good news and bad news for BBB

@Butrflynet,

Balancing a 5lb bag of sugar on the foot is beyond primative.

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@Butrflynet,

Those CBC results look very good, Bfn. The H&H and RBC counts are all on the rise and her WBC counts are normal and stable meaning there's no sign of infection. Her platelet count is bouncing back nicely.

Don't be too excited about a normalizing INH. They may boost her coudamin to try to get that back up in the elevated range. Keep in mind that they want to prevent blood clots and the roll of the coumadin is to elevate the INH and the Pro-time.

Re the BUN and erratic results. Kidney problems are the first thing people think of with an elevated BUN and/or creatinine, but it could also be an indication of congestive heart failure and/or dehydration. With her history of chronic diarrhea I'm not surprised that she has erratic results in her kidney profile assays. If she passes a lot of fluid through her stools then it doesn't pass through the kidneys and her kidney profile may show signs of dehydration.

The anion gap is a mathematical calculation from her electrolyte results. It's a formula used to take all of her electrolyte levels and put them into a single outcome that can be qualified as low, normal, or high. I doubt the doctor is specifically ordering an anion gap because he/she is worried about her electrolytes being out of balance. It's usually reported automatically along with the individual Na, Cl, K and HCO3 results.

TSH is a general thyroid function test. It's sometimes ordered alongside a T3 and/or T4 to check on thyroid function.

In general, don't worry about one normal value compared to another normal value on the same assay from day-to-day. For instance, a WBC of 8.8 isn't clinically different than a WBC of 8.3. They both indicate that she has plenty of WBC to fight off infection should the need arise (WBC count is not low) and that there's no current indication of infection (WBC count is not high).

The RBC indices (MCHC, MCV, and RDW) are all indications of the size and shape of her red blood cells. Again, don't be concerned if there are fluctuations within the normal range. The slightly elevated RDW on 6/30 is most probably associated with the transfused RBCs she received. As she produces more of her own RBCs and her blood loss slows down/stops that value should normalize, as you see in today's CBC.

It looks like she's doing nicely from a lab standpoint. I hope she's feeling more comfortable from a surgical standpoint.

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Thanks for the info, JPB. Sounds like I can relax a bit about all the fluctuations.

I've been spending a lot of time there over the holiday weekend because they aren't as well staffed as they are during regular hours. Met her physical therapist today and watched mom get up and out of bed by herself and take a few steps with a walker to the porta potty by her bed. The physical therapist put her through a bunch of leg exercises and also had her get up out of bed and back down half a dozen times. Mom is pretty weak, and her leg is even weaker, but she's making loads of progress. I may not be able to keep up with her energy once she's back in shape and discharged.

I taped on her wall a bunch of photos of her dogs to keep her company and several of the nurses told me that patients are allowed to have their dogs come visit them as long as they're (the dogs) on a leash. So, I'll try bringing Maddy to visit her tomorrow and see how things go. If it works well, Dolly will get her turn the next day.

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@Butrflynet,

Oh, you're welcome. It's my pleasure to help you sort through all the tests and outcomes, particularly if it helps relieve some of your anxieties over what it all means.

It sounds likes she's progressing as expected. She'll love having a visit from her pooches! Don't forget to tend to your own needs during all this. She'll need your help when she gets home and you'll need to save some of your own capacity for giving for later. Are you getting enough rest?

thanks, soz.

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@Butrflynet,

Cool, bfn, glad the doggie can visit.

I've enjoyed reading the lab stuff. I'm a sort of dinosaur - my beginning lab days were just before the machines came into play, right around 1965. Test tube city...
My main interest past that was always hematology, which worked out in that I ended up working with a hematologist/immunologist.

So far so good, BBB.
Kick ass, girl.

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@JPB,

JPB, that was very generous of you. As a member of BBB's community I really appreciate it.

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I'd been telling people for 3 or 4 days that I thought the anti-clotting stockings they had on her legs were cutting off the circulation but no one paid any attention to it. Sunday, her whole leg was getting enormous with swelling, she was in a lot of pain and she wasn't able to do anything, not even stand up to get on the porta potty by her bed. They did doppler tests and an x-ray but found nothing. Finally they took the stockings off her legs and her leg has been improving ever since. The swelling is down and she's been able to do her leg exercises and take steps to the door of her room. BBB took about 15 steps from her hospital bed to the door before she got too weak and had to be wheeled back.

