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The result should be compared to the reference (normal) value. If the BUN goes up to 20, but the Creatinine is still 1.0, they are still within the ratio. Ed Becker_ PSN Moderator: Why the difference in clotting tube vs not clotting? Eric Hoy: Whether we use clotted blood or unclotted depends on the test and the method used for that test. If not I'll just ask some that people have forwarded to me.. Eric..a vasculitis patient gets lab results that come back "abnormal" what would you say are the key things that person should realize, understand or take into consideration to keep perspective? Eric Hoy: It depends what is "abnormal" and how abnormal the results are. I guess it's about taking in all of the test results to get the clear picture. So a question—What does a high Creatine reading mean if it’s much higher than BUN. Eric Hoy: OK, a quick indicator of the relationship between BUN and Creat In our hospital lab, the normal BUN level is 6-20, and the normal Creatinine is 0.6-1.2. It is usually between 10:1 and 20:1, Ed Becker_ PSN Moderator: Eric. Does that mean that ratio may be diff in another hospital? Eric Hoy: There may be slightly different "normal" ranges in different labs, based on the method they are using, the patient population, and the units that they report. So if someone has a BUN of 10, and a Creatinine of 1.0, they are in the normal ratio. These tubes may have an anticoagulant in them to prevent clotting of the blood, or they may be plain plastic tube in which the blood will clot. v=c Ig ZA29FITk Ed Becker_ PSN Moderator: Please ask away.Ed Becker_ PSN Moderator: You mentioned in your video that people should not only focus on the abnormal, but the too that can tell you a lot, correct? Eric Hoy: Yes, the normal is important, and the history of lab results is important, too. I would want to watch the patient carefully, but it is not reason to panic. So really the bottom line to the patient when they get their labs back is to really have a discussion with their doctor about it. This is why the tests are sometimes called "serologies".For example, if we are looking at kidney function tests, there are 2 tests that are a good screening indicator. Ed Becker_ PSN Moderator: Both are very important, right. What is the significance of the BUN reading to the Creatinine reading? Go over and don’t just focus on one test, but look at the whole spectrum. He asked if you could walk through the whole lab process from when the blood is drawn to when it comes back as a report. The vial goes to the lab, and may be separated into smaller portions to go to various parts of the lab and different instruments.I mean, if one is much higher than the other is that a red flag? Eric Hoy: If both have been normal for a long time, and on one occasion the BUN is slightly high, but the creatinine is still normal, that would be a reason to watch, but not to panic. Some of the instruments are highly automated, and will run the appropriate tests with very little human intervention. Eric stepped away, but when he comes back let's ask him Dr.

Other tests require a lot more interpretation and care from a well-trained laboratory scientist. Eric Hoy: Ed, yes, tissue, blood, urine, saliva, whatever we have used for the tests gets disposed in the same ways. Eric Hoy: Lamar, which is a question for your doctor(s).

The BUN and Creatinine are among the automated tests, and tests like ANA (Anti-Nuclear Antibody) and ANCA (Anti-Neutrophil Cytoplasmic Antibody) require more interpretation. Eric Hoy: I was in a lab this week where they receive over 4,000 specimens a day, and run over 15,000 individual tests per day. Ed Becker_ PSN Moderator: Now when you say a tests like ANA or ANCA need that physically done? Eric Hoy: Yes, the ANA and ANCA require an examination under a specialized microscope. Eric Hoy: If we find something really interesting, we may keep a little bit of the sample for teaching new techs what to look for (that's what I was doing last week in the UK), but most of the leftover part goes to sewage treatment, or a very high temperature incinerator. This is obviously true whether it's blood or tissue from a biopsy? Lamar: My inflammatory markers all returned to normal before being treated but was still started on Prednisone. They may be looking at inflammation from a biopsy, even though the marks are back to normal.

The management of specimens is a huge task of the laboratory professionals. But I always wondered how my vial of blood doesn't go missing or something. Is there a lab tech who studies it and evaluates the reading? The individual has to be trained in what to look for, and how to interpret what they are seeing. Karen: which labs in particular (if any) indicate flare? Eric Hoy: Karen, often there is no change in the labs, even though symptoms change. Eric Hoy: Elevated creatinine indicates reduced kidney function, but it depends on how elevated the creatinine is, how long it's been elevated, and other factors.

Not only lost, but mixed up samples can be a huge problem, and we are constantly coming up with better handling system. The difference in the way tests are run helps explain why some results may be available the day after your blood is drawn, and others may take a couple of days. If the test they are using is inferior (some reagents are cheaper than others), or the person who is examining the sample isn't skilled, the answer can be wrong. Joyce: The VF's mission is to help educate our patients and family members about vasculitis and help you find physicians and resources to help you manage the disease. The VF offers a detailed website, newsletter, VF consultants, symposiums, chapters, etc.

Ed Becker_ PSN Moderator: I am honestly amazed how often it doesn't go wrong given the thousands of specimens. This is where the automated microscope that I helped develop comes in. It doesn't eliminate the human, but makes the job easier for that person. We use up most of it, and the rest gets treated to make it non-infectious (in case you have some dread disease), then it goes to a special waste treatment facility. I am thrilled we have two people from Australia as well as Hawaii and Missouri and Atlanta. We just selected 3 studies for funding starting this month.

Ed Becker_ PSN Moderator: Trying to picture this actual environment. Eric Hoy: Usually not hundreds working on the same test. The doctor will call an expert in lab test analysis for clarification. You help the doctor understand so he or she can communicate to patient. Eric Hoy: Yes, most GP's don't see autoimmune diseases often enough to become familiar with all of the tests, and the possible interactions among the tests. That's what has been buttering my bread for over 30 years. Ed_PSN Moderator: Folks, rather than go into a lot of detail here tonight in this venue, I’ll steer you to the VF website where you can really dig into the details. the VF is also heavily involved in promoting vasculitis research, correct? Ed_PSN Moderator: Talk about what happened this past year in terms of significant events, goals, and accomplishments.​ Joyce: Well..funded our V-RIDI impact study - which is a two year study to during the impact of vasculitis on our patients and families.