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cheryl_v
06-12-2008, 05:50 PM
Ok, needed old medical records for new rhuemy from old rhuemy. They are from 2004/2005. I understand almost everything. Need help understanding a few things. Don't want to appear like an idiot if any questions are asked. Here goes:

Labs revealed a positive anti-DNA of 61 (19) ANA positive 1:160 speckled pattern, anti-streptolysin O titer was 243 (200). Sed rate 30.

Few months later:
Anti-nuclear AB positive, ANA titer 1:80, ANA pattern speckled. Weak positive units between 20-39.

Nothing like that was ever mentioned or discussed with me. She said everything was neg. with 1 inclusive, and that didn't mean anything either. All she ever did (and wrote) was complaining I was not fixing my teeth like she suggested. Claimed she even gave me a number to a local dentist (never did). I don't want to talk bad about her to new doc and want to act as if I understand. I've seen people talk about speckles and #'s, just never quite understood.

Thaks in advance :D .

cheryl_v
06-12-2008, 06:50 PM
I forgot to say:

Can someone please tell me what the heck those lab things mean? I have no idea since it wasn't mentioned or discussed with me. I've never even new all those things were done. Just told once that ANA was a little high, see a rhuemy. Rhuemy just asked a few questions and ran some test. Said the neg thing and had me come back every 3 months to see if meds worked. That's all really ever discussed, that and see dentist and stop smoking (I did :D , yeah). Its kind of why I'm at a lost what all this is :? .

KathyW1958
06-13-2008, 04:03 AM
Hi Cheryl,

I have the speckle pattern ANA too. My doctor did diagnose me with SLE and told me that that titer alone is not enough for a diagnosis of lupus. I am wondering if you have Sjogrens disease as well, because this type of ANA speckle pattern is seen in Sjogrens disease. That may be why the doctor made that remark about your teeth. This type of ANA pattern is also seen in people that have Scleroderma. Sjogrens disease can destroy your teeth fast and you need to see a good dentest. I am just wondering, because I have SLE (Lupus) and Sjogrens, but they had to rule out Scleroderma as well. You also see people with this that are RO positive as I am. You need to get the doctor to check all of this out and do a serum C complement test as well. I hope that this helps in some way and that you can get some answers and help very soon.

cheryl_v
06-13-2008, 06:11 AM
Hi KathyW1958, thanks for the info. Sjogrens is something I wondered about because of dry mouth, eyes and skin. Scleroderma is something I never considered because I don't have hard skin or problems much with skin. Just dry and little red now and then. Some of what you said I got, but lost at titers and patterns. Sorry, never discussed things like this.

Also, not to sound dumb, what are these test listed? I've heard ANA test, that's about it. What do they mean? Englih, please :) ? I just want to know and say yes I know this and understand. These numbers and test mean.................

The last rhuemy just quickly got me in and out. This time I actually have a doctor conceltation(sp?) and want to spend it with little amount of time on breaking down info and actually talk. Who knows if I get a chance like this again where he won't be so rushed (I hope :) ).

Oluwa
06-13-2008, 07:29 AM
Hey you, Cheryl...

I had the anti-DNA ds...(ds - double strand) though..Mine was a 144. Seems you may have had the single strand (ss) maybe. From my lab site it reads...

* Negative: 0-99 units/mL
* Equivocal: 100-120 units/mL
* Positive: >120 units/mL

Use
Specific assay for confirming the diagnosis of systemic lupus erythematosus (SLE)
Limitations
Low antibody levels may be found in other connective tissue diseases.
Methodology
Multiplex bead flow cytometry
Additional Information
Antibodies to DNA, either single- or double-stranded, are found primarily in systemic lupus erythematosus, and are important, but not necessary or sufficient for diagnosing that condition. Such antibodies are present in 80% to 90% of SLE cases. They are also present in smaller fractions of patients with other rheumatic disorders, and in chronic active hepatitis, infectious mononucleosis, and biliary cirrhosis.

In the past, it was considered unnecessary to test for anti-DNA in patients with a negative test for antinuclear antibodies. A group of “ANA-negative lupus” patients has been described with anti-ssDNA and anti-SS-A/Ro and anti-SS-B/La. However, HEp-2 substrate is much more sensitive than frozen section substrates, and it is uncommon for anti-SS-A/Ro to be negative with these newer substrates.

