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209591 tn?1267414714

Is it normal to have bloodwork done during/after LP

The hospital that I had the lumbar puncture at just called me, keep in mind it is 10 pm, asking me to come back to have some blood work done.  I live in a whole different county and cannot make it tonight, so she said that I could come as early as 7:30 in the morning.  I have had an LP before, and I know for sure that I did not have to have a sample done then.  Is it normal procedure to have bloodwork done with an LP?  I already have an appointment scheduled about 90 miles the other way for Vestibular Therapy, but I am so concerned now, I am considering cancelling that and heading straight over there in the morning.  She also stated that they had been trying to call me all day, and I did see it on my caller ID..This time, she actually called from her cell phone, which scares me even more.  Should I be concerned....

My Neurologist ordered  them to look for the opening pressure, cell count, differential, glucose, protein, IgG index, Oliogoclonal Bands Serum, and Albumin.  He again is searching for MS and anything inflammatory.

All I heard during the test to give me any clue of the results was that the opening pressure was 60.  What is the norm?



Some background:

I am 27 and have been experiencing Neurological symptoms for a little over three years now.  I started seeing a Neurologist three years ago, actually today, and he has been NO GOOD.  MATTER OF FACT JUST A YEAR AGO HE STARTED TREATING THE MIGRAINES HE KNEW I HAD, FROM DAY ONE.  My first symptoms were numbness and tingling in my extremities that appeared in my left leg, but slowly spread to the rest of my body.  I found out about a year later from my Rheumatologist that it was actually Neuropathy, Restless Leg Syndrome as well as Myoclonus all of which are considered Neurological.  
     stiffness, major fatigue, depression, major headaches, spasticity, spasms, myoclonus, restless leg, tingling in head and extremities, vibration sensations, buzzing sensations when moving head from time to time, anxiety, major cognitive dysfunction, sleeping dysfunctions, inability to feel and recognize touches unless they are visual, muscle weakness – especially in extremities, extra tension in arms and legs with usage, chronic indigestion, walking (I have a gait), constant state of tiredness – inability to complete most tasks – moving or lifting items, exercising, walking, carrying grocery, brushing hair, etc
     To make the situation worse on October 28th I woke up and the room was spinning and has been since.  As soon as my Neurologist's office opened I called and informed them of the fact that I was unable to walk with out running into items or falling completely down.  The nurse told me to lie down immediately and to do nothing until she called back.  When she called back, she told me to either go straight to the ER or come there.  I was told that I was suffering from Vertigo.  Unfortunately he has done no testing, just continued to take me off of medication the last few months, which has not helped.
    My Rheumatologist last month looked in my ear and noticed that my eardrum was swollen remarkably on the right side so decided to send me to my ENT.  He also decided before the appointment to prescribe two weeks of high dose prednisone 4 5mg tablets in the am, and 4 at night as well as two 600 mg antibiotics daily for two weeks.  This helped the eardrum go down as well as the apparent ear infection I had at the time.  The ENT said that it could have made the Vertigo worse, but was not the main cause, and in turn sent me for an MRI with and w/o contrast and well as Vestibular PT.  I had already done the Vestibular PT eval just 6 weeks in advance.
     This time the results were much worse she said, she didn't give me the results from the first time.  This time though when she scored me standing still and doing a few different exercises I scored only 13 out of 24.  When she scored me for gait it was 8 out of 24, so both are pretty poor.  She said that she hasn't seen it get that bad that quickly.   Now I am facing life using a walker, my Vestibular Therapist ordered a walker this past Friday, and is hoping to keep it at just a walker.
    We are unsure as to what is causing the Vertigo, I had several MRIs before years ago searching for MS, as well as a LP, a Evoked Potential and all came back normal.  This MRI came back normal as well.  Everyone seems to think the cause of the Vertigo still is Neurological, just not sure why, I am firing my current Neurologist though.  But cannot get into another one for a few months.
   My latest ENG, March 16th, showed an abnormality in my right ear.  My new Neurologist wants to state that this is the cause of the Vertigo.  Keep in mind my very first ENG in November was normal, could this be possible?  My Vertigo actually started in October?
Best Answer
572651 tn?1530999357
Sorry I'm too tired to read all of this tonight but

YES YOU MUST HAVE BLOOD WORK DONE at the SAME TIME AS THE LP otherwise the spinal fluid count of o-bands is useless.  What they are looking for it the difference in numbers between how many o-bands are in your blood versus how many are in your spinal fluid.  The excess number in your CSF is a marker for MS.

If you don't get the blood work done in a timely manner, it will make your CSF useless for o-band testing.

don't skip this important step.
Lu
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1221035 tn?1301000508
It is normal to have blood drawn at the same time as an LP.

When checking for Oliogoclonal Bands, they compare the bands in the blood to the ones in the CSF.....and only if there are ones that show up in the CSF that are not in the blood are the ones the count toward diagnosis.

So, yes....they need your blood sample to compare.

