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Test shows high platelet count. Have ankle swelling. Taking Allergen, Augmentin. Have sacrosiliac joint arthritis

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Practicing since : 1966
Answered : 4506 Questions
My mother had CBC, Thyroid , Fasting sugar taken today.

Fasting sugar is 135 when normal range threshold is 110
CBC has Platelet count at 4.49 lakhs/cumm when threshold is 4 lakhs
MCH is less than normal
TSH is 12.35 when threshold is 4.2

Rest are within the normal range. What shall we infer from these results, especially high platelet count? What tests are needed further? Could this be a sign of leukemia?

For your information,she had swelling on both the ankles. It increases whenever she strains her foot and ankle. On 15 Mar she was prescribed to Allergen, Augmentin 625, Nurovit B and one anti-inflammatory tablet. Even after taking all these until this morning, swelling has increased a bit by this evening. She has sacrosiliac joint arthritis.
Posted Tue, 9 Apr 2013 in Diabetes
Answered by Dr. Anantharamakrishnan 3 hours later
Hi friend,
Welcome to Health Care Magic

Very likely your mother is diabetic.
She should go for GTT (Glucose Tolerance Test) and HbA1c (glycosylated haemoglobin) to confirm and plan for treatment.
Also, this is the time to check Lipid profile and renal function...

TSH is high.
It can not be read in isolation - it is interpreted in relation with T-4.
With normal T-4, it is hypo-thyroid and she needs thyroid replacement.
If elevated, it is thyroid over-activity and needs suppression.
She may need further tests like thyroid antibodies and scan.
Endocrinologist will be the ideal specialist to assess and assist. He is also the one for diabetes...

Platelets are raised a bit. This is a usually an acute Phase Reactant - any inflammation may contribute. Repeat it after a week - after the antibiotic and anti-inflammatory agent.

Take care
Wishing speedy recovery
God bless
Good luck
Above answer was peer-reviewed by
Follow-up: Test shows high platelet count. Have ankle swelling. Taking Allergen, Augmentin. Have sacrosiliac joint arthritis 6 minutes later
How about the swelling on the ankles? On straining (by standing for a while), it swells again. Is it extended form of arthritis?

Will filaria symptoms mean 'higher than normal' or 'lower than normal' platelets?

In general what're all the possibilities for 'higher than normal' platelets considering the details I provided in my previous input?
Answered by Dr. Anantharamakrishnan 22 minutes later
Ankle swelling needs to be EXAMINED for proper opinion.
If it is bilateral, it is due to systemic cause.
One side may mean local cause.
If it is only on standing and disappears with rest and lying down, it is called dependent and may have several causes - kidney, heart, liver, chronic venous insufficiency, low protein and anaemia.
It needs examination...

Filaria like any other infection can raise the platelets at the time of activity
This rise is not very high to warrant extensive investigation at the moment.
One need not do anything for platelets at the present time.
It has to be repeated after about a week / after the treatment.
If it is still high, a specialist in blood diseases - haematologist - will have to take up further investigations...
Above answer was peer-reviewed by
Follow-up: Test shows high platelet count. Have ankle swelling. Taking Allergen, Augmentin. Have sacrosiliac joint arthritis 13 minutes later
Thanks a lot doctor. It is very information. Just one query.

As I mentioned in my 1st query, she did have all those high dosage medicines (for 5 days). Could it be filaria, even after that, especially with the increase in platelets? Actually, it all began with some insect (expected to be mosquito, as it was high that day) bite on 14th Mar. She scratched for the same reason, which developed to itching on both the legs, rash that spread to hands and swelling on the ankles. The dosage as in my 1st query was after diagnosing to be cellulitis symptoms by doctor who checked her on 18 March. Doctor who examined yesterday says filaria signs. There was no fever.

Why I've this doubt is because another general physician who examined her yesterday said it to be the sign of filaria for her. How could it happen, with other symptoms like fever, swelling just on ankles that too on 9th day of the issue?

He says her pulse is normal for now.
Answered by Dr. Anantharamakrishnan 25 minutes later
In an endemic area, diseases like filaria and malaria are often treated empirically, without scientific proof...
Because, investigation entail inconvenience, time and money...
To confirm Filaria, for instance, blood must be sampled in midnight!
Filaria causes lymphangitis, which can prolong.../ has long term consequences like lymphangiectasia (elephantiasis) and hence a course of treatment is at times given...
Fever is usual, but not a must in many cases.
In Medicine, absence of proof is no proof absence – of a disease.
In many circumstances, it may not be possible to find the cause / yet treatment is feasible – typical example is blood pressure.
It could have been any viral fever with rash
Rash is radically different from cellulitis – which is bacterial infection

The medicine doses appear appropriate; not high – adult dose of Augmentin, for example, is 2 grams a day..
Above answer was peer-reviewed by
Follow-up: Test shows high platelet count. Have ankle swelling. Taking Allergen, Augmentin. Have sacrosiliac joint arthritis 18 minutes later
Thanks. So, I understand you mean it can't be filaria. Am I right? I am concerned because doctor who checked her yesterday, has prescribed another set of medicines for 10 more days,in addition to what she had already.

What're all the tests to be taken to rule out LEUKEMIA, RHEUMATOID ARTHRITIS, GOUT, HEART, LIVER, KIDNEY ailments?

Considering her case detailed below
She was diagnosed to have osteoarthritis (both the sacrosiliac joints) in Nov '12

From health check in Nov '12 - She had protein crystals and epithelial cells were numerous in urinalysis. Urine culture came normal. She was prediabetic (FBS 101.1 mg), Hypothyroid TSH at 11.6 (T4 has been normal), total cholesterol at 247. E Sedimentation Rate was above normal. PCV and MCHC were abnormal in CBC test.

From tests in Feb '13 - Fasting Sugar shot to 123, cholesterol to 253 and TSH to 8.65

From tests taken yesterday - Fasting sugar at 135, cholesterol within normal limits, TSH at 12.35, Platelets at 4.49 lakhs/cumm

So many crest and trough in her health, with new issues reporting/being reported, in a span of just 3 months.
Answered by Dr. Anantharamakrishnan 2 hours later
It is the overall patient, who is treated, not the lab report.
You seem to be over-reacting to laboratory values... Biological values are not – rather should not be – constant. They vary day to day / even different times of the day. A value of 4.5 lakhs is the upper normal range for platelets. Till 5, nothing to do, but to repeat.
It is probably wiser to take the second course of medicines and look for improvement.

She is Dyslipidemic, Hypothyroid, and most likely Diabetic
She needs lifetime medicines (Statin / thyroxine / Oral hypoglycemic) and folow up for all these.

You have raised too many queries about many diseases! –
     Bone marrow aspiration/biopsy is the most important test to evaluate leukemia. (Haematologist)
     For Rheumatoid arthritis – RA factor, anti-CCP antibody & X-ray of the joint / Repeated ESR to follow up (Rheumatologist)
     For heart – blood test like CKMB, Troponin, BNP. Other basic investigations are ECG & ECHOcardiography. (Cardiologist)
     For the liver – basic liver function test and (USG) UltraSonoGraphy (Hepatologist)
     For kidney – renal function tests, 24-hour urine protein and USG (Nephrologist)
Depending on the outcome of the results, more tests may be needed – for example, angiography is the gold standard for the heart / viral markers and tumour markers for XXXXXXX / CT abdomen or MRI for liver and kidney /

There are too many compexities and specialists in different fields are involved.
The ideal option will be to GET HER ADMITTED TO A MULTI SPECIALITY TERTIARY CARE HOSPITAL and get invetigated and treated.
Above answer was peer-reviewed by
Follow-up: Test shows high platelet count. Have ankle swelling. Taking Allergen, Augmentin. Have sacrosiliac joint arthritis 3 minutes later
Thanks a lot. Hypothyroidism initiated the urge in me, to get my mom healthiest possible. Your detailing is very much informative, which will help in future case too.
Answered by Dr. Anantharamakrishnan 8 minutes later
She just needs follow up
God bless her ... and you too!
Above answer was peer-reviewed by
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