Big improvement.

The dogs stopped eating on Thursday and were sulking around the house. I took Dolly for a visit with BBB on Sunday and Maddy went on Monday. That made all of them happy and the dogs are eating again.

I am taking a day off from hospital visits today. Need to catch up on chores around the house. So far I've picked beans, peas and tomatoes, pulled weeds, watered both front and back gardens, drove BBB's car around for an hour to recharge the battery, did a load of laundry and made some banana muffins. Later if it isn't too hot in there, I'm going to start tackling the garage to get rid of a lot of the junk piled in there.

BBB said she and Roger had a nice conversation on the phone the other day. He was surprised at how pain-free her voice sounded. She and Diane had a long talk too. BBB is keeping the staff entertained. One of them even said they all like coming to her room because she's so talkative and funny.

If anyone wishes to call her, let me know and I'll give you the direct number to her bed.

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They're giving BBB 2 more pints of blood today. Her blood chems still aren't looking good. Her RBC (was 2.85), Hct (was 25) and hemoglobin (was 8.4) were below the lowest range of the standard levels yesterday. They've started running the more comprehensive versions of the tests to see if there are any clues there (CBC with differential and comprehensive metabolic panel).

They're also running a bunch of other tests to see if they can determine if she's experiencing some internal blood loss somewhere. They say they are giving her the usual potassium, calcium supplements that she takes daily, yet her potassium and calcium levels are also very low. If her potassium gets much lower, she's at risk for experiencing the rapid heartbeat syndrome she's had in the past when her potassium was low.

Other than that, she had a very good day yesterday. Was able to shower for the first time since surgery and was able to walk out into the hall to where they have a little break room for patients and visitors.

I'll be heading out for a visit with her later this afternoon when it is too hot to do anything in the garage and gardens. Will give an update if there are any changes.

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@Butrflynet,

JPB, here's yesterday's test results:

https://lh6.googleusercontent.com/-CsnJwv-mIOQ/ThSIW9e67RI/AAAAAAAABtc/z7EuMZfCGAw/s576/momtest1.jpg

https://lh3.googleusercontent.com/-lFw-CnO97EA/ThSIW1K3u8I/AAAAAAAABtg/m_gNTFY-YFw/s576/momtest2.jpg

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Anyone know if vitamin K, chemical K, and potassium are the same things?

This confuses me:

http://www.fatfreekitchen.com/nutrition/potassium.html

Quote:

Potassium (chemical symbol K) is a mineral having 19 protons and 19 electrons. What does potassium do for the body? It is essential for normal body functioning of all cells and nervous, muscle function, the transmission of nerve impulses, prevention of excess fluid retention and for the metabolism of carbohydrate and protein. But too much potassium or less potassium i.e. deficiency is harmful to the body.

Are chemical symbol K and vitamin K the same thing?

Quote:

Risky Potassium High Level

Our kidneys maintain the right amount of potassium in our body. But if the kidneys are not functioning properly, then you need to reduce foods that can increase the potassium in your blood to high levels (see the list below), because excessive potassium can cause irregular heartbeats and even heart failure (cardiac arrest). Potassium supplements should therefore not be taken without the advise of your doctor. If you feel weakness and numbness, it may be due to high level of potassium and you should consult your doctor.

The symptoms of high level of potassium are irregular and/or rapid heart beat, low blood pressure, kidney disease, infrequent menstrual cycles, muscle spasms or cramps, joint / back pains, higher risk of cancer, bladder infections, poor immune system, anxiety, insomnia, irritability, impotence.

Doctors have prescribed potassium supplements for most of BBB's adult life because of her chronic diarrhea and being prone to rapid heartbeats when it gets low. The above is saying that rapid heartbeats are a symptom of a high level of potassium.

Quote:

You may have a potassium deficiency (low level) if you have vomited very frequently or have diarrhea or extreme sweating. You can also have a deficiency of potassium if you are taking a diuretic medicine like Lasix for urination. Diuretic medicine is often prescribed to the people having high blood pressure. You can eat the foods that are high in potassium content (see the list below).

