Testing is a lottery. How modern medical laboratories work

Can the results of such analyzes be trusted? And if not, then what to do? Doctor and blogger Tatyana Tikhomirova has collected the most bright sayings on this matter and accompanied them with an exhaustive commentary.

Yes, it's convenient, but...

Yes, now there are a decent number of companies that have a lot of analysis material on their website in a form accessible to a non-specialist. You can choose what you want to test for, and then even interpret the results yourself using lab interpretations. It's convenient, although not cheap. In this case, you donate blood without sitting since eight in the morning for a couple of hours in a terrible line in district clinic and not to rude laboratory assistants, but sitting on a soft sofa in a clean office with a TV, and only for a couple of minutes. Or without leaving home at all. And at a time convenient for you. And the tests are sent to you wherever you want, and you don’t have to go to the clinic again for them. Naturally, a lot of people take advantage of this, demand creates supply, and the number of companies grows. And this would all be just wonderful if Russia had at least some kind of analysis quality control system.

But no one controls anything

But there is no such system in Russia. Maybe on paper it exists somewhere, but in reality it does not exist in any form. External blind control: control samples are sent to the laboratory “incognito” in advance known results. Laba gives an answer; if it is incorrect, then the license for this analysis is withdrawn, the laboratory pays a fine and is obliged to obtain permission to do it again, as well as provide information about the reason for the error and what measures have been taken. And it is also obliged to find and notify all clients in its database that the analysis was done incorrectly, and return their money. External open control: samples are sent to the lab, but the laboratory workers know that they are control samples, they just don’t know the answers. They do the analysis, send it away, the consequences are the same. Worse than that that “stream” samples can be made as usual, and “control” samples can be made to the highest quality and strictly according to the rules. Like in a confectionery factory, there is the concept of “making a cake for your own,” and the result is very different from other cakes. But there is not even such control, anywhere.

Internal quality control. The principle is the same, but the personnel responsible for control themselves send control samples for analysis, at different intervals, blindly and openly. They give you a hat inside the laboratory, no one takes away the license. This is all in theory. Practice looks different: if the head of the lab is interested in quality, internal control is done here and there. If not, which happens much more often, nothing is done.

Why it is useless to sue and seek the truth in other ways

For the same reason that there is no control system. You have two tests on your hands: according to one, you are healthy, according to the other, you are sick. Let's say anemia. There is a clinic for anemia, so the lab that gave the result “everything is ok” is wrong. Theoretically, in another country and in a different situation, the situation would develop like this: you file a complaint with a higher authority responsible for control. He requests a duplicate of your blood from the “wrong” lab, but it’s better that you withdraw it yourself (and they are obliged to give it out without any explanation). A duplicate of the same sample, where “everything is ok”, is transferred to another lab, usually certified as a quality sample according to this analysis, it makes its conclusion, caps fly. But in Russia there are no labs whose answer is considered as exemplary, as true. Therefore, no matter what nonsense they write to you as an answer, no one, anywhere and in any way can prove that the nonsense is in a lab where anemia was not found, and the truth is in a lab where it is.

If you are trying to find the truth by simply presenting tests from another lab, these attempts are even more pathetic and useless. Well, they’ll take your blood, let’s say even for free, again, well, they’ll do it normally or they’ll draw what you want, will that change anything? No. Will Labe get anything for this? No, because on what basis? And how can you prove it?

We have imported reagents and instruments, which means everything is ok?

Next. Why is the risk of getting bullshit instead of an answer to the test now extremely high, no matter where you donate your blood. Any analysis requires reagents; I won’t discover America here. But there are two pitfalls here that people outside the laboratories don’t know about. The first is that if the laboratory has indeed purchased very high-quality instruments and reagents, it is expensive to work on them. It is so expensive that the price of consumables may exceed the final price of the analysis, and it will be unprofitable, at a loss. If you raise the price to a reasonable price, all customers will go to competitors. Therefore, we have to align the price with the market. In this case, the only honest way not to work at a loss is to remove high-cost analyzes from the list (some do this, but this also loses clients). There is a second honest way - to increase the batch of patient samples for one procedure, that is, put not two samples per analysis, but 20. Then there will be the same number of controls (they are used inside the analysis), but the cost of the analysis will drop by about 10-15 times . But how do you get 20 people into the lab at the same time who want to be tested for Rocky Mountain Fever? No way, unless you are a lab of a large center where there are an abundance of such patients. You can accumulate samples by canning and freezing until you have accumulated a batch that will allow you to analyze without a loss. But then the patients run away. They don’t care about the difficulties of the lab, they need quick answers, not in two weeks. And they can be understood.

Therefore, other methods are used to reduce the cost of analysis. For example, you can set controls not every time, but every other time or two, build a control curve not using five points, as stated in the instructions, but using three. You can replace the branded buffer, which costs 10 bucks per bottle, with a similar one produced near Moscow, which costs 50 rubles per bucket. Or mix it yourself, using salts from the basement. You can reduce the amount of reagents by 2-3 times by dropping not the prescribed 50 microliters into the test tube, but a barely visible pisyun. You can cut the test strips into 2-3 pieces lengthwise. And for tests, of which there are a lot, and which have a stream of negative answers, you can use the “bucket” method. In this case, all samples are mixed in one test tube and the analysis is carried out as if it were one sample. There will be a plus on it - we put everyone separately a second time, looking for which of them is positive. And most often everything is negative, and we saved test reagents by 10.

There are a lot of such tricks. And all these tricks would not be a problem if there were quality control, at least internal. When, having come up with an economical trick, you first prove that it really does not deteriorate the quality of the analysis, and then make sure that it does not deteriorate further, also being wary of the punishing stick in the form of external quality control from above. But, as I already said, there is no quality control of any kind. Therefore, any trick to reduce the cost of analysis is tested only if someone cares about it, and they rarely do. And I don't mean to imply that evil lab rats are intentionally screwing things up. Not at all. It’s just that the theory of how to save on analysis, as well as the physics and chemistry of the process, is not taught in any medical institutes, not even in advanced training courses. In my practice, I have encountered such enchanting methods of reducing prices that my hair stood on end. But to my question: it’s impossible for this reason and that’s why - the lab workers made huge eyes: “Yes-ah-ah-ah?!” Ra-a-a-really?! But everyone does this, and nothing!”

Therefore I will upset you simple conclusion: no imported machines, reagents or kits are a guarantee of quality simply because working on them strictly according to the instructions is at a loss, prices cannot be raised, and almost no one knows how to save wisely.

We have very high-quality Russian reagents, here are 20 diplomas and 10 medals for them!

Is it possible to solve the problem using cheap Russian instruments and reagents? Of course, it’s possible, because the classic Zhiguli car drives, right? It’s absolutely the same in laboratory work: all Russian reagents, reagents, all kits are licked. All instruments are licked and outdated. After licking, they are often classified as “advanced” technologies that have no analogues” and “support the domestic manufacturer” and receive all their diplomas and medals. At the same time, no one bothers to open the first online catalog of a foreign company, order a similar reagent device there and check the effect of the local brainchild. there are no analogues, remember? Or they pass this test... well, making a cake “for their own.”

Further - worse. Just like in the auto industry, Russian government extremely concerned about supporting everything Russian. Therefore, many labs in government institutions are, excuse me, poorly equipped. Even if you do commercial analyzes and receive your own money for them, you cannot use this money to buy normal imported reagents and equipment in the laboratory. Because there is a tender, according to which there is an “exactly the same quality” (and cheaper) analogue of the Red Banner Mukhosran plant on sale. And you are obliged to buy something that is the same, but cheaper. The quality is confirmed by diplomas, medals and recommendations from above. Some get out of this situation, some don't. Sometimes you read with horror an article in the newspaper that the Red Banner Mukhosransky has again made an advanced device or reagent. This means - khan, you can’t order German anymore.

Conclusion: tests are a lottery. And you don't know the chance to win

Let me emphasize right away. Eat simple tests, there are old tests. Clinical blood test, blood biochemistry, general analysis urine - this is the set with which the probability of flying through and receiving nonsense in response is the lowest. These are new Lada cars on a flat, dry road at a speed of 5 km per hour. These analyzes are cheap, they take at least 50 years to complete, the reagents used for them are usually simple and cheap, and the probability of error is relatively small. But there is a danger here too, since lately even in the most run-down clinic clinical analysis blood tests began to be performed not in the form of a laboratory assistant - glass - microscope, but on an automatic device. The biochemistry of blood has also changed; now there are devices that, one strip with a drop of blood, give all the necessary answers. Fast, but expensive. And that is why now the amount of crap in these analyzes is growing at an alarming rate, as people in labs are trying new ways to reduce the cost of working on miracle devices. Therefore, if the answer on clinical blood was given to you on a scruffy yellow form, filled out with crooked hands and a pen, press it to your heart, it is more real and truthful than a printout in the form of “WB 0.02” on a check.

