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I Have Went To A Hematologist/ Oncologist Regarding A Factor

Posted on Sat, 17 Oct 2020

Question: i have went to a hematologist/oncologist regarding a factor 8 level of 212 and she had runs labs and ca 19.9 is 71. Now i am scared

Answered by Dr. Indranil Ghosh (4 hours later)

Brief Answer:
CA 19-9 may not be significant

Detailed Answer:
Hi
Thanks for your query.

It seems factor VIII Level is high, even though you didn't mention the units. I would like to know why this test was done in the first place. Was it due to an episode of thrombosis, or bleeding?

CA19-9 is not a good screening test for malignancy in the setting of unexplained thrombosis. It is very non significant, more so at levels < 100. I would recommend a CT scan of chest and abdomen rather to rule out occult malignancy, if that's required.

Hope this helps.
Regards

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Indranil Ghosh (1 hour later)

I want to give you full story. I have been my whole life with gerd, i had recently went to hospital as it was very severe. Upoer gi showed chronic esophagitis and negative biopsy. Also labs at that time showed total bilirubin of 2.2 as I also want to mention intermittent nausea and inability to eat so lost maybe 6 lbs within a yr. Still have intermittent nausea and most recently had labs for coag due to ct with contrast showing mild fatty infiltrate of liver at 13 cm at this time in May everything else was normal. I am not 100% sure why she tested this
Possibly because my labs from hospital were total bilirubin 2.2, albumin 4.9, and nausea combined with inability to eat loss of 6lbs in a yr, but as mentioned ct scan normal aside from what i mentioned. Now ca 19.9 71 now what does this mean? Thank you

Follow up: Dr. Indranil Ghosh (2 minutes later)

should i get a new ct scan?

Answered by Dr. Indranil Ghosh (6 minutes later)

Brief Answer:
Most likely benign

Detailed Answer:
Ok.

Ca 19-9 of this level is more likely benign and can be well explained by fatty liver. Weight loss is not significant. Albumin 4.9 is very good actually. If the CT scan was fairly recent, I wouldn't get another one.

Regards

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Indranil Ghosh (27 minutes later)

I am very worried now Dr about pancreatic cancer or any other malignancy now. Is there anything else tbat i should look for regarding cancer. Also what is the significance of my weight loss attributed to the nausea and bilirubin being 2.2? Also what else aside from cancer can cause elevated ca 19.9 or can it be this elevated in the healthy population? Thank you Dr

Follow up: Dr. Indranil Ghosh (3 minutes later)

any other tests that you recommend to rule put any cancer aside from what you mentioned above? I did forget to mention that sometimea my stool is a yellow xolor? Is this of any significance, and what are usually the ca 19.9 levels of a person with cancer? Thank you

Follow up: Dr. Indranil Ghosh (1 hour later)

Would a regular contrast ct scan be a reliable and accurate diagnostic tool for cancer? Will I need a pet scan or any other test? Thank you Dr

Answered by Dr. Indranil Ghosh (4 hours later)

Brief Answer:
CA19-9 very non specific

Detailed Answer:
CA 19-9 is elevated in many benign conditions like fatty liver. If more than 100 then evaluation for malignancy required usually.

contrast enhanced CT scan is enough. PET doesn't add much.

Weight loss of 6 lbs in a year is not significant for malignancy. Stool color can normally be yellow. So nothing to worry.

Regards

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Indranil Ghosh (5 hours later)

Thank you for all your replies Dr. I appreciate them. I have another wuestion. I have just received results for antiphospholipid igm and anticardiolipin igm being positive. Antiphos is 32 and anticardiolipin is 23. Does this have anuthing to do with anything and what are the significance of these being elevated and why? Thank you. Hope your having a good day

Follow up: Dr. Indranil Ghosh (9 hours later)

Dr XXXXXXX remember how i stated i had a ct of chest abd and pelvis in XXXXXXX im gonna try to ask this the way i need to. So in XXXXXXX the ct scan was negative aside from the mild fatty liver like i mentioned. You mentioned a new ct scan is not indicated. Is it possible for something to brew or show up in 3 months time as Idk what the ca 19.9 was due to that not being tested at that time. Does this question make sense?

Answered by Dr. Indranil Ghosh (8 hours later)

Brief Answer:
Maybe another CT scan is indicated now

Detailed Answer:
Considering that 3 months elapsed after the CT and CA 19-9 was unknown at that time, we can get another CT done now.

Those antibodies show a predisposition to thrombosis or blood clots. But not related to ca 19-9 or malignancy.

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Indranil Ghosh (5 hours later)

Is another ct scan only aftrr 3 months truly indicated? I have been tested when I was in my teens for apa and the beta 2 glyco was positive at that time, now the apa and anticardiolipin high. I forgot to mention i have multiple auto immune diseases would that have anuthijgto do with positive apa, anticardiolipin and ca 19.9 aside from mild fatty liver? Thank you

Answered by Dr. Indranil Ghosh (43 minutes later)

Brief Answer:
Autoimmune diseases and antibodies related

Detailed Answer:
However, it's not related to fatty liver or CA19-9 levels. We do CT scans in 3 months if required. No problems with that. Another option would be to repeat the CA 19-9 in a month and if it rises further then only do the scan.

Regards

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Indranil Ghosh (13 hours later)

Hi Dr. Sorry one more question. I was reading a little about this and says it can be elevated with cysts and colon also, but a ct scan is not able to see anything with colon, correct? What would be the next step for that. What would you suggest? Is it significant enough to go looking for the cause or rather easier to just retest marker in month? Thank you

Follow up: Dr. Indranil Ghosh (11 hours later)

Hi dr. Dr wants me to get pt scan instead. Is a pt scan warranted in this case? Thanks you

Answered by Dr. Indranil Ghosh (7 hours later)

Brief Answer:
CT scan can also pickup some things in colon but not all

Detailed Answer:
Subtle changes in colon can't be picked up on CT. But I don't think there's any great suspicion for colon here.

PET scan also has CT scan is it, so it's more sensitive than CT. But I doubt there's any need for it now. You can just retest the marker in some time and then decide.

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Indranil Ghosh (28 hours later)

Dr if it goes down or normal is rhere any follow up or should I still get a ct scan? Can I get thw lab done before a month, would it be ok to do in 2 weeks? Thank you

Answered by Dr. Indranil Ghosh (1 hour later)

Brief Answer:
You can do in 2 weeks

Detailed Answer:
If it goes down then no need of CT scan now.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar