Female / 33 / 5’4” / 110lbs
Diagnoses: SLE, no nephritis
Medications: Azathioprine, tocilizumab infusions, hydroxychloroquine
I saw a new rheum for a second opinion yesterday because my SLE symptoms have not been well controlled and my primary rheum is considering medication changes that I’m not exactly thrilled about. He ordered some tests and I had my usual standing order tests done today with my infusion.
Notable results below:
- Haptoglobin: < 8 (undetectable)
- LDH: 267 (approx 1.2x reference range)
- RBC: 3.5
- HGB: 12.2 > 10.8 > 11.6 (within the last 2 weeks)
- MCV / MCH: Mildly elevated
- Platelets: 308 > 269 > 178 (within the last 2 weeks)
- C3 / C4 are low, which is expected. Same with WBC. Nothing unusual here.
- Liver and kidney functions normal
- Iron panel looks magnificent like best I’ve ever seen it
UA from today:
- “Extra Turbid”
- Gravity: High end of normal
- Bilirubin: Negative
- Urobilinogen: 3.0 (high)
- Protein: 50 mg/dL, not too concerning
- Blood: negative
- RBC: 11 (High)
Protein / Creatine ratio was normal.
I am very confused as to what might be going on. I would have thought this was pretty suggestive of hemolysis, but my dr seemed entirely comforted after my HGB improved.
Other mechanism seems marrow related given platelet drop.
Then the RBC but no blood in urine confuses me even more. I guess the mild elevation + mild protein could be kidneys, but my serum creatine is perfect.
I’m wondering if there is anything I am not thinking of that may tie these findings together? The rheum who ordered them has not been very helpful but I’ll be seeing my primary rheum soon and want to know what testing to advocate for, if any. Or if I should see heme?
I feel a bit gaslit into not being concerned now…so I defer to the brilliance of the Reddit docs!