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    What does this blood report indicate?

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Posted on Wed, 9 Aug 2017 in Blood Disorders
Question: This should really perhaps be a follow on question to previous advice on this app by dr XXXXXXX sanghvi and not an entirely new question - but fresh advice from fresh heamatologyst is also fine . On 21/3/17 i had a big knee operation on left leg , 4 days later got a provoked blood clot behind the left knee and started rivaoxaban - which i am still on and now wearing thigh length compression stocking . The clot was quite small and recent doplar scans show it has cleared . But i was prescrived the compression stocking as venous function was not perfect with some evidencd of venal hypertension - one leg slightly different colour to the other - a problem that has been helped by the compression stocking - but i am still getting some pain behind the knee where clot was - suggesting veins there are a bit damaged / enlarged .
By coincidence i had recent routine blood tests to monitor kidney performance( raised creatine 110 to 130 but stable over 10 years- no symptoms or treatments ) and was also tested for SLE ( lupus) - ANA test ( without my knowledge ) - which came back positive and titre 1:320 speckled.( not good news as my mum (deceased ) had sle . I have now had further tests aimed at testing for hughes syndrome . The results are attached .

I have 5 questions . 1.1 were these the right tests ( i was aiming at antiphospholipid anti body test and anti cardiolipin anti body tests ) ? 1.2 what do the test results show / say - they seem neutral / ok not indicative of hughes syndrome 1.3 what should happen next - are further tests needed if so why ? 1.4 would you precribe any drug or other treatments?1.5 can i stop the rivaoxaban now ? 1.6 do these tests say anything more about whether i really have SLE and should i havd further tests to confirm this . I assume the tests done to date do not definitively determin the SLE matter ?
doctor
Answered by Dr. Hardik Sanghvi 1 hour later
Brief Answer:
Detailed answer is mentioned below.

Detailed Answer:
Hi, dear
Welcome back
I have gone through your question & report. I can understand your concern.

1. These test are right for antiphospholipid antibody syndrome.
2. Test result show that it is normal.
3. Further tests are needed.

You need to check for lupus anti coagulant test after 12 weeks of the first test which shows ANA is positive with titre of 320.

Because For Hughes syndrome diagnosis criteria one clinical criteria and one laboratory criteria is required.

Venous thrombosis is a clinical criteria.
For laboratory criteria anti phospholipid antibodies or lupus anticoagulant should be positive two times at least 12 weeks apart.

4. Right now no other drug is required.

5. No you should not stop rivoxaban right now. You should continue it according to advice.

6. These tests are for Hughes syndrome. It is nor regarding SLE.
For SLE your primary screening test is positive (320 titre). For confirmation you should go for complete ANA profile.

Hope I have answered your question. If you have any doubts then please feel free to ask me. I will be happy to answer. Thanks for using health care magic.
Wish you a very good health.
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Hardik Sanghvi 23 hours later
To clarify
1. To confirm no hughes syndrome , i have to repeat the anti phospholipid anti body test 12 weeks or more after original ANA titre test . If that is negative ,then in clear for hughes .
2 .Will taking the ANA profile test prove whether or not i have SLE . So if this test is positive , i have SLE , if negative i do not . If this is case , why was Ana profile test not done in the first instance ?

3 Is the Ana profile test more expensive or does it take longer ?

4. What are the treatment advantages of this ana profile test . What will it tell me and how might that shape future treatment
doctor
Answered by Dr. Hardik Sanghvi 3 hours later
Brief Answer:
Explained in detail.

Detailed Answer:
Hi,dear
I have gone through your question.
I can understand your concern.

1. No need of repeat antiphospholipid antibody test. You need to repeat test for lupus anticoagulant after 12 weeks. If it is negative then there is no hughes syndrome.

2. If ANA profile test shows positive results then it will give you exact type of diagnosis like systemic lupus erythematous or other connective tissue disease.

