Miscellaneous
Immunology Report Templates
Andy Nguyen, MD
5/16/2022
1.CSF
CSF
with restriction bands and corresponding bands in serum
There are two faint
restriction bands in the gamma regions with corresponding bands in serum
protein electrophoresis.
CSF protein
electrophoresis results (see pattern description) are suggestive of a systemic
monoclonal gammopathy and spillage of the monoclonal immunoglobulin into the
CSF. Serum protein electrophoresis is suggested if clinically indicated. The
CSF IgG index is elevated indicating that there is an increase in intracerebral
IgG synthesis. There is no indication of increased permeability of the blood
brain barrier based on the CSF/serum albumin ratio.
The electronic medical record has been
reviewed for relevant history.
I have personally reviewed the test results
and concur with the resident's interpretation.
CPT 84166-GC
CSF with increased permeability of the blood
brain barrier
CSF protein electrophoresis did not reveal
evidence of an oligoclonal process in the CNS. The CSF IgG index is within the
reference range indicating that there is no elevation in intracerebral IgG
synthesis. There is also evidence of increased permeability of the blood brain
barrier based on the CSF/serum albumin ratio (in the absence of increase in RBC's in CSF).
The electronic medical record has been
reviewed for relevant history.
I have personally reviewed the test results
and concur with the resident's interpretation.
CPT: 84166-GC
CSF Oligoclonal bands
The CSF protein electrophoresis and
immunofixation revealed presence of two faint oligoclonal bands in the CSF
lane. The CSF IgG index is elevated indicating that there is an increase in
intracerebral IgG synthesis. The CSF/serum albumin ratio is elevated that in
the presence of a significant number of RBCs (281/mm3) is indicative of blood
admixture to the CSF specimen.
The electronic medical record has been
reviewed for relevant history.
These findings in a proper clinical setting
are consistent with the presence on an oligoclonal process involving the CNS.
The electronic medical record has been
reviewed for relevant history.
I have personally reviewed the test results
and concur with the resident's interpretation.
CPT 84166-GC
CSF:
no serum sample sent
CSF protein electrophoresis does not show
an oligoclonal process in the CNS (see pattern description for limitations) but
a concurrent serum sample was not submitted for comparison. For the same reason
the CSF IgG index and the CSF/serum albumin ratio cannot be calculated.
The electronic medical record has been
reviewed for relevant history.
I have personally reviewed the test results
and concur with the resident's interpretation.
CPT: 84166-GC
CSF:
no serum sample sent; high RBC in CSF
CSF protein electrophoresis does not show
an oligoclonal process in the CNS (see pattern description for limitations) but
a concurrent serum sample was not submitted for comparison. For the same reason
the CSF IgG index and the CSF/serum albumin ratio cannot be calculated.
However, the intensity of staining in the CSF lane is most likely due to blood
admixture in CSF specimen (the CSF RBC count is >58,000/mm3).
The electronic medical record has been
reviewed for relevant history.
I have personally reviewed the test results
and concur with the resident's interpretation.
CPT: 84166-GC
CSF: a faint band is noted in the gamma region of
the serum lane with no corresponding band in CSF.
The gel demonstrates appropriate resolution
of the main protein bands. No oligoclonal bands are seen in the gamma region of
the CSF lane. However, a faint band is noted in the gamma region of the serum
lane.
The CSF protein electrophoresis does not
reveal the presence of an oligoclonal process in the CNS. However, a band is
noted in the gamma region of the control serum lane suggestive of a possible
monoclonal gammopathy. Recommend serum and 24-hour immunofixation
electrophoresis for confirmation.
The CSF IgG index is within the reference
range indicating that there is no elevation in intracerebral IgG synthesis.
There is also no evidence of increased permeability of the blood brain barrier
based on the CSF/serum albumin ratio.
The electronic medical record has been
reviewed for relevant medical information.
I have personally reviewed the test results
and concur with the resident's interpretation.
CPT 84166-GC
CSF:
band in CSF with subsequent negative immunofixation
The gel demonstrates appropriate resolution
of the main protein bands. The gamma region shows continuous distribution of
proteins in the serum lane. There is a distinct single band in the CSF lane
with a possible additional constriction with no corresponding bands in the
serum lane.
The intensity of staining of the main
protein fractions in the CSF lane is stronger than usually seen and is
comparable with the intensity of staining in the serum lane.
CSF protein electrophoresis did not reveal
definitive evidence of an oligoclonal process in the CNS. However, in a proper
clinical setting, the described findings (see pattern description) could be
suggestive of an oligoclonal process. Additionally, the distinct band could be
associated with a chronic inflammatory process or,
less likely, with brain plasmacytoma. The CSF IgG index is within the reference
range indicating that there is no elevation in intracerebral IgG synthesis. The
CSF/serum albumin ratio is elevated. In the absence of RBCs in the CSF specimen
(0/mm3), this is consistent with increased permeability of the blood brain
barrier.
The electronic medical record has been
reviewed for relevant history.
I have personally reviewed the test results
and concur with the resident's interpretation.
CPT: 84166-GC
Addendum (xx/xx/xx):
further CSF protein immunofixation shows polyclonal IgG and kappa band. No
evidence of monoclonal gammopathy is found. The findings are supportive of a
chronic inflammatory process.
CSF: one faint monoclonal band in the CSF lane
without corresponding band in the serum lane
The CSF protein electrophoresis revealed
presence of one faint monoclonal band in the CSF lane without corresponding band
in the serum lane. The CSF IgG index is elevated indicating that there is an
increase in intracerebral IgG synthesis. There is no indication of increased
permeability of the blood brain barrier based on the CSF/serum albumin ratio.
Considering these findings, an oligoclonal process involving the CNS cannot be
ruled out. Recommend follow-up with repeated testing at a
later time and clinical correlation.
