Dr.Megan Ralf

Positive ANA and Positive Anti-RNP Antibodies negative dsDNA

Q: Positive ANA and Positive Anti-RNP Antibodies while dsDNA is Negative, what do the results mean?

During the time I had my blood work I was on natural detox medication 12 supplements that start from 6 am-7:30 am I was on my 9th day of doing it at about 9 am I went to do this blood test could this have affected my blood test or is it possible I really have a disease

I don’t have any symptoms besides now it feels like I have inflammation in my back and arms.

Below results show

  • ANA: Positive
  • RNP Antibodies: 3.0, a high result when compared to the negative reference 0-0.9
  • Anti-DNA (Ds( Ab: Negative
  • Smith Ab: Negative
  • Sjogren’s anti-SS-A: Negative
  • Sjogren’s anti-SS-B: Negative
  • CRP: Negative
Positive ANA and Positive Anti-RNP Antibodies
cbc and cmp for rnp positive mctd

Answer:

When blood test results show positive ANA antibodies, it means you probably have SLE disease or mixed connective tissue diseases (MCTD), in order to differentiate which autoimmune disease is responsible for ANA elevation you must look to the other results of autoantibodies (include: dsDNA, Sm, RNP, Ro/SSA, and La/SSB), in this case, the ANA and RNP antibodies came positive while the rest of antibodies is negative which means it’s likely you have mixed connective tissue diseases (MCTD).

Having Mixed connective tissue diseases (MCTD) means that you have the features of more than one autoimmune disease at the same time, MCTDs include:

  • Systemic lupus erythematosus
  • Rheumatoid arthritis
  • Polymyositis
  • Dermatomyositis
  • Scleroderma
  • Bacterial infections
  • Idiopathic pulmonary arterial hypertension
  • Primary Raynaud disease

Symptoms change over time which makes it difficult to make differential diagnosis for any CTD disease: It means, patients primarily diagnosed with Mixed connective tissue diseases (MCTD) can go forward with the clinical features of other connective tissue diseases such as Rheumatoid Arthritis, Systemic sclerosis (SSc), Sjogren syndrome, and Systemic lupus erythematosus (SLE), And the opposite can also happen, It means that patients with undifferentiated CTD can turn into MCTD.

However, Positive ANA and Positive RNP antibodies suspect Polymyositis and/or Dermatomyositis by 20% more than other diseases.

Treatments:

MCTD can go on its own with complete resolution in many cases while others can develop life-threatening complications that may include Pulmonary hypertension, Interstitial lung disease, Infections (accelerate atherosclerosis), cardiovascular diseases, and malignancies (side effects of immunosuppressives), as well as the presence of IgG anticardiolipin antibodies.

To make the treatment effective and prevent complications of MCTD you must do an early visit to the rheumatologist and take the treatment early then close follow-up by medical test results, radiological, and clinical findings.

MCTD live expectancy:

According to studies (https://www.ncbi.nlm.nih.gov/), the survival rate for 5 and 10 years after diagnosis was 98% and 96% respectively.

Other Blood Tests To Follow-up MCTD

What blood tests are done for connective tissue disease?

  • A complete blood count: to demonstrate the level of anemia and leukopenia (which is common in more than 70% of MCTD patients)
  • Protein Electrophoresis Test: to demonstrate if there is Hypergammaglobulinemia
  • Erythrocyte sedimentation rate (ESR test): The ESR test results have always seen high in patients with autoimmune diseases
  • Anti-nuclear antibody (ANA) usually is high specifically greater than 1280 and titer speckled pattern in MCTD patients.
  • Anti-U1-RNP: always found high titer in MCTD patients
  • Anti-U1 70kd antibody: MCTD results usually demonstrate high titers.
  • Rheumatoid Factor test: more than half of MCTD patients show high RF test results.
  • Anti-CCP test: About half of MTCD patients have positive anti-CCP
  • Creatine Phosphokinase test (CK, CPK): because MCTD includes myositis, muscle inflammation features, myositis patients usually have high CK levels.
  • The antiphospholipid antibody: to follow-up pulmonary hypertension complications in patients with MCTD.
  • IgG anticardiolipin antibodies: if positive it means the increased severity of the disease.
  • C3 and C4 tests: they called complements and usually seen low in MCTD cases.
  • Urinalysis test: to demonstrate proteinuria which is having excess protein in your urine.

Other immunological markers should be negative in MCTD, including You anti-double-stranded DNA test, anticentromere test, anti-Scl-70 test, and anti-PM-1 test.

In some cases, they show positive VDRL but it should be a false result.

Some definitions in a glance:

ANA stands for antinuclear antibody.

RNP stands for Antibodies to ribonucleoprotein

What Test Shows Why knee Pain When Taking Thyroxine Pills?

Q: My mother takes thyroxine tablets but after many months she feels pain in her knees. how can I solve the reason for knee pain using medical tests?

Answer:

Thyroxine tablets are the treatment for the under-active thyroid gland, a medical condition in which the thyroid gland secretions are lower than the healthy level, also called hypothyroidism in medical terms.

A simple diagram to illustrate how high TSH causes joint and knee pain
A simple diagram to illustrate how high TSH causes joint and knee pain

When the thyroid gland is under-active, the pituitary gland, also called the master gland, will release TSH hormone as normal feedback to stimulate the thyroid gland, and therefore the proteins deposit in the tissues excessively, because the thyroid gland is responsible for the management of proteins, thus these excessive precipitated proteins cause pain in joints and knees.

So that, the joint and knee pain when taking thyroxine-replacement-therapy is not due to the pills themselves, nevertheless, it is due to high TSH levels.

Conclusion:

To know why you have joint and knee pain when on thyroxine treatment you may do thyroid function blood tests (TSH, FT4, and FT3), it might reveal that TSH level is high which can lead to precipitation of proteins and cause pain in joints and knee.

low cd4 count and percentage and high viral load of HIV

What Does High HIV Viral Load and Low CD4 Count Mean?

The short answer is, when HIV viral load is a high number and CD4 result is low, it means that the AIDS virus is working and still destroying your immunity power, as CD4 represents the immunity power and viral load represents the viremia, and below is the detailed information.

  • What are HIV and AIDS?
  • What is Viral Load
  • What is CD4
  • Normal HIV
  • Normal CD4
  • Classification of AIDS based on viral load
  • Case Study example

What does CD4 stand for?

CD4 represents the receptor antigen found on some white blood cells (helper T-Cells), monocytes, and macrophages cells in the human blood, CD4 cells are prone to attack by HIV virus, that’s why “the CDC” used to use CD4 count for determining the immunodeficiency status of the AIDS-infected persons, but not CD4 count alone, because the CD4 count can go down in many diseases other than HIV infections, such as a person on chemotherapy, Herpes virus, pneumonia, or even one have a flu.

“CD4+” is a blood test used for measuring the count and percentile percentage of white blood cells that carry CD4 antigens.

What do HIV and AIDS stand for?

“H” is for Human, “I” is for Immunodeficiency, “V” is for Virus, and therefore the HIV word is a medical short form for the sentence (human immunodeficiency virus), HIV is a virus that attacks the human immune system and can lead to the disease AIDS if not treated, AIDS is a medical short form for the disease (acquired immunodeficiency syndrome).

So that, not all HIV is AIDS but AIDS is necessarily HIV.

HIV 1,2,0 blood test; is a rapid quantitative test that can be done by two drops of the blood at home, two lines results mean positive (i.e. the antibodies to HIV-1, HIV-2, and Subtype O is found in the whole blood, one line (opposite to the letter “C”) always means negative HIV Antibodies result, a negative result means you’re not infected with HIV virus at all or you infected but your body hasn’t produced antibodies to the virus yet which called (window period). Read more about HIV 1,2,0 test

If you’re in the window period, you must retest for HIV after 4 weeks at least. If you need a more accurate HIV test is the nucleic acid test (NAT) which can detect HIV infection 10 to 33 days after HIV exposure. read the list of HIV tests

What does Viral Load stand for?

A viral load test or HIV PCR is the laboratory method of counting HIV virus such as real-time PCR technique so that when a blood test report says a viral load result is 100, it means the count of virus units in your blood is 100, and when viral load result is written “zero” or “below detection limit” or “Negative”, it should mean that your blood has no sufficient viral units to be counted by the PCR instrument.

And Of course, the Viral load (VL) test result strongly predicts the progression to AIDS disease which leads to death and a surrogate marker for the response to ART therapy treatment.

Acute HIV infection is defined as the period after exposure to the virus but before seroconversion.

Seroconversion or the window period is the period during which the body starts producing detectable levels of HIV antibodies. This usually occurs several weeks after initially contracting the virus. During seroconversion, a person may experience flu-like symptoms, such as fever and body aches.

HIV Viral Load Chart (quantitative HIV PCR); HIV-1 RNA:

Below the HIV test chart that shows normal ranges of viral load for untreated patients who are not given medical treatment and those for under-treatment patients:

ConditionNormal Range(copies/mL)HIV Risk
Undetectable viral load,
Untreated Person,
or 1-3 months after treatment
Below 50 Zero
Low-Level Viremia>50-1,0005-30%
Medium-Level Viremia>1,000-10,000>30-50%
High-Level Viremia>10,000-100,000>50-75%
Extreme-high-Level Viremia>100,000>75-100%

ART means anti-retrovirus therapy, a treatment method or regimen for patients with the HIV virus.

LLV stands for Low Level Viremia which refers to two or more consecutive HIV-1 RNA test results at least 50 copies/ml, a person in the LLV classification has an estimated prevalence of between 5 and 30%. Low-level-viremia range is between 50 and 1000 copies/ml during ART According to WHO guidelines. Patients in the LLV range can pass HIV virus to others.

Some guidelines categorize LLV range during Antiretroviral treatment into three subcategories to ease the follow-up process.

Undetectable viral load means that your blood and body fluids don’t have sufficient HIV virus RNA units to progress to AIDS disease or to pass HIV virus to another partner during sex, in other words, you are neither infected nor infectious. So that No, you cannot infect someone if your viral load is undetectable.

Medium and high level viremia means the HIV virus units is between 1,000 – 100,000 copies per mL of blood, which is sufficient to let the HIV virus pass into blood and most of body fluids such as mucus, urine, stool, and semen. Semen infection with HIV viral units let the virus transported during unprotected-sex with a partner and become infectious by a high degree.

Extreme level viremia is any HIV count greater than 100,000 viral copies per mL of blood, this range represents the highest risk to develop AIDS disease and the highest mortality. A person who carries more than 100,000 units of the AIDS virus in his blood must be quarantined as soon as possible because he is in a very contagious state to others and is at great risk of death.

For specialists only, FDA Approved Quantitative HIV-1 (Viral Load) Assays

The below table contains updates from the Association for Molecular Pathology which maintains an up-to-date listing of “FDA Cleared/Approved Molecular Diagnostic Tests.” To access this list, please visit http://amp.org/, under “Resources.”

Below, the table shows the lowest detection limit and the highest detection limits of viral load tests in different kits.

MANUFACTURER TEST Name METHODLINEAR RANGE (copies/mL)
Roche Molecular DiagnosticsAmplicor HIV-1 Monitor RT-PCR 400–750,000 standard
50–100,000 ultrasensitive
BioMerieux, Inc. NuclisensNASBA176–3.47*10^6
Siemens Health Care Diagnostics VERSANT HIV-1 RNA 3.0bDNA375–500,000
Abbott Molecular, Inc. Abbott Real-Time HIV-1Real-time PCR40–10^10

CD4 Normal chart

Below are universal normal ranges, but each laboratory can make its range-chart.

The normal range for a CD4 count is between 400 and 1,600 cells per microliter of blood (uL), it means the AIDS-negative person when do CD4 count must see his result in between these limits.

Normal CD4% is >25%, it means normal person must have more than 25% of the counted cell contain CD4 antigen.

A case study from messages sent to the official Facebook page

In that case, we can find low CD4 count and low CD4 percentile percentage with high-level-viremia more than 150,000 copies of HIV virus, these results present progressive HIV infection which need treatment and quarantine.

CBC test results of the patient show the low total count of white blood cells and low neutrophil cells which is an indicator of low CD4 T cells as well, the low the neutrophil cells the higher the HIV viral load.

Hope that information helps and let me know if you need more information.

snippet of RDW values from a CBC test report

Low RDW in CBC Blood Test Explained

Many blood count tests today write the RDW as a part of the CBC test results, as below picture:

screenshot of low RDW value from a CBC test report

This screenshot of a RDW value in a CBC report shows:

  1. RDW: is a shortcode of the medical term “Red-blood-cell Distribution Width”, RDW represents the degree of variation of the sizes of red blood cells inside human blood, the normal range of RDW is 11.5% up to 14.5%,

The thalassemia trait doesn’t elevate RDW and still be normal, that why the normal RDW doesn’t exclude anemia.

High RDW appears when you have anemia due to iron deficiency, medically (a type of microcytic hypochromic anemia).

  1. The “L” letter beside the RDW value: means “low” as usually represented in the medical reports, Low RDW than the reference limits is medically insignificant because of inaccurate blood cell automatic counting or due to sampling errors or other hidden unattended errors in the procedures, thus why many clinicians don’t rely on RDW values.
  1. The reference range for RDW readings (11.5 – 14.5): doesn’t mean it is normal when your RDW lye inside this range, rather the RDW values within the reference range mean either normal size variation without anemia or means anemia with single size RBCs (i.e. thalassemia).

Does low RDW a valid indicator in diagnosis of anemia?

Should you worry when RDW level is low?

When your RDW value is below the limits, you shouldn’t worry because any tiny error in the testing procedures can result in such a falsely low result and can’t indicate a disease or a medical issue, and it’s beneficial to know that Low RDW value doesn’t necessarily mean that red blood cells are all in the small size, but the normal RDW is a more significant indicator of single size RBCs.

Did you understand yet what does high RDW means?