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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

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What do my lab test reports indicate?

Answered by
Dr.
Dr. Noble Zachariah

Internal Medicine Specialist

Practicing since :1974

Answered : 2276 Questions

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Posted on Sat, 3 Sep 2016 in Medicines and Side Effects
Question: Hi, I am trying to work out why I feel nausea everyday and lost weight suddenly 15kgs in 3 weeks) and most blood results are just within the normal range. Ct and Mri scans show small calcified lesions in spleen, base of right lung and frontal lobes. My cholesterol is a little high 5.6-5.8. I have had the E.BVirus but outside of the current timeframe. My last colonoscopy / endoscopy was clear of polyps or growths but 2 years ago 3 polyps (bowel) and an unidentified lesion was removed from my stomach. I do have an abscess on my gum since 2012 that repeated antibiotics has not removed. Recently I have had bouts of cellulitis and been diagnosed with blepharitis. My last CT scan showed sinus infections but no tumours or lesions. I am a smoker - giving up but have decided to give up drinking alcohol. My liver and kidney blood tests are in the middle of normal but the trend is dropping. My MCH is at 32.8. My wbc was a little high but falling. My b12 is just above normal but my iron saturation has dropped substantially from 33 to 20. Doctors are either at a loss or just say everything appears to be normal. I am nauseated everyday, experience regular fevers 2-3 / week with sudden drops in energy levels. Dizziness and leg weakness has been brought under control by diet and stress management. I have served the Army in the Solomons and PNG but negative results to ever having malaria. I am 49 years old and a teacher. Can you or your colleagues suggest my next step I am desperate.
doctor
Answered by Dr. Noble Zachariah 4 hours later
Brief Answer:
Requires an in depth search

Detailed Answer:
Hello,

Welcome and thanks for your query.
I agree with you that an unintentional loss of weight of 15 kgs over a period of 3 weeks is concerning. Your poor appetite and nausea and hence the poor food intake are factors. But one has to look for other causes. The drop of iron saturation form 33 to 20 would call for searching for conditions of blood loss from the GI tract. Stool test for occult blood , if not done, is a simple way.
Diabetes and hyperthyroidism are conditions that also lead to weight loss which can be excluded through HbA1c and Thyroid function tests.
Malignancies and HIV infection are other causes and blood examination for tumor markers and HIV may be done if not done already.
I am not able to see your test results or treatments tried and would be helpful if you could upload them.
Do get back to me with your input.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Noble Zachariah 44 minutes later
Hi, just had fever after eating just then and have been feeling a little feverish have all day. Will try and type results as don't have online. To date 2012 abyss tooth and colonoscopy that removed 3 polyps. 2014 colonoscopy removed 3 polyps and an area of hyperplasia from stomach. Series of scans and strong antibiotics - 2 courses as I became quite ill following colonoscopy. ESR went to 11 but in recent times fallen back to 2. 2015 series of tests done including MRI's. Found areas of calcification of around 5 mm front lobe brain, lungs and 7 mm (grown from 3 mm in early 2014). Other tests done by an immunologist found e.b.v virus and ruled out t.b which the calcifications may have looked like. Monoclonal A was an issue. I believe he also ruled out more obvious things like hepatitis etc. I did have sti tests done in 2009 that were negative and no reason to redo. I have given blood since with no screening issues. This year blepharitis diagnosed by optometrist and in recent times treated for cellulitis for fingers both hands. Recent endoscopy and colonoscopy found no polyps but waiting for results from biopsies. Last cat scan sinus infection. Last year also tried 6 months psychotherapy (including) drugs as doctors were concerned that it was a reaction to the death of a family member mid 2015. Drugs had no impact upon symptoms. Latest bloods (where big difference to previous test, I will indicate):
Iron now 13.3 was in 7/04/15 23.6
Transferrin 2.72, 2.55
Saturation 20, 37
Ferritin 118. 108

Sodium 143 142
Potassium 4.5 4.4
Chloride 109, 109
Bicarbonate 27, 27
Urea 5.3, 5.2
Creatinine 75, 80
Egfr 90^
Urate 0.37
Calcium 2.38, 2.43
Adja 2.44, 2.38
Magnesium 0.86, 0.86
Phosphate 1.03, 1.08
T protein 69, 69
Albumin 40, 39
Alp 94, 88
Bilirubin 10, 14
Ggt 28, 23
Ast 21, 17
Alt 22, 18

Total cholesterol 5.8 5.4
Hdl 1.2 (2015)
Ldl 3.7 (2015)
Triglyceride 0.9, 1.2
Hdl / ladle ratio 3.1 (2015)
Chol / Hdl ratio 4.5 (2015)

Glucose 4.9, 4.9

Haemoglobin 167, 168
Rbc 5.14, 5.12
Pcv 0.47, 0.48
Mcv 94, 93
MCH 32.5, 32.8
McHc 346, 353
Rdw 13.2, 13.2
Wcc 7.9, 9.8 (was 11.8 late 2014)
Neutrophils 4.3, 6.3
Lymphocytes 2.8, 2.6
Monocytes 0.6, 0.8
Eosinophils 0.2, 0.2
Platelets 304, 317 (was above 350 late 2014)
Esr 2 (2015) (was up to 11 late 2014)

Vitamin B12 470, 323
Folate 24.2, 20.7

Urine current 7 ph

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Follow up: Dr. Noble Zachariah 22 minutes later
Thanks for getting back to me, some other things not mentioned above 2015 sputum test negative for bacteria, lung function normal, faeces tests no blood. Can trace glandular fever to pre 2009 . 2001 very sick with similar but more intense symptoms Kokoda track (5-7 days into trip)

Weight loss was just after colonoscopy in 2014.

