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How common are lab mistakes
My liver specialist called me tonight to go thro all my last labs with me and he said that they still look fine. I am still ACUTE!!!!!!!!!!!!!!!!! Geez I am gonna be the first ever permanent ACUTE Hepb patient in history! However doc did say that my last labs indicated that my HBV DNA had reduced to UND in just 3 weeks from 14000. He said he thought this was more than likely a lab mistake and as a result of this rather superb result, he had asked the lab to recheck....boohooo. So my question is - how common are such mistakes? AND what can I do to the little white-coated lab guy who made this mistake?
Brit
Brit
Quite so! I tried to donate blood... and they said "your blood is no good". I then dropped the idea of donating organs too (donating much much later, I mean) :-)
Diabetes is one crazy disorder! Considering how many things in the body it screws around with, I won't be surprised if it has an effect on the progression of HepB too. Are you insulin dependent?
By the way, pegasys does not come in tablet form: it is injected once a week for a year. The most powerful meds for HepB... but comes with a huge list of likely side-effects, very expensive, and cannot be given life-long (like other HepB meds) because it is too dangerous to do so.
Some people who go HBeAg negative go back positive after a while. This could happen to you and/or to me. I suppose that is why your doc put you on Tenfovir after a while - to be on the safer side.
Diabetes is one crazy disorder! Considering how many things in the body it screws around with, I won't be surprised if it has an effect on the progression of HepB too. Are you insulin dependent?
By the way, pegasys does not come in tablet form: it is injected once a week for a year. The most powerful meds for HepB... but comes with a huge list of likely side-effects, very expensive, and cannot be given life-long (like other HepB meds) because it is too dangerous to do so.
Some people who go HBeAg negative go back positive after a while. This could happen to you and/or to me. I suppose that is why your doc put you on Tenfovir after a while - to be on the safer side.
Sounds like the tabs did their work really quickly! Just a year or so and you got to UND - well done you!
I am on Tenofovir. Doc has put me on them to see if they can finish off the clearing out of the virus. I am not hopeful about getting rid of the virus and have now gotten used to the fact that I am gonna have this for life.
Before starting meds I managed to get to the following results:
I got my HBsAg down to 0.1
HBe antigen negative
Anti-HBe positive
HBV DNA down to possible UND (needs to be re-checked)
So looked like I was getting rid of virus...but then it just stopped. My immune system would not clear the final bits. That's why I am on Tenofovir. Doc thinks maybe as a result of my diabetes, I may need longer to clear than 6 months. To be honest I am so fewd up with the waiting, that I am just gonna thik of myself as positive and anything else will just be a wonderful suprise!!! lol.
How did you manage to find out you had this virus? Was it just as a result of a routine blood test? Lucky you found out eh?
Brit
I am on Tenofovir. Doc has put me on them to see if they can finish off the clearing out of the virus. I am not hopeful about getting rid of the virus and have now gotten used to the fact that I am gonna have this for life.
Before starting meds I managed to get to the following results:
I got my HBsAg down to 0.1
HBe antigen negative
Anti-HBe positive
HBV DNA down to possible UND (needs to be re-checked)
So looked like I was getting rid of virus...but then it just stopped. My immune system would not clear the final bits. That's why I am on Tenofovir. Doc thinks maybe as a result of my diabetes, I may need longer to clear than 6 months. To be honest I am so fewd up with the waiting, that I am just gonna thik of myself as positive and anything else will just be a wonderful suprise!!! lol.
How did you manage to find out you had this virus? Was it just as a result of a routine blood test? Lucky you found out eh?
Brit
Me? I'll copy/paste the background info from my profile :-).
==>
Infected with HBV, probably as a kid. Detect in Jan 2008. HBsAg+, HBeAg+, Baseline HBV viral load ~ 4,000,000 copies/ml, Genotype D.
On Pegasys between April 2008 and April 2009. Current HBV viral load below detectable levels. Now HBsAg+, HBeAg-.
==<
Since the pegasys seems to have had some effect, I'm not on any meds now. My doctor and I both think that the best course of action is to wait and watch.
Coming back to your genotype: I think it is quite unlikely that your doc would know your genotype - this test is as expensive as the VL test, and is a completely different test. I mean... you will not know the result as a component of some other test. I mean... like in the LFT, you get to know so many other things... there is no test where you find out the genotype as one of the components of the result.
What tabs are you on?
==>
Infected with HBV, probably as a kid. Detect in Jan 2008. HBsAg+, HBeAg+, Baseline HBV viral load ~ 4,000,000 copies/ml, Genotype D.
On Pegasys between April 2008 and April 2009. Current HBV viral load below detectable levels. Now HBsAg+, HBeAg-.
==<
Since the pegasys seems to have had some effect, I'm not on any meds now. My doctor and I both think that the best course of action is to wait and watch.
Coming back to your genotype: I think it is quite unlikely that your doc would know your genotype - this test is as expensive as the VL test, and is a completely different test. I mean... you will not know the result as a component of some other test. I mean... like in the LFT, you get to know so many other things... there is no test where you find out the genotype as one of the components of the result.
What tabs are you on?
who knows what the story is with this virus? I was told 9 months ago that I was going to without any doubt clear this virus, next thing I know I haven't and I am being called in and put on tabs, yet still NOT classed as chronic. I have decided just to let the doc make all my decisions as I know so little about this virus. Maybe he has knowledge of my genotype but doesn't think there's any point in telling me this info? How are you keeping sharp. How long have you been on your meds for? Have they worked for you? What's your status with HBV?
Brit
Brit
I guess that he has not asked for a genotype test because the course of action is the same regardless of genotype -- the same medicines, the same dosages, etc. Genotype testing may help understand your situation better, and get a more accurate estimate about the outcome, etc., but it is not going to help you decide what to do.
All this is my guess, based on what I have learnt. I am not trying to speak for your doctor :-)
All this is my guess, based on what I have learnt. I am not trying to speak for your doctor :-)
My doc hasn't mentioned anything about genotype to me. Maybe coz he is still hoping I might clear this?? I dunno. Its something I will mention at next appt.
Brit
Brit
The first article I linked to says "Because of a distinct mechanism of precore and core
promoter mutations in regulating HBeAg synthesis [29], the time during which HBeAg seroconversion takes place accompanied by active liver disease is short in the individuals with genotype B infection, while it is long in those with genotype C infection. Thus, hepatitis persists longer in individuals infected with genotype C than B..."
Honestly, I don't know how short "short" is and how long "long" is, but I suppose this is a good starting point to find out more.
promoter mutations in regulating HBeAg synthesis [29], the time during which HBeAg seroconversion takes place accompanied by active liver disease is short in the individuals with genotype B infection, while it is long in those with genotype C infection. Thus, hepatitis persists longer in individuals infected with genotype C than B..."
Honestly, I don't know how short "short" is and how long "long" is, but I suppose this is a good starting point to find out more.
Loosely, you can think of the various genotypes of the HBV as variants of the virus.
The article at http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowPDF&ArtikelNr=74988&ProduktNr=224031&filename=74988.pdf talks about genotypes in great detail. You may want to skim it to get the idea.
Some articles at [ http://www.hivandhepatitis.com/hep_b/news/genotypes.html ] demonstrate a correlation between the genotype and the progression of the disease and/or the effectiveness of medication, etc.
I asked because you have been acute for such a long time... and I was wondering if it had something to do with your HBV genotype.
The article at http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowPDF&ArtikelNr=74988&ProduktNr=224031&filename=74988.pdf talks about genotypes in great detail. You may want to skim it to get the idea.
Some articles at [ http://www.hivandhepatitis.com/hep_b/news/genotypes.html ] demonstrate a correlation between the genotype and the progression of the disease and/or the effectiveness of medication, etc.
I asked because you have been acute for such a long time... and I was wondering if it had something to do with your HBV genotype.
I don't know anything about genotype. What does that do? What difference does a certain Genotype mean?
Brit
Brit
It was interesting for me to learn about your system. Thanks!
By the way, what's your HBV genotype?
By the way, what's your HBV genotype?
NHS is our health service. It's paid from the nation's taxes. So we get it all 'free'. But in fact we have really paid into it all our lives through taxation. But when you are ill it means all tests, care etc is free.
My doctor has already put in for a 're-check' of my HBV DNA. He said that he would maybe expect it to be a little lower but not UND. Each time tho that I ask him, 'Look am I not chronic by now' he keeps saying no. He says my case is a most unusual one that he has only ever seen once before and has put it down to me being diabetic. He still expects me to clear the virus!!!!!! I don't know how. But I will keep with his idea another few weeks and then I am just gonna start thinking of myself as chronic. I cannot stand this flaming waiting game.
I hate my immune system for being so cruel and wicked by dragging this out like this.
I have real faith in my doc and he has so far been totally superb. Iknow I am in good hands. But the lab mistake thing is a bummer for sure.