This standard dsDNA detects both low- and high-affinity antibodies, providing a very sensitive test for diagnostic purposes; however, it is less predictive for severe nephritis, which is associated with the presence of high-affinity antibodies.

laurid8967
06-13-2008, 07:40 AM
Hey Cheryl,
Hope your new rheumy is good. I am confused. Are these the results that led your rheumy to say everything was negative? Or are these later test results? These results are considered positive - maybe not specifically for lupus - but there is certainly an autoimmune response going on. Those results are alot more than many of us get! I guess my question is, did your last rheumy say you were fine and/or negative after looking at these results? Because, that is a serious mistake. I know if any of my test results had come back like that at any time over the past several years, I would have been diagnosed right away. Anyway, I guess at this point it doesnt matter as you are going to see a new rheumy. Thank God! I hope you get the answers/treatment you need in order to start feeling better. Good luck and keep us posted!!
Lauri

Oluwa
06-13-2008, 07:43 AM
ANA (Antinuclear Antibody) Test

To perform the ANA (antinuclear antibody) test, sometimes called FANA (fluorescent antinuclear antibody test), a blood sample is drawn from the patient and sent to the lab for testing.

Serum from the patient's blood specimen is added to microscope slides which have commerically prepared cells on the slide surface. If the patient's serum contains antinuclear antibodies (ANA), they bind to the cells (specifically the nuclei of the cells) on the slide.

A second antibody, commercially tagged with a fluorescent dye, is added to the mix of patient's serum and commercially prepared cells on the slide. The second (fluorescent) antibody attaches to the serum antibodies and cells which have bound together. When viewed under an ultraviolet microscope, antinuclear antibodies appear as fluorescent cells.
# If fluorescent cells are observed, the ANA (antinuclear antibody) test is considered positive.
# If fluorescent cells are not observed, the ANA (antinuclear antibody) test is considered negative.
How is the ANA titer determined?

A titer is determined by repeating the positive test with serial dilutions until the test yields a negative result. The last dilution which yields a positive result (flourescence) is the titer which gets reported. For example, if a titer performed for a positive ANA test is:
1:10 positive
1:20 positive
1:40 positive
1:80 positive
1:160 positive
1:320 negative

The reported titer in our example is 1:160.
Three parts of an ANA report

An ANA report has three parts:
# positive or negative
# if positive, a titer is determined and reported
# the pattern of flourescence is reported
What is the significance of the ANA pattern?

ANA titers and patterns can vary between laboratory testing sites, perhaps because of variation in methodology used. These are the commonly recognized patterns:
# Homogeneous - total nuclear fluorescence due to antibody directed against nucleoprotein. Common in SLE (lupus).
# Peripheral - fluorescence occurs at edges of nucleus in a shaggy appearance. Anti-DNA antibodies cause this pattern. Also common in SLE (lupus).
# Speckled - results from antibody directed against different nuclear antigens.
# Nucleolar - results from antibody directed against a specific RNA configuration of the nucleolus or antibody specific for proteins necessary for maturation of nucleolar RNA. Seen in patients with systemic sclerosis.
What does a positive ANA result mean?

ANAs are found in patients who have various autoimmune diseases, but not only autoimmune diseases. ANAs can be found also in patients with infections, cancer, lung diseases, gastrointestinal diseases, hormonal diseases, blood diseases, skin diseases, and in elderly people or people with a family history of rheumatic disease. ANAs are actually found in about 5% of the normal population.

The ANA results are just one factor in diagnosing, and must be considered together with the patient's clinical symptoms and other diagnostic tests. Medical history also plays a role because some prescription drugs can cause "drug-induced ANAs".
What is the incidence of ANA in various diseases or conditions?

Statistically speaking the incidence of positive ANA (in percent) per conditon is:
# Systemic lupus erythematosus (lupus or SLE) - over 95%
# Progressive systemic sclerosis (scleroderma) - 60-90%
# Rheumatoid Arthritis - 25-30%
# Sjogren's syndrome - 40-70%
# Felty's syndrome - 100%
# Juvenile arthritis - 15-30%

Subsets of the ANA (antinuclear antibody) test are sometimes used to determine the specific autoimmune disease. For this purpose, a doctor may order anti-dsDNA, anti-Sm, Sjogren's sydrome antigens(SSA, SSB), Scl-70 antibodies, anti-centromere, anti-histone, and anti-RN.

The ANA (antinuclear anibody) test is complex, but the results (positive or negative, titer, pattern) and possible subset test results can give physicians valuable diagnostic information.

Oluwa
06-13-2008, 07:50 AM
What is a sedimentation rate?

A sedimentation rate is common blood test that is used to detect and monitor inflammation in the body. The sedimentation rate is also called the erythrocyte sedimentation rate because it is a measure of the red blood cells (erythrocytes) sedimenting in a tube over a given period of time. Sedimentation rate is often abbreviated as sed rate or ESR.

How is a sedimentation rate performed?

A sedimentation rate is performed by measuring the rate at which red blood cells (RBCs) settle in a test tube. The RBCs become sediment in the bottom of the test tube over time, leaving the blood serum visible above. The classic sedimentation rate is simply how far the top of the RBC layer has fallen (in millimeters) in one hour. The sedimentation rate increases with more inflammation.