Also right ventricular valve in early 2014 just on cusp of being a problem but cholesterol was above 8

Only medication, apart from antibiotics in 2014 has been nexium.

Was offered statins and bp meds early 2014 but refused, preferring to exercise and diet. When feverish Bp can fall. It rises quite high in Arvos but normally sits around 133/88

No swelling in ankles but occasional and unexplained joint pain - some osteo arthritis in spine

Cannot think of anything else apart from faulty hemochromatosis gene but only 1 not 2

Could it be either staphylococcus infection or malaria (though test is negative for having had it) or a combination of small but significant things adding up to a medium problem?

Thanks
doctor
Answered by Dr. Noble Zachariah 28 minutes later
Brief Answer:
Discussion follows

Detailed Answer:
Thank you for the details.
Have you checked your temperature? Please let me know how high it reaches and whether there are rigors or sweating. These are common in fever due to malaria. When was the last time you were in an endemic area and when did you have the episode of malaria? Staphylococcus infection usually has a focus usually in the skin. With a staphylococcus blood infection, you would be very sick.
How recent is your urine examination? Urinary infection may mimic malaria in symptoms of rigors and sweating and burning while passing urine is not an essential feature. Was your stool tested for occult blood?This is different from the usual stool test.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Noble Zachariah 13 minutes later
Thanks,

Malaria no positive tests but did have a letter from Red Cross stopping me from giving blood as a batch that I had given blood to after, returned positive (I wasn't singled out). In PNG 2 weeks each 2001, 2002, 2004 and 2006. XXXXXXX Islands 8 months 2007. Symptoms fevers, nausea, loss of appetitive, aches and initially flu like symptom. Usually quite mild, 2-3 times year. Similar symptoms but accompanied by stomach pain and diarrhoea late 2014,

Faeces tests last year for occult blood

Urine test this week

If it wasn't for negative malaria tests I would swear that that was what it is.

Will purchase thermometer and monitor before this conversation expires

Thanks again, might get sti's tested again if you think warranted but don't think needed. I suspect the answer is obvious from the above but want to rule anything else out???

Please get back to me with your thoughts whilst I monitor temperature as I suspect that writing everything down may achieve clarity and direction - thanks heaps!
doctor
Answered by Dr. Noble Zachariah 13 minutes later
Brief Answer:
You are welcome

Detailed Answer:
Malaria vivax can remain in the liver in an asymptomatic state for variable periods but 2 years is a long time.
If you had loss of weight recently and as there is a drop in iron content, blood loss from the gut is a possibility and can be detected through stool occult blood.
Let us see what the temperature range is and how well it correlates with your symptoms.
I have enjoyed this conversation.
Do get back with your input.

Have a great day
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Noble Zachariah 36 hours later
Hi, temperature rises by about 1 degree. Very mild but the fever is mild. My thoughts are that I contracted a very serious infection during first colonoscopy in 2014. This created a small infection in brain, spleen, lungs and ongoing in stomach. This was made worse by my body already fighting E.B.V and possibly malaria. Bloods would indicate a slow recovery, hampered by stress of family member dying and work. But still lingering fear of something more sinister or developing.

And still no treatment. I was almost hospitalised in 2014 but was already on long service leave

What do you think?
doctor
Answered by Dr. Noble Zachariah 1 hour later
Brief Answer:
Relax, it is probably not a serious illness.

Detailed Answer:
There can be upto 1 degree fluctuation in temperature normally and so this may not be fever.
If you contacted a serious infection it would show in the blood test as a high WBC count, high ESR and CRP.
EBV is a possibility if IgM antibodies are present. Malaria is less likely.
There is an entity called psychogenic fever which is also to be considered in the differential.
One thing I am sure is that it is not a dangerous illness and may go away if you look the other way.
Wish you good health


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Noble Zachariah 23 minutes later
I think you have confirmed my thoughts. My CRP, ESR etc were high in 2014. Pity my gastroenterologist was going on holidays and brushed me off without clear guidance. I will meet half way and discount anything serious but will continue my journey
doctor
Answered by Dr. Noble Zachariah 6 minutes later
Brief Answer:
Right think to do

Detailed Answer:
I am glad that you have decided to live your life.
It was nice interacting with you and I shall be happy to be of any assistance if you have any queries in the future.

Best wishes
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Noble Zachariah 23 hours later
No I am upset , I was a little ill before 2014, went to hospital and ended up sleeping on a plastic sheet in the kitchen for a week due to diarrhoea and have felt really ill ever since. all I have been offered 2 different types of psych drugs and nexium. This could be as simple as a food allergy, it could be psychos emetic or it could be getting over a serious infection or finally, the start of something serious. I just want a plan that will lead to effective treatment.

As soon as docs decide that it is in my head it is "look the other direction" but when you wake in a cold sweat vomitting 2 years down the track, for any of the above options, I deserve to be treated. NAPLAN results were good for my school and all my relationships a e great (both personal and professional) - not a cloud in the sky and yet last night I woke up sweating and vomitting
doctor
Answered by Dr. Noble Zachariah 13 hours later
Brief Answer:
Discussion folllows

Detailed Answer:
Hello XXXXXXX

I understand your concern and empathize with you.
There are so many symptoms for which the exact cause is not clear and when the known organic causes are excluded the doctors have a tendency to call it functional or psychogenic. History has proven them wrong several times. A simple example is that of ulcers in the stomach. It used to be considered a psychosomatic disease but now we know that it is also caused by a bacterium called H.Pylori.
You may have an irritable bowel syndrome from the description and it may be due to several reasons. I have patient who developed diarrhea with Nexium.
Work in unison with a doctor with an open mind and together you would detect the cause and manage well.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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