - AxSYM HIV 1/2 Ag/Ab MEIA              but to me it seems to be
                                                 some kind of
                                                 measurement???
                                                                                32
Obsessed by HIV
    hi ascls,this is me again…there is something i
     still cant get convinced enough about the blood
     circulation of the eyes..well, does the blood
     from the eyes flow thru down the body..? but i
     just wonder does blood in the capillaries of the
     eyes flow back to the body..? this question is
     crucial to me as im afraid hiv virus might get
     into the eyes as for my past encounter of the
     semen gettin to my eyes..
    (And then, 7 e-mails later)…i recently had a
     couple of dust particle from my shoe went into
     my coke drink…..will i get any hiv disease
     drinking that lot of dust in the drink or pose any
     danger to my health?
                                                          33
    Why me?
   I have bugs-yes bugs- in my urine. I noticed in the toilet
    little things floating & upon closer inspection with
    magnifying glass there were lots...of them swimming. I
    went to my doctor who did a urine test, said

   I had infection & gave me 30 cephalexin caps. I've taken
    all of them which has been 10 days but I still see some
    bugs & lots & lots of eggs in all different stages of
    development.

   I think the bugs I pass now are not alive
    but why are there still so many eggs
    & when will they be gone?




                                                                 34
Typical Immunology Question Mix
   ANA                          35%
   RF/RA                        16%
   Celiac Disease                4%
   Complement                    2%
   Miscellaneous                43%
    –   Mono
    –   Rast, IgE
    –   Cardiolipin Antibodies
    –   Immunoglobulins
    –   Other antibodies
                                       35
Immunology
   Typical questions include
    – ANA:
       My ANA came back positive. the Titer
       was 1:320 and speckled what does this
       mean?
    – RF or RA:
       I had been tested for RA 6 years ago. I have
       my medical records and I don't know how to
       ead it. What test would hev been ordered
       and how is it abbreviated? Also what would
       the test results look like? Lab test ordered
       under what heading would I find the info?
       thanks very much                               36
Other Questions
   am a 49 y/o female, my lab results are
    the following:
    complement component
       C3.......mg/dl........130.03
    complement component
       C4.......mg/dl..........10.71
    are these within the normal range

   Is this (antiphospholipids) the same as
    anticardiolipin antibodies?               37
Some Questions Are Different...

   Can you tell me how many serological
    celiac tests are done annually in the
    US? Thank you.




                                            38
And My Personal Favorite
Question
Can you get pregnant from
oral sex?




                            39
Ongoing Dialogue

   Happy Holidays! I have to ask another
    question. Does +ANA, speck patt and
    +Anti-nRNP happen in about 5% of the
    population when nothing is wrong with
    them? As always I look forward to
    hearing from you. Respectfully Yours




                                            40
Help Needed at Times

   Follow up questions after the initial
    answers are sent.

Original question sometimes requires
 help:
   How old does a baby have to be to
    have a RAST test?

                                            41
Some Questions Require Team Discussion
   My sister has been suffering from severe attacks for
    the last couple of years and does not seem to be
    getting anywhere with her doctors. Her normal
    symptoms are hives (a bad attack looks like severe
    burns as the hives all merge together), shivering,
    occasional loss of sight, weakness, low blood
    pressure, fainting, weeing herself and crying (fear).
    She finds an antihistamine calms the attack down but
    very rarely has enough warning an attack is looming
    until it hits her. She has recently performed a home
    test on her blood which shows a high level of Ige anti-
    bodies and really wants to push on to get some help
    from her doctors……
                                                              42
Some Questions Require Team Discussion
 (cont.)…. Our mother attracted anti-bodies after she gave
 birth to my sister 30 years ago and at that time there were
 only 3 people out of a population of 35,000 with these anti-
 bodies diagnosed. Any advice you can give us to help my
 sister would be appreciated as I worry about her driving in
 case she takes an attack on a busy road and harms herself.
 The only factors we can identify as common are the change
 in body temperature (i.e. gym then walking into cold air),
 cheese, vodka, white wine and bread and she has tried
 eliminating and also combining but cannot make an obvious
 connection to her attacks. I look forward to your reply in the
 hope you can shed some light on what she could be going
 through.
                                                             43
Answers….

   Often similar for common questions
   Resources used
    – Texts
    – PDR
    – Reference laboratory web sites
    – Internet
    – Colleagues

                                         44
And there are times we’d rather
not know…
   I am a 17 year old male and i have a 2 inch
    penis. I am emailing you to find out will my penis
    grow any more. If no, is there some type of
    medication (that works) and is to increase my
    penis. It is kind of embarrising not to have a
    girlfriend or take a shower at school.