The rest: PCR, allergy tests, tests for infections, immunoblot, " immune status”, tumor markers and markers of everything in the world and all the rest of the “fresh stuff” - analyzes of a high-risk group. It is on them that they train to hone their saving techniques.

What to do?

Trite: go to the doctor. Find a good doctor. And having found it, grab it with a death grip, feed it, please it and never lose it. And not because the doctor is very good. But because he has a lot of patients. And he, unlike you, has analysis statistics. That is, he sees the clinic, sees the laboratory’s answers and knows in dynamics and in a group of examples where they are doing things wrong and where everything is fine. Good doctor often directs the patient to donate blood to 2-3 different places. Because in lab A they do analysis 1 and 2 well, but they suck at analysis 3 and 4, and in lab B - 3 is fine. Lab I is located far away and works very inconveniently, but they don’t screw up the analysis 4. You don’t know all this, and you can’t collect such statistics on your own. In addition, the doctor, unlike you, knows such a thing as mutually exclusive tests. That is, with answer “A” there are no such and such numbers in analysis “B”. You don't know it and won't even notice it.

And therefore, do not be surprised that when you come to the doctor with a pack of tests, you will hear that you need to retake everything, and he will tell you exactly where. Now you know why. And by the way, I’ll also make a reservation: doctors in state medical institutions are sometimes obliged to send tests only to their “native” laboratory, even knowing that what they are doing there is nonsense. And they can’t tell you about it, otherwise they’ll get hit. Therefore, it is worth clarifying this question yourself in the form: “Doctor, I will take tests at the laboratory of your institution. But you know, I’m so paranoid, I want to be sure, can you tell me where else I can take this same test? Just for myself, doctor."

But I don’t want to see a doctor!

Do you have money? Well then, I’ll suggest one more or less reasonable way: donate blood at 2-3 different places for the same thing. Compare the answers. Donate the same blood different surnames(required!) in the same lab, compare the answers. Draw your own conclusions about where the answers agree and where they don’t. But this method only works in the case of “digital” responses, and not in the case of “no, not detected” for exclusion rare disease. But it's better than nothing.

And never draw conclusions about the quality of a lab based on the fact that your friend had everything ok there. Because he could do some tests that are really ok, but you need others. Or because there is such a thing - statistics, and one case does not form it.

Alexandra, hello!

Your relationship with medical organization fall under the Law of the Russian Federation of 02/07/1992 N 2300-1 “On the Protection of Consumer Rights”. You should submit a claim addressed to the head of the organization (in two copies, on yours they must put a mark on receipt of the claim), stating, according to your choice, the requirements provided for in Art. 29 of the Law on ZPP:

Article 29. Consumer rights when discovering deficiencies in the work performed (service provided)
1. When discovering deficiencies in the work performed (service provided), the consumer has the right, at his own discretion, to demand:
free elimination of deficiencies in the work performed (service provided);
corresponding reduction in the price of work performed (service provided);
free production of another thing from a homogeneous material of the same quality or repeat work. In this case, the consumer is obliged to return the item previously transferred to him by the contractor;
reimbursement of expenses incurred by him to eliminate deficiencies in the work performed (service provided) on his own or by third parties.
Satisfying the consumer's demands for the gratuitous elimination of defects, for the manufacture of another item, or for the repeated performance of work (provision of a service) does not relieve the contractor from liability in the form of a penalty for violating the deadline for completing the work (provision of a service).
(edited) Federal Law dated December 17, 1999 N 212-FZ)
The consumer has the right to refuse to fulfill the contract for the performance of work (rendering a service) and demand full compensation for losses if, within the period established by the specified contract, the shortcomings of the work performed (service provided) are not eliminated by the contractor. The consumer also has the right to refuse to fulfill the contract for the performance of work (provision of a service) if he discovers significant deficiencies in the work performed (service provided) or other significant deviations from the terms of the contract.
(as amended by Federal Law dated December 21, 2004 N 171-FZ)
The consumer also has the right to demand full compensation for losses caused to him in connection with deficiencies in the work performed (service provided). Losses are compensated within the time limits established to satisfy the relevant consumer requirements.

