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What do my lab test reports indicate?

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Posted on Tue, 4 Oct 2016
Question: Hi

Please find details of my four reports. Please provide some valuable comments on my situation. After the 3rd test I was prescribed to take REHEPTIN but you can see there is no improvement in the 4th test. Also the SGOT levels have started rising now.

I am not able to find the cause of this increasing levels. Right now I am not eating any junk food, and any other bad food for the last 8 months, in fact I am eating very very simple and healthy diet for the last 8 months but then also condition is not improving, so I am not able to understand it.

Can you suggest what may be the reason for this and what can be the consequences of this situation and what step should I take now.

Also find my ultrasound reports.

Thanks
doctor
Answered by Dr. Yogesh D (6 hours later)
Brief Answer:
Increased Red Blood cell destruction. Need to do peripheral smear test.

Detailed Answer:
Hello Mr XXXXXXX

Thank you for posting your query with the new test reports.

I had earlier answered your query and had suggested you to get the tests done out of which you seem to have missed one test, that is peripheral smear examination.

I have seen the attached reports and the report is quite clear about the increased turnover of the RBC (Red blood cells), as you can see in the report, the hemoglobin level is slightly on the lower side, but RBC numbers are high and red cell distribution width is also high. This clearly means that more and more RBCs are getting destroyed in the spleen, that is why the spleen is enlarged.

This increased destruction of RBCs is what is responsible for increased bilirubin levels, particularly the indirect bilirubin.

If you remember our last discussion, I had mentioned this.

The next step is to get a peripheral smear done to find out the cause for RBC destruction.

Usually, RBCs get destroyed in the spleen if their shape is not normal, that is, if they are unusually more round or bent then they get destroyed.

More round RBCs are seen in G6PD (Glucose-6-phosphate dehydrogenase), deficiency, it is an X-linked recessive genetic disorder.

A peripheral smear will help in identifying this problem and to confirm you can go for Beutler fluorescent spot test.

Other disease that causes irregularly shaped RBCs is sickle cell anemia.

This is again a genetic disorder which is caused by mutation in genes that encode hemoglobin chains.

This is also easily identified by a peripheral smear examination.

Please get this test done and consult a physician at the earliest.

I am sorry to inform you that you will need to consult a doctor in person for physical examination and confirmation of these findings.

You do not need to consult a gastroenterologist, ideally you must consult an internal medicine MD.

I hope this answers your question.

Best wishes.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Yogesh D (20 hours later)
Thanks again Dr. XXXXXXX

I am just confused if this is due to any genetic disorder, then I must have faced this situation very early in my life not much suddenly.

My second test report was showing a positive result for both bilirubin and SGOT, SGPT,,, but after that it started showing bad results in the 3rd and 4th report.
The change which I did after the first test report was that (1)I started drinking a lot of milk, (2)having evening snacks (just biscuit and namkeens), (3)eating papaya daily.
rest all the things were same.
So I am just confused whether it depends on some specific foods irrespectively of whether it is a healthy food. Because I feel out of three changes drinking milk has led to a bad result further, can you please provide your valuable comments on this.
doctor
Answered by Dr. Yogesh D (26 hours later)
Brief Answer:
Not all genetic disorders present at birth itself. Please get the test done

Detailed Answer:
Hello Again Mr XXXXXXX

Thanks for writing back,

Many genetic problems do not cause noticeable problem from birth itself.

Particularly the conditions mentioned generally present after many years and that too when something triggers them and causes stress.

Not all genetic disorders are severe, the severity can vary from person to person so the diagnosis can be quite late.

Your SGOT and SGPT levels are not too high to be worried about right now.

Yes, some foods can trigger G6PD, but milk and papaya are not among those triggering foods, it is usually flat beans.

Please get the tests done and consult your local doctor for further management.

Wishing you good health.

Best regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Yogesh D (16 hours later)
Hi XXXXXXX

Can you please tell me where this test can be done and full name of the test, I mean can this be done at normal pathology labs like Lal Path Labs.