It is required only after ANA IIF test. Because it is very costly. IIF is screening test and it is positive in your case. So you should go for ANA profile test.

3. Yes ANA profile test is more experience. Time duration is not the issue.

4 ANA profile gives you exact diagnosis whether you have SLE, SLE, sjogren syndrome, mixed connective tissue disease and many more diagnosis. So you should plan your treatment accordingly.


Hope I have answered your question.
If you have any doubts then feel free to ask me.
I will be happy to answer. Thanks for using health care magic.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Hardik Sanghvi 20 hours later
To clarify
1 . In 12 weeks after I first did the test ( so early october ) , I repeat the lupus anti coagulant test ( called the anti cardiolipin test ) . That will rule out hughes syndrome ( hopefully). Correct ?
2 . Now i must do the ANA Profile test - what is the proper name of this test to ensure I ask for and specify the correct test ?

3 . You refer to ANA IIF sceening test - which i have already done . For completeness , as i do not understand the abbreviations ANA IIF stands for . Can you give me the full name so there is no misunderstanding .

4 . I assume i do not need to stop rivaoxaban to take either ANA profile or lupus anti coagulent test .
5 . As We have now seen negative result for both anti cardiolipin and anti phospholipid anti body test , would that be evidence to stop rivaoxaban or move to a less strong /Toxic blood thinning drug ? . There are risks with rivaoxaban if say i have a car accident and my blood vessels are damaged .
doctor
Answered by Dr. Hardik Sanghvi 20 hours later
Brief Answer:
Explained in detail.

Detailed Answer:
Hi,dear
I have gone through your question.
I can understand your concern.

1. Anticardiolipin test and lupus anticoagulant test both are different. Anticardiolipin test is for Anti phospholipid antibodies.

I don't have your reports of October right now. If you have lupus anticoagulant positive in October then you can take it after 12 weeks from there. But before stopping drug consult your treating doctor once and then go for testing.

If your lupus anticoagulant test comes negative then it will rule out hughes syndrome.

Then anticoagulant treatment remains same as general population with thrombosis and SLE.

2. Proper name of ANA profile test is Anti Nuclear antibody test profile.

3. ANA IIF means anti nuclear antibody test by indirect immunofluorescence method. It is screening test. It gives results in different pattern like you have speckled positive. (320 is dilution ratio).

4. No need to stop rivoxaban for ANA profile test. For lupus anticoagulant test you need to draw the blood 24 hr after the dosage of rivoxaban.

5. You can take less stronger anticoagulant like warfarin instead of rivoxaban but these all are prescription based medicine and it need proper evaluation. So you have consult your treating physician for changes of drug or dosage. Because of limitations we can not prescribe it. If you are my patients then I will switch over to less stronger anticoagulant after rule out hughes syndrome.

Hope this will clears your all doubts.

If still you have any doubts then feel free to ask me.
I will be happy to answer. Thanks for using health care magic.
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Hardik Sanghvi 3 days later
Are these the right Ana profile tests

1.auto antibody profile 1 - thyroid peroxidase anti body , anti nuclear anti body , mitcchondrail antibody , smooth muscle antibody , gastric parietal cell anti body , reticulin anti body , lkm

2. Auto anti body profile 2 : thyroid peroxidase anti body , islet cell anti body adrenal anti body , gastric parietal anti body , gonadal testicular abs
doctor
Answered by Dr. Hardik Sanghvi 7 hours later
Brief Answer:
No it's not like that.

Detailed Answer:
Hi,dear
I have gone through your question.
I can understand your concern.

Anti Nuclear antibody profile test detect antibodies against following antigen.

D's DNA, nucleosome, histone, smD1, PCNA, SSA, SSB, PO, CEPNB, Scl 70, U1-snRNP, AMA M2, XXXXXXX 1, PM scl, Mi2,ku.

Hope I have answered your question.
If you have any doubts then feel free to ask me.
I will be happy to answer. Thanks for using health care magic.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Dr. Hardik Sanghvi

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