Question: I have a complex medical history. I am currently undergoing IV iron infusions due to anemia with a Hematologist after a complex gastric bypass left me with deficiencies that were not being met with oral supplements. I have had several GI bleeds. I have also survived Sepsis in 2011 after the bypass. I have a history of recurrent miscarriages (7). I have had prior genetic testing several times. The first time I was told that I had Lupus Anticoagulant. The next time they told me that was at the cutoff and it was really Anticardiolipid Antibodies. The next time, I was told it was actually MTHFR. Each time, I was treated with blood thinners during my pregnancies. During my recent blood tests with the Hematologist, they found that my ANA test came back positive. They are now recommending a follow up with a Rheumatologist due to the ANA test and suggested that I may have Lupus.

Here is what the Hematologist has diagnosed me with that they are treating me for:
Iron deficiency anemia 01/01/2012
Megaloblastic anemia due to vitamin B>12< deficiency

This is what health concerns they report I have:
Abnormal loss of weight
Arthritis (This one I am not sure where they got this from)
Disease related fatigue
Duodenal ulcer
Dyspareunia
Ectopic pregnancy
Feeling Weak
Irregular menstrual cycle (This has since resolved)
Vitamin B12 deficiency anemia

Here is my blood work results: The results are followed by the range
Basophil count (BA #) 0 x 10^3/uL 0 || 0.1
Eosinophil count (EO #) 0.03 x 10^3/uL 0 || 0.2
Platelet count (PLT) 150 x 10^3/uL 150.0 || 450.0
Lymphocyte count (LY #) 2.05 x 10^3/uL 1.3 || 2.9
Monocyte count (MO #) 0.1 x 10^3/uL 0.3 || 0.8
Mean corpuscular volume (MCV) 93 fL 80.0 || 100.0
Hemoglobin determination (HGB) 12.2 g/dL 11.0 || 15.5
Hematocrit determination (HCT) 36.3% 33.0 || 48.0
Red cell distribution width determination (RDW) 14.3% 11.0 || 16.0
Mean corpuscular hemoglobin concentration determination (MCHC) 33.5 g/dL 32.0 || 36.0
Mean corpuscular hemoglobin determination (MCH) 31 pg 27.0 || 31.0
Neutrophil count (Neu # (ANC)) 3.4 x 10^3/uL 2.2 || 4.8
White blood cell count (WBC) 5.6 x 10^3/uL 4.8 || 10.8
Red blood cell count (RBC) 3.9 x 10^6/uL 4.0 || 5.5
Basophil, percent (BA %) 1% 0 || 3.0
Eosinophil, percent (EO %) 1% 0 || 8.0
Monocyte, percent (MO %) 2% 2.0 || 12.0
Lymphocyte, percent (LY %) 37% 24.0 || 44.0
Neutrophil, percent (Neu %) 60% 42.0 || 71.0
(Transferrin saturation, %) 5% 11.0 || 50.0
Hepatitis B core antibody measurement, IgM type (Hepatitis B core antibody, IgM) Negative
Hepatitis B surface antigen measurement (Hepatitis B surface antigen) Negative
Hepatitis A virus antibody, IgM type (Hepatitis A IgM antibody) Negative
ANA screen, qualitative (Anti-nuclear ab screen, qual) POSITIVE

Chemistries (Comprehensive Metabolic Panel)


Lab Test

Result

Range


Protein measurement (Total protein) 7.8 g/dL 6.1 || 8.1
Creatinine measurement, serum (Creatinine) 0.77 mg/dL 0.5 || 1.1
Vitamin B12 measurement (Vitamin B12) 632 pg/mL 200.0 || 1100.0
Chloride measurement (Chloride) 105 mmol/L 98.0 || 110.0
Urea nitrogen measurement (BUN) 15 mg/dL 7.0 || 25.0
Sodium measurement (Sodium) 138 mmol/L 135.0 || 146.0
Calcium measurement (Calcium) 9.3 mg/dL 8.6 || 10.2
Alkaline phosphatase measurement (Alkaline phosphatase) 58 U/L 33.0 || 115.0
Albumin measurement (Albumin) 4.8 g/dL 3.6 || 5.1
Potassium measurement (Potassium) 3.8 mmol/L 3.5 || 5.3
Bicarbonate measurement (CO2) 20 mmol/L 19.0 || 30.0
Glucose measurement (Glucose) 83 mg/dL 65.0 || 99.0
Albumin measurement (Albumin) 3.9 g/dL 3.5 || 4.7
Protein measurement (Total protein) 7.8 g/dL 6.1 || 8.1
Hepatitis C antibody measurement (Hepatitis C antibody, qual) Negative
(Hepatitis C signal to cutoff ratio) <1.00