The electronic medical record has been
reviewed for relevant history.
I have personally reviewed the test results
and concur with the resident's interpretation.
CPT 84166-GC, 86335-GC
CSF-One monoclonal band
The gel demonstrates
appropriate resolution of the main protein bands. One faint band is present in the gamma region
in the CSF lane that is not seen in the serum lane.
The CSF protein
electrophoresis revealed presence of a solitary faint band in the CSF lane
which is not present in the serum lane. The CSF IgG index is mildly elevated
indicating that there is a slight increase in intracerebral IgG synthesis.
There is increase in the CSF/serum albumin ratio indicating increased
permeability of the blood brain barrier. These findings do not fulfill the
criteria for oligoclonal process in the CNS. Clinical correlation is suggested
I have personally
reviewed the test results and concur with the resident's interpretation.
CPT 84166-GC
++++++++++++
2.SPE
SPE with distortion in beta region
Total protein is within
the reference range. Serum protein electrophoresis shows normal distribution of
the main protein fractions except for an increase in beta fraction. A
distortion (0.81 g/dL) in the beta region is identified. This requires further
evaluation by serum and 24-hour urine immunofixation to rule out monoclonal
gammopathy.
The electronic medical
record has been reviewed for relevant history.
I have personally
reviewed the test results and concur with the resident's interpretation.
CPT: 84165-GC
SPE
with distortion in gamma region, normal immunofixation
Serum capillary immunofixation
demonstration an increase in gamma globulin fraction with a distortion of the
gamma region. However, serum immunofixation electrophoresis is negative for
momonoclonal gammopathy (see separate report). Recommend evaluation by 24 hr
urine immunofixation if clinically indicated.
Otherwise, total protein is within the
reference range. Serum protein electrophoresis shows normal albumin level.
Prominent polyclonal hypergammaglobulinemia is present. This could be seen in
chronic inflammation, chronic liver disease, in autoimmune and lymphoproliferative
disorders.
I have personally reviewed the test results
and concur with the resident's interpretation.
CPT 84165-GC
SPE
with distortion in gamma region
Total protein is within reference range.
Serum protein electrophoresis demonstrates mild hypergammaglobulinemia with a
minimal decrease in the albumin fraction and mild beta-gamma bridging. A
distortion is seen in gamma region. A monoclonal gammopathy cannot be ruled
out. This requires further evaluation by
serum and 24-hour urine immunofixation.
Hypergammaglobulinemia could be associated
with chronic inflammation, chronic liver disease, autoimmune and
lymphoproliferative disorders. Presence of beta-gamma bridging is usually seen
in chronic liver disease/liver cirrhosis. Clinical correlation is required.
I have personally reviewed the test results
and concur with the resident's interpretation. `
CPT 84165-GC
SPE
with distortion in gamma region
Capillary electrophoresis demonstrates a
mild distortion of the gamma zone. This requires further evaluation by serum
and 24 hr urine immunofixation to rule out monoclonal gammopathy. As there is
no distinct peak, quantification is not possible.
Total protein level is within the reference
range. Serum protein electrophoresis shows normal distribution of the main
protein fractions.
The electronic medical record has been
reviewed for relevant history.
I have personally reviewed the test results
and concur with the resident's interpretation.
CPT 84165-GC
SPE
with distortion in gamma region
Serum protein electrophoresis shows a
distortion in the gamma region. The polyclonal gamma globulin background is not
suppressed. Recommend serum and urine
immunofixation electrophoresis for further evaluation.
Total protein level is within the reference
range. Serum protein electrophoresis
shows relatively reduced albumin level and alpha-1 globulin fraction. These
findings are otherwise consistent with chronic liver disease, protein loss, and
possible inflammation.
Please submit a 24-hour urine specimen.
I have personally reviewed the test results
and concur with the resident’s interpretation.
CPT: 84165 GC
SPE
with restriction in gamma region
Total protein is within reference range.
Serum protein electrophoresis shows a restriction (0.83 g/dL) in the gamma
region suggestive of monoclonal gammopathy. Recommend serum and urine
immunofixation electrophoresis for further evaluation. Please submit a 24-hour
urine specimen.
I have personally reviewed the test results
and concur with the resident's interpretation.
CPT 84165-GC
SPE with monoclonal band, SIFE with monoclonal
bands
Total protein is within the reference
range. Serum protein electrophoresis shows normal distribution of the main
protein fractions. A monoclonal band (0.33 g/dL) in the gamma region is
identified, suggestive of a monoclonal gammopathy. A corresponding serum
protein immunofixation shows IgG-kappa monoclonal gammopathy (see separate
report).
The electronic medical record has been
reviewed for relevant history.
I have personally reviewed the test results
and concur with the resident's interpretation.
CPT: 84165-GC
SPE with distortion in gamma region
Capillary electrophoresis demonstrates a
distortion of the gamma zone. As there is no distinct peak, quantification is
not possible. This requires further
evaluation by serum and 24 hr urine immunofixation.
Total protein is mildly decreased. Serum
protein electrophoresis shows mildly reduced albumin level with relative
elevation of the alpha-1 and gamma globulin fractions. This electrophoretic
pattern is otherwise consistent with mild protein loss.
The electronic medical record has been
reviewed for relevant history.
I have personally reviewed the test results
and concur with the resident's interpretation.
CPT 84165-GC
SPE: IgM-Kappa with faint IgG-Lambda bands, 66 y/o M
with CLL
Total protein is within
normal limits. Serum protein electrophoresis shows a distinct monoclonal peak
(1.74 g/dL) and a secondary minor peak (0.16 g/dL) in the gamma region
consistent with a monoclonal gammopathy. Serum immunofixation electrophoresis
revealed a predominant monoclonal band of IgM-kappa isotype with secondary
IgG-lambda gammopathy (see separate report). Clinical correlation is
recommended.