Attach documents confirming the expenses you incurred for repeated tests, the results of these tests (copies), and you also have the right to indicate the amount you require as compensation for moral damage (Article 15 of the ZPP Law).

Your demands must be satisfied within a period not exceeding 10 days from the date of delivery of the claim.

If the claim is ignored or denied, you have the right to go to court.

I hope I was able to help you. If they appear additional questions- contact us.

Every year in Russia, thousands of laboratories perform billions of tests. But is there a guarantee that results your laboratory tests truthful?

Errors can be different: from incorrectly defined to incorrect interpretation of cytological material. Only mistakes that lead to very serious consequences become public. For example, in a 33-year-old woman, as a result of a laboratory technician’s error, the presence of malignant tumor on early stage, although she did all the studies recommended by the doctor. She calmed down, but when the tumor was discovered, it was too late...

Most mistakes, fortunately, do not entail any serious consequences. You may not even realize there is a mistake. For example, if it shows low level hemoglobin, you simply include iron-rich foods and iron-containing foods in your diet food additives, and a repeat test shows that hemoglobin is normal. But even if the result of the first analysis was erroneous, you simply ate excess iron.

Where do mistakes lie?

Laboratory research consists of three parts: preanalytical(from preparing the patient until the moment the biomaterial enters the work), in fact analytical And post-analytical(from the moment the material leaves the device until the results are delivered to the patient). And at each of these stages an error can occur.

1. Error can be laid down already at the beginning, upon registration research order. This stage accounts for more than half of all errors. The nurse may write the patient's name incorrectly or illegibly, or confuse the directions for tests or test tubes.
2. Error can happen directly during the analysis. In laboratories that use outdated research methods, the likelihood of such errors is higher. They do not involve the use of disposable laboratory glassware; many operations are performed manually. But in equipped with modern devices In laboratories, the possibility of error during research is practically eliminated.
3. Error possible when interpreting studies of cytological and histological materials. In these cases, exclusively expert assessment is used, that is, the doctor examines the material under a microscope. There is a possibility that he will not “see” certain changes in the patient’s cells or tissues or will misinterpret them.
4. The culprits of the mistakes may become failures in the operation of devices.
5. Exists probability of transfer of microscopic particles of biomaterial from one sample to another, although it is very small.

How to protect yourself?

Come on in laboratory tests only in government medical institutions or commercial laboratories licensed to medical activities. If it is not hung in a frame in reception department, ask to see it. About high quality work institution also testifies to its long-term presence in the medical services market .

Feel free to check that the nurse has written your last name, initials, and date of birth correctly. Make sure that your first and last name, identification number or unique barcode were applied to your test tube.

If research were carried out within medical examination or, for example, to obtain a medical certificate, and the results showed deviations from the norm, you should consult a doctor. He will assess how significant these deviations are and will refer you for repeat examinations in seven to ten days. If deviations are detected again, he will order in-depth studies.

If you are found clinical signs this or that diseases, and laboratory studies do not confirm this, then you can individually conduct the study again using the same material.

Special case - histological and cytological studies, requiring expert assessment. In some materials, two doctors examine the materials, in others - one doctor, but all complex and dubious cases are sent for verification to medical institution, with whom the laboratory has an agreement.

If found positive result to such social significant infections, like HIV or hepatitis, the laboratory, according to current legislation, is required to conduct a confirmatory test from the same material. The patient should be informed about the results of the studies only after a definitively confirmed answer has been received.

Our expert Elena Anatolyevna Kondrashova, director of the technological department of the INVITRO laboratory:

Most mistakes happen when placing an order for research. Automation of this process can reduce these types of errors to almost zero. At this stage, the laboratory employee creates an order and assigns it unique barcode. All data about the client is entered immediately in his presence to the information system. The barcode is stuck to the test tube and with this test tube the client goes to the treatment room. Subsequently, the test tube comes with this barcode into all devices. Modern equipment allows you to use it in 99% of cases "primary tube", i.e. biomaterial, for example blood, is not transfused from one large test tube, as was the case before, into several small ones. Everything is automated: the test tube “moves” in the device from one analyzer to another who reads barcode. Thus, it is no longer possible to mix up initially correctly designed test tubes.

And about the quality of analyzes in this laboratory, following a discussion in one of the social network groups.
I will quote the entire post here in full.
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Medical damage. PART 6. The myth about laboratory tests or the whole truth about INVITRO!