Thanks...
doctor
Answered by Dr. Yogesh D (18 hours later)
Brief Answer:
You can request the below mentioned tests, Lal Pathlabs will do it.

Detailed Answer:
Hello again Mr XXXXXXX

Please find the names of tests that are required in your case.

Direct antiglobulin test (DAT)
Urine free hemoglobin test
Urine hemosiderin test
Red blood cell survival test
Cold agglutinin titer
Glucose-6-phosphate dehydrogenase (G6PD) screen
Sickle cell screen

These tests will cover most common causes for hemolysis and will give a good idea as to what is happening.

But you must consult your local doctor for a complete physical examination, because there is no substitute for a clinical examination.

I am trying to make you understand the importance of a direct clinical examination from the start of this discussion, but unfortunately you do not seem to understand my requests.

Please consult a local doctor and proceed further.

Wishing you good health.

Kind regards
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Yogesh D (3 hours later)
Hi XXXXXXX

Thanks for providing the names of the tests.

I have consulted three doctors till now and had proper physical examination by each one of them. They all didn't suggest any serious effects but today I consulted a gastro doctor and he says that I have XXXXXXX syndrome, I don't know how he claim so without any test,,, and prescribed me medicines for 10 days (see attachment). but he has a different perspective then the previous doctors. He says to eat everything, and says that it will not effect liver anytime, and also says that this is a lifetime disease and can't be cured but there nothing to get stressed about this. But the previous doctor told me not to take oily, fatty foods.

So I am just confused whether to worry about this and eat selective things only or just eat everything carefree as doctor today prescribed me.

I will follow up next tym with these test reports.

Thanks!
doctor
Answered by Dr. Yogesh D (24 hours later)
Brief Answer: XXXXXXX Syndrome does not have hemolysis, you need to get the tests done.

Detailed Answer:
Hello Mr XXXXXXX

The reason I asked you to consult a general medicine MD or a heamaologist is precisely this, the whole picture has to be seen not just the liver.

the primary problem in your case is not liver.

The primary reason for elevated bilirubin levels is increased hemolysis.

The reason for hemolysis needs to be found out.

The medicines prescribed by that gastroenterologist is not going to be of any use in your case.

Please get the tests done and consult either a hematologist or physician (MD internal medicine).

Hope this clarifies things further.

Best regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Yogesh D

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What do my lab test reports indicate?

Brief Answer: Increased Red Blood cell destruction. Need to do peripheral smear test. Detailed Answer: Hello Mr XXXXXXX Thank you for posting your query with the new test reports. I had earlier answered your query and had suggested you to get the tests done out of which you seem to have missed one test, that is peripheral smear examination. I have seen the attached reports and the report is quite clear about the increased turnover of the RBC (Red blood cells), as you can see in the report, the hemoglobin level is slightly on the lower side, but RBC numbers are high and red cell distribution width is also high. This clearly means that more and more RBCs are getting destroyed in the spleen, that is why the spleen is enlarged. This increased destruction of RBCs is what is responsible for increased bilirubin levels, particularly the indirect bilirubin. If you remember our last discussion, I had mentioned this. The next step is to get a peripheral smear done to find out the cause for RBC destruction. Usually, RBCs get destroyed in the spleen if their shape is not normal, that is, if they are unusually more round or bent then they get destroyed. More round RBCs are seen in G6PD (Glucose-6-phosphate dehydrogenase), deficiency, it is an X-linked recessive genetic disorder. A peripheral smear will help in identifying this problem and to confirm you can go for Beutler fluorescent spot test. Other disease that causes irregularly shaped RBCs is sickle cell anemia. This is again a genetic disorder which is caused by mutation in genes that encode hemoglobin chains. This is also easily identified by a peripheral smear examination. Please get this test done and consult a physician at the earliest. I am sorry to inform you that you will need to consult a doctor in person for physical examination and confirmation of these findings. You do not need to consult a gastroenterologist, ideally you must consult an internal medicine MD. I hope this answers your question. Best wishes.