I have personally
reviewed the test results and concur with the resident's interpretation.
CPT 84165-GC
SPE: hypogammaglobulinemia in a 78 y/o male
Total protein and albumin levels are within the reference
ranges. A mild decrease in the gamma globulin fraction is present. No
monoclonal bands are identified. Considering the age of the patient,
hypogammaglobulinemia could be an indication of a light chain disease.
Recommend urine protein immunofixation electrophoresis to rule out presence of
Bence Jones proteins. Other causes of hypogammaglobulinemia, including lymphoid
malignancies, have to be considered. Clinical
correlation is required.
Please submit a 24-hour urine specimen.
I have personally
reviewed the test results and concur with the resident's interpretation.
CPT: 84165 GC
SPE: marked hypogammaglobulinemia in a 51 y/o female
with normal serum IFE
Total protein level is
normal. Serum protein electrophoresis shows relatively elevated albumin level
and markedly reduced gamma globulin fraction with a mild distortion of the
gamma distribution curve. The concurrent serum immunofixation study shows
polyclonal distribution of immunoglobulin. However, this requires further
evaluation by 24 hr urine immunofixation to rule out the presence of a light
chain disease. Please submit 24-hour urine for immunofixation studies.
Other causes of
hypogammaglobulinemia, including lymphoid malignancies and/or drug effect, also
need to be considered. Clinical correlation is required.
The electronic medical
record has been reviewed for relevant history.
I have personally
reviewed the test results and concur with the resident's interpretation.
CPT 84165-GC
SPE: Bisalbuminemia
Total protein level is mildly elevated. Serum protein electrophoresis
shows essentially normal distribution of the main protein fractions except for
two bands in the albumin portion. This is consistent with bisalbuminemia
associated with no clinical significance. No monoclonal bands are
detected. Serum protein electrophoresis shows no significant pathologic
changes.
The electronic medical
record has been reviewed for relevant history.
I have personally reviewed the test results and concur with
the resident's interpretation.
CPT 84165-GC
SPE: A prominent Spike suggestive of monoclonal
gammopathy
Total protein is mildly
elevated. Serum protein electrophoresis shows a prominent spike in the gamma
region suggestive of a monoclonal band. The polyclonal gamma globulin
background is significantly suppressed.
Based on the current electrophoretic scan, the concentration of the
spike is approximately 2.83g/dL. Recommend serum and urine immunofixation
electrophoresis for further evaluation.
Please submit a 24-hour
urine specimen
I have personally
reviewed the test results and concur with the resident’s interpretation.
CPT: 84165 GC
SPE:
Slight Distortion in Gamma Region, 14 y/o male
Capillary
electrophoresis demonstrates a slight distortion of the gamma zone. This
requires further evaluation by serum and 24-hour urine immunofixation, although
a monoclonal gammopathy is unlikely in this age group.
Total protein level is
within the reference range. Serum protein electrophoresis shows normal
distribution of the other main protein fractions.
The electronic medical
record has been reviewed for relevant history.
I have personally
reviewed the test results and concur with the resident's interpretation.
CPT 84165-GC
++++++++++++
3.
IFE
sIFE free light chain
Serum immunofixation electrophoresis
results (see pattern description) are suggestive of a possible low level
monoclonal gammopathy of free lambda isotype. The polyclonal gamma globulin background
is not affected. Recommend urine immunofixation electrophoresis for further
investigation.
Please submit a 24-hour urine specimen.
I have personally reviewed the test results
and concur with the resident's interpretation.
CPT 86335-GC
sIFE:
Switching of light chain in B cell lymphoproliferative disorders
The immunofixation electrophoresis results
(see pattern description) are consistent with monoclonal gammopathy of
IgG-lambda isotype. Low intensity of protein staining in other lanes indicates suppression
of synthesis of polyclonal immunoglobulins.
Of note, the patient has history of chronic
lymphocytic leukemia, undergoing chemotherapy treatment. The previous serum
immunofixation electrophoresis on xx/xx/xx showed a monoclonal gammopathy of the
IgG-kappa isotype (report and gel were reviewed). The current serum
immunofixation electrophoresis shows a monoclonal gammopathy of the IgG-lambda
isotype. In light of this discrepancy, a repeated
serum protein immunofixation at a later date is suggested if clinically
indicated. Switching of light chain in B cell lymphoproliferative disorders has
been reported after chemotherapy.
Relevant medical information in the EMR was
reviewed.
I have personally reviewed the test results
and concur with the resident's interpretation.
CPT: 86334-GC
sIFE: IgM-Kappa with faint IgG-Lambda bands, 66 y/o M
with CLL
A prominent monoclonal
band is present in the IgM lane with a corresponding
band in the Kappa light chain lane. There are also three faint bands in the IgG lane with corresponding faint bands in the Lambda lane.
Faint diffusely staining immunoreactivity is present in IgG, IgA
The immunofixation
electrophoresis results (see pattern description) are consistent with a
predominant monoclonal gammopathy of IgM-Kappa isotype. There is also presence
of monoclonal gammopathy of IgG-lambda isotypes at much lower quantity.
Relevant medical
information in the EMR was reviewed.
I have personally
reviewed the test results and concur with the resident's interpretation.
CPT: 86334-GC
sIFE:
possible free lambda light chain
A very faint band is identified in the
lambda lane with no corresponding bands in any of the other lanes. Diffusely
staining immunoreactivity is present in IgG, IgA, IgM, kappa
and lambda lanes in a normal distribution.
Serum immunofixation electrophoresis
results (see pattern description) are suggestive of the presence of free
monoclonal lambda light chains at a very low level. Follow-up of patients with
repeated serum protein immunofixation at a later date is
suggested if clinically indicated.
