Test Issues

This might be long, bear with me, i need educated opinions.

A few weeks back i was admitted to the hospital in Florida with 103+ fever. They did 7,366,798 blood tests and a chest x ray. What came back was a conclusion that i had a viral pneumonia (they still pumped me full of antibiotics, didnt tell me it was viral till i checked out). I got copies of all the bloodwork results and the x-ray. Was told to follow up with my doctor when i got home.

10 days ago, i saw my PCP. I have a great relationship with him and consider him a good doctor. Some of my friends used to see him but stopped, saying that in their opinions he is test happy and refers to a specialist too much.
So thats the background.

When i saw him last Monday, he observed that there was trace amount of blood in my urine (labeled "small" on the test results. Also he noted that my Hemoglobin and RBC count were both low, indicating that i had anemia.
Now some more background...about a year ago, maybe a little more, i had the same situation on the anemia, and my ferritin tested low. He sent me to a hematologist who did his own tests, then put me on iron pills. That did not help. So he gave me iron via IV, like a transfusion. That did the trick, i never followed up with him, after that, which he did tell me to do.

Ok back to now...so my PCP's tests came back. Today the PA calls me and tells me that it still showed microscopic blood in Urine, so i need to see a Urologist, not urgent but see one. I said i have one, and i have an appointment next week (its my surgeon)

Also, told me that my ferritin came back HIGH. So i should go back to the hematologist.
Ugh, back down the rabbit hole of testing testing and more testing.

I asked her to fax me the test results and when i got them i observed.

Yes, Ferritin was high, at 487, normal ref range 30 - 400. I saw on Dr Google that Ferritin for men has a ref range up to 500. But another said 300 (without differentiating by sex) . Also, one website, might have been Mayo, dont recall, stated that Ferritin above 1000 (same unit of measurement) would require a referral

However, Hemoglobin and RBC Count was normal

Re the blood in urine results....

the dipstick test was negative. The microscopic test which she said again showed hematuria, came back at 3/hpf, normal ref range 0-4. Now here, Dr google results took me to a website that said a 2 or 3 indicates hematuria. But this hospitals lab says 0-4 ref range.

So on these two issues, what gives?

I'm tempted to ignore it, but at the same time, afraid.

I'm also wondering, maybe my friends are right, maybe he refers to a specialist when its really not necessary. What he said is high, is borderline high, and in the case of the urine, according to the lab, yeah there were 3 RBCs per h/f, but up to 4 is normal?

Anybody have any thoughts on this? Do i need a new PCP? Am i overreacting? Do i really need to enter the rabbit hole?

Thanks, for any responses, i know this is a little off topic (although i wonder if the urine RBCs might be related to PC, or even to my ever so slowly rising psa

let me tell ya what I think Pratoman. (although my opinion's uneducated....those will be along later......so do with it what you will ) ....or tell you...rather....about myself and my experience

When I was in the throes of my saga.....(lasted about a year....close to it...counting stricture work, DVT blood thinner... kidney stones...which, btw....trace blood can be a common symptom of...)

When I'm in *that* "mode" (if you will...which you may be.....considering your eminent test...which is *extremely* anxiety producing).....

My anxiety manifests itself....physically. I begin to think about my ailments. And when I begin to think about my ailments....I go to doctors. And when I go to doctors...I get copies of *everything*.....because....what I do with them is....I bring them home...and I go over them..every sheet of paper. I go over every bit of blood work....line by line....making sure nothing's even close. I google every single thing that could be even remotely considered to be.....close to being....borderline. And I look that up. The last time I was in your headspace....Prat, I had paperwork on my desk, floor, computer desk....I'd had so many blood tests....that....I had them spread out....3 or 4....comparing them for "trends". And then I'd think to myself...."Ya know.....I had some blood drawn 6 months ago. Where is that sheet? And I'd find it....so I could look at it and compare....to see...what if anything....was changing....and in what direction...and I'd look that up...to see what it *could* be. It filled my mind with stuff that....to be honest....wasn't the problem. The problem *I* had was....I was....for lack of a better term prat....traumatized....from all that was going on...not only in the physical realm....but in the emotional. It gave me a sense of control (I think). It made me *not* feel....because...as long as I was "on the hunt" (so-to-speak)....the emotions of anxiety, fear, and no control....would eat at me....to the point...that....it felt as if...I was missing something..that could possibly .... kill me.


I'm not saying that's what this is. I'm not saying that there's not something wrong with you that's gonna raise it's ugly head and make you wish you'd never been born. What I *am* saying is....that's where I've been with this stuff....(and probably....at some point...will be again...although I don't know that). But...right *now*....without the pressure of having been in the hospital lately (which for a year....I could never say...."I've not been in the hospital lately".....but you can....plus this ****ing disease....that in our case...wasn't a slam dunk....(which I hate for you....as I do for myself)....because...it's never far away...even though we push it away....and have reprieves. But you really have been sick lately....*go to the hospital* kinda sick....and that....along with this other crap....is enough...or has been with me anyway (I used to be ashamed to admit...but now...you've helped me to overcome my .... umm...*embarrassment*?. And thank YOU SO MUCH FOR ALL YOU HAVE DONE FOR ME PRAT!

you understand...in some special way....you just have *that* ability prat....whatever *that* is

I think you'll live. But then again....that just shows how much *I* know.

