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What Does The Following Test Result Indicate?
Question: >I THINK DR XXXXXXX SARKAR DID AN EXCELLENT JOB>> Thank you for repeating your answer >> In the hospital report my wife went in the hospital Aug 19th with the heart pumping at 10% After being in the hospital a Another Ecko was taken on Aug 22 to assess left ventricular function (( EF =-10-15%pleural effusion is noted ))>>I just put in what is in the report<< After that they started an IV Drip of Dobutamine for most of her stay..To get her heart pumping better to move forward with the stent procedure. When they upgrade her pacemake with the ICD implantation (Comb)..I'm going to ask a what if question >.. If my wife's heart at anytime later start to pump at a lower rate of the 25% 10-15 or so can they put a extra wire to that area to help it get back to at least 25% >I know there is a device that can do this I just do not know the name of it..
This is a very important ???
Thank you Again
XXXXXXX DiLemmeCH.O·CBCwJ AUto Olff
WBC---6.4
Neutrophil6 (Gran$')--53
Lymphocytes 2.31 K1UL 1.09-299
Monocytes O.50 KlUL 0.24-0,79
Eo:!inophil$ L---0.14 0,30-0.4.4
Basophils C---0.05 o.ooo.8o
Neutrophils (GraM} % 53 % 37·92
Lymphoc}1e% 36 % 10-59
MonQc>i~O/O 3 % ', 1·10
'; EcSin6hiiilS .1.% ' .2. % "0·5
Basc~JPHIS 'l% .\'7<> 0-2
RBC L- 3.54 12.0.18.0
,HCT---L--33.6 37.0,--51.C
MCV----94.9 ..,... 80.0-97 C
'MCHC ---- ;34.4 . . 31.0 36.0
::MCH H 32.7 26.0 32.
Platelet'COunT '.' '," 232 140--440
Total Protein. SPE -; 6.9 6.4-8.2
Albumin % L 33.0 REL% 55.13-60.1
AJGRaoo;SPE L 1.13 1.39--2.23
Alpha·1...,L% 4.1 REl% 2.9 4.9
Alpha·2.- H 12.1 ~ . 7.1-11.8
Beta Globulin %H 13.5 8.4--13.1
.GammaGlobulin % 17 . 3 11.1--18.8
M-Splke% 0 _0 REL%
Attlumin.SpE ~.4.19 GrNOL
Alpha" 1.globulin !) 0. 32 GM/DL
AIPha-2..g1obulin a. 0.96 GMfOL
6eta G!oeulin 1•07 GM/DL
Gamm~Globulin 1.7 GfNDL
M~Spike 0 _00 CMlOL
SPE 'nt~rpretation
1.3S-22~
2.9-49
T.H1.e
8.",·131
1'.1-18.8
I -)
ACt:1E: .C..ND CP.RONIC
. 1~291
Free LightChains. Quant
Kappa Free Light Chains H 25.82· .MG.'1. 3.30:-19.40
LamlXla free I.ighl '14.36 MGiL 5.7'1-26.30
KappaJLambda Free Ratio H 1.87 026-1.65
Haptoglobin 195 MGiOL 30·200
ImmunoelectrophoreSi$& QUIG$
IgA H' 545 MGJDL 69·309.
IgG 1280 MGIOl 632-1295
IgM L 30 MG1DL 53-334
S Imn'>unofixInterp
LDH (Total)198 94.211
NO ~MONCCLONAL GRMMCPATHY RESENT
INCREASED IBA WITH DECRESSED ICM & NORMAL
IGG.REVIEVWED BY DR BENSILT
,S ProteIn Eiectro w/M-Splke
•
This is a very important ???
Thank you Again
XXXXXXX DiLemmeCH.O·CBCwJ AUto Olff
WBC---6.4
Neutrophil6 (Gran$')--53
Lymphocytes 2.31 K1UL 1.09-299
Monocytes O.50 KlUL 0.24-0,79
Eo:!inophil$ L---0.14 0,30-0.4.4
Basophils C---0.05 o.ooo.8o
Neutrophils (GraM} % 53 % 37·92
Lymphoc}1e% 36 % 10-59
MonQc>i~O/O 3 % ', 1·10
'; EcSin6hiiilS .1.% ' .2. % "0·5
Basc~JPHIS 'l% .\'7<> 0-2
RBC L- 3.54 12.0.18.0
,HCT---L--33.6 37.0,--51.C
MCV----94.9 ..,... 80.0-97 C
'MCHC ---- ;34.4 . . 31.0 36.0
::MCH H 32.7 26.0 32.