I have personally reviewed the test results
and concur with the resident's interpretation.
CPT 86335-GC
sIFE-Biclonality
The immunofixation
electrophoresis results (see pattern description) are consistent with bi-clonal
gammopathy IgG-kappa (predominant) and IgG-lambda (faint) isotypes.
Preservation of diffusely staining immunoreactivity indicates that the
production of polyclonal immunoglobulins is not suppressed.
Relevant medical
information in the EMR was reviewed.
I have personally
reviewed the test results and concur with the resident's interpretation.
CPT 86334-GC
sIFE: Very light staining
Light staining present
in IgG and IgM lanes and no staining immunoreactivity is present in the IgA,
kappa, and lambda lanes.
Recommend quantitative
measurement of the serum immunoglobulins to rule out (primary or secondary)
immunodeficiency if clinically indicated.
I have personally
reviewed the test results and concur with the resident's interpretation.
CPT 86334-GC
uIFE:
Constriction in kappa and lambda lanes
Urine immunofixation
electrophoresis revealed spillage of polyclonal immunoglobulins mainly of IgG
and IgA isotypes. The constrictions in kappa and lambda lane may represent
polyclonal light chains due to impaired tubular reabsorption.
Relevant medical
information in the EMR was reviewed.
I have personally
reviewed the test results and concur with the resident's interpretation.
CPT 86335-GC
+++++
4.Hgb
Normal
Hemoglobin electrophoresis
No abnormal hemoglobins are detected;
normal hemoglobin electrophoresis pattern.
The electronic medical record has been
reviewed for relevant history. This patient has microcytic hypochromic anemia.
Differential diagnosis includes iron deficiency and beta thalassemia. Iron
studies are unavailable from the EMR. Please note, iron deficiency may falsely
lower HbA2 levels, thus masking beta thalassemia trait.
I have personally reviewed the test results
and concur with the resident's interpretation.
CPT 83020-GC
Elevated
HgF in pregnancy
No abnormal hemoglobins are detected. A minimal amount of Hgb F is present. Mild
increase in Hgb F has been previously reported in normal pregnancy (Ref).
The electronic medical record has been
reviewed for relevant medical information.
I have personally reviewed the test results and concur
with the resident's interpretation.
Ref: M. Ibrahim et al - Pattern of
HB F Level Rise During Normal Pregnancies - 2009, Hemoglobin, Vol. 33, No. 6:
Pages 534-538
CPT 83020-GC
Elevated HgF
No abnormal hemoglobins are
detected. Hemoglobin F is slightly elevated (1.3%). Slight increases in hemoglobin F concentration are non-specific and may
be found in a variety of unrelated hematologic disorders, such as aplastic
anemia, hereditary spherocytosis, and myeloproliferative disorders. Hb
F is commonly increased to as much as 5% to 10% in normal pregnancy. Slight
elevation in hemoglobin A2 may also occur in hyperthyroidism or when there is
deficiency of vitamin B12 or folate. Clinical correlation is
recommended.
The
electronic medical record has been reviewed for relevant history.
I have
personally reviewed the test results and concur with the resident's
interpretation.
CPT
83020-GC
Normal Hgb with low MCV
No abnormal hemoglobins are detected;
normal hemoglobin electrophoresis pattern.
This patient has microcytic hypochromic
anemia. Differential diagnosis includes iron deficiency and beta thalassemia.
Iron studies are unavailable from the EMR. Please note, iron deficiency may
falsely lower HbA2 levels, thus masking beta thalassemia trait.
I have personally reviewed the test results
and concur with the resident's interpretation.
CPT 83020-GC
Hgb SS, s/p transfusion, small C peak from donor
Per EMR, the patient has a diagnosis of sickle cell disease
(Hb S/S) and was transfused on xx/xx/xx. Hemoglobin electrophoresis results are
consistent with sickle cell disease (Hgb SS) status post transfusion. The current levels of Hb A is
67.7 %, Hb S is 21.6 %, Hb F is 6.9 %, and Hb A2 is 2.5 %.
There is a minor peak in the C region (1.3 %), also seen on
previous hemoglobin electrophoresis, which may be derived from donor and is
clinically insignificant.
The electronic medical record has been
reviewed for relevant history.
I have personally reviewed the test results and concur with
the resident's
interpretation.
CPT 83020-GC
Hgb mild increase in Hgb F
Hemoglobin electrophoresis shows slightly
elevated level of hemoglobin F (1%) and slightly decreased level of hemoglobin
A. No abnormal hemoglobins are detected. An elevated level of hemoglobin F
might be associated with numerous pathologic conditions such as pregnancy,
aplastic anemia, anemia of chronic disease, pernicious anemia, hematologic
malignancies etc. Recommend follow the patient and repeat hemoglobin studies in
6-12 months.
The electronic medical record has been
reviewed for relevant history.
I have personally reviewed the test results
and concur with the resident's interpretation.
CPT 83020-GC
Hgb normal
No abnormal hemoglobins are detected;
normal hemoglobin electrophoresis pattern
The electronic medical record has been
reviewed for relevant history
I have personally reviewed the test results
and concur with the resident's interpretation.
CPT 83020-GC
Hgb normal with microcytic hypochromic anemia
No abnormal hemoglobins are detected;
normal hemoglobin electrophoresis pattern
The electronic medical record has been
reviewed for relevant history. This
patient has microcytic hypochromic anemia. No iron panel is available for
review. Please note, iron deficiency may falsely lower hemoglobin A2 levels,
thus masking beta-thalassemia trait.
I have personally reviewed the test results
and concur with the resident's interpretation.
CPT 83020-GC
Hgb normal with iron deficiency anemia
No abnormal hemoglobins are detected;
normal hemoglobin electrophoresis pattern except decreased hemoglobin A2 level.
