A Lab’s Advice Spurs a Physician to Action

A Lab’s Advice Spurs a Physician to Action


[music] So we had a patient who had previously
been treated for a pituitary tumor who was trying to become pregnant. And she showed up to her
primary care physician, they measured HCG in her serum, which is what we typically
measure to detect pregnancy. And it was positive,
which indicated pregnancy and it was climbing at the intervals
that are expected with normal pregnancy. And all of a sudden it just
kind of plateaued. And typically in a normal pregnancy we expect to see it double
about every couple days. And so the clinician thought
maybe it was ectopic pregnancy where the fertilized embryo lands
somewhere outside of the uterus. So they worked her up for that. They treated her appropriately. And normally following
appropriate treatment, the HCG levels are going to
start to drop off. And following treatment
they still stayed totally flat. So they then came to us and said
what is this? So we did some studies in the lab and we ruled out any
interfering substance. It appeared it really was HCG. We measured some other things to
kind of rule out a pituitary source. And so we came back and said
this is probably still ectopic pregnancy. You need to manage this patient.
You need to be concerned about this. So they went back
and treated her again, and fortunately, following the second
treatment, the HCG then dropped off. We were able to give the clinical team
some really actual meaningful advice. And that allowed them to take action
and treat the patient appropriately in a timely fashion rather than waiting and
waiting and waiting until that patient’s symptoms
got severe and there were more
dangerous complications. They were able to take action. And she emerged from this potentially really
damaging situation pretty much unscathed. So I’m Dr. Rob Nerenz. I’m the Assistant Director of
Clinical Chemistry at Dartmouth–
Hitchcock Medical Center. [music]

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