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What Do These Following Lab Reports Indicate?
Question: Dear Doctor
I had consulted you in May this year regarding my angiogram. I hope those details may be visible to you still in this site. However I shall still summarize my medical history:
I am 45 years / male / 97Kg/ 184 cm. In May 2015 I underwent a TMT test that was positive and have since been advised for an angiogram (you had also advised me to have one) but am still awaiting the angiogram (mostly later this month). Also had some vit B12 deficiency, which is since come to normal levels (377). Also had some balancing / dizziness (uncompensated vestibular lesion), which had improved but recently come back a little.
Due to breathlessness and waking up gasping for breath at night, I underwent a sleep study and was diagnosed with severe sleep apnea (AHI 62, oxygen desaturation going down upto 50% at nights). I have been given a CPAP machine, but am not able to fully use it. As soon as I put it on, I get some involuntary jerks of the body, like rapid exhalations, somewhat like hiccups from the stomach but not actually hiccups. So I am able to use the CPAP for only short periods of time.
I have been very tired and fatigued recently. I underwent a full blood test. Some of the numbers were out of range. I seek your opinion in whether I need to be much concerned about these, and the course of action to take.
MCV 106.1 (range 83 - 101)
MCHC 27.9 (31.5 - 34.5)
RDW - SD 64.4 (39 - 46)
RDW - CV 16.7 (11.6 - 14)
Print out says:
Alert!!! Predominantly normocytic normochromic with macrocytes and ovalocytes
(Note: I had a vit B12 def earlier which is now corrected (currently 377)
SGOT 38.1 (0 to 37)
SGPT 48.6 (13 to 40)
BUN 19.84 (7.9 to 20) - Note: It was 17 in earlier test 3 months ago
All these numbers were more or less normal in earlier blood tests. Since I have severe sleep apnea I was wondering whether that might be affecting my other organs like liver/kidneys etc. Do these numbers indicate any such thing?
Also my HbA1c is now 6.2 (pre-diabetic) as compared to 5.4 2-3 months back.
Also my BP is now 160/90 to 160/100. It was within 140/90 last month.
Am wondering if all this may be related to sleep apnea and oxygen desaturation.
The blood test also had a number for Lipoprotein (a) [Lp(a)] - value 68.1, reference range < 30. Any medicine to reduce this to normal range?
My main question is, Should I be concerned about these numbers. They seem to be only a little out of range, but since they were all well within range last time (3 months back) I am wondering if it is the start of something not so good. Please advise. Also which type of doctor (speciality) should I consult for the above, (if needed).
Also I am experiencing breathlessness on exertion. Also visited a pulmonologist - he did a PFT and said there is mild restriction in lungs.
Also any suggestions for alternative to CPAP machine for sleep apnea or on how to overcome my problems in using the CPAP.
Regards & Thank You
I had consulted you in May this year regarding my angiogram. I hope those details may be visible to you still in this site. However I shall still summarize my medical history:
I am 45 years / male / 97Kg/ 184 cm. In May 2015 I underwent a TMT test that was positive and have since been advised for an angiogram (you had also advised me to have one) but am still awaiting the angiogram (mostly later this month). Also had some vit B12 deficiency, which is since come to normal levels (377). Also had some balancing / dizziness (uncompensated vestibular lesion), which had improved but recently come back a little.
Due to breathlessness and waking up gasping for breath at night, I underwent a sleep study and was diagnosed with severe sleep apnea (AHI 62, oxygen desaturation going down upto 50% at nights). I have been given a CPAP machine, but am not able to fully use it. As soon as I put it on, I get some involuntary jerks of the body, like rapid exhalations, somewhat like hiccups from the stomach but not actually hiccups. So I am able to use the CPAP for only short periods of time.
I have been very tired and fatigued recently. I underwent a full blood test. Some of the numbers were out of range. I seek your opinion in whether I need to be much concerned about these, and the course of action to take.
MCV 106.1 (range 83 - 101)
MCHC 27.9 (31.5 - 34.5)
RDW - SD 64.4 (39 - 46)
RDW - CV 16.7 (11.6 - 14)
Print out says:
Alert!!! Predominantly normocytic normochromic with macrocytes and ovalocytes
(Note: I had a vit B12 def earlier which is now corrected (currently 377)
SGOT 38.1 (0 to 37)
SGPT 48.6 (13 to 40)
BUN 19.84 (7.9 to 20) - Note: It was 17 in earlier test 3 months ago
All these numbers were more or less normal in earlier blood tests. Since I have severe sleep apnea I was wondering whether that might be affecting my other organs like liver/kidneys etc. Do these numbers indicate any such thing?
Also my HbA1c is now 6.2 (pre-diabetic) as compared to 5.4 2-3 months back.
Also my BP is now 160/90 to 160/100. It was within 140/90 last month.
Am wondering if all this may be related to sleep apnea and oxygen desaturation.
The blood test also had a number for Lipoprotein (a) [Lp(a)] - value 68.1, reference range < 30. Any medicine to reduce this to normal range?
My main question is, Should I be concerned about these numbers. They seem to be only a little out of range, but since they were all well within range last time (3 months back) I am wondering if it is the start of something not so good. Please advise. Also which type of doctor (speciality) should I consult for the above, (if needed).
Also I am experiencing breathlessness on exertion. Also visited a pulmonologist - he did a PFT and said there is mild restriction in lungs.
Also any suggestions for alternative to CPAP machine for sleep apnea or on how to overcome my problems in using the CPAP.
Regards & Thank You
Brief Answer:
Sleep apnea is the reason for your abnormal reports.
Detailed Answer:
Thanks for your question on Health Care Magic.
I can understand your concern.
Yes, your all these current abnormal reports are due to sleep apnea.
Sleep apnea causes low saturation at night, this in turn causes hypoxia at tissue (organ) level leading to organ damage.
This is the reason for your abnormal reports.
Your breathlessness can be due to sleep apnea and heart disease.
Actually sleep apnea is the cause for your cardiac problem. Sleep apnea causes dyslipidemia (high lipo protein) and this can cause coronary artery obstruction. So coronary Angiography is must for you.
Sleep apnea is mostly due to either obesity or upper airway obstruction.
So you need to lose weight first.
Consult ENT (ear, nose, throat) doctor to rule out upper airway obstruction.
Along with CPAP, weight reduction and treatment of airway obstruction if present are treatment options.
So in your case continue CPAP. Reduce weight. This will also reduce your CPAP requirement.
Consult ENT doctor to rule out airway obstruction.
Hope I have solved your query.
I will be happy to help you further.
Wish you good health. Thanks.
Sleep apnea is the reason for your abnormal reports.
Detailed Answer:
Thanks for your question on Health Care Magic.
I can understand your concern.
Yes, your all these current abnormal reports are due to sleep apnea.
Sleep apnea causes low saturation at night, this in turn causes hypoxia at tissue (organ) level leading to organ damage.
This is the reason for your abnormal reports.
Your breathlessness can be due to sleep apnea and heart disease.
Actually sleep apnea is the cause for your cardiac problem. Sleep apnea causes dyslipidemia (high lipo protein) and this can cause coronary artery obstruction. So coronary Angiography is must for you.
Sleep apnea is mostly due to either obesity or upper airway obstruction.
So you need to lose weight first.
Consult ENT (ear, nose, throat) doctor to rule out upper airway obstruction.
Along with CPAP, weight reduction and treatment of airway obstruction if present are treatment options.
So in your case continue CPAP. Reduce weight. This will also reduce your CPAP requirement.
Consult ENT doctor to rule out airway obstruction.
Hope I have solved your query.
I will be happy to help you further.
Wish you good health. Thanks.
Above answer was peer-reviewed by :
Dr. Sonia Raina
Thank you for your quick and clear response. I have a few more queries, please.