Brit
My doctor has already put in for a 're-check' of my HBV DNA. He said that he would maybe expect it to be a little lower but not UND. Each time tho that I ask him, 'Look am I not chronic by now' he keeps saying no. He says my case is a most unusual one that he has only ever seen once before and has put it down to me being diabetic. He still expects me to clear the virus!!!!!! I don't know how. But I will keep with his idea another few weeks and then I am just gonna start thinking of myself as chronic. I cannot stand this flaming waiting game.
I hate my immune system for being so cruel and wicked by dragging this out like this.
I have real faith in my doc and he has so far been totally superb. Iknow I am in good hands. But the lab mistake thing is a bummer for sure.
Brit
Yes! that would be a lot of fun :-).
I don't quite understand this NHS business... can you get the VL load at another lab? Would that be too expensive? A HBV DNA VL test costs about USD100 to USD150 in India. How much is it there?
I don't quite understand this NHS business... can you get the VL load at another lab? Would that be too expensive? A HBV DNA VL test costs about USD100 to USD150 in India. How much is it there?
Thanks sharp. I am peed off that the great result is prolly not correct but hey ho that's life. I am from UK so I can't demand refunds or even complain coz the NHS is actually really quite fantastic and care is very good. But you are right there is always a chance that things can get srewed up. But hey you kow what if they made THAT mistake then MAYBE they made a huge mistake back in August and maybe....I was NOT even HBsAG +ve to begin with?????? lol What do ya think?
Brit
Brit
How common are they? Depends! Over the last one year, I too have seen various kinds of errors. Once, one of the labs reported that my VL is so high that it is beyond measurable range! Once, when I added up all the % components of a CBC, it exceeded 100%. And other such errors.
As a general rule, I recommend:
* If you have a reason to suspect the first test, retest at another place.
* Some tests are done entirely on computerized equipment, and the machine prints out the results on a slip of paper. I have seen that lab technicians then look at the results and enter it into the lab's formal report template. I have seen them screwing up when reading the slip and writing into their formal report. Insist on the computer slip, wherever possible - that way you will also get to know what time your blood sample was fed to the computer - sometimes this helps in finding out if the sample was taken from you.
* If the new re-test result does not match the old result, as the first lab for another free retest or a refund.
"what can I do to the little white-coated lab guy who made this mistake?"
I suppose it is only human to make mistakes once in a while. If I am confident that the lab workers are diligent, there is nothing much I would do - just inform them about their mistake, and they will be more careful the next time. If I think they are careless, I ask for a refund and never visit the lab again, and tell all my friends about how screwed up they are (not in writing!). If you are the socially active type, I suppose you can even sue them or report them to the health board. Personally, I would do that only if I believe that they are largely screwed up and that is going to put lives of their customers at stake.
As a general rule, I recommend:
* If you have a reason to suspect the first test, retest at another place.
* Some tests are done entirely on computerized equipment, and the machine prints out the results on a slip of paper. I have seen that lab technicians then look at the results and enter it into the lab's formal report template. I have seen them screwing up when reading the slip and writing into their formal report. Insist on the computer slip, wherever possible - that way you will also get to know what time your blood sample was fed to the computer - sometimes this helps in finding out if the sample was taken from you.
* If the new re-test result does not match the old result, as the first lab for another free retest or a refund.
"what can I do to the little white-coated lab guy who made this mistake?"
I suppose it is only human to make mistakes once in a while. If I am confident that the lab workers are diligent, there is nothing much I would do - just inform them about their mistake, and they will be more careful the next time. If I think they are careless, I ask for a refund and never visit the lab again, and tell all my friends about how screwed up they are (not in writing!). If you are the socially active type, I suppose you can even sue them or report them to the health board. Personally, I would do that only if I believe that they are largely screwed up and that is going to put lives of their customers at stake.
bberry the UND came before I went on the meds. Hew took blood then sent me away with pills tot start that day. When that lab result came in it said UND. He says he thinks its a lab mistake but if it wasnt then he would be ecstatic. He really doesn't know what's happening. He says everything else in bloods indicating still being in clearing phase. But you are right I am long time now. But would the taking of meds not slow down the clearing phase now?
Brit
Brit
not sure if i remember but did the UND reading come after you'd started your meds?
i know you did blood work and i also know your doc had you on meds as well..did the blood work take place after you starting taking the pills or not ?
10 months is pretty long to stay acute. not being a pessimist but i'd check the facts with my doc if i were you..ask to him him and make sure you ask a lot of questions as well..he gets paid for his time by the way
good luck brit
i know you did blood work and i also know your doc had you on meds as well..did the blood work take place after you starting taking the pills or not ?
10 months is pretty long to stay acute. not being a pessimist but i'd check the facts with my doc if i were you..ask to him him and make sure you ask a lot of questions as well..he gets paid for his time by the way
good luck brit
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