The electronic medical record has been
reviewed for relevant history. This
patient has microcytic hypochromic anemia and iron deficiency. Please note,
iron deficiency may falsely lower hemoglobin A2 levels, thus masking
beta-thalassemia trait. Recommend repeat hemoglobin electrophoresis,
if anemia persists after treatment of iron deficiency.
I have personally reviewed the test results
and concur with the resident's interpretation.
CPT 83020-GC
Sickle cell trait vs sickle cell disease s/p
transfusion
Hemoglobin electrophoresis results are
consistent with sickle cell trait (Hb AS), unless the patient has been recently
transfused (as in sickle cell disease, s/p RBC transfusion). Clinical
correlation is suggested.
I have personally reviewed the test results
and concur with the resident's interpretation.
CPT 83020-GC
Hgb SS vs. S/HPFH vs. S/Beta(0)
Hemoglobin electrophoresis shows presence of 67.8% of
hemoglobin S and 25.6% of hemoglobin F. A small fraction of hemoglobin A is
also seen (2.9%). This may be consistent
with the following conditions: homozygous S disease (Hb SS) with hydroxyurea
therapy and remote transfusion, or S/ HPFH (S/hereditary persistence of fetal
hemoglobin) with remote transfusion. S/beta (0) - thalassemia hemoglobinopathy
with remote transfusion also cannot be excluded. Transfusion history as well as
hematological and clinical correlation are necessary for final diagnosis.
The electronic medical record has been
reviewed for relevant history.
I have personally reviewed the test results and concur with
the resident's interpretation.
CPT 83020-GC
Hb S/S with high Hgb F
The patient has a history of sickle cell disease (Hb S/S).
The current level of Hb S is 78.3%, the level of Hb F is 18.8%, and the level
of Hb A2 is 2.9%. Hemoglobin electrophoresis results are consistent with sickle
cell disease. Significantly elevated level of hemoglobin F may be due to either
hydroxyurea treatment or to association of Hb SS with a specific haplotype
known to have high level of hemoglobin F (Arab-Indian,
for example). Hemoglobin S/HPFH, non-deletional form of hereditary persistence
of fetal hemoglobin, is another possibility.
The electronic medical record has been
reviewed for relevant history.
I have personally reviewed the test results
and concur with the resident's interpretation.
CPT 83020-GC
Hgb Electrophoresis: Alpha Thal Trait
No abnormal hemoglobins are detected;
normal hemoglobin electrophoresis pattern.
However, this patient is noted to have
microcytic hypochromic anemia with normal iron studies. These findings are most
suggestive of alpha thalassemia trait.
The electronic medical record has been
reviewed for relevant history.
I have personally reviewed the test results
and concur with the resident's interpretation.
CPT 83020-GC
Hgb SS vs Hgb S/HPFH
The current level of Hb S is 73.3%, the level of Hb F is
24.7%, and the level of Hb A2 is 2.0%. Hemoglobin electrophoresis results are
consistent with either
(a) sickle cell disease (Hgb SS) on hydroxyurea, or
(b) Hgb S/HPFH (heterozygous S/Hereditary persistent Fetal
Hgb)
Clinical correlation is suggested.
I have personally reviewed the test results and concur with
the resident's
interpretation.
CPT 83020-GC
Hgb SS vs Hgb S/HPFH, 1 y/o
The current
level of Hb S is 69.7%, the level of Hb F is 28%, and the level of Hb A2 is
2.3%. Hemoglobin electrophoresis results are consistent with either
(a) sickle
cell disease (Hgb SS) with high HgF in this 1 y/o female
(b) Hgb S/HPFH
(heterozygous S/Hereditary persistent Fetal Hgb)
Repeated
testing in 3-6 months would yield more definitive diagnosis. In sickle cell
disease, Hgb F will decrease as patient grows older. In Hgb S/HPFH, Hgb F will
stay elevated. Clinical correlation is suggested.
I have
personally reviewed the test results and concur with the resident's
interpretation.
CPT 83020-GC
Possible
Alpha Thal Trait
No abnormal hemoglobins are detected;
normal hemoglobin electrophoresis pattern.
The patient is noted to have microcytic
hypochromic red blood cells but with normal iron studies and a normal Hb A2
level. Findings are suggestive of alpha thalassemia trait. Clinical correlation
is required.
The electronic medical record has been
reviewed for relevant history.
I have personally reviewed the test results
and concur with the resident's interpretation.
CPT 83020-GC
Hgb Electrophoresis: cannot r/o Beta Thal trait
No abnormal
hemoglobins are detected. Normal hemoglobin electrophoresis pattern. Per
electronic medical record, this patient’s MCV and MCH are low (72.3 fL and 22.7
pg. respectively), but no iron studies are available for review. Hb A2 levels
may falsely decrease in case of iron deficiency, thus interfere with the
diagnosis of a concurrent beta-thalassemia trait. If the patient has the
condition, recommend to repeat hemoglobin studies six
weeks after correcting the iron status.
The electronic medical record has been
reviewed for relevant history.
I have personally reviewed the test results
and concur with the resident's interpretation.
CPT: 83020-GC
Hgb Electrophoresis: Hgb AS or SS s/p
transfusion, elevated HgF with placental abruption (A 84%, F 2.8%, S 10.4%, A2
2.8%)
Hemoglobin electrophoresis results may
indicate sickle cell trait (Hb AS) after transfusion or sickle cell disease (Hb
SS) after transfusion. Per review of the EMR, the patient was transfused on
7/7/2015. Also, patient has had recent pregnancy with placental abruption which
may cause elevation in Hgb F (2.8%). Recommend repeat hemoglobin studies 3-6 months
after latest transfusion. Clinical correlation necessary.
The electronic medical record has been
reviewed for relevant history.