1. From what I understand those blood test numbers indicate - red blood cells problem, and possible liver & kidney issue. I understand this can be due to sleep apnea; what should I do about it. Does it need a visit to a doctor for medicine etc to prevent further decline? Is it likely to deteriorate further, what can it lead to?
2. I have been told that my upper airway is narrow; also that I have a deviated septum. One ENT doctor advised septoplasty / turbinoplasty; it was also suggested that I consider sleep apnea surgery(?) Would any of this help. I am not keen on surgery.
3. I am not able to use the CPAP machine continuously. When I lie down I get body spasms (like hiccups but not hiccups); when I put on CPAP mask this worsens. I also wake up several times each night; and do not have even the energy to put back the mask each time. I feel fatigued and tired.
4. Since I am not able to lie down flat (as mentioned in point 3 above) I am hesitating to go for angiography. Any alternative to angiography; will a CT angiogram be helpful for me?
Thank you
1. From what I understand those blood test numbers indicate - red blood cells problem, and possible liver & kidney issue. I understand this can be due to sleep apnea; what should I do about it. Does it need a visit to a doctor for medicine etc to prevent further decline? Is it likely to deteriorate further, what can it lead to?
2. I have been told that my upper airway is narrow; also that I have a deviated septum. One ENT doctor advised septoplasty / turbinoplasty; it was also suggested that I consider sleep apnea surgery(?) Would any of this help. I am not keen on surgery.
3. I am not able to use the CPAP machine continuously. When I lie down I get body spasms (like hiccups but not hiccups); when I put on CPAP mask this worsens. I also wake up several times each night; and do not have even the energy to put back the mask each time. I feel fatigued and tired.
4. Since I am not able to lie down flat (as mentioned in point 3 above) I am hesitating to go for angiography. Any alternative to angiography; will a CT angiogram be helpful for me?
Thank you
Brief Answer:
CT Angiography can be done.
Detailed Answer:
Thanks for your follow up question on Health Care Magic.
I can understand your concern.
Answer to your 1st question.
Yes, all these decline is due to sleep apnea. So treatment of sleep apnea is must. Weight reduction, correction of upper airway obstruction and CPAP are treatment of sleep apnea. Once obstruction and weight reduction are achieved, CPAP requirement can be decreased.
If not treated properly, permanent organ damage can be expected.
Answer to your 2nd question.
Yes, you should get done surgery. Surgery I'd the only option for fixed obstruction.
Answer to your 3rd question.
Possibility of hypercarbia (high carbon dioxide) is more in your case. So get done ABG (arterial blood gas) analysis.
Answer to your 4th question.
Alternative to percutaneous coronary Angiography, CT Coronary Angiography can be done. But you have to lie down in this also.
Hope I have solved your query.
I will be happy to help you further.
Wish you good health. Thanks.
CT Angiography can be done.
Detailed Answer:
Thanks for your follow up question on Health Care Magic.
I can understand your concern.
Answer to your 1st question.
Yes, all these decline is due to sleep apnea. So treatment of sleep apnea is must. Weight reduction, correction of upper airway obstruction and CPAP are treatment of sleep apnea. Once obstruction and weight reduction are achieved, CPAP requirement can be decreased.
If not treated properly, permanent organ damage can be expected.
Answer to your 2nd question.
Yes, you should get done surgery. Surgery I'd the only option for fixed obstruction.
Answer to your 3rd question.
Possibility of hypercarbia (high carbon dioxide) is more in your case. So get done ABG (arterial blood gas) analysis.
Answer to your 4th question.
Alternative to percutaneous coronary Angiography, CT Coronary Angiography can be done. But you have to lie down in this also.
Hope I have solved your query.
I will be happy to help you further.
Wish you good health. Thanks.
Above answer was peer-reviewed by :
Dr. Prasad
Dear Doctor
Thank you for your clear, point-by-point reply. I am getting a clearer picture now. May I ask a few more queries -
1. I have been advised an angiogram. Since it is an invasive procedure, I was not very keen on it. What is the risk in avoiding the angiogram, and just continuing with medicines? Is there a risk of heart attack? Or for how long can I postpone it?
2. I have read about 'false positive' stress tests. What is the chance that my stress test was 'false positive'. I have read that for those with conditions like LVH or bundle branch blocks, stress tests may be false positive. I have these two conditions. Can my stress test be a false positive.
'
3. Will repeating the stress test to check out be of help?
4. I am trying to manage the sleep apnea with CPAP. In the meantime is any medicine needed for the abnormal blood test; or should I just focus on treating the sleep apnea and heart issues.
Thank you & Regards
Thank you for your clear, point-by-point reply. I am getting a clearer picture now. May I ask a few more queries -
1. I have been advised an angiogram. Since it is an invasive procedure, I was not very keen on it. What is the risk in avoiding the angiogram, and just continuing with medicines? Is there a risk of heart attack? Or for how long can I postpone it?
2. I have read about 'false positive' stress tests. What is the chance that my stress test was 'false positive'. I have read that for those with conditions like LVH or bundle branch blocks, stress tests may be false positive. I have these two conditions. Can my stress test be a false positive.
'
3. Will repeating the stress test to check out be of help?
4. I am trying to manage the sleep apnea with CPAP. In the meantime is any medicine needed for the abnormal blood test; or should I just focus on treating the sleep apnea and heart issues.
Thank you & Regards
Brief Answer:
Yes, there is risk for heart attack.
Detailed Answer:
Thanks for your follow up question on Health Care Magic.
I can understand your concern.
Answer to your 1st question.
Yes, there is definite risk for heart attack in future. You are having ischemia on TMT, so if untreated, possibility of future heart attack is high. Angiography is to see the degree of blockage. If the vessels involved are less and blockage is minimal, medicines are given. But if number of vessels involved are more and block is larger than angioplasty or CABG is advisable.
Answer to your 2nd question.
Yes, you are right about false positive TMT.
But if you have both LVH and bundle branch block than this mean that your heart is already weak and you are at higher risk of heart diseases.
Answer to your 3rd question.
No need to go for repeat stress test. Instead, go for 2d echo or heart function scan to see the functional capacity of heart.
Answer to your 4th question.
For your abnormal blood reports, no drugs are needed. Proper treatment of sleep apnea (CPAP, surgery) and heart diseases are required.
Please let me know
1. Have you ever undergone 2d echo?
2. Have you ever undergone ABG (arterial blood gas) analysis?
Please reply me answers of above asked questions, so that I can guide you better.
I will be happy to help you further.
Wish you good health. Thanks.
Yes, there is risk for heart attack.
Detailed Answer:
Thanks for your follow up question on Health Care Magic.
I can understand your concern.
Answer to your 1st question.
Yes, there is definite risk for heart attack in future. You are having ischemia on TMT, so if untreated, possibility of future heart attack is high. Angiography is to see the degree of blockage. If the vessels involved are less and blockage is minimal, medicines are given. But if number of vessels involved are more and block is larger than angioplasty or CABG is advisable.
Answer to your 2nd question.
Yes, you are right about false positive TMT.
But if you have both LVH and bundle branch block than this mean that your heart is already weak and you are at higher risk of heart diseases.
Answer to your 3rd question.
No need to go for repeat stress test. Instead, go for 2d echo or heart function scan to see the functional capacity of heart.
Answer to your 4th question.
For your abnormal blood reports, no drugs are needed. Proper treatment of sleep apnea (CPAP, surgery) and heart diseases are required.
Please let me know
1. Have you ever undergone 2d echo?
2. Have you ever undergone ABG (arterial blood gas) analysis?
Please reply me answers of above asked questions, so that I can guide you better.
I will be happy to help you further.
Wish you good health. Thanks.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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