                                                         45
Truly legal implications

   How does one test for the presence of
    semen in a sample of womans
    underware? I have several samples I
    have collected, but don‘t know what to
    do with them. Please help. Thank you.




                                             46
Unique outside research needed
to answer some…
   do you think that if doc ock used amylase and
    starch hydrolysis he could defeat spider
    man? (listed as a ―health care provider‖!)

…then there’s always back to
square one…
       what does protective mean on the
        green level
                                               47
And what do our healthcare
colleagues ask?
 I am a pharmacist and would like to
  know what electrolytes testing tells a
  doctor. Also, is there a web site that
  would tell tell me what lab testing
  reveals to a doctor? What is so
  important about a relation between
  Sodium and Potassium?

                                           48
And what do our healthcare
colleagues ask?
 I am a physician. What are the
  effects/consequences of pancreas
  removal?

   As a nurse, I am curious if you can tell
    the difference between inherited and
    acquired osmotic fragility?

                                               49
Time to challenge the clinician!
   I am 28 years old from the philippines. I had this bad
    headache at the back of my head. It‗‘s agonizing. for
    almost a month its attacking once in a while but lately
    more thank a week now the headache is getting
    worst. So, i had an ESR test and it say there the
    normal range is 0-20 but my result is 40. But the
    doctor ask my age and I said 28 and he
    added 14 into it that makes it normal he said.
    so, am not really sure if what he said is correct. so,
    pls. let me know so they're be light into this matter.
                                                             50
Words of Thanks

   Thank you very much... you are a big
    help, you heaved me from depression...

   WELL YOU WERE RIGHT (CA19-9)




                                         51
Words of Thanks

   THANK YOU THANK YOU THANK YOU!!!!
    I‘m so glad that I could FINALLY get an
    answer (couldn‘t even get one from the Doc!)
   dear sirs, i have gratefully received your
    prompt response , and would like to thank
    you for your concern and for taking the
    trouble to examine my test and send me a
    reply. (saudi arabia)

                                               52
Words of Thanks
   thank you for avverything, I appreciate. P.S.
    Send an email should you ever visit Greece :)
   Thank you for your prompt reply.
    That was awesome.
   I just wanted to thank you for your prompt
    response, and I want to congratulate all of
    you for this wonderful site.
   You are providing an invaluable
    service! Thanks again.

                                                53
Words of Thanks
mother’s HDL

   Thank you very much for your prompt
    reply… The service your profession
    provides is truly remarkable: the fact
    that you work 'behind the scenes' is
    immaterial to a person who has
    received correct treatment due to the
    initial accurate work done by
    professionals like yourself. God
    bless you all.                           54
Words of Thanks
   I am humbled and impressed by the fact
    that you actually answered my dog
    questions.
   I graduated from Harvard Public Health
    School. I have worked in Shanghai for
    almost 3 years. I am confused most of the
    time when I go to hospital. Now I will re-
    evaluate what those doctors say before I
    take any medical action.

                                            55
Words of Thanks
   Wow, thank you so much! What a great
    service you provide, isn't the Internet
    just great? Well, sometimes :) In this
    case for sure, GREAT! Thanks for
    sharing your knowledge.
   Bernadette, you guys are awesome. I
    found this site about two years ago and
    have used it about four times. For those
    of us that seek knowledge, since
    knowledge is power, I love this site    56
Words of Thanks
   Am I impressed or what! Here I was, alarmed at
    home, and there you are ---right on time with
    reassurance that nothing that is happening inside my
    body should keep me pacing the floor at night. What
    a service! I send you my gratitude. I must tell
    everyone I know about this service. I have already e-
    mailed my own physician. Here in Toronto one now
    waits twelve hours to be seen, and can count on
    another six or seven hours before anything is
    said. Whoever is funding you may I just say: Money
    well spent. Keep up the good work. Canadian
    blessings
                                                        57
Words of Thanks

   Thank you so much for your information. You
    are the first person to speak to me about this
    in an intelligent, non-layman way. I find that
    though I do my own research and bring my
    ideas to the doctor's office for discussion, I
    never get a straightforward and intellectually
    elevated answer. Thanks for clearing up
    some of my questions and for digging into
    this issue for me.
                                                58
Getting interested?
   What is it worth to you?
    – You get 1 CEU towards your NCA
      requirement every year.
    – You join a unique group of people who
      are
       • Creating a new awareness of clinical
         laboratory science across the world
       • Actually, really, honestly saving lives
       • Some of the best friends you will ever have


                                                       59
Want to get involved?

   Talk to me.
    – I will send you a copy of an orientation
      manual and hook you up with a current
      member. (I happen to have a few with
      me right now.)
    – They will guide you through the manual
      and get you up and running.
    – Thanks for coming! We look forward to
      talking with you!
                                             60

				
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