What is the normal sedimentation rate?

The normal sedimentation rate (Westergren method) for males is 0-15 millimeters per hour, females is 0-20 millimeters per hour. The sedimentation rate can be slightly more elevated in the elderly.

Sed Rate:
Various inflammatory conditions, including autoimmune conditions like Lupus, increase the rate at which the red blood cells (erythrocytes) sink in a test tube and form a sediment. The normal sed rate for females is <20. A marker of non-specific inflammation, tends to be raised in lupus. Erythrocyte sedimentation rate (ESR), also called "sed rate," determines if you have inflammation. The higher the sed rate, the greater the amount of inflammation.

Oluwa
06-13-2008, 07:53 AM
Antistreptolysin O titre (AS(L)O titre or AS(L)OT) - titre of (serum) antistreptolysin O antibodies; a blood test used to assist in the diagnosis of a streptococcal infection or indicate a past exposure to streptococci.

The ASOT helps direct the antimicrobial treatment and is used to assist in the diagnosis of scarlet fever, rheumatic fever and post infectious glomerulonephritis.

A positive test usually is >200 units/mL,[1] but normal ranges vary from laboratory to laboratory and by age.[2]

The false negatives rate is 20-30%.[1] If a false negative is suspected then an anti-DNase B titre should be sought. False positives can result from liver disease and tuberculosis.[1]

Oluwa
06-13-2008, 07:59 AM
ANTI-NUCLEAR AB
ANA by IFA is a screening test for the presence of these abs and as a screening test for SLE. ANA are commonly found in a variety of autoimmune diseases. Antibody frequency increases with age in apparently healthy people. ANA patterns on Hep-2 slides provide only general clues about particles (chromatin, nucleosomes, and spliceosomes). ANA patterns (other than centromere pattern) are not reli-ably correlated with the presence of specific abs, and must be further evaluated by EIA using individual ENA antigens.

Oluwa
06-13-2008, 08:03 AM
Cheryl..I bold typed your results as you mentioned in you post..hope it isn't confusing. Need a simplified break down?

Love,
Oluwa

cheryl_v
06-13-2008, 08:43 AM
Hi Lauri, I had no idea these test were run. Just told she ran test and everything looked neg. with one inconclusive (said that didn't need to be anything worth worrying about, pretty much a neg.). Did mention once, I forgot, possible OA. Just watch and see. Thats why I was confused, nothing about numbers or titers were discussed. Glad to for new rhuemy, hope he's nice and friendly.

Hi Oluwa, thanks. The first post was a bit confusing. The rest I think I understand. It read fairly easy, thanks for breaking it in sections. I do feel better informed and able to understand words he may throw my way. You have been most helpful, again :D . Thanks.

Hi Kathy, thanks for reminding me of sjogrens. I wrote it down to ask.

Oluwa
06-13-2008, 09:07 AM
Cheryl..

The first post was about Anti-DNA..it is more accurate in confirming the diagnose of IT and IT's activity. Your's being 61 at the time of the test indicates it wasn't very active because less than 99 is negative.

Perhaps Plaquenil dosing at the time of the test, not flairing without fish net stockings?

Again negative doesn't mean you don't have IT, your ANA was positive, plus having met many of the 11 criteria...means you likely have IT...

1:80..1:160 is an indication of a possible diagnose...was positive.
Sed Rate 30...high, inflammation of the body.

In case, if not on hand to read.....
The Eleven Criteria Used for the Diagnosis of Lupus are..

Malar Rash ...Rash over the cheeks

Discoid Rash ....Red raised patches

Photosensitivity ....Reaction to sunlight, resulting in the development of or increase in skin rash

Oral Ulcers ...Ulcers in the nose or mouth, usually painless

Arthritis ...Nonerosive arthritis involving two or more peripheral joints (arthritis in which the bones around the joints do not become destroyed)

Serositis ...Pleuritis or pericarditis (inflammation of the lining of the lung or heart)

Renal Disorder ....Excessive protein in the urine (greater than 0.5 gm/day or 3+ on test sticks) and/or cellular casts (abnormal elements the urine, derived from red and/or white cells and/or kidney tubule cells)

Neurologic Disorder ....Seizures (convulsions) and/or psychosis in the absence of drugs or metabolic disturbances which are known to cause such effects

Hematologic Disorder.....Hemolytic anemia or leukopenia (white blood count below 4,000 cells per cubic millimeter) or lymphopenia (less than 1,500 lymphocytes per cubic millimeter) or thrombocytopenia (less than 100,000 platelets per cubic millimeter). The leukopenia and lymphopenia must be detected on two or more occasions. The thrombocytopenia must be detected in the absence of drugs known to induce it.

Antinuclear Antibody ....Positive test for antinuclear antibodies (ANA) in the absence of drugs known to induce it.