I have personally reviewed the test results
and concur with the resident's interpretation.
CPT 83020-GC
Hgb Electrophoresis: elevated HgF in pregnancy
(A 95.6%, F 1.9%)
No abnormal hemoglobins are detected. A
slightly decreased level of Hgb A with a mild increase in Hgb F is present.
Mild increase in Hgb F has been previously reported in pregnancy (Ref).
The electronic medical record has been
reviewed for relevant history.
I have personally reviewed the test results
and concur with the resident's interpretation.
Ref: M. Ibrahim et al- Pattern of HB level
rise during normal pregnancies, Hemoglobin, 2009, vol. 33, No.6: pages 534-538
CPT 83020-GC
Hgb A2’
Hemoglobin electrophoresis shows 97.7% of
hemoglobin A, 1.3% of hemoglobin A2. There is a 1.0% peak in zone 1 (by
capillary electrophoresis method) coordinating with 0.9% concentration at
retention time of 4.49 min (by High Performance Liquid Chromatography method).
This is consistent with heterozygous hemoglobin A2 variant (hemoglobin A2'), a
finding of little clinical significance. The summation of hemoglobin A2 and
hemoglobin A2 ' is 2.3%, which is within the reference range. This is an
essentially normal hemoglobin electrophoresis pattern.
The electronic medical record has been
reviewed for relevant medical information.
I have personally reviewed the test results
and concur with the resident's interpretation.
CPT 83020-GC
Hgb: Hgb E disease
Hemoglobin
electrophoresis results are consistent with homozygous hemoglobin E
hemoglobinopathy. Hgb E is at 91.2%.
Elevation of hemoglobin F is usually seen in this condition, which is almost
entirely restricted to individuals of Southeast Asian origin. It is known to be
a benign condition, which might present as a thalassemia minor. Reproductive
counseling is important since double heterozygotes (E/beta-thalassemia) could
develop severe thalassemic disorder.
The electronic medical
record has been reviewed for relevant history.
I have personally
reviewed the test results and concur with the resident's interpretation.
CPT 83020-GC
Hgb: Hgb SS disease with 6.2% Hg A, no Hx of
transfusion available
Hemoglobin electrophoresis results are consistent
with sickle cell disease
(Hgb SS).
The current level of Hb S is 80.0%, the level of Hb F is 10.5%, the
level of Hb A2 is 3.3% and Hb A level is 6.2%. The presence of Hb A is likely
due to previous transfusions, although no recent transfusion history is not
available in the EMR.
The electronic medical
record has been reviewed for relevant history.
I have personally
reviewed the test results and concur with the resident's interpretation.
CPT 83020-GC
Hgb: Hgb D trait or G trait
Hemoglobin
electrophoresis demonstrates 79.9% hemoglobin A and 17.9 % of a variant
hemoglobin. Position of this hemoglobin band on capillary electrophoresis
(between zones 5 and 6), together with HPLC retention time at 4.2 minutes, are
supportive of Hemoglobin D trait. Hemoglobin
G trait is also a possibility. These traits are clinically insignificant.
Clinical and hematological correlation are recommended.
The
electronic medical record has been reviewed for relevant history.
I have
personally reviewed the test results and concur with the resident's
interpretation.
CPT 83020-GC
Hgb: Normal s/p transfusion, small S peak from donor
Per EMR, the patient has a low Hgb of 4.4 was transfused with
5 units of RBCs.
The current levels of Hb A is 93.2
%, Hb A2 is 2.5 %. There is a minor peak in the S region (4.4 %), which may be
derived from donor (Hgb S trait donor) and is clinically insignificant.
The electronic medical record has been
reviewed for relevant history.
I have personally reviewed the test results and concur with
the resident's interpretation.
CPT 83020-GC
Hgb: Alpha Thal trait is a possibility
No abnormal hemoglobins
are detected; normal hemoglobin electrophoresis pattern.
This patient has mild
microcytic hypochromic anemia. Differential diagnosis includes iron deficiency,
anemia of chronic disease, and thalassemia trait. Iron studies are within
normal limits (ruling out iron deficiency anemia, and anemia of chronic
disease). Beta thalassemia trait is also
ruled out with normal Hgb A2. If alpha
thalassemia trait is a clinical consideration, recommend genetic studies to
rule it out if clinically indicated.
The electronic medical
record has been reviewed for relevant history.
I have personally
reviewed the test results and concur with the resident's interpretation.
CPT 83020-GC
Hgb Normal Neonate (15 hrs):
Hemoglobin
electrophoresis shows elevated level of hemoglobin F (73.0%). No abnormal
hemoglobins are detected. An elevated level of hemoglobin F is seen at this age
as a variant of normal.
The electronic medical
record has been reviewed for relevant history.
I have personally
reviewed the test results and concur with the resident's interpretation.
CPT 83020-GC
Hgb: atypical band at zone 12, fresh sample
Hemoglobin
electrophoresis shows presence of 89.4% hemoglobin A, 2.5% hemoglobin A2 and a
significant amount (5.3%) of an unidentified hemoglobin, possibly degraded
hemoglobin A. This abnormal hemoglobin was present in the previous sample
also.
Dr. xxxx's office had
been called on xx/xx/xx and requested to send the fresh blood sample to the
ARUP laboratories for Hemoglobin Evaluation Reflexive Cascade test (Test code:
2005792) for further confirmation. This has not been done and the current
sample is being sent to ARUP for further evaluation.
I have personally reviewed
the test results and concur with the resident's interpretation.
CPT 83020-GC
Hgb: S Trait at 6weeks old (15.6% A, 71% F, 13% S,
0.4% A2)
Hemoglobin electrophoresis
results are consistent with sickle cell trait (Hb AS) unless the patient has
been transfused. An elevated level of
hemoglobin F could be seen at this age (6 weeks old) as normal. However, an
increase in hemoglobin F might be associated with hereditary persistence of
fetal hemoglobin if elevated after one year of age. Recommend follow the
patient and repeat hemoglobin studies when patient is one year old if
clinically indicated.