Good luck man...and again....thanks for bein' you

Thanks for the responses. Gary, IT, not even sure what you said. In fact, not even sure what I'm asking. Probably just being my usual OCD self.

I hate doctors and tests

Post Edited (Pratoman) : 11/8/2017 7:09:02 PM (GMT-7)

No clue Fairwind, I didn't notice it was missing until you mentioned it

Ferretin is what is called an acute phase reactant, that is it it becomes elevated during an infection and may stay high for awhile after the infection has passed. A bit over 400 is not that high. Among my many ailments is hereditary hemochromatosis (iron overload) and my ferritin was more than 2000 for nearly a year before they finally figured out the cause and it remained over 1000 during many months of treatment.

Have it retested in a few months if you are concerned but I would not worry at this point...

Thanks guys.

@Joe, hood information. I've read about hemocratosis as a possible underlying cause of high ferritin. More important, as I mentioned in my first post, I was hospitalized with a viral infection, about 2 weeks before this latest test. So maybe that's the cause.
I made an appointment with the hematologist but with his PA, not him, so she'll just do the same tests he would and this gets me in quicker.

What is odd about this whole thing is that about a year or 16 months ago. I was treated for anemia, unknown cause, and I looked back at that time, my ferritin was 5.

@Paul, you are probably right. On the one hand, as a very nervous guy when it comes to healthcare, I'd rather be with someone like him (my referrral and test happy PCP}, being as cautious as he is. On the other hand all these tests and referrals make me more nervous. Not sure what the right thing to do is.

I'm still concerned about the trace blood in urine. I'm seeing my urologist/surgeon next week, I'll mention it to him. But I'm worried that he'll want me to do a chtoscopy. Which I've never done, and dread.

Thanks for the responses.

Prato, ferritin is one of non specific markers of inflammation ( acute phase reactant) and indeed often gets elevated with any inflammatory process ( like the one you recently had, which was pneumonia). It would be too premature to see hematologist - just retest in 2-3 month and take it easy.

As for few rbcs in your urine - the golden rule again, retest ! It again may be related to recent infection. It may need attention if it persists.

So my suggestion: retest until normal, i would say the likelihood of normal values on retest is quite high !

So the hematologist PA, back in November, after speaking with the hematologist, said it might be from the infection, so don't worry, just retest in about 6 weeks. That was in November. I retested end January, and it was still high at 421, but down from 487. I was in Florida, enjoying the winter, so I just said **** it, and didn't speak w the doctor.

The last few weeks I've had pain in my fingers, sometimes pretty bad. This, from what I understand , is a classic symptom of early hemochromatosis. So now I'm almost convinced of my self diagnosis. But I've also read that it could be a sign of inflammation, infection (as mentioned by some of you above) or cancer . Couple that with my low but rising PSA, I'm almost hoping for a hemochromatosis diagnosis.

I keep telling myself that as long as I'm alive, and not feeling like I'm dying, I'm not going to let this cr@p bother me, and I'll just deal with whatever comes up. But I find it hard to execute on this philosophy.
One member, who I consider a friend, has told me to just man up, and deal, because we're all gonna die. He's right. But I find logic overtaken by emotion.

I'm just venting, thanks.

I have almost no opinion about your lab tests, other than it doesn't sound very serious to me.

I have observed, in a lot of meetings with doctors, that they often take their cues from patients. If you think that the slightly abnormal readings are cause for concern, your doctor will pick up on your anxiety, and will try to solve your problem. "Solving" usually means more tests and referrals to specialists. That in turn causes more anxiety on the patient's part - he must think this is really serious if he's sending me to specialists.

The way I manage my PCP is I keep my questions and comments factual. I ask about the odds of each differential diagnosis, and roughly determine my expected value of pursuing remote possibilities. I have no problem telling my doctor no, I don't want to pursue that; I don't want those tests; or I don't want that referral. It's about patient empowerment - even if it's the "wrong" decision, it's my decision to make and take responsibility for. Doctors are advisors, not dictators.

wow, you're good. I never even heard of hemochromatosis.

Andrew

T.A. and G.I. are on the right track, methinks, Pratoman. I'd follow them, not me, on this one.
A perhaps pertinent aside: Last year my wife's calcium was high, her PCP wanted her to bring it down, which she succeeded in doing. She went back to him today for something unrelated, he took a look at her latest test results and said, I'd like to see you bring that calcium number up a bit. She reminded him her calcium was high last year, and he said, Oh, you're right! Forgot that! Well, let's not make any more changes...

For what it's worth, I've had trace amount of blood in my urine since forever.
3 years ago my uro doc did a cystoscopy and found nothing.
Every time I do a "pee in the cup" at the GP's office, they say, you have blood in your urine!!! I say yep, I know and my uro isn't worried about it.
Like I said, for what it's worth.

So to update this thread, saw the doc, had my ferritin retested, its down from 421 TO 303. Its just at the top of the normal range, doc said since i had aggressive therapy of iron plasma transfusions 18 months ago, its expected to be high, it means i am retaining the iron. Nothing to do but follow up in a month just to keep an eye on it.
So i guess i dont have Hemochromatosis.

One down. Next on the hit parade, PSA, blood drawn today, so I'll have results in a few days.