Other


Lab Test

Result

Range


Folic acid measurement, serum (Folate, serum) 22.9 ng/mL 5.5 || 24.0
Ferritin measurement (Ferritin) 13 ng/mL 10.0 || 154.0
(BUN/Creatinine ratio) 19.5 6.0 || 22.0
Bilirubin, total measurement (Bilirubin, total) 0.5 mg/dL 0.2 || 1.2
Albumin/Globulin ratio (A/G ratio) 1.6 1.0 || 2.5
Lactate dehydrogenase measurement (LDH) 150 U/L 100.0 || 200.0
Iron measurement (Iron) 28 ug/dL 40.0 || 190.0
(TIBC) 544 ug/dL 250.0 || 450.0
Globulin measurement (Globulin) 3 g/dL 1.9 || 3.7
(Unbound iron capacity) 516 ug/dL 110.0 || 370.0
(AST/SGOT, IU/L) 20 IU/L 10.0 || 30.0
Glomerular filtration rate, calculated (GFR estimate) 99 mL/min/1.73m2
(GFR XXXXXXX XXXXXXX estimated) 114 mL/min/1.73m2
(ALT/SGPT, IU/L) 17 IU/L 6.0 || 29.0
Beta-2-microglobulin measurement (Beta 2 microglobulin) 2.27 mg/L 0 || 2.51
Haptoglobin measurement, chemical (Haptoglobin) 103 mg/dL 43.0 || 212.0
Immunoglobulin G measurement (IgG, quant) 827 mg/dL 694.0 || 1618.0
Immunoglobulin M measurement (IgM, quant) 206 mg/dL 48.0 || 271.0
Immunoglobulin A measurement (IgA, quant) 254 mg/dL 81.0 || 463.0
(Gamma globulin) 1.2 g/dL 0.6 || 1.6
(Beta globulin) 1.3 g/dL 0.8 || 1.4
(Alpha-2 globulin) 1 g/dL 0.5 || 1.0
(Alpha-1 globulin) 0.4 g/dL 0.1 || 0.3
Monoclonal spike, g/dL (M-spike, SPE, g/dL) ABSENT
Homocysteine, serum (Homocysteine) 9.7 umol/L 0 || 10.3
Fibrinogen measurement (Fibrinogen) 329 mg/dL 175.0 || 425.0
(Light chains, serum) NONE
(HIV-1/2, EIA) NONREACT
(Heavy chains, serum) NONE
(Centromere antibody screen) <1.0 NEG
(RNP ab, AI) <1.0 NEG
(Smith antibodies, AI) <1.0 NEG
(Sjogren's antibodies (SSA), AI) <1.0 NEG
(Sjogren's antibodies (SSB), AI) <1.0 NEG
(SM/RNP antibody, AI) <1.0 NEG
(Scl-70 antibody, AI) <1.0 NEG
(Chromatin (nucleosomal) ab, AI) <1.0 NEG
(JO-1 antibody, AI) <1.0 NEG
Antibody to double stranded DNA measurement (ds-DNA antibody, quant) <1
(Kappa light chain, free) 20.3 mg/L 3.3 || 19.4
(Lambda light chain, free) 23.2 mg/L 5.7 || 26.3
(Free K/L ratio) 0.88 0.26 || 1.65
(Lupus anticoagulant interpretation) RESULT: Negative
(Methylmalonic acid, serum) RESULT: ?
(Cardiolipin antibody results) RESULT: ?

I have placed a call to my doctor's office to confirm if the Cardiolipin and Methylmalonic acid results were also Negative.

Thank you for your reply. For your follow up questions:

1. What was the reason for which you underwent Gastric Bypass? Was it your duodenal ulcer which ruptured or something else?How much of the segment was removed. The absorption of iron and Vitamin B 12 are in the ileum( small intestine). So i am wondering if any segment of that is removed too - I had gastric bypass as a revision to a prior lapband. I had lapband in 2004 due to a high BMI and comorbidity of high blood pressure & pre-diabetes, lost all the weight and BP went down and had a slip 2 years out with awful reflux that caused esophageal dilation. Liquid would come out my nose when I was sleeping. They moved it in 2007, which didn't solve the problem. They replaced the band in 2009 with a larger band which also didn't solve it either. It also caused regain of 90 pounds. In 2011, I had the conversion to RNY due to the issues caused of reflux as this was the only way to deal with the regain and reflux. I am unsure of how much was removed as I ended up in a medically induced coma for nearly a month on a ventilator in Septic Shock after with a multitude of medical issues which are still present today. The ulcer has grown and grown that has repeatedly hemorrhaged. I had to have a feeding tube put in at the junction at the small intestine below where I had the hole from the surgery that led to the Sepsis that remained in place for 3 months post surgery. My GI system is pretty rocked from all I sustained from this surgery.

2. The miscarriages you had, which trimester were they in? How many have you had so far?Did you manage to conceive after it. I had a total of 7 miscarriages including an Ectopic. I have carried 3 pregnancies to term with the help of progesterone and

3. What is the dilution of ANA positivity? 1: 40 or 1:80 or 1: 160??

4. Do you experience any other symptoms of dry eyes or dry mouth or anytime you noticed joint swelling?Any early morning stiffness. I always have dry eyes, dry mouth. No joint swelling. A little early morning stiffness, but it's not unmanageable.

5. Any history of clotting anywhere in the body? Yes, I have had blood clots a few times and have had to be treated for them. Usually in my extremities. About 3-4 times.

6. Any history of oral ulcers or hair fall? I have had inside mouth sores, nothing serious or long term and not that frequent. My hair has fallen out, but I have attributed that to my bypass, lapband, malnutrition due to the time that I was on the PEG tube, recent sudden weight loss in the last year and vitamin nutrition. My hair has begin to get thinner around my hairline especially in the front. Again, I attributed that to my lack of nutrition.