Frequently Asked Questions
|Q||My son has hemophilia. Does that mean I'm a carrier? Should I tell my doctor?|
|A||I am sorry that you family has to deal with this condition. I know many families with this condition that have done very well. Hemophilia is a genetic condition. Some individuals have inherited from their mother and some have a new mutation. There are ways to determine whether or not you are a carrier and what the risk is for other children. There is a very well known hemophilia clinic in portland @ OHSU. Carriers rarely have any medical problems. I suggest that you meet with someone knowledgable about the disease either in hematology or genetics.|
|Answered at 2/14/2008|
|Q||What are NEUTRO 's in a CBC test?|
|A||Neutrophils are granular leukocytes (white blood cells). Neutrophils are phagocytes engulfing bacteria and cellular debris. An increase in the number of neutrophils occurs in acute infections, certain malignant neoplastic diseases, and some other disorders.|
|Answered by Stephen Erfurth, M.D., Clinical Chemistry, Springfield, Stephen Erfurth PhD (4/28/2005)|
|Q||What does it mean if my TIBC is high and also my SATURATION is low?|
|A||A high TIBC with a low iron saturation suggests uncomplicated iron deficiency. Your physician may perform additional tests such as ferritin and a complete blood count to confirm iron deficiency. The usual causes of depleted iron stores include blood loss and inadequate dietary iron. |
|Answered by Stephen Erfurth, M.D., Clinical Chemistry, Springfield, Stephen Erfurth PhD (4/20/2005)|
|Q||How long does it take a blood clot to resolve itself after getting the heparin injections and starting on coumadin? Is there any danger of the clot breaking loose before it's resolved?|
|A||I assume you are talking about a clot in a vein in the lower extremity. My answer is predicated on that location. To some extent it depends on whether the clot is in a vein below the knee or above the knee. In a vein below the knee the risk of breaking off is relatively low and above the knee it is higher. Heparin and coumadin reduce the risk significantly. Within 48-72 the risk for below the knee clots is close to zero. In clots above the knee the risk is close to zero in about 3-5 days. In both instances the clot is partially disolved by the heparin. The heparin has an immediate effect of preventing fresh clots from forming. Coumadin also prevents fresh clots from forming but it usually takes about 72 hours for the coumadin to be effective. In addition, the clot that is present adheres to the wall of the vein which prevents it from breaking off. The process of adhering to the wall of the vein isn't affected by either heparin or coumadin. |
|Answered by Loren Barlow, MD, Internal Medicine, , (9/30/2004)|
|Q||How many platelets is a normal count?|
|A||A normal platelet count ranges from 155 to 356. Increased platelet counts, up to twice the upper end of normal, frequently occurs in patients with an inflammatory process. |
|Answered by Stephen Erfurth, M.D., Clinical Chemistry, Springfield, Stephen Erfurth PhD (3/12/2004)|
|Q||I have been diagnosed with Raynauds Syndrome. Can you tell me of anything that I can do to slow down, or help this syndrome through diet, exercise, etc.?|
|A||Simply stated, probably not much through diet or exercise. The main thing would be to try and keep your extremities warm under all circumstances. Avoid vasoconstrictive substances such as nicotine. For some people with Raynauds, vibration can also induce symptoms. If that's a problem for you, avoid it. If needed, there is medication which can be used (usually only in the most severe cases, though) to help minimize the symptoms.|
|Answered by Frank Littell, MD, Hospitalist, Springfield, PeaceHealth Hospital Medicine (8/29/2003)|
|Q||How are white blood cells replenished?|
|A||The white blood cells, of which there are 5 main types (neutrophils, eosinophils, basophils, monocytes, and lymphocytes), are central to immunity to infection. The first 4 types are constantly replenished by the bone marrow, where red blood cells and platelets are also made. Lymphocyte production is more complicated, and some of them emanate from lymph nodes. The spleen generally gobbles up old white blood cells after their short life span. The bone marrow is very capable of pumping out white blood cells unless is it diseased. Many treatments exist for low white blood cell counts (leukopenia).|
|Answered at 8/27/2003|
|Q||I was seen in the ER this week for pyelonephritis, and the doctor I saw said that I had an extremely elevated WBC count and was "pushing out immature WBC's." He told me the medical term but I can't remember what it was. Can you help? I'm a medical assisting teacher and would like to pass it on to my students.|
|A||Any severe infection or inflammation can produce an elevated white blood cell count (leukocytosis). In the case of a bacterial infection, the white blood cells increased are the neutrophils (neutrophilia). If immature cells are being released from the bone marrow in a serious infection that is often termed a "left shift." If very early cells are found in the blood in significant numbers in a benign inflammatory state, the situation is sometimes called a "leukemoid reaction." The first early cells to emerge are "band" or "stab" cells and a "bandemia" is said to be present.|
I'm glad that you have recoverd sufficiently that you can be intellecutally curious about your infection!
