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IATROGENIC PATHOLOGICAL REPORTS
O P Kapoor
Hon. Visiting Physician, Jaslok Hospital and Bombay Hospital, Mumbai,
Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
Iatrogenic medicine is becoming of more importance day-by-day than general medicine. More the number of super specialists, more the number of investigations and more the number of drugs available in the market - more are we going to see iatrogenic illnesses.
Till now this terminology was applied for patients to explain their symptoms and to make their diagnosis. I am now drawing the attention of the GPs towards iatrogenic pathological reports. The following are the examples:-
1. Tumour Markers - PSA (Prostate Surface Antigen) : The rise of this enzyme is diagnostic of cancer of the prostate. However, the commonest cause of elevation of this enzyme to even 2-3 times the normal reading is rectal examination done on the previous day.
2. Enzymes : LDH (Lactic Dehydrogenase) - Though elevation of this enzyme is diagnostic of megaloblastic anaemia, haemolysis of RBCs as in malaria or advanced secondary malignancy, the commonest cause of raised LDH is wrong collection of the sample when the technician after collecting the blood in the bottle shakes it violently.
3. CPK (Creatine Phospho-Kinase) : when elevated is diagnostic of fresh myocardial infarction (specially iso-enzymes MB). However, the commonest cause of high CPK is an IM injection given to the patient or a moderately brisk exercise like walking done before the blood sample is collected.4, Other blood tests : Raised serum bilirubin is often diagnostic of liver disease apart from many other causes. 5% of the population have benignly raised bilirubin due to Dubin Johnson syndrome or other congenital disorder.
The important thing to remember is that when these patients are given wrong advice of omitting the food, in view of the liver involvement (wrongly diagnosed), fasting increases the level of serum bilirubin in such patients and is still benign.
Low serum iron levels are diagnostic of iron deficiency but a single tablet of iron consumed by a patient will raise the serum iron levels for 3-4 days and give a wrong reading. Even the transferin saturation will increase.
Patients who are on oral diuretics will have high blood uric acid reading.
Patients who are on betablockers will have high lipid levels.
Patients who are on Amiodarone can have abnormal T3, T4 and TSH levels.
Finally, if the patient does severe dieting or fasting before the glucose tolerance test is ordered the report will be abnormal. Vice versa if 14 hours of fasting is not observed before serum lipid levels are done, the lipids will be found to be raised specially serum triglycerides.
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