Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Does My Blood Test Result Indicate?
Posted on
Tue, 18 Nov 2014
Medically reviewed by
Ask A Doctor - 24x7 Medical Review Team
Tue, 18 Nov 2014
Answered on
Mon, 22 Dec 2014
Last reviewed on
Question : Hello Dr Vora,
I had asked you a question about my father on october 29th and not sure if you have access to it or not; but I will copy and paste it here.
Hello, question is about my 89 year old father. He had a blood test done last week; everything was normal (CBC, electrolytes, chemistry) except his CRP was at 16.5. I assumed he was coming of a cold. He had another test done this week, the WBC went from 6.8 to 8.0 and the CRP is 15.4. He has this chronic cough which doesn't go away. My question is should I be concerned with CRP of 15.4 and WBC of 8.0 and the chronic cough?? he does have history of aspiration pneumonia. physically he is fine, mentally he is also fine for him. Medication wise, he is on 5 mg norvasc, baby aspirin, aricept 10mg. Could the cough be a side effect of aricept? it seems to have increased when we increased the dosage from 5 to 10. thank you"
since then his GP put him on Avelox 400 mg for 8 days, the problem did not go away so he put him on Cipro 500 mg twice a day. Today was day 6th of this. I believe he has gotten better and has another blood draw tomorrow BUT he just is not fully well. His GP basically told us today that he doesn't know what to do so we asked for a referral from either a geriatric specialist or a lung specialist but I really think we need the right antibiotics to kill this thing without hospital stay. We live in canada so with social care I am sure it will take months to see any specialist. His GP didn't order an Xray or culture of sputum and basically went by the sound in his chest.
I keep reading about what antibiotics are optimal for aspiration pneumonia empirically and I am so confused.
He doesn't have a fever, he has good appetite, his BP is normal, his mental state is almost same as usual aside from effects of constant antibiotic usage.
Honestly I can not be a google doctor anymore.
I had asked you a question about my father on october 29th and not sure if you have access to it or not; but I will copy and paste it here.
Hello, question is about my 89 year old father. He had a blood test done last week; everything was normal (CBC, electrolytes, chemistry) except his CRP was at 16.5. I assumed he was coming of a cold. He had another test done this week, the WBC went from 6.8 to 8.0 and the CRP is 15.4. He has this chronic cough which doesn't go away. My question is should I be concerned with CRP of 15.4 and WBC of 8.0 and the chronic cough?? he does have history of aspiration pneumonia. physically he is fine, mentally he is also fine for him. Medication wise, he is on 5 mg norvasc, baby aspirin, aricept 10mg. Could the cough be a side effect of aricept? it seems to have increased when we increased the dosage from 5 to 10. thank you"
since then his GP put him on Avelox 400 mg for 8 days, the problem did not go away so he put him on Cipro 500 mg twice a day. Today was day 6th of this. I believe he has gotten better and has another blood draw tomorrow BUT he just is not fully well. His GP basically told us today that he doesn't know what to do so we asked for a referral from either a geriatric specialist or a lung specialist but I really think we need the right antibiotics to kill this thing without hospital stay. We live in canada so with social care I am sure it will take months to see any specialist. His GP didn't order an Xray or culture of sputum and basically went by the sound in his chest.
I keep reading about what antibiotics are optimal for aspiration pneumonia empirically and I am so confused.
He doesn't have a fever, he has good appetite, his BP is normal, his mental state is almost same as usual aside from effects of constant antibiotic usage.
Honestly I can not be a google doctor anymore.
Brief Answer:
Many reasons for cough could be there.
Detailed Answer:
Hello XXXXXXX Welcome again.
I remember you and your question regarding your father. Your care towards him is really appreciable.
It's good to hear that he is improving at least somewhat. There are many reasons I have found regarding cough of your father. Let me explain it one by one.
1.Regarding side effects of medications.
Actually I have previously told that the drugs he is taking usually don't cause cough but they can precipitate cough once it's already there. Aspirin and donepezil(arisept) can precipitate cough. I advice you to change aspirin with tab clopidogrel (written prescription is must) and ask your doctor if he can reduce the dosage of donepezil also.
2.Regarding blood reports you have mentioned, they usually are not specic for infections at old age. I have advised you before regarding Pre calcitonin levels which are highly specific for infections. So kindly go for that.
3.Longterm usage of antibiotics at old age may leads to fungal infection. It's possibility can't be ruled out. So I advice you to do
SPUTUM ROUTINE AND CULTURE study
Xray chest.
