Well I've pretty much decided to have the cytology as I am now in a position to find out what I want rather than being a mindless consumer of the NHS.

I have just, 13:00, been talking to Martina Hornby, Chief Bio-technician at Derriford Cytology. She was not aware of cytology being used to test for blood cells as a way of finding the source of haematuria. This made me read the info I had more carefully. See my email to her, which also queries the procedure for supply samples of urine.

However I have just revisited the site where I thought cytology was mentioned in relation to types of blood cells, thinking I was mistaken only to find this.
From: CarePathOnLine.com

If There Is Blood in Your Urine
If red blood cells are present in your urine sample, the pathologist will examine them closely with a high-powered microscope to observe their shape. The shape of the cells tells the pathologist whether they came from the kidney or from another part of your urinary tract. The pathologist also will study the physical appearance, acidity (pH), and chemical makeup of your urine and determine whether any casts are present in your urine (see below). All this will be helpful in identifying the nature of your problem.

So I hardly need to call to confirm, but will. They may be my best option. CarePath Online is the support feature for 'Dianon'. a Labcorp Company. 200 Watson Boulevard Stratford, CT 06615 Phone: 001-203-381-4000

-:- 14:20 Have just called Dianon and had to leave a message for Matthew Plamkoodin. I have also email him there via plamkom@labcore.com

-:- 17:05 have just emailed Dr Mccormick with my latest findings re: assessing red blood cell origin and the three shots procedure for the cytology at Derriford as per Martina's reference. About to call Dianon again.

-:- 17:20 Have just spoken to Matthew Plamkoodin and he has confirmed that they can tell if blood source in the urine is from the kidney, urinary tract or bladder. He will get back to me on how its done and how to get them to do it for me if its not available in the UK. -:- 17:38 Just sent email.

-:- 17:39 Have also just received a reply from wisegeek.com, which directs me to leave a message for other users. Not going to follow this up, as the issue is resolved in communications with Matthew Plamkoodin.

27th June 14:50
I've just about given up on Plamkoodin and co. I've sent yet another email and have no reply. I'm thinking they can only differentiate between blood from the kidneys as the cells are somewhat squashed together other than any other part of the urinary system.

I have managed to secure the offer of a cytology test via my GP: Quote the email

"You can certainly have the cytology screen done on the urine. Mr Hammonds' (the Urologist) opinion is that it is too insensitive to be reliable, apart from in very highly malignant cases. This means essentially that whilst a positive test is likely to be significant, a negative test does not reassure either of us that there is not a cancer there."

There are a few things I want to address before deciding whether to have one. Some of these are technical issues, others philosophical. The later need addressing first, else there's no test. However as the technical issues have finite goals and outcomes they can actively be resolved and so take the focus and action. The philosophical issues will resolve themselves automatically by sitting back and relaxing, they cannot be resolved by analysis but more by weight of feeling.

Technical:

• Timing: Take a sample that has a lot of blood and is cloudy and has bits. I note from the initial blood sample there were no casts in the specimen.
• Find data on results relative to stages etc.
• Find data on the specifics of the test. Can it be a DIY process?

Philosophical:
The main issues here are as to the reason for having the test.

• Curiosity
• What would happen next
• What to family think as I'm under pressure to act to their desires and 'benefit'

30th May 09:24 Well I've heard Vyaj has had her final exam plus I'm feeling more positive so I'm inclined to have the cytology just for curiosity. However I will no doubt mull over this change and see what underlies it and consider the consequences. Most of such will be done subconsciously.

31st May 09:50 Have emailed Dr McCormick

6th June 09:33
From: carepathonline.com

Your doctor may order urine cytology if you have blood in your urine and a definite cause of the bleeding has not been identified. The medical name for blood in the urine is hematuria. It has many causes, including strenuous exercise, too much stress, infection, kidney and bladder stones, and even cancer. When there is blood in your urine, it is important to identify what part of your urinary tract the blood is coming from so any problems can be properly diagnosed and treated.

