My doctors are stumped, and I would appreciate an opinion on a very unusual case.?

Question

Hi -
I am 42 yrs. old, diagnosed with thrombocytopenia "idiopathic and cyclic (currently at 50 k) here in Spain. I am also apparently beginning Polycythaemia, they call it Poliglobulia(Hemoglobin now 18 (norm to 16) and my hematocrit is at 52 (norm. 50). I also have Hepatosplenomagaly with very elevated gamma gt, ast and alt, but normal billiruben, although the ldh was elevated. The last blood work showed a positive CEA (how much, I don't know) and I had the CA-19-9 at 6 (norm. 0-3). Is that high? They want to do an abdominal and thorax CT scan and a bone marrow test. What could they be looking for? I tested negative for all viruses (hep. a, b, c, and e as well as HIV). My autoimmune exams (anti-ro, ANA, and anti-ssm and platelet antibodies were negative...still pending the anti-dna. I also have psoriasis, and on the HLA antibodies exams I came out with the following:
B27 negative, DR-7 Negative, but the B-5 was very positive (90%).I would appreciate any opinion or ideas out there.

Answer 1

A diagnosis is made as follows : 75% from history n 25% from physical examination n lab tests. U have mentioned only lab stuff .

What are the peripheral blood smear findings ??Elevated Haemoglobin n Haematocrit maybe 'coz of volume depletion too .Is the RBC count also elevated ? Low platelet count could be 'coz of hypersplenism.Liver enzymes maybe elevated with enlargement .CEA and CA 19-9 point towards pancreatic cancer /Colon cancer but usually seen in the 6th decade of life.

People with pancreatic CA are also at risk for acute leukemia .AML-acute myelogenous leukemia is seen at your age and less commonly CML-chronic myelogenous leukemia(also associated with HLA-B5 and colon /pancreatic cancer).

Regarding psoriasis it could be from man causes like trauma,upper respiratory infection...or maybe if u have low serum albumin and therefore low calcium...which may cause it.

Anyways can't say much without any hint of HISTORY ???what are your complaints?abdominal pain ?bowel habit?Taking any medicine?blood in stool?mouth ulcers?joint pain?.etc . Give us details. White cell count ??Peripheral blood smear ?

GOD bless.

Answer 2

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Answer 3

Sounds to me like your a med student looking for answers to a test: sorry : either that or your very knowledgeable in the medical field already.

Answer 4

all that and not ONE typo... wow. anyway, try looking up some of the terms on Wikipedia. it has lots of articles and may have a link to associated conditions.

Answer 5

Have your doctor's considered Sjogren's Disease? They may consider it even iwth a normal ANA.