Immunologic Disorder ....Positive anti-double stranded anti-DNA test, positive anti-Sm test, positive antiphospholipid antibody such as anticardiolipin, or false positive syphilis test (VDRL).


Love,
Oluwa

cheryl_v
06-13-2008, 09:28 AM
Thank you. At the risk of being annoying and sounding dumb again, what would the numbers in th parenthesis be? What do they stand for? Do you know?

Oluwa
06-13-2008, 09:34 AM
Cheryl...

You mean, (1) (2)? If so, that is referencing a footnote from the page I copied and pasted...but I didn't include the footnote...

Footnote being, a book reference, an article reference. Basically a quote from some reference...

And you are not annoying and not dumb...so stop insulting yourself..

Hugs,
Oluwa

cheryl_v
06-13-2008, 11:25 AM
Oh, sorry for not being specific. I ment on the lab work results. The (19) and (200). Thanks, I think I know. Just want to see what someone else says. Kind of like a pop quiz. See if I got it right or wrong.

Oluwa
06-13-2008, 12:13 PM
CV..
Oooh..no, I do not know what your results the doctors wrote in parenthesis mean. Each lab has their own range and etc as in how low or high they will go to say positive or negative and how sensitive their test is...

But from my research the info I posted seems the standard. Maybe contact the lab who conducted the results. I know they won't give you the results, but maybe they will help you to understand the way it is written....

I couldn't find anything on the Internet through a Goggle...

Love,
Oluwa

cheryl_v
06-13-2008, 12:38 PM
Thanks anyways. The lab was in California and I have no # anyways being 3-4yrs ago. I just thought maybe the #on left was maybe base on the one in parenthesis. That one I will ask rhuemy myself. If thats due to a specific lab, then he wouldn't really expect me to know anyways. I do feel more prepared, thanks for all the info. I'm going to read again night before app. to refresh my mind. I don't feel so illiterate any more :) .

cheryl_v
06-13-2008, 12:40 PM
I keep forgeting to add.......... :D LOVE that smiley!! Heshey's is my all time fav!!!!!

laurid8967
06-13-2008, 12:59 PM
Oluwa,
You are so incredibly helpful to everyone here - you seem very patient and compassionate. What a blessing you are to us newbies!!
Love Lauri

Oluwa
06-13-2008, 01:03 PM
Hershey's is mine too.. You could buy my love, persuade me with a bar...well, it would take two I mean. I am not that easily persuaded, though today my husband would say elsewise.

When he travels he sometimes brings me a Hershey's or a Sees candy bar...


Maybe keep a stash in your undie drawer when feeling stressed like today...

And you are not illiterate. We just can't know everything, but wouldn't that be wonderful if we did. Oh, maybe not..then what will there be left to be in ah-ment about....

Happy Evening..hugs.
Oluwa

cheryl_v
06-13-2008, 02:24 PM
Hubby says I'm a push-over for hersheys. For almost all occassions I get a hersheys and cherry pepsi. Says I make a easy wife to by for. His co-workers said I need to influence their wives :lol: . I can tell when he's bought something or wants something when he brings it home for no reason. Really know its something bad when its the king size candy bar with a 2 liter, and a big grin saying "sorry". Its my favorite combo, Hersheys and Cherry Pepsi-YUMMMMMM!!!!!!!!

I know its impossible to know everything. I just underdstand docs better when I know what they are trying to say to me. Some are patient and don't mind breaking it down. Some are not, and I really don't like listening to the childish talk. Hopefully he's a patient man.

Oluwa
06-13-2008, 05:32 PM
Lauri,

Thank you for the compliment..but I don't know about how patient I am. I've lost a lot of it over the last few years.

We all help one another out in various ways...indirectly and directly...when down and beaten, sharing in our elation, our experiences, trials and tribulations..good, bad it really all contributes to the family...

Thank you for being apart of it...

Hugs,
Oluwa

Oluwa
06-13-2008, 05:34 PM
CV..

Oh, the Giant size....Lucky you...aren't they a pounder or a half pound..:shock: .Each block is a letter...

Feed me..get into my belly now...
Oluwa

cheryl_v
06-13-2008, 07:57 PM
Hi Oluwa, unfortunately getting the giant one isn't a good thing. Means a bill has went up. "Ooops, sorry :D . Here, I love you :wink: ". At least lately I haven't gotten one, yet :lol: .

Patience seems to be something I'm slowly losing too. But your right, eveyone here is what helps. I was so lost and confused and depressed at times. Talking, venting and giving advice when I can helps so much. I love this little family that has come together here. So glad to have the privilege of being part of it :D .

Oluwa
06-14-2008, 07:02 AM
Hey you, CV..

I am glad you are here too..I enjoy our chat abouts...hugs.

Love,
Oluwa