Platelet'COunT '.' '," 232 140--440
Total Protein. SPE -; 6.9 6.4-8.2
Albumin % L 33.0 REL% 55.13-60.1
AJGRaoo;SPE L 1.13 1.39--2.23
Alpha·1...,L% 4.1 REl% 2.9 4.9
Alpha·2.- H 12.1 ~ . 7.1-11.8
Beta Globulin %H 13.5 8.4--13.1
.GammaGlobulin % 17 . 3 11.1--18.8
M-Splke% 0 _0 REL%
Attlumin.SpE ~.4.19 GrNOL
Alpha" 1.globulin !) 0. 32 GM/DL
AIPha-2..g1obulin a. 0.96 GMfOL
6eta G!oeulin 1•07 GM/DL
Gamm~Globulin 1.7 GfNDL
M~Spike 0 _00 CMlOL
SPE 'nt~rpretation
1.3S-22~
2.9-49
T.H1.e
8.",·131
1'.1-18.8
I -)
ACt:1E: .C..ND CP.RONIC
. 1~291
Free LightChains. Quant
Kappa Free Light Chains H 25.82· .MG.'1. 3.30:-19.40
LamlXla free I.ighl '14.36 MGiL 5.7'1-26.30
KappaJLambda Free Ratio H 1.87 026-1.65
Haptoglobin 195 MGiOL 30·200
ImmunoelectrophoreSi$& QUIG$
IgA H' 545 MGJDL 69·309.
IgG 1280 MGIOl 632-1295
IgM L 30 MG1DL 53-334
S Imn'>unofixInterp
LDH (Total)198 94.211
NO ~MONCCLONAL GRMMCPATHY RESENT
INCREASED IBA WITH DECRESSED ICM & NORMAL
IGG.REVIEVWED BY DR BENSILT
,S ProteIn Eiectro w/M-Splke
•
Brief Answer:
Hematologist Consultation Needed
Detailed Answer:
Hi, thanks for posting back again.
You have stated reports of hematological evaluation and now I think you want to know what is in the report. You have written your query in continuation with the past query, which I answered back a few days ago.
The bad news is that your wife has got another sort of problem. That is not related to her heart. Rather it is a hematological problem, that is related to the blood and abnormality simply speaking is related to the production of globulin or antibodies in the body. Medically it is called monoclonal gammopathy. There are some typing errors in the query. But still the report is evident along with the test results.
Now that your wife is already a cardiac patient and she has got this problem, you should urgently consult your local hematologist.
Per se not much intervention is needed for this sort of problem, except for evaluation of complications.
I think bone marrow biopsy and skeletal survey may be needed. Along with that, these abnormal globulins often get deposited in the kidney causing renal dysfunction. So, evaluation for renal function will be needed. For that she needs to have blood for urea and creatinine done.
Furthermore, such patients are usually prone to develop infection, particularly because there is deficiency of Ig M. Therefore, continuous close surveillance is needed, which actually you have been providing for long. In case of fever, or elevated white cell count (which is normal now, 6400) should trigger the alarm.
Prophylactic antibiotic treatment may be advised by your doctor, if found necessary. In case of serious infection ever, transfusion of fresh frozen plasma may be needed.
Therefore now, you need to consult a hematologist and perhaps your treating doctor would also do that urgently.
Please get back to me once you get hematologist's advice.
In case of any other query, please write back to me.
Regards,
Dr. Kaushik Sarkar
Hematologist Consultation Needed
Detailed Answer:
Hi, thanks for posting back again.
You have stated reports of hematological evaluation and now I think you want to know what is in the report. You have written your query in continuation with the past query, which I answered back a few days ago.
The bad news is that your wife has got another sort of problem. That is not related to her heart. Rather it is a hematological problem, that is related to the blood and abnormality simply speaking is related to the production of globulin or antibodies in the body. Medically it is called monoclonal gammopathy. There are some typing errors in the query. But still the report is evident along with the test results.
Now that your wife is already a cardiac patient and she has got this problem, you should urgently consult your local hematologist.
Per se not much intervention is needed for this sort of problem, except for evaluation of complications.
I think bone marrow biopsy and skeletal survey may be needed. Along with that, these abnormal globulins often get deposited in the kidney causing renal dysfunction. So, evaluation for renal function will be needed. For that she needs to have blood for urea and creatinine done.
Furthermore, such patients are usually prone to develop infection, particularly because there is deficiency of Ig M. Therefore, continuous close surveillance is needed, which actually you have been providing for long. In case of fever, or elevated white cell count (which is normal now, 6400) should trigger the alarm.
Prophylactic antibiotic treatment may be advised by your doctor, if found necessary. In case of serious infection ever, transfusion of fresh frozen plasma may be needed.
Therefore now, you need to consult a hematologist and perhaps your treating doctor would also do that urgently.
Please get back to me once you get hematologist's advice.
In case of any other query, please write back to me.
Regards,
Dr. Kaushik Sarkar
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
hematologist Is in a wait and see program >>> XXXXXXX DiLemme
Brief Answer:
Treatment is in right direction.
Detailed Answer:
Hi XXXXXXX
Thanks for posting back again.
As I can see, your hematologist has decided for observation. This is what is actually needed right now. As I have told you in the previous thread that no intervention is needed right now, except watching for complications. I think your hematologist is confirmed that right now there is no complication present. So, observation is the only thing that can be done right now.