The electronic medical
record has been reviewed for relevant history.
I have personally
reviewed the test results and concur with the resident's interpretation.
Hb G-Philadelphia trait
Hemoglobin (Hb)
electrophoresis results by capillary method reveals a peak in zone 6 quantified
at 33.2%; The Hb identification by High Performance Liquid Chromatography
(HPLC) shows a G peak eluting at 4.17 minutes with a minor G2 peak at 4.56
minutes consistent with Hb G-Philadelphia variant.
Hemoglobin G
Philadelphia is an alpha globin variant and the most common gene variant in
African Americans, also rarely seen in Chinese or Italians. Hb G-Philadelphia
trait, as seen in this patient, has no clinical of hematological effects. Individuals should be reassured that there
are no clinical problems.
The electronic medical
record has been reviewed for relevant medical information. This patient does
not have a history of blood transfusions.
I have personally
reviewed the test results and concur with the resident's interpretation.
CPT 83020-GC
Sickle
cell disease (Hb SS), status post RBC transfusion vs. Hgb S/beta
(+) thalassemia hemoglobinopathy
Hemoglobin
electrophoresis revealed 76.5% of hemoglobin S, 12.2% of hemoglobin A and 7.7%
of hemoglobin F. The level of hemoglobin A2 is 3.6%. Per electronic medical
record, this patient has sickle cell disease recently admitted with acute pain
crisis and his MCV, MCH, RBC, and Hgb are low (77.9 fL, 26.9 pg, 3.31/mm3, and
8.9 respectively). Considering this
information and the CBC results the most likely diagnosis is homozygous cannot
be completely ruled out. Hematological and clinical correlation is necessary.
The electronic medical
record has been reviewed for relevant medical information.
I have personally
reviewed the test results and concur with the resident's interpretation.
CPT 83020-GC
Hb SS on a chronic transfusion protocol vs. a sickle
cell trait individual massively transfused vs. a person recently transfused
with blood products containing Hgb S
Hemoglobin studies
revealed presence of 9.7% of hemoglobin S. She was recently admitted for acute
on chronic anemia (Hgb 5.6) and was transfused 2 units of pRBC's on 7/12/2016.
She has no history of sickle cell disease per EMR. This low level of hemoglobin S could be seen
either (a) in a patient with sickle cell disease (Hb SS) on a chronic
transfusion protocol, not the case in the patient, (b) in a sickle cell trait
individual massively transfused for any other cause, or (c) in a person who was
recently transfused with blood products containing Hgb S (such as donors with S
trait who are eligible to donate blood). Clinical correlation is suggested.
The electronic medical
record has been reviewed for relevant medical information.
I have personally
reviewed the test results and concur with the resident's interpretation.
CPT 83020-GC
Sickle cell disease (Hb
SS) status post transfusion/exchange or on a chronic exchange
Hemoglobin electrophoresis shows presence of 2.9%
of Hb S, 94.3% of Hb A, and 2.8% of Hb A2. Per EMR the patient has known
history of sickle cell disease (Hb SS) s/p stroke who is on chronic RBC
exchange treatment and has undergone RBC exchange with 8 units of PRBC on
7/13/16. This result is consistent with sickle cell disease (Hb SS) status post
transfusion/exchange or on a chronic exchange regiment. This is the post RBC
exchange sample.
The electronic medical
record has been reviewed for relevant history.
I have personally reviewed
the test results and concur with the resident's interpretation.
CPT 83020-GC
An
unidentified hemoglobin, located between zone 6 and zone 7 in capillary
electrophoresis.
Hemoglobin
electrophoresis shows presence of 79% hemoglobin A, 2.8% hemoglobin A2 and a
significant amount (18.2%) of an unidentified hemoglobin, located between zone
6 and zone 7 in capillary electrophoresis.
HPLC study picks up only 1.1% Hgb F in this 6-month-old male who had
abnormal newborn screen with unknown hemoglobin.
To further work up this
case, please send a fresh blood sample to the ARUP laboratories for Hemoglobin
Evaluation Reflexive Cascade test (Test code: 2005792) for further
confirmation.
I have personally
reviewed the test results and concur with the resident's interpretation.
CPT 83020-GC
Sickle
cell trait (Hb AS).
Hemoglobin
electrophoresis results show the possibility of sickle cell trait (Hb AS), or
sickle cell disease (Hb SS) with recent transfusion. According to EMR the
patient has never received PRBSs. Therefore, the Hemoglobin electrophoresis is
more consistent with sickle cell trait (Hb AS). Clinical correlation is
suggested.
The electronic medical
record has been reviewed for relevant history.
I have personally
reviewed the test results and concur with the resident's interpretation.
CPT 83020-GC
ADDENDUM to send for Hemoglobin Evaluation Reflexive
Cascade test
We were contacted by
patient's hematology attending (Dr. xxxx) who would like to rule out Hgb S
variants (such as S-Antilles) that would need more advanced testing techniques
for detection. We suggested to Dr. xxxx to send sample to ARUP with specific
order:
"Please send to
ARUP laboratories for Hemoglobin Evaluation Reflexive Cascade test (Test code:
2005792) to rule out Hgb S Antilles or other Hgb S variants"
The immunofixation
electrophoresis results (see pattern description) shows a faint constriction in
the Ig A heavy chain lane with a corresponding faint constriction in kappa
light chain lane. Preservation of diffusely staining immunoreactivity indicates
that the production of polyclonal immunoglobulins is not suppressed. Recommend
repeat the serum immunofixation electrophoresis in 3-6 months to rule out a
low-level IgA-kappa monoclonal gammopathy
Relevant medical
information in the EMR was reviewed.