Best of Luck!
Helpful - 0
209591 tn?1267414714
So in your opinion, I should skip my other appointment, and go straight to the hospital..Would 2 hours make a difference?
Helpful - 0
572651 tn?1530999357
Yes, there is a certain window of time that the blood serum sample should be taken in comparison to the CSF.  sorry, but going there first is top priority unless you want to do the LP again. Maybe the VT can be done later in the day?   -L
Helpful - 0
209591 tn?1267414714
Ok, I will head there in the morning..Maybe even before vestibular therapy.
Helpful - 0
Avatar universal
Hi

My blood was ment to be taken at the same time but it was done 4 hours later..the doctor said that was ok...

Seemed to me that i4 hours would have made a difference

Steve
Helpful - 0
209591 tn?1267414714
I skipped VT this morning and went straight to the hospital in order to have the bloodwork done.  Gonna lie down, have some severe pain in my back, that just wasn't present the last time I had this procedure done.  I am starting to really regret having it done.
Helpful - 0
209591 tn?1267414714
We (the doctors office and I) are still awaiting the results of the lumbar puntuce.  I called Friday to see what was holding them up and they said that they had heard nothing from the hospital either.  So, the nurse called and was told that they had only received the results of the protein and albumin, and as soon as they received them all they would forward it to the doctor's office.  Do they know how hard it is on a person to wait for results?  Its been about to kill me...
Helpful - 0
572651 tn?1530999357
I hate to tell you but the LP results for the o-bands can take up to 2-3 weeks, depending on what lab is doing the work.  It is often shipped out to a lab because there are few places that do this type of work.  And it takes a while to *cook* the samples for the results.

Patience is so hard when it is your own health - hang in there.

Lulu
Helpful - 0
209591 tn?1267414714
Well the doctors office finally got my labs from my LP in today, but would not give them to me over the phone...I do have an appointment tomorrow, this will actually be my third appointment tomorrow...I am already tired thinking about it...Oh, I am getting nervous just thinking about it.
Helpful - 0
209591 tn?1267414714
Well last Tuesday I did go to see my Neurologist, and as always was greatly disappointed with my appointment with him.  My day had already not been going to great.  First of all, this was my third appointment for the day, so I was extremely tired.  While leaving the second doctor's office and going to my car, due to my unsteadiness, gait and Vertigo I had an accident and wound up on the pvement next to my quite quickly.  I didn't even have time to react, to even try to correct it...needless to say a week later and the pain is persisten, and it looks as though I have actually fractured my elbow...And seriously skinned up my other arm.  Keep in mind this is all before my appointment with my Neurologist, maybe 20 minutes before...Well, because I was bleeding profusely I had to go get some bandaids and then I went straight to his office.  By that time I had already bled through one bandaid, that is how serious the accident was...I get back there, the nurse states that they do have some of the results in from the LP but not all...This clues me in, and I started to say that I would cancel my appointment and see him on another day, because he is such an IDIOT...but I digress...Against my better judgment I did see him...Needless to say he couldn't read the results, he was unable to tell me how the pressure was read, when I asked what normal pressure was...He did state that mine was 70 and that is all he stated...Stated that he thinks that MCG which is the Medical College of Georgia would be a better fit for me, my dog lol could diagnose better..I believe...I am so frustrated..But then despite the fall, the blood, the pain, he decides to see me PRN..I have decided not to see him EVER, and I mean EVER again.  ANY suggestions?
Helpful - 0
560501 tn?1383612740

  WOW!  That was quite a nasty fall.
      I agree w/ you in finding different Neuro as this one is a bit...Well......You Know!
Make sure and get all your test results as well as medical records from his office
to take w/ you when you do go to another Neuro...Is there an MS Neuro around your area?

Good Luck,
~Tonya
Helpful - 0
1312898 tn?1314568133
Hi, it sounds like you have really been through the wringer with all of this!!

The one thing this doc did right was to suggest that you seek care from a facility that is equipped to deal with MS or any other neuro disease.  Did he give you a recommendation?  He should since he suggested it.  

I am not a doctor but the pressure reading is a concern.  Normal pressure is 7-15, 20-25 is typically treated and anything over 100 is considered Intra-Cranial Hypertension (ICH).  ICH can be caused by a number of things like a Chiari Malformation etc.  You definately need to seek care from a good doc.  


Tonya was right about obtaining your medical records. It is your right to have copies of every procedure, test or visit you have had.  I have all my paperwork filed in a binder and take it in to appointments with me.  My docs appreciate it.

Take care, lois
Helpful - 0
1045086 tn?1332126422
Don't panic yet.  A while back there was a question about an abnormally low LP opening pressure of 17.  Someone answered that normal pressure could be measured as mm H2O (70-180 being normal) or cm H2O (7-18 being normal).  

Not every institution uses the same measuring stick.  You often need the written report that will list that particular labs normal range along with the specific test result.

Mary
Helpful - 0
209591 tn?1267414714
I am actually going to see a specialist at Emory University in August, he specializes in MS and several other Neurodegenerative diseases....He seems to be really good, the wait time to see him was extremely long, I have waited since late March.
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