So, I don't see anything wrong in his approach. However, as I have said earlier, your wife has low Ig M level and she is prone to certain infections now. You should be very much cautious to prevent emergence of any such infection and follow proper hygiene measures and after having conversation with you for so long, I think you already have been following the same and truly speaking I really appreciate the care you have been providing her.
Regular follow up will be needed as well. Therefore, repeat investigations may be done 3-6 months later, as per advice of your treating doctors.
Thank you again for informing me and please don't worry. Treatment is in right direction and if there is no unprecedented event, your wife will stay with you in good health.
Wish you two a very good health in the coming New Year.
If you find my answer satisfactory, please close the thread and rate my answer. For any further information please right back.
Regards,
Dr. Kaushik Sarkar
Treatment is in right direction.
Detailed Answer:
Hi XXXXXXX
Thanks for posting back again.
As I can see, your hematologist has decided for observation. This is what is actually needed right now. As I have told you in the previous thread that no intervention is needed right now, except watching for complications. I think your hematologist is confirmed that right now there is no complication present. So, observation is the only thing that can be done right now.
So, I don't see anything wrong in his approach. However, as I have said earlier, your wife has low Ig M level and she is prone to certain infections now. You should be very much cautious to prevent emergence of any such infection and follow proper hygiene measures and after having conversation with you for so long, I think you already have been following the same and truly speaking I really appreciate the care you have been providing her.
Regular follow up will be needed as well. Therefore, repeat investigations may be done 3-6 months later, as per advice of your treating doctors.
Thank you again for informing me and please don't worry. Treatment is in right direction and if there is no unprecedented event, your wife will stay with you in good health.
Wish you two a very good health in the coming New Year.
If you find my answer satisfactory, please close the thread and rate my answer. For any further information please right back.
Regards,
Dr. Kaushik Sarkar
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
What is the normal heart EF or the Normal heart Pumping as you know my wift went to 37% How fare is she away from the Normal?? Thank you again XXXX
Brief Answer:
normal LVEF 55-75%
Detailed Answer:
Hi XXXXXXX good to hear from you again. And I am very happy to know that she now has improved to such an extent.
Now, the answer of your query is, normal LVEF ranges from 55 to 75%. However, in compromised patients, improvement upto LVEF of 50% is considered fair enough. Although, strictly speaking 50% is considered in the range of 35-54% or below normal, if improvement occurs to that point, I shall be very happy.
For any further information, please write back.
Regards
Dr Kaushik Sarkar
normal LVEF 55-75%
Detailed Answer:
Hi XXXXXXX good to hear from you again. And I am very happy to know that she now has improved to such an extent.
Now, the answer of your query is, normal LVEF ranges from 55 to 75%. However, in compromised patients, improvement upto LVEF of 50% is considered fair enough. Although, strictly speaking 50% is considered in the range of 35-54% or below normal, if improvement occurs to that point, I shall be very happy.
For any further information, please write back.
Regards
Dr Kaushik Sarkar
Above answer was peer-reviewed by :
Dr. Shanthi.E
Thanks for the information>>
Is there any exercise that my wife could
do with proper monitoring: to help the EF level??
Thanks for your help XXXX
Is there any exercise that my wife could
do with proper monitoring: to help the EF level??
Thanks for your help XXXX
Brief Answer:
Start with supine exercises
Detailed Answer:
Hi XXXXXXX Merry Christmas, My understanding is that your wife can try exercise, but with proper caution. The goal is very gradual increase in venous return to the heart so that it can adapt well with increasing load, or else it will lead to heart failure and even death.
To start with she can simply lie down supine and move her feet backward and forward. This should be started 5 times in two occasion’s every day, then after 3-4 days can be increased to 10+5, then 10+10.
Thereafter, if everything remains uneventful, she can lift one leg up to 30 degree in supine position, and hold for 5 seconds and bring down. The frequency and duration may be gradually increased.
But, it would have been better if your doctors could demonstrate such movements and also their opinions are very important in this regard because they know the actual clinical status of the patient.
Gradual loading with avoidance of any unwanted stress is the only goal.
Hope this helps you out.
If you find my answer helpful, please close the thread and rate my answer.
Regards
Dr Kaushik Sarkar
Start with supine exercises
Detailed Answer:
Hi XXXXXXX Merry Christmas, My understanding is that your wife can try exercise, but with proper caution. The goal is very gradual increase in venous return to the heart so that it can adapt well with increasing load, or else it will lead to heart failure and even death.
To start with she can simply lie down supine and move her feet backward and forward. This should be started 5 times in two occasion’s every day, then after 3-4 days can be increased to 10+5, then 10+10.
Thereafter, if everything remains uneventful, she can lift one leg up to 30 degree in supine position, and hold for 5 seconds and bring down. The frequency and duration may be gradually increased.
But, it would have been better if your doctors could demonstrate such movements and also their opinions are very important in this regard because they know the actual clinical status of the patient.
Gradual loading with avoidance of any unwanted stress is the only goal.
Hope this helps you out.
If you find my answer helpful, please close the thread and rate my answer.
Regards
Dr Kaushik Sarkar
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
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