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  • Input on wonky blood results

    Just looking for some input here.

    My husband had his left testicle removed on 1/3/18. Pure seminoma, stage 1a. He went under surveillance and has had ct scans and MRIs every 3 months up until February 2019. They found a lesion in his liver, but it was small, non malignant, but indeterminate as to what it actually was. They did several scans trying to figure out what it was. No biopsy was done.

    Fast forward to this past Thursday. We get a referral authorization for blood work at an outside lab. His most recent appointment was on 4/30. It didn't say what for so I logged into our insurance and it says acute hepatitis panel. Oooook. So this sounds alarm bells in my head and I start researching. Everything says elevated liver enzymes. We never got a call from his oncologist but she is clearly looking into something. The week prior he went to his PCM at my urging because he has had severe heel pain for a long time. I'm thinking plantar fasciitis but they drew a CBC on him. His eosinophils came back high. Normal was 0 to 3, his was 9. Xray was normal on his foot so probably plantar fasciitis.

    The next morning he gets on the horn with the oncologist to try to figure out what's going on. I have been bugging him for months to get access to his charts online so we can see his test results. Finally with me being up his ass about it (LOL) we get it done and I log in to look around as he heads off to work. His hepatitis panel is completely negative.

    Everything is boring and normal up until his February appointment, and then his bloodwork gets weird. For reference these values are November, February, April. I'm just including what was highlighted as abnormal.

    WBC 4.5 > 10 > 4.3
    Platelets 269 > 282 > 233
    Neutrophils 2.3 > 9.3 > 1.8
    Granulocytes % 51.4 > 92.3 > 41
    Lymphocytes % 33.7 > 6.4 > 40.9
    Monocytes 7.8 > 0.9 > 8.2
    Eosinophils 6.0 > 0.0 > 9.0

    CO2 28 > 26 > 34 (high is 32)

    Fasting blood glucose 96 > 138 > 97 (prior to these 3 readings he was in the 70s and low 80s every time).

    AST 23 > 26 > 94
    ALT 25 > 28 > 54

    LDH 375 > 396 > 521
    AFP 3.2 > 3.8 > 4.2

    I am trying to think back to what was going on on February 5th. I don't remember him being sick. He is a light occasional drinker, a couple beers here and there at most. He did not drink from March 25th until the first week of May, so that doesn't explain the liver enzyme increase on April 30th, and I refuse to buy tylenol because it's just a liver toxin.

    In November and February he had to take prednisone, 3 doses 8 hours apart, prior to his imaging because he has an allergic reaction to the contrast. They started prescribing prednisone because someone died in their care from an allergic reaction. Anyway, this could explain his February results I'm pretty sure, but not the increase in liver enzymes in April and why wouldn't his November results be similar since he had the prednisone then too? He doesn't take any medication otherwise and eats pretty healthy. He's 175 lbs and is active.

    His tumor markers were never elevated at diagnosis. His LDH was 161 2 days before surgery but as I understand it's not a good indicator of anything other than inflammation. His AFP was 4.2 at diagnosis. It then went down gradually, it was 3.2 in November, and it's now curving back up and is 4.2 again. The fact that it was on a downward trend and then turned back up concerns me but they say anything under 10 is normal regardless. Historically though, he was "normal" and had a huge tumor.

    Anyway, he has an MRI on Friday now. His next imaging was not until July but after contacting his oncologist she put him in for imaging sooner seeing as he did have a small lesion on his liver.

    Any thoughts on any of this?

  • #2
    His LDH is rising and that’s absolutely not normal. Ot necessarily recurrence of TC but unfortunately highly suspicious. LDH was my only elevated marker, for example. Yes other issues can cause rising LDH, but it’s absolutely a valid potential marker for TC. The MRI should provide the answers you need.

    FWIW, my liver enzymes have bounced up and down from the 20s to around 100 for several years. Nobody can figure out why.

    Comment


    • #3
      Originally posted by vxmike View Post
      His LDH is rising and that’s absolutely not normal. Ot necessarily recurrence of TC but unfortunately highly suspicious. LDH was my only elevated marker, for example. Yes other issues can cause rising LDH, but it’s absolutely a valid potential marker for TC. The MRI should provide the answers you need.

      FWIW, my liver enzymes have bounced up and down from the 20s to around 100 for several years. Nobody can figure out why.
      Thanks for your reply. An almost 130 point jump in 2 months in LDH did seem like a lot. His blood tests are graphed online so seeing these large changes are definitely alarming. I'm glad he is getting in for imaging, just obviously worried.

      Comment


      • #4
        Something is going on it seems like, but since LDH is really only an indication of cell turnover and the AFP number is still just normal variation within the normal range there really is nothing pointing towards TC at this point.
        6/5/15: bHCG 27,AFP 8.66, LDH 361, 5.6cm lymph node - Stage IIC
        6/16/15: Left I/O 85% EC, 10% chorio, 5% yolk sac opinion 2 (mayo) 90% EC, 10% yolk sac
        7/7/15: bHCG 56, AFP 42, LDH 322
        7/13/15: begin 4xEP, end 9/18/15
        10/1/15: bloodwork normal, ct scan shows 2 lymph nodes 1.0cm
        10/26/15: 2nd opinion on CT results - lymph nodes normal. Surveillance!
        4/6/16: 1.7cm X 1.5cm lymph node found with markers normal.
        4/20/16: RPLND @ IU - teratoma only!
        4/15/19: all clears up to this date!

        Comment


        • #5
          Hi selectivefocus,

          I actually had something similar happen right after my chemo. I was always within range for ALT, AST and LDH (never high numbers) and all of a sudden those were all elevated.