I have personally
reviewed the test results and concur with the resident's interpretation.
CPT 86334-GC
Hgb S/beta-(0)
thalassemia on Hydrea vs Hgb S/HPFH
The patient has a history of sickle cell
disease. Current hemoglobin study
results reveal
Hgb S of 64.3%, Hgb F of 30.1%, and Hgb A2 of
5.6%. The CBC shows MCV 69.4 fL, MCH 22.8 pg, RBC 5.43. Considering these
results, Hgb S/beta-(0) thalassemia is the most likely diagnosis. This is a
sickling disorder. Knowledge of concurrent beta-thalassemia trait is important
for future reproductive counseling. The high level of Hgb F is likely secondary
to hydroxyurea treatment. If this patient is not on such treatment,
heterozygous Hgb S and Hereditary Persistent Fetal Hemoglobin (Hgb S/HPFH) is a
consideration. Clinical correlation is suggested.
The electronic medical
record has been reviewed for relevant medical information.
I have personally reviewed the test results and
concur with the resident's interpretation.
CPT 83020-GC
Hgb SS with elevated
HgF at 6 months old
Hemoglobin electrophoresis
results are most consistent with sickle cell disease (Hgb SS). The current level of Hb S is 63.9%, the level
of Hb F is 34.3%, and the level of Hb A2 is 1.8%. The elevated HgF is associated with patient's age (6 months old). A
repeated Hgb electrophoresis is suggested at 1 year of age for baseline.
I have
personally reviewed the test results and concur with the resident's
interpretation.
CPT 83020-GC
Delta-beta
thalassemia trait
No abnormal hemoglobins
are detected. Hb F is high (10.9%) with normal level of other hemoglobins. Per electronic medical record, this patient’s
MCV and MCH are low (66.2 fL and 22.0 pg.
respectively). The findings are most supportive of delta-beta thalassemia
trait.
The electronic medical record has
been reviewed for relevant history.
I have personally reviewed the test
results and concur with the resident's interpretation.
CPT: 83020-GC
Sickle cell trait (Hb AS) at 2 week-old
Hemoglobin electrophoresis revealed 4.4 % of hemoglobin S,
5.1% of hemoglobin A and 90.5% of hemoglobin F.
Hemoglobin electrophoresis results are most consistent
with sickle cell trait (Hb AS) unless the patient has been
transfused. An elevated level of hemoglobin F could be seen at this
age (2 weeks old) as normal. However, an increase in hemoglobin F might be associated
with hereditary persistence of fetal hemoglobin if elevated after one year of
age. Recommend follow the patient and repeat hemoglobin studies when patient is
one year old if clinically indicated.
The electronic medical record has been reviewed
for relevant history.
I have personally reviewed the test results and
concur with the resident's interpretation.
CPT 83020-GC
Hemoglobin
SG
Hemoglobin studies
(capillary electrophoresis and HPLC) detected two abnormal hemoglobins:
HbS and HbG-Philadelphia.
They revealed presence of 28.0% of hemoglobin S,
10.0% of hemoglobin G, 7.8% hemoglobin S/G, 0.8% hemoglobin G2, and 65.0% of
hemoglobin A. According to the EMR, the patient had no recent RBC transfusions
and had a history of anemia of unknown etiology. Considering this information,
the findings are consistent with Hemoglobin SG.
HbG-Philadelphia
is the most commonly occurring
hemoglobin caused by alpha-chain mutation. It is a stable, normally
functioning hemoglobin not associated with any hematological abnormalities.
Thus, hemoglobin SG, a combination of HbS and HbG presents
clinically as a sickle cell trait.
Medical records were
reviewed for relevant clinical and laboratory information.
I have personally reviewed the test results
and concur with the resident's Interpretation.
CPT 83020-GC
5 week old
female with HgF 99.8 %, Hgb A2 0.2%
No abnormal hemoglobins are detected. Hemoglobin F is elevated at
99.8%. No Hb A is present. These findings raise the possibility of several
differential diagnoses:
1. Beta thalassemia
major
2. Homozygous HPFH
3. Homozygous delta
beta thalassemia
4. Double
heterozygous state of beta thalassemia and delta beta thalassemia
Clinical correlation
is required. Recommend repeat hemoglobin electrophoresis at 6 months of age for
confirmation.
The electronic
medical record has been reviewed for relevant medical information.
I have personally
reviewed the test results and concur with the resident's interpretation
CPT: 83020-GC
Hgb
H disease
Capillary hemoglobin
electrophoresis shows Hgb H (zone 15) at 11.9%, Hgb A at 82.4%, Hgb F at 0.4%,
Hgb A2 at 0.9%. Additionally
there is a small peak in zone 2 at 4.4% which may represent Hgb Constant Spring
or Hgb C from RBC donors in previous RBC transfusion.
This patient is a 24
y/o Asian female who has microcytic hypochromic anemia. Patient had had a
history of transfusion due to anemia. The overall findings are most consistent
with Hgb H disease (alpha thalassemia major). Genetic testing is suggested if
clinically indicated.
I have personally
reviewed the test results and concur with the resident's interpretation.
CPT 83020-GC
Hgb
Lepore
Hemoglobin electrophoresis demonstrates 80.3% hemoglobin A,
8.5% hemoglobin F, and 8.7 % of a variant hemoglobin. Position of this
hemoglobin band on capillary electrophoresis (in zone 6), together with HPLC
retention time at 3.7 minutes, are supportive of Hemoglobin Lepore. Genetic
testing for confirmation is suggested.
The electronic medical record has been reviewed for
relevant history.
I have personally reviewed the test results and concur with
the resident's interpretation.
CPT 83020-GC