Blood Work questions

[becjonz]

I know there is some disagreement regarding the importance/ability to draw conclusions from the titers but I wonder if anyone can offer some insight on my son's results.

 

He was first tested 3/3. Results were:

ASO Screen: Negative

DNAse- B antibody: 480

 

Tested again on 5/10. During a flare up. Results were:

ASO Titer: 229

Anti DNA double: <1

Mycoplasma AB I:

IgG: H 2.26 (ref. range <=.9)

IgM: 390 (ref. range <770)

 

 

We are in limbo as he appeared to have hives each time he had antibiotics. Mycoplasma was tested as dr. felt that instead of allergic reaction to abx it could instead be result of mycoplasma. He is seeing allergist next month in order to fully resolve that question.

[Buster]

I know there is some disagreement regarding the importance/ability to draw conclusions from the titers but I wonder if anyone can offer some insight on my son's results.

 

He was first tested 3/3. Results were:

ASO Screen: Negative

DNAse- B antibody: 480

 

Tested again on 5/10. During a flare up. Results were:

ASO Titer: 229

Anti DNA double: <1

Mycoplasma AB I:

IgG: H 2.26 (ref. range <=.9)

IgM: 390 (ref. range <770)

 

 

We are in limbo as he appeared to have hives each time he had antibiotics. Mycoplasma was tested as dr. felt that instead of allergic reaction to abx it could instead be result of mycoplasma. He is seeing allergist next month in order to fully resolve that question.

 

I'm presuming you got your answer -- I'm curious if you got a throat culture during the flair up. You seem to be running blood work but I didn't see any cultures.

 

Presuming you had the tests run by the same laboratory, the ASO would indicate that somewhere around Feb 27th-May 1st your child had a strep infection.

 

There's only a single measurement of of AntiDNAse B so the single result is not clear whether it was rising or falling. The High IgG value of Mycoplasma AB would indicate that your child did have mycoplasma pneumonia in the past, but it's not clear whether this is a recent infection (due to the low IgM).

 

Buster

Edited May 22, 2010 by Buster

[becjonz]

I'm presuming you got your answer -- I'm curious if you got a throat culture during the flair up. You seem to be running blood work but I didn't see any cultures.

 

Presuming you had the tests run by the same laboratory, the ASO would indicate that somewhere around Feb 27th-May 1st your child had a strep infection.

 

There's only a single measurement of of AntiDNAse B so the single result is not clear whether it was rising or falling. The High IgG value of Mycoplasma AB would indicate that your child did have mycoplasma pneumonia in the past, but it's not clear whether this is a recent infection (due to the low IgM).

 

Buster

 

I have not gotten any answers. I got the test results from the hospital this past week since I like to have copies of everything. However, I have not heard from either of our dr.'s since these tests were run in May. I kind of wanted to have an idea of what sort of things I should even ask the doctor. My understanding was that our specialist asked our pedi. to get both titers done again. Is the anti DNA double a screening of sorts before the Anti DNAse B? (excuse my ignorance) On the first set it appeared that they screened for ASO, it was negative so my hospital didn't send it out for further testing and then I kind of assumed that the same held true for the antiDNA, since it came out negative then they didn't send it out to lab in VA for more involved testing.

 

He did have a rapid strep test on 4/23 but it was negative and they didn't do a culture. I was not smart enough to insist on a culture but will know next time. My son had a sore throat and was congested so that is why I sought the strep test. I was told it was a cold. Within in a few days we had the flare up.

The new blood work was ordered after seeing our specialist for our regularly scheduled follow up which happened to coincide with the exacerbation.

 

So my questions: Did he get the wrong antiDNA test? should I be asking for the antiDNAse B to be done? Would you treat this or wait and watch? Due to the possible abx allergy all we did for exacerbation was increase risperidone to double normal dose. (normal is 1/2 of a .25mg tablet). We doubled for 2 weeks and then went to normal dose. Of course since reducing I've seen anxiety, tics, adhd, getting fixated on words so he repeats and repeats and seems not to hear you. We also resumed therapy at doctor's request but his anxiety and adhd are impacting the success of that. What are your thoughts on next steps?

Edited May 22, 2010 by becjonz

[Buster]

Is the anti DNA double a screening of sorts before the Anti DNAse B?... Did he get the wrong antiDNA test? should I be asking for the antiDNAse B to be done? Would you treat this or wait and watch?

They probably ran the wrong test or were checking for SLE. Anti DNA DS is a test for Lupus. It is not the same as AntiDNAseB.

 

ASO rises between 1-4 weeks after a strep infection in about 54% of children. AntiDNAseB rises between 6-8 weeks after a strep infection in about 45% of children.

 

He did have a rapid strep test on 4/23 but it was negative and they didn't do a culture.

The 4/23 would fall within the timeline for a rising ASO on 5/10. If the actual infection was the week of 4/23, you'd be at the limit of AntiDNAse B now but you certainly can check.

 

Due to the possible abx allergy all we did for exacerbation was increase risperidone to double normal dose. (normal is 1/2 of a .25mg tablet). We doubled for 2 weeks and then went to normal dose.

 

Risperdone modulates dopamine essentially smoothing out spikes. Did your doctor prescribe this for tics or for bipolar or for some other condition? It sounds however, like it has been helpful in your case. I ask because in about 10% of cases Risperdone itself causes tremors in hands, headaches and insomnia. So I guess I'm checking if the tics preceeded the medication.

 

How old is your child? Therapy generally requires insight to be effective.

 

Buster

[becjonz]

Buster,

Thanks so much for your help. Now I get it about the two strep titers and the timelines of when they show a rise. I will add that to my PANDAS binder so I don't have to keep asking.

The risperidone is for the tics to kind of smooth them out as you said. I was against it in the first place. I am a special ed. teacher of students with emotional disorders so typically at least 75% of my class is on Risperidal or it's generic each year. I have seen absolute horror stories with it- permanent tongue tremors so that speech therapy had to stop since there was nothing they could do for him after that and more. Our doctor said that studies have shown that only when you are at 1mg or above do you see such side effects. So I agreed with the 1/2 of .25mg since he was first on tenex and he was a zombie.

Matt is 10 and is very intelligent as is the common PANDAS profile and he can really be quite insightful about this whole thing BUT only when in remission. Otherwise either the anxiety or the lack of attention make it pretty near impossible.

 

I will request a new blood test. Our specialist says it is often hard to get the lab work through insurance when she orders it so she puts the requests through our pediatrician. This keeps him informed about Matt's progress BUT leads to mistakes such as this one with the blood work. Thankfully I have kind people such as you on this board to help me keep on top of what needs to be done for Matt.

Thanks again for your help!

Edited May 23, 2010 by becjonz