Today we’ll get personal by mentioning the name of the laboratory... Do you know what prompted me to write this article? But just yesterday on Facebook, in the pro-mam group, there was a thread in which it was discussed that many doctors do not advise taking in vitro tests. They say they are slacking, their blood clots, they lose tests, etc. Wow, let's take a closer look at what's really going on, otherwise the world of the Internet is full of rumors, yeah... And these rumors are from supposedly very authoritative doctors, yes, yes!!

I’ll say right away that I am not engaged, not affiliated and not lured in vitro, that is, I have no relation to this laboratory at all and never have had anything to do with it. Neither direct nor indirect and people who believe rumors more than a person who has a valid certificate of a clinical doctor laboratory diagnostics and having worked in one of the largest laboratories in Russia, they can cool their ardor, intending to accuse me of lobbying someone or something!

Well, let's begin! So, the first myth. Invitro is a small basement laboratory, we have been there more than once, they are sitting in the basement. Cool down, comrades. Invitro is one of the largest players in this segment of medicine, and what you call a basement laboratory are just franchise offices that anyone can open by paying a couple of million and hanging up the INVITRO sign. But this does not mean that the analyzes are done there. Invitro provides its franchisees with consumables, and the courier picks up the biomaterial in a strictly certain time and delivers it to its own laboratory, where the production process itself takes place... Yes, yes, that’s what it’s called!

Second myth. In invitro they do tests by hand and everything depends on the change of doctor. If migrant workers are on shift, they will do it wrong, so the blood clots and the results are incomprehensible. This is generally a rare nonsense. Firstly, such a laboratory per day, and such laboratories work around the clock, processes tens of thousands of samples, and if everything is done by hand, then the laboratory staff will be many thousands, which will lead to the fact that prices for analyzes will be tens of times higher than they are Now. Almost all tests are performed on automatic analyzers from the world's leading companies and their measurement accuracy is hundreds of times higher than when performed manually. Only microbiological cultures, determination of sensitivity to antibiotics and some ELISA and CLLA tests can be done by hand. [The laboratory now, judging by the “Equipment” section on the website, has at least 2 microbiological analyzers and a pre-analytical sorting system, i.e. handmade and they try to minimize the “human factor” in errors].

The third myth. Their test standards are incorrect. The medical textbook contains other norms for blood tests. This is a very common mistake here. Anything can be written in a textbook and it will be far from the truth. Each laboratory may have its own standards and may differ from the standards of other laboratories. Norms or REFERENCE VALUES are established not by the laboratory, but by the manufacturer consumables, which the laboratory uses! unfortunately, many doctors don’t know this either and also refer to textbooks from the 60s and 70s, calling the laboratory and starting a scandal that they supposedly don’t know how to interpret the analysis, since the references differ from those written in the textbook.....

The fourth myth. Invitro saves on tests and invents results without doing real analysis . Well, I won’t comment on anything here at all, sorry. This is more like post-hangover syndrome. This is a judicial matter and each test tube that is sent to the laboratory is stored for up to 14 days after the analysis is completed and can be sent for re-work if there are doubts about the result or a re-order is needed for execution from the same test tube. This, for example, happens when an analysis has been performed, the result has come to the doctor, and he wants to look at some more parameters based on the result obtained. Then an additional appointment is made and from an existing test tube is made new fence for analysis. By the way, few people know about this, but it can be used!
This is not to say that everything is smooth; there are problems in laboratory diagnostics. For example, 2-5% of all analyzes may be performed with errors. and this is not an in vitro problem, this is a global practice. Well yes, unfortunately...
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and now the traditional digression and the whole truth about doctors. The problem, comrades, is not in the laboratory, but in the qualifications of our doctors or, even worse, in the love of our people for self-diagnosis, self-prescription and self-medication.
Most errors occur not during the production of the analysis, but at the preanalytical stage, that is, at the stage of taking the analysis. There are certain rules of preanalytics that are violated by our doctors and franchisees left and right, this is due to low qualifications medical personnel, but they don’t want to admit it; it’s easier to blame the laboratory.
For example, I have encountered scandalous surgeons who send pus to the laboratory for microbiological culture and determination of sensitivity to antibiotics. There are hundreds and hundreds of such examples. And among these doctors there are honored figures, doctors of science, professors. But none of them knows that horseradish can be grown from pus, since by definition these are dead microorganisms, blood plasma and the same dead leukocytes….. And something can only be grown from living…. But they are good at arguing and yelling and beating themselves in the chest that everyone is bad, but they are doing everything right!
Things are even worse with gynecologists. These people generally like to take tests without really understanding why and for what purpose, and even less understanding the rules for taking tests in gynecology. For example, for most gynecological smears you need to take vaginal, urethral or cervical canal. But it is precisely the separated, not the allocated. Can't you hear the difference?? Well, gynecologists don’t smell it either and take what’s secreted, not what’s discharged. That is, what the vagina secretes by itself, that is, discharge, while according to the rules it is precisely necessary to completely remove these discharges and scrape the mucous membrane, that is, separate the epithelium. Most smears are performed using the polymerase method. chain reaction, abbreviated PCR, in which blood and mucus can act as an inhibitor of the reaction and lead to a false negative response.
And so we can continue to tell, and there is a lot to tell. Each technique has preanalytical rules and those who carry out the analysis must know them.

