Cases from the Consumer
Information Website
Cheryl Caskey
Susan Leclair
Mary Ann McLane
Mary Beth Miele
Bernadette Rodak
Omega Diagnostics, L.L.C.
University of Massachusetts at Dartmouth
University of Delaware
University of Delaware
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-subscriptionbased, international service for consumers
– http://www.ascls.org
– http://www.LabTestsOnLine.org

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
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
YearlyIncreases
700
We always need
and welcome new
volunteers.
600
500
Number of Questi ons

400
300
200
100
0
1
2
3
4
year s
5
6
3
Workload by discipline
Assignment to a team
Hematology
15 - 20%
Immunology
20 - 30%
Microbiology
0 – 5%
Chemistry
60 – 65%
Handle all of your
discipline questions in
that 24 hour period
Team decides how to
handle “overlapping”
questions
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
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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
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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

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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
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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
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PT and INR – by far the most common
APTT
Lupus anticoagulants
Anti-phospholipid antibodies
Protein C and Protein S
16
Coag Examples
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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
for a month without any
monitoring. I wanted to
get off, so the doctor
ordered an INR. It
came back 11.1 and he
called me at work to
come right to his office
for a shot of vitamin K.

The doctor apologized.
Three days after the
vitamin K shot, my INR
is 1.6. No one told me
that I could not take fish
oil or that there were
any diet restrictions
while taking coumadin.
Thanks for all your
information.
18
This is a foreign language to me

I was found to have an elevated APTT in preop 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
What is thrombosis?
Why would my
physician suggest that I
take a baby aspirin
every day??

NOT SO EASY

My daughter has been
diagnosed with Klippel
Trenaunay Syndrome. Her
doctor wants to start her on
Coumadin. How does that
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
Fritsma
came
through

I am homozygous for Factor V
Leiden and heterozygous for
MTHFR C677T. My two sons’
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
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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
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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 diabetes.
cefalopatia,
colecistopatia
acalculosa 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 please disregard my message, thank
transcrevi
abaixo:
you. direta 7,10 mg/dl; Bilirrubina indireta 4,90 mg/dl;
Bilirrubina
Bilirrubina total 12,99 mg/dl
Material: sangu; Método: Jendrassik mod.

My 77-year-old father has been asked to have a
"12/60 creatinine"http://www.altavista.com
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
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Include specimen
collection
Interpretation
– Culture results
– Antibody levels
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6%
8%
17%
14% 15%
40%
STD
Hepatitis
Resp
GI-UTI
Skin
Misc
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
screened for HepB as part of
pregnancy blood testing. No
known risk factors.

Wife Results Oct/04
HepB-HBsAg positive
HepB-HBeAg non reactive
HepB-Anti-HBe Reactive

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Given results below were the
husband and wife ever exposed to
HepB, are they currently
infectious (acute/carrier), is
further testing required?

Wife Retest Results Nov/04
HepA-AB(IgG+IgM)
Negative
HepB core IgM AB
Negative
HepBs Antibody <10 Nonimmune
Wife Second Retest Nov/04
HepBs Antibody <10 Nonimmune
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What do you think?

Husbands results Nov/04
Surface Antibody (Anti-HBs) <2.0
Liver Markers Normal
Antibody (Anti-HAV) Not detected
30
Serology Testing for HBV
Susceptible
HBsAg Anti-HBs Anti-HBc Anti-HBc
IgM
Total
Neg
Neg
Neg
(neg)
Acute
infection
POS
Neg
POS
POS
Chronic
infection
POS
Neg
POS
Neg
Immune Past inf.
Neg
POS
POS
Neg
Immune Vaccinated
Neg
POS
Neg
Neg
31
HIV serology
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Hi - I would just like to know what the
numbers mean on my negative HIV
test results. My print out is as follows
for 4 tests since May 2004.

May 2004
AxSym HIV 0.30
HIVNG
Jul 2004
AxSym HIV 0.29

HIVNG
Oct 2004
AxSym HIV 0.40
HIVNG
April 2005
AxSym HIV 0.30
HIVNG
Test - AxSYM HIV 1/2 Ag/Ab MEIA
What are these numbers
(ie. 0.30 etc) and why do
they change?
If I am HIV Neg why is
there a reading at all?
This is very confusing and
I asked the nurse at the
clinic where I got the
results who said “the
number is just something
to do with the type of test”
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
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ANA
RF/RA
Celiac Disease
Complement
Miscellaneous
–
–
–
–
–
35%
16%
4%
2%
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 antibodies 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 antibodies 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 reevaluate 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 emailed 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