|Answered at 4/7/2003|
|Q||What does the differential mean in lab values? For instance, how would a high lymphocyte count be considered different when your overall white count is normal? |
|A||The white blood cells (leukocytes) come in different types. The number and/or percentages of the various types is known as the differential white blood cell count or "differential." Typically, the automated blood counting machine determines a 5-part differential: neutrophils, lymphocytes, monocytes, eosinophils, basophils. Lymphocytes should, depending on age be no more than 50% of white cells, and number no more than 5000 per mm3 or uL. One of the first steps if the lymphocyte count is elevated is to have a pathologist review your blood smear. Many disorders cause increased lymphocytes, some of which go away in short order. Your physician will be able to sort these out or refer you to someone who can.|
|Answered at 3/25/2003|
|Q||I have taken a blood test that included a complement test to establish the level of inflamation in my blood. What is a low - normal - high range?|
|A||You have asked a very interesting question. Complement is a family of 11 blood proteins involved in immunity and inflammation. The basic purpose of complement is to rupture and destroy bacteria that the immune system has coated with antibody. Activation of complement also causes inflammation, attracting white blood cells to the site of the injury or infection and producing leaky blood vesels and swelling. Complement is a complex topic over which medical students struggle before each exam and then forget until next time!|
Basically, a low complement level (also called total hemolytic complement or complement activity) is seen in people whose bodies are gobbling up complement because of diseases like rheumatoid arthritis, lupus, and kidney disease. Complement levels can be used to follow activity of these diseases (the lower the more active). Genetic deficiencies of complement can also cause low levels. High levels of complement are noted in infections, inflammations, and tumors generally. A high level is very non-specific and could be seen in anything from pneumonia to lymphoma. A low total complement level may prompt a doctor to order levels of specific complement proteins, typically C2, C3, C4, C5 or factor B.
The exact normal ranges for complement will be listed on the lab report and vary from facility to facility.
|Answered at 2/21/2003|
|Q||When patients have Deep Vein Thrombosis , do the clots eventually resolve or do the veins stay blocked?|
|A||The blocked vein, or veins, may recannalize (open up) partially with time if the length of the blocked vein is not very great. More likely, however, is the persistent obstruction of the vein, with development of alternative routes for blood to travel. This will lead to varying degrees of swelling of the limb affected.|
Depending on the severity of the presenting symptoms, intervention with potent clot dissolving drugs or various types of surgery may be reccommended.
|Answered by Robert Schauer, MD, General Surgery, Eugene, Robert Schauer MD (1/18/2003)|
|Q||Is there some resource out there that would have a healthy diet for someone who has hemochromatosis -- as, foods good and bad, etc.. other than the "Low Iron" foods, that is?|
|A||Here is a link to the American Hemochromatosis Society web page. This is a highly credible organization. I found this on their FAQ page:|
Q: Is there a special diet I should eat or foods I should avoid?
A: Basically, iron in the diet is not going to make much difference in relation to your treatment, however, it is wise to check the labels of processed foods for their iron content. For instance, certain breakfast cereals contain 100% RDA of iron as do other products. Avoid alcohol and vitamin C which enhance iron absorption, cooking in cast iron cookware, and never take iron pills or supplements containing iron. Hemochromatosis patients should not eat raw seafood or shellfish (cooked is fine) due to a bacteria (vibrio vulnificus) which can kill the patient within hours of ingestion (due to a compromised liver which many HH patients have) unless emergency treatment of antibiotics (tetracycline) is administered. (Note: this can also happen to fishmen who handle and clean fish). Drink tea and coffee with your meals which will help block the iron in the foods you do eat.
Hope this helps. The website has an array of interesting resources for further information. Another resource is the Hemochromatosis article in the
Healthwise Knowledgebase on the PeaceHealth website. Check the Topic Overview and the Home Treatment section.
|Answered by Tom Ewing, MD, Family Practice, Eugene, Planned Parenthood of Southwest Oregon (12/4/2002)|
|Q||I have had blood in my stool the last few times I have used the bathroom. I am on coumadin. Is this anything to worry about?|
|A||There are many harmless reasons why blood can show up in the stool. Examples include local skin irritation, hemorrhoids and small fissures. On the other hand the presence of blood in the stool can be indicators of far more serious conditions including ulcerations,polyps, cancer, vascular abnormalities and diverticula. |
Please check in with your doctor about this ASAP. This is all the more important because you are on coumadin, and if significant bleeding was to occur, it would be all the more difficult to treat.
|Answered by Tom Ewing, MD, Family Practice, Eugene, Planned Parenthood of Southwest Oregon (7/24/2002)|
|Q||What is the current medical protocol for blood transfusions for people who travel overseas, particularly in developing countries. Most of the literature says avoid it and consider international air ambulance. Have you any good sources to recommned?|
|A||I have no sources to recommend. You might consider joining IAMAT (www.travelershots.com and go to the Link page). If you are traveling, fall seriously ill and have less than the necessary amount of confidence in your health-care system, consider air evacuation.|
Unfortunately, developing countries may not TRY to test blood intended for transfusion for as many infectious diseases as in the US, and they may not be as PROFICIENT in testing as US blood banks. In this setting I would probably not agree to transfusion unless it were necessary to save life, usually due to trauma, rarely due to GI bleeding.
|Answered by John Wilson, MD, Infectious Disease, Eugene, The Travel Clinic (6/7/2001)|
|Q||What can you tell me about a blood disorder called Protein S deficiency?|
|A||Protein S is one of the body's natural "anti-coagulants," meaning that it is a substance that the body produces to counteract or lessen blood clotting. Such natural anti-coagulants are necessary so that blood clotting remains localized to the site of bleeding and is not excessive. Protein S deficiency is a genetic disorder in which one (rarely both) of the two genes that codes for Protein S is defective. The individual with the deficiency has a tendency to abnormal blood clotting, especially clots in the veins of the legs. These clots may never appear or may only appear alongside another condition that promotes blood clotting, such as pregnancy, estrogen therapy, immobility, or surgery. Assuming that the Protein S deficiency has been confirmed by lab tests, most patients with a Protein S deficiency that has produced blood clots should be on anticoagulant therapy. The duration of treatment (6 months? forever?) is controversial and should be individualized after discussion between the patient and the physician. Birth control pills probably should be avoided. On average, half of the children of an individual with Protein S deficiency will also be deficient. Therefore, genetic counseling and testing of offspring may be in order.|
|Answered at 6/27/2000|
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