The symptoms and effects of low level of potassium are irregular and/or rapid heart beat, high blood pressure, stroke, kidney disease, asthma, muscle spasms or weakness, bladder weakness, water retention, high blood sugar, liver disease, weight gain, fatigue, impotence.

This is saying that low potassium levels also cause rapid heart beats.

They are still having to give her anti-nausea medication to keep her from vomiting. Shouldn't the vomiting side effects from surgery be over with by now?

If vitamin K, chemical K and potassium are all the same thing, she's supposed to be avoiding vitamin K while on the Coumadin. Yet, they are giving her potassium supplements to try to raise her low potassium levels.

1 Reply

@Butrflynet,

I have a guess but that's all it is. There are two reasons that one becomes anemic after surgery - bleeding and/or hemolysis. Her slightly elevated SGOT and low TP/ALB indicate that her liver is trying to clear some hemolysis, but it could still be from some internal bleeding somewhere. Is she jaundiced?

If it was my mother I'd ask them to do a Direct Anti-globulin Test (Direct Coombs, or DAT) to rule out the possibility of a delayed hemolytic transfusion reaction. The new sample sent to the blood bank for today's crossmatch order may have already been tested for that. Has she ever been transfused before? I know she's had at least two pregnancies. Pregnancy and previous transfusions can result in the formation of antibodies against some red cell antigens. Over time these antibodies can become so low in titer that they don't show up in initial screening/crossmatching but will spike 4-8 days later if she gets a transfusion that contains rbcs that are positive for an antigen to which she has a latent antibody. In that case, the blood bank needs to make sure that the specific antibody is identified and that future transfusions are negative for that antigen.

If the DAT is negative then I'd go back to looking for internal bleeding somewhere.

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@Butrflynet,

No, Vitamin K and Potassium are not the same thing.

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@JPB,

They did these additional tests yesterday. I have no idea what they are for or what they mean.

RETICULOCYTES, AUTO

Component Results
Component Your Value Standard Range Flag
Retic 2.8 0.3 - 2.4 % H
Abs. Retic 0.08 0.02 - 0.11 x10E6

Each time they have done a blood transfusion, they have also done what they call a Type & Screen which includes a test for antibodies. Each time it has been negative.

BBB has had many surgeries and blood transfusions in her lifetime. Besides her 3 births, I can count 9 surgeries and at least 6 of those required blood transfusions.

Interesting about the liver. I'll request they run the tests you suggest. Thanks.

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@Butrflynet,

For those like me who didn't know what it is:

Quote:

Hemolysis
Hemolysis is the breakdown of red blood cells.

See also: Hemolytic anemia
Information

Red blood cells normally live for 110 - 120 days. After that, they naturally break down and are usually removed from the circulation by the spleen.

Some diseases and processes cause red blood cells to break down too soon. This requires the bone marrow to make more red blood cells than normal. The balance between red blood cell breakdown and production determines how low the red blood cell count becomes.

Conditions that can cause hemolysis include:

Immune reactions
Infections
Medications
Toxins and poisons
Treatments such as hemodialysis or the use of the heart-lung bypass machine

Quote:

Hemolytic anemia

Hemolytic anemia is a condition in which there are not enough red blood cells in the blood, due to the premature destruction of red blood cells. There are a number of specific types of hemolytic anemia, which are described individually.
Causes

Hemolytic anemia occurs when the bone marrow is unable to increase production to make up for the premature destruction of red blood cells. If the bone marrow is able to keep up with the early destruction, anemia does not occur (this is sometimes called compensated hemolysis).

There are many types of hemolytic anemia, which are classified by the reason for the premature destruction of red blood cells. The defect may be in the red blood cell itself (intrinsic factors), or outside the red blood cell (extrinsic factors).