          The blood work was done after my chemo 3BEP, about 5 weeks after. The weekend before, i went to the gym and was extremely sore. I also had taken some vitamins that i realize now were set for weight mgmt.

          All this to say that a few weeks after i redid the test, no gym before, no more vitamins and it was normalized. I know that ALT and AST and LDH can bump with exercise because of muscle tear, maybe this could apply to you?

          Comment


          • #6
            Hello there. I'm no doc, just reading a lot online. You don't have to worry about eosinophiles, they ussualy indicate alergy or maybe parasites. And they didn't came high in April, they were just low in February, and that's because other WB cells were high. You see, all WB cells like neuthrophiles, granulocites, lymphocites, monocites etc. are declared in percentage units, which means that they represent percentage of total WB cells, like if eosinophiles are 9%, that means that there are 9 eosinophiles in 100 WB cells. So, if some bacteria attacks body, body will produce more WB cells that will fight bacteria, and less WB cells that fight alergy or parasites, because anti-bacteria cells are needed more. Seems to me that he had some minor infection in February somewhere in the body that messed up his bloodwork, and it is now resovled, and you don't have to worry about it now. About elevated AST and ALT, and ALT is very mildly elevated, it may be just sporadic elevation, it can be due to meds, or it can have something with that liver lesion. It doesn't indicate any relation with TC, I think, but MRI will tell us more what it is.
            45yo, left I/O 07/30/2018, T1 pure seminoma, surveillance...
            Waiting...

            Comment


            • #7
              I doubt his results are TC related, but there is some reason his LDH is over twice normal, AND it has been over normal in all three tests. I'm not sure what the normal range is for AST & ALT, but the rise in both of those along with a big rise in LDH is probably what triggered the order for the hepatitis panel. They really need to find out what is causing the high LDH. That can be difficult to pin down since so many things can cause it to be high, including problems with the liver. Here are a couple of links to LDH info, many more are available:

              https://www.webmd.com/a-to-z-guides/...ogenase-test#1

              https://labtestsonline.org/tests/lac...hydrogenase-ld
              Last edited by Davepet; 05-16-19, 06:32 PM.
              Jan, 1975: Right I/O, followed by RPLND
              Dec, 2009: Left I/O, followed by 3xBEP

              Comment


              • #8
                Originally posted by biwi View Post
                Something is going on it seems like, but since LDH is really only an indication of cell turnover and the AFP number is still just normal variation within the normal range there really is nothing pointing towards TC at this point.
                So, there actually is statistical data that I found with similar markers where the TC had spread. The LDH was barely elevated. I hope to God it's not the case of course but the upward trend and sudden jump does concern me. He had a pure seminoma. The AFP and HCG almost never is elevated on the spread of stage 1 pure seminoma tumors (from all the literature I have read).

                Comment


                • #9
                  Originally posted by Harxxony View Post
                  Hello there. I'm no doc, just reading a lot online. You don't have to worry about eosinophiles, they ussualy indicate alergy or maybe parasites. And they didn't came high in April, they were just low in February, and that's because other WB cells were high. You see, all WB cells like neuthrophiles, granulocites, lymphocites, monocites etc. are declared in percentage units, which means that they represent percentage of total WB cells, like if eosinophiles are 9%, that means that there are 9 eosinophiles in 100 WB cells. So, if some bacteria attacks body, body will produce more WB cells that will fight bacteria, and less WB cells that fight alergy or parasites, because anti-bacteria cells are needed more. Seems to me that he had some minor infection in February somewhere in the body that messed up his bloodwork, and it is now resovled, and you don't have to worry about it now. About elevated AST and ALT, and ALT is very mildly elevated, it may be just sporadic elevation, it can be due to meds, or it can have something with that liver lesion. It doesn't indicate any relation with TC, I think, but MRI will tell us more what it is.
                  I have read the same and hope for the best obviously, I just don't know what would do that to his WBC and lower his platelet count, plus mess up his fasting glucose. It could be pancreatitis.

                  Comment


                  • #10
                    Originally posted by wjonw View Post
                    Hi selectivefocus,

                    I actually had something similar happen right after my chemo. I was always within range for ALT, AST and LDH (never high numbers) and all of a sudden those were all elevated.

                    The blood work was done after my chemo 3BEP, about 5 weeks after. The weekend before, i went to the gym and was extremely sore. I also had taken some vitamins that i realize now were set for weight mgmt.

                    All this to say that a few weeks after i redid the test, no gym before, no more vitamins and it was normalized. I know that ALT and AST and LDH can bump with exercise because of muscle tear, maybe this could apply to you?
                    He had not been to the gym or taken supplements. I remember what he was doing because he is a military drill sgt and was on cycle break. He also has not had chemo. But these are good points that it could be minor.

                    Comment


                    • #11
                      Originally posted by Davepet View Post
                      I doubt his results are TC related, but there is some reason his LDH is over twice normal, AND it has been over normal in all three tests. I'm not sure what the normal range is for AST & ALT, but the rise in both of those along with a big rise in LDH is probably what triggered the order for the hepatitis panel. They really need to find out what is causing the high LDH. That can be difficult to pin down since so many things can cause it to be high, including problems with the liver. Here are a couple of links to LDH info, may more are available:

                      https://www.webmd.com/a-to-z-guides/...ogenase-test#1

                      https://labtestsonline.org/tests/lac...hydrogenase-ld
                      The data online shows the highs and lows for normal results which is super helpful. He has been on the phone all morning trying to get the referral for this MRI expedited because his appointment is supposed to be tomorrow afternoon.

                      Comment

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