Once the infection is confirmed then specific therapy can be advised. Don't take unnecessary antibiotics.
4.You have once mentioned that your father also has yellow discharge from ear. This discharge can also go towards throat particularly at night and cause persistent cough. So kindly consult Ent specialists for that and clear this possibility also.
5.Your father should do
Regular breathing exercise,
Steam inhalation 3 times a day,
Chest physiotherapy regularly by professional physiotherapists.
Nebulisation with mucomix will be helpful in removing already clogged mucus from lung. So kindly consult your doctor about this also.
I hope my advice will help you. You can anytime ask me after reports. Your questions are always welcome.
As such your father's health is looking well according to your description. So don't worry.
Thank you.
Have a nice day.
Many reasons for cough could be there.
Detailed Answer:
Hello XXXXXXX Welcome again.
I remember you and your question regarding your father. Your care towards him is really appreciable.
It's good to hear that he is improving at least somewhat. There are many reasons I have found regarding cough of your father. Let me explain it one by one.
1.Regarding side effects of medications.
Actually I have previously told that the drugs he is taking usually don't cause cough but they can precipitate cough once it's already there. Aspirin and donepezil(arisept) can precipitate cough. I advice you to change aspirin with tab clopidogrel (written prescription is must) and ask your doctor if he can reduce the dosage of donepezil also.
2.Regarding blood reports you have mentioned, they usually are not specic for infections at old age. I have advised you before regarding Pre calcitonin levels which are highly specific for infections. So kindly go for that.
3.Longterm usage of antibiotics at old age may leads to fungal infection. It's possibility can't be ruled out. So I advice you to do
SPUTUM ROUTINE AND CULTURE study
Xray chest.
Once the infection is confirmed then specific therapy can be advised. Don't take unnecessary antibiotics.
4.You have once mentioned that your father also has yellow discharge from ear. This discharge can also go towards throat particularly at night and cause persistent cough. So kindly consult Ent specialists for that and clear this possibility also.
5.Your father should do
Regular breathing exercise,
Steam inhalation 3 times a day,
Chest physiotherapy regularly by professional physiotherapists.
Nebulisation with mucomix will be helpful in removing already clogged mucus from lung. So kindly consult your doctor about this also.
I hope my advice will help you. You can anytime ask me after reports. Your questions are always welcome.
As such your father's health is looking well according to your description. So don't worry.
Thank you.
Have a nice day.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Here is the situation without going to why what we wsnted has not happened.
- procalcitoninh test is actually not offered/done by labs in BC province
- we finally was able to get a chedy xray requisition and are going in tomorrow for that
- sputum sample is hard to collect from him; i have failed 3 times but giving it a final try in AM
- here is what has happened: his cbc yrsterday showed normal WBC of 6.5; everything fine except low hemoglobin and CRP of 13.8.
His GP has had him on cipro 500 twice a day and today was day 8. I have had to crush these pills as they are 2 big for him to swallow.
I actually believe that i see improvement in him as far as phlem production goes. He is fatigued and his GFR was a bit low at 58. But when he coughs its probably 40% phlem priduction compared to before.
We have requested a coucil from pulminary specialist but that could take months. His gp says it is what it is.
Since we feel he actually has improvements, should we continue with cipro gor atleast 10 days.
Thank you again
- procalcitoninh test is actually not offered/done by labs in BC province
- we finally was able to get a chedy xray requisition and are going in tomorrow for that
- sputum sample is hard to collect from him; i have failed 3 times but giving it a final try in AM
- here is what has happened: his cbc yrsterday showed normal WBC of 6.5; everything fine except low hemoglobin and CRP of 13.8.
His GP has had him on cipro 500 twice a day and today was day 8. I have had to crush these pills as they are 2 big for him to swallow.
I actually believe that i see improvement in him as far as phlem production goes. He is fatigued and his GFR was a bit low at 58. But when he coughs its probably 40% phlem priduction compared to before.
We have requested a coucil from pulminary specialist but that could take months. His gp says it is what it is.
Since we feel he actually has improvements, should we continue with cipro gor atleast 10 days.
Thank you again
Brief Answer:
It seems his condition is improving.
Detailed Answer:
Hi XXXXXXX Welcome again.
The reports you have suggested has definitely shown that his condition is improving. So that is a good sign. Usually due to old age some weakness will be there for some days more.
Both his CRP and WBC counts have been going down and also the ESR. So that suggests recovery.
So, my advice at present is that you continue ciprofloxacin as per your GP advised. It's OK if right now you don't do the reports but in future you remember My advices regarding reports and other possibilities of cough also.
You should continue steam inhalation and warm water gargles as I have suggested. It will help to clear up the remaining mucus.
Right now there is no need to rush to the lung specialist. At present everything looks like normal. Avoid cold beverages, curd etc for him.
I hope you have got my advice. Any further questions or confusions are always welcome. You are free to ask.
Thank you. Have a nice day.
It seems his condition is improving.
Detailed Answer:
Hi XXXXXXX Welcome again.
The reports you have suggested has definitely shown that his condition is improving. So that is a good sign. Usually due to old age some weakness will be there for some days more.
Both his CRP and WBC counts have been going down and also the ESR. So that suggests recovery.
So, my advice at present is that you continue ciprofloxacin as per your GP advised. It's OK if right now you don't do the reports but in future you remember My advices regarding reports and other possibilities of cough also.
You should continue steam inhalation and warm water gargles as I have suggested. It will help to clear up the remaining mucus.
Right now there is no need to rush to the lung specialist. At present everything looks like normal. Avoid cold beverages, curd etc for him.
I hope you have got my advice. Any further questions or confusions are always welcome. You are free to ask.
Thank you. Have a nice day.
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Thank you again.
the sputum sample was contaminated with oropharyngeal hence test was not completed. We finally were able to do the pre calcitonin test but they had to sent it to another lab service, hence results will not be back for a week. We did chest Xray yesterday; we were told if results are "bad" we will hear today, otherwise Monday. We haven't heard anything so assuming its not "bad". Meanwhile, he has been on cipro for the past 10 days and fortunately his cough has really improved in the past 2 days. For example, he had a productive cough today only once and probably a 10th of normal sputum produced. He does have a dry cough but that is not that bad either; basically he is very comfortable but weak due to antibiotics. We have placed a humidifier in his room which is on 24/7.
right now we really have no test that we are waiting for aside from xray; which I assume we will about on Monday. Pre calcitonin is just useless at this point. My question is how do we know when to stop cipro? his GP at this point says up to you and well we are not doctors, even if I listen with a stethescope, I am not sure what I will be listening for.
Since it has been 3 days now of solid improvement, do you think its wise to stop cipro or should we go for XXXXXXX of 14 days as I read somewhere for lower respiratory infection.
your help has been very much appreciated.
regards,
the sputum sample was contaminated with oropharyngeal hence test was not completed. We finally were able to do the pre calcitonin test but they had to sent it to another lab service, hence results will not be back for a week. We did chest Xray yesterday; we were told if results are "bad" we will hear today, otherwise Monday. We haven't heard anything so assuming its not "bad". Meanwhile, he has been on cipro for the past 10 days and fortunately his cough has really improved in the past 2 days. For example, he had a productive cough today only once and probably a 10th of normal sputum produced. He does have a dry cough but that is not that bad either; basically he is very comfortable but weak due to antibiotics. We have placed a humidifier in his room which is on 24/7.
right now we really have no test that we are waiting for aside from xray; which I assume we will about on Monday. Pre calcitonin is just useless at this point. My question is how do we know when to stop cipro? his GP at this point says up to you and well we are not doctors, even if I listen with a stethescope, I am not sure what I will be listening for.
Since it has been 3 days now of solid improvement, do you think its wise to stop cipro or should we go for XXXXXXX of 14 days as I read somewhere for lower respiratory infection.
your help has been very much appreciated.
regards,
Brief Answer:
You can stop cipro now. Don't worry.
Detailed Answer:
Hello XXXXXXX Welcome again.
It's good to hear that your father is almost cured now and reports are suggestive that his infection has been nearly gone or completely gone, I have to say.
It's enough to give ciprofloxacin for 10 days, previously moxifloxacin has been already given for so many days. So, you can safely stop now tab ciprofloxacin.
Longterm usage of ciprofloxacin or moxifloxacin will cause tendinitis (means tendon injury) and weaknesses. So that might be improved once you stopped ciprofloxacin.
Nothing more we need to do now. My advice will helpful next time if he has this type of problem.
One more advice I want to give is Pneumococal vaccine, which will prevent occurance of pneumonia for next 5 years from the most common organism of pneumonia. You can go for that also. Ask your doctor.
Hope I haveggiven you satisfactory answer to all your questions. Thank you.
Have a nice day dear.
You can stop cipro now. Don't worry.
Detailed Answer:
Hello XXXXXXX Welcome again.
It's good to hear that your father is almost cured now and reports are suggestive that his infection has been nearly gone or completely gone, I have to say.
It's enough to give ciprofloxacin for 10 days, previously moxifloxacin has been already given for so many days. So, you can safely stop now tab ciprofloxacin.
Longterm usage of ciprofloxacin or moxifloxacin will cause tendinitis (means tendon injury) and weaknesses. So that might be improved once you stopped ciprofloxacin.
Nothing more we need to do now. My advice will helpful next time if he has this type of problem.
One more advice I want to give is Pneumococal vaccine, which will prevent occurance of pneumonia for next 5 years from the most common organism of pneumonia. You can go for that also. Ask your doctor.
Hope I haveggiven you satisfactory answer to all your questions. Thank you.
Have a nice day dear.
Above answer was peer-reviewed by :
Dr. Raju A.T
hello again Dr Vora,
he has been off cipro for 2 days and cough is back again. He had delirium last night. I honestly have no idea what to do now. He was perfectly fine till last night when delirium set in. We have cipro, clarithromycin, avelox and tetracyclin at home. I know it would be great to get a suputum sample but we can't. I really don't want to take him to ER as I know he wouldn't come back home in one piece.
any suggestions are welcome. We are waiting for xray results which have not come in yet.
Regards.
he has been off cipro for 2 days and cough is back again. He had delirium last night. I honestly have no idea what to do now. He was perfectly fine till last night when delirium set in. We have cipro, clarithromycin, avelox and tetracyclin at home. I know it would be great to get a suputum sample but we can't. I really don't want to take him to ER as I know he wouldn't come back home in one piece.
any suggestions are welcome. We are waiting for xray results which have not come in yet.
Regards.
Brief Answer:
Don't worry. It can not be related to ciprofloxacin stoppage.
Detailed Answer:
Hello XXXXXXX . I can totally understand your concerns.
Actually there are limitations when we can not examine the patient stitemperaturemy opinion delirium has nothing to do with ciprofloxacin stoppage so don't start it again.
Don't start any antibiotics just on presumption. Already he has been given many antibiotics.
I don't think even this delirium is due to infection even. He doesn't have infection at present.
However we haven't done all reports I have advised plus I haven't seen the patient but still I think that there is no need of antibiotics .
Delirium at 90 years of age is common even in mild change in electrolytes like sodium, potassium, calcium etc. Even slightest temperature elevation can cause delirium.
So, my advice to you is -
1. Just wait and watch. Do all home measures I have adviced for cough. Better if sputum report come, otherwise it's OK.
2.Go for his serum electrolytes levels, check whether he has any temperature elevation and low sugar levels. Also see whether he is passing at least 1 litre of urine.
His sleeping bed should be 20 degree elevated (cardiac bed)
Message me when you get all this reports or if you have any f urther questions.
Thank you. Best of luck and keep calm.
Don't worry. It can not be related to ciprofloxacin stoppage.
Detailed Answer:
Hello XXXXXXX . I can totally understand your concerns.
Actually there are limitations when we can not examine the patient stitemperaturemy opinion delirium has nothing to do with ciprofloxacin stoppage so don't start it again.
Don't start any antibiotics just on presumption. Already he has been given many antibiotics.
I don't think even this delirium is due to infection even. He doesn't have infection at present.
However we haven't done all reports I have advised plus I haven't seen the patient but still I think that there is no need of antibiotics .
Delirium at 90 years of age is common even in mild change in electrolytes like sodium, potassium, calcium etc. Even slightest temperature elevation can cause delirium.
So, my advice to you is -
1. Just wait and watch. Do all home measures I have adviced for cough. Better if sputum report come, otherwise it's OK.
2.Go for his serum electrolytes levels, check whether he has any temperature elevation and low sugar levels. Also see whether he is passing at least 1 litre of urine.
His sleeping bed should be 20 degree elevated (cardiac bed)
Message me when you get all this reports or if you have any f urther questions.
Thank you. Best of luck and keep calm.
Above answer was peer-reviewed by :
Dr. Yogesh D
Thank you.
the xray just came to us and this is exactly what it says
"hyperinflation/COPD. otherwise normal. no pnuemonia."
the xray just came to us and this is exactly what it says
"hyperinflation/COPD. otherwise normal. no pnuemonia."
Brief Answer:
COPD might be cause
Detailed Answer:
Hello XXXXXXX .
As per I have told before it doesn't look like infection. Your father has COPD (chronic obstructive pulmonary disease).
In COPD usually patients have long standing cough with expectoration. On and off symptoms will be there.
The cause of delirium might be CO2 retention, that means carbon dioxide is accumulated in the body due to improper breathing. The condition is called
'CO2 narcosis '.
You have to check his oxygenation level (SPO2 level) and arterial blood gas analysis. IF oxygen is low then you might need home oxygen supplements at least for 8 to 10 hrs a day..
You can ask me after checking his oxygenation level. As such we have got our diagnosis at present.
Thank you.
COPD might be cause
Detailed Answer:
Hello XXXXXXX .
As per I have told before it doesn't look like infection. Your father has COPD (chronic obstructive pulmonary disease).
In COPD usually patients have long standing cough with expectoration. On and off symptoms will be there.
The cause of delirium might be CO2 retention, that means carbon dioxide is accumulated in the body due to improper breathing. The condition is called
'CO2 narcosis '.
You have to check his oxygenation level (SPO2 level) and arterial blood gas analysis. IF oxygen is low then you might need home oxygen supplements at least for 8 to 10 hrs a day..
You can ask me after checking his oxygenation level. As such we have got our diagnosis at present.
Thank you.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Hello again,
His SPO2 levels are 99.5; lungs are doing o.k.
I am again stumped. He again had a severe episode of fever/confusion/chills on Thursday and has stabilized again once started on cipro again.
We did a urine microbiology and it came back negative on Friday.
Only other thing I had not mentioned is that he has severe constipation; we are trying to fix that problem but his dysphasia has gotten worst since couple of days ago in that I think he has esophageal problems; food comes back up after he swallows.
could this be diverticulitis? he does have a history of diverticulosis.
I think "we" GPs and NPs here are practically killing him. He has been on one antibiotic or other since november 4th with no test that shows an infection. As a result he has gotten weaker and weaker and can't eat much anymore. We are afraid to stop the cipro in case fevers/chills come back and I want to stop them as I know it needs to leave his system before we can see any hope.
waiting for any other suggestions you might have.
regards,
His SPO2 levels are 99.5; lungs are doing o.k.
I am again stumped. He again had a severe episode of fever/confusion/chills on Thursday and has stabilized again once started on cipro again.
We did a urine microbiology and it came back negative on Friday.
Only other thing I had not mentioned is that he has severe constipation; we are trying to fix that problem but his dysphasia has gotten worst since couple of days ago in that I think he has esophageal problems; food comes back up after he swallows.
could this be diverticulitis? he does have a history of diverticulosis.
I think "we" GPs and NPs here are practically killing him. He has been on one antibiotic or other since november 4th with no test that shows an infection. As a result he has gotten weaker and weaker and can't eat much anymore. We are afraid to stop the cipro in case fevers/chills come back and I want to stop them as I know it needs to leave his system before we can see any hope.
waiting for any other suggestions you might have.
regards,
Brief Answer:
Might be a stomach infection. Review antibiotics.
Detailed Answer:
Hello XXXXXXX It's so unfortunate that you are facing so much of problems.
Actually now it's time that you take him to hospital and start him on injectable antibiotics.
Ciprofloxacin is a weak antibiotic and many bacterias has found resistant to that .
It doesn't look like a diverticulitis but a stomach infection to me (however clinical examination is very important)
Go for sonography of abdomen, CBC and stool routine and micro. I know I recommend you investigations everytime but that is necessary when you are not seeing patients clinically.
Please be careful regarding regurgitation of food otherwise he may aspirate it and develop aspiration pneumonia. He needs proper treatment in hospital with injectable antibiotics. Don't wait now. We have tried enough at home now.
Meanwhile you can give him curd, fruit juices, chicken soup etc.
Hope you have understand my concerns. Any further confusions are always welcome.
Don't worry... I am happy to help you.
Thank you.
Might be a stomach infection. Review antibiotics.
Detailed Answer:
Hello XXXXXXX It's so unfortunate that you are facing so much of problems.
Actually now it's time that you take him to hospital and start him on injectable antibiotics.
Ciprofloxacin is a weak antibiotic and many bacterias has found resistant to that .
It doesn't look like a diverticulitis but a stomach infection to me (however clinical examination is very important)
Go for sonography of abdomen, CBC and stool routine and micro. I know I recommend you investigations everytime but that is necessary when you are not seeing patients clinically.
Please be careful regarding regurgitation of food otherwise he may aspirate it and develop aspiration pneumonia. He needs proper treatment in hospital with injectable antibiotics. Don't wait now. We have tried enough at home now.
Meanwhile you can give him curd, fruit juices, chicken soup etc.
Hope you have understand my concerns. Any further confusions are always welcome.
Don't worry... I am happy to help you.
Thank you.
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