So, the results! A minimum set of knowledge, so to speak!

1. If you do self-diagnosis and prescribe tests, then take the trouble to read multi-volume works on laboratory diagnostics or at least call the medical department of the laboratory and find out the rules for taking a particular test.

2. Reference values. We remember that they may differ from each laboratory, and if you take tests over time, then they should be taken in one laboratory, and not in several, then you will be able to clearly track the dynamics and evaluate the quality of treatment. [My article about ].

3. It is always better to donate blood from a vein rather than from a finger. Unfortunately, many doctors claim that it is better to donate blood from a finger, especially for young children. This is an ERROR! Modern tubes are vacuum, which ensures their filling with blood along a pressure gradient and minimal trauma, as well as the preservation of blood due to the lack of contact with external environment and the presence of a preservative inside the tube, while all these criteria are absent when collecting blood from a finger. This procedure is much more traumatic and the degree of reliability of the analysis may be lower than when taken from a vein.

4. Spermogram. It’s better to hand it over not at a collection point located far away, in the franchisee’s office, but at a collection point located in the laboratory itself, this will ensure a minimum delivery time to a laboratory doctor and a more reliable result. By the way, here you should also remember that having received not very good results spermograms, a competent doctor is not in a hurry to prescribe treatment, but investigates all the reasons, collecting information about the preanalytical stage and makes a conclusion about the need to prescribe treatment only based on the results of 2-3 spermograms taken over a certain period of time.

5. Blood culture for sterility. In general, I do not recommend taking this test, which doctors love to prescribe. This is complete nonsense. Blood is inherently sterile BY DEFINITION! It does not contain bacteria from which colonies can be grown and a microbiological test for sensitivity to antibiotics can be done. If a doctor prescribes this test, then he is a complete idiot! IMPORTANT TO REMEMBER! a disease in which the blood ceases to be sterile is called SEPSIS, motherfucker... Google it and look at pictures of what a person with sepsis looks like. He doesn’t go to doctors, he lies there and passes into another world... You can take his blood for sterility, but from others it’s pointless!

6. General blood test. You can take it not only in the morning and not only on an empty stomach. If you ate and took a general blood test immediately after eating, then you don’t have to worry, its reliability will not decrease, but this does not apply to biochemical tests!

7. Hormones! It is very important to know preanalytics! Many hormones have rhythmic peaks of production and some hormones should be taken strictly at a certain time, as well as at rest. For example, prolactin, beloved by gynecologists, tends to significantly increase for almost any reason (I’m exaggerating, of course). And if you have elevated prolactin, this is already a reason for the doctor to prescribe an x-ray of the sella turcica or an MRI of the pituitary gland, while you just need to redo the analysis or take the trouble to find out under what conditions the analysis was collected. A prolactin value above 800-1000 units may indicate the likelihood of the presence of an adenoma (prolactinoma) of the anterior pituitary gland. Do not rush to immediately do an MRI of the brain and faint with your doctor; often it is enough to just retake the test to make sure that everything is OK.

In general, by tradition, I wish you all good health, Nikita Yuryevich Istomin, clinical laboratory diagnostics doctor, obstetrician-gynecologist, doctor was on the air with you ultrasound diagnostics, osteopathic doctor. Hello to the group, I hope I answered your questions. If you have any other questions, I will try to answer!
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