Intrinsic factors are often present at birth (hereditary). They include:

Abnormalities in the proteins that build normal red blood cells
Differences in the protein inside a red blood cell that carries oxygen (hemoglobin)

Extrinsic factors include:

Abnormal immune system responses
Blood clots in small blood vessels
Certain infections
Side effects from medications

Types of hemolytic anemia include:

Hemoglobin SC disease (similar in symptoms to sickle-cell anemia)
Hemolytic anemia due to G6PD deficiency
Hereditary elliptocytosis
Hereditary ovalocytosis
Hereditary spherocytosis
Idiopathic autoimmune hemolytic anemia
Malaria
Microangiopathic hemolytic anemia (MAHA)
Non-immune hemolytic anemia caused by chemicals or toxins
Paroxysmal nocturnal hemoglobinuria (PNH)
Secondary immune hemolytic anemia
Sickle-cell anemia
Thalassemia
Transfusion of blood from a donor with a different blood type

Symptoms

Chills
Dark urine
Enlarged spleen
Fatigue
Fever
Pale skin color (pallor)
Rapid heart rate
Shortness of breath
Yellow skin color (jaundice)

Exams and Tests

These are tests for red blood cell destruction (hemolysis). Specific tests can identify the types of hemolytic anemia. They are usually performed when hemolysis is suspected or has been determined.

Absolute reticulocyte count
Free hemoglobin in the serum or urine
Hemosiderin in the urine
Red blood cell count (RBC), hemoglobin, and hematocrit (HCT)
Serum haptoglobin levels
Serum indirect bilirubin levels
Serum LDH
Urine and fecal urobilinogen

This part was interesting. One of the comments from the surgeons was the increased amount of osteoporosis in her knee and that the inside of the bone was all crumbly from it. I wonder if that is interfering with the bone marrow's job of producing more red blood cells.

Quote:

Some diseases and processes cause red blood cells to break down too soon. This requires the bone marrow to make more red blood cells than normal.

1 Reply

@Butrflynet,

During the surgery, her doctor took tissue and fluid cultures from 4 locations in her leg and had them all tested for infections. The report on all 4 of them said the same thing:

Gram Stain No organisms seen
Few white blood cells seen

Culture No Aerobic or Anaerobic Growth

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@Butrflynet,

If I read that right, she is slightly high in retics (but wait for JPB)

http://en.wikipedia.org/wiki/Reticulocytes

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@ossobuco,

Yeah, that just means that she's pumping out immature RBCs because she's anemic. It means that she has an active anemia and that her body is trying to keep up with it by putting RBC production into overdrive.

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@JPB,

I printed out all this stuff and gave it to her doctor this evening. She's going to look it over while at home and discuss it all with BBB tomorrow after she sees the next cycle of test results.

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@Butrflynet,

Hi Butrfly - can't stay, am at work - but if you check this thread before you talk to doc - get them to explain AST level - LFTs- liver function tests - her AST is way high <I knows of what I speaky but not enough to explain;)>

http://en.wikipedia.org/wiki/Liver_function_tests

try not to worry yourself as they will be on to all the tests if they are doing them daily

keep asking questions

maybe give Farmerman a PM - he was dealing with K (pot) levels on the aging thread, and Noddy, way back when, so he may be able, if available, to help you those or give you some questions to ask the doc.

Please do send Mom my love and remember, take some time for you before Mom comes home - hugs, love x

edit: also, as they appear to be running tests, I can't see ESR, PV (plasma viscosity) or CRP(CReactiveProtein). Raised levels are indicative of inflammation infection or activity. Would be worth knowing.

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@Butrflynet,

A couple things in this list jumped out at me.

Quote:

Extrinsic factors include:

Abnormal immune system responses
Blood clots in small blood vessels
Certain infections
Side effects from medications

Types of hemolytic anemia include:

Hemoglobin SC disease (similar in symptoms to sickle-cell anemia)
Hemolytic anemia due to G6PD deficiency
Hereditary elliptocytosis
Hereditary ovalocytosis
Hereditary spherocytosis
Idiopathic autoimmune hemolytic anemia
Malaria
Microangiopathic hemolytic anemia (MAHA)
Non-immune hemolytic anemia caused by chemicals or toxins
Paroxysmal nocturnal hemoglobinuria (PNH)
Secondary immune hemolytic anemia
Sickle-cell anemia
Thalassemia
Transfusion of blood from a donor with a different blood type

I'm sure they're looking for clots and the DAT will tell you if it's a delayed hemolytic transfusion reaction. How did yesterday's transfusion go? Hopefully her blood counts are back up and her liver function is improved today.

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good news and bad news for BBB

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