From: wisegeek.com

Another important aspect in the discipline of cytology is examining cell interaction. By studying how cells relate to other cells or to the environment, cytologists can predict problems or examine environmental dangers to cells, such as toxic or cancer-causing substances. In humans and other multi-cellular structures, cytology can examine the presence of too many of one kind of cell, or the lack of enough of a certain kind of cell. In a simple test like a complete blood count, a laboratory can look at white blood cells and identify the presence of an infection, or it may examine a low level of certain types of red blood cells and diagnose anemia.

-:- 10:05 Just emailed the above as follows:
"Hi. I'm about to have a cytology examination of urine to assess if I have cancer of the bladder, as I have haematuria. My 'Doctor' is under the impression that only cancer cells will be looked for.

I found that
"it is important to identify what part of your urinary tract the blood is coming from" from http://www.carepathonline.com/Topic.aspx?Nav=0&Rel=166 and
"of certain types of red blood cells" from your web site.

Accordingly, checking for cancer cells is not the only or better option.

If no cancer cells are found, then knowing where the blood comes form is very significant.

The fact that there is this option to check the red blood cell type means I can provide two samples.

One with obvious (gross) haematuria so that the blood cells can be easily available for analysis and a second, clear sample, as my Dr said the blood may interfere and obscure the cytologist in the search for cancer cells.

Can you please confirm that there are different types of red blood cells and direct me to any on-line or other reference, so I can present such to my Dr.

Thank you"

haemolysis(or hemolysis)

I am trying to understand the difference between haemolyitic and non-haemolytic reads on the urine tests.

It appears that test for blood checks for haemoglobin from both broken and intact cells and to further complicate the matter 'UriTest'cliam the sticks are equally sensitive to myoglobin.
 

1.
Origin: from the Greek Hemo-, meaning blood, -lysis, meaning to break open.

- the lysis or the breaking open of red blood cell (erythrocyte) causing the release of haemoglobin into the surrounding fluid.
biology-online.org

2.
The destruction or dissolution of red blood cells, with release of hemoglobin. Also called erythrocytolysis, erythrolysis.
medical-dictionary.thefreedictionary.com

As my recent blood test showed an abnormal level I've been investigating:-

1. Significance of low serum alkaline phosphatase activity in a predominantly adult male population

2. Is an isolated LOW alkaline phosphatase significant in a patient?

3. amarillomed.com/howto.htm

" Alkaline phosphatase is an enzyme found primarily in bones and the liver. Expected values are higher for those who are growing (children and pregnant women) or when damage to bones or liver has occurred or with gallstones. Low values are probably not significant. "

4.answers.yahoo.com

" Alkaline phosphatase is something that is released into the bloodstream by accident. It plays no role there. By the time it's detectable in the blood, it's a waste product. There is no role for looking at a low alk phos level and wanting it higher. That's like driving down the street and wishing that there was more garbage in people's trash cans. "

5.labcorp.com

" Causes of low alkaline phosphatase are said to include:

Hypothyroidism - but most hypothyroid patients have normal alkaline phosphatase.

Pernicious anemia: - in very few patients.

Hypophosphatasia: Very low alkaline phosphatase values are found in the presence of normocalcemia or hypocalcemia. This diagnosis may be confirmed by quantitation of urinary phosphoethanolamine.

Malnutrition: has been reported to relate to low values, but in practice, diseases causing malnutrition relate often to high alkaline phosphatase results (eg, disseminated neoplasia).

Some drugs: (clofibrate, azathioprine, estrogens and estrogens in combination with androgens) lower serum ALP activity. "

Well I'm waiting for the results of blood tests and am 'hoping' the worst is kidney stones so I'm doing some research.

There are many kinds of kidney stones (link here later) the most common appears to be calcium, so that's what I'm investigating.

Oxalates (oxalic acid salts) seem to draw metal to them, they are used to remove rust for example. Well calcium is a metal and an oxalate molecule will fuse with a calcium atom and form insoluble form, these then grow in size.

They form in the kidneys and attach themselves to the cell structure when they are microscopic, and as they enlarge they get squeezed out.

Well 'squeezed out' is the problem, as a) they may be too big or b) they may cause bleeding of the urinary tract if they get that far and are too big to pass easily.

So the best solution is a) to stop them growing and b) to get them out.

Both of which get a separate slot.

Following page (2) topics on : Prevention (limit or stop their growth) and the subsequent page (3) will focus on removal.

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