Need Assistance Interpreting Blood Tests

[jaggirl47]

We received the blood work the GI ordered for my son on Monday, except for the genetic test which will take a couple more weeks to come in. The link to my original post with his other labs will be added at the end of this post. Please assist in digging through the results so I know what I should speak with the GI about at our next appointment.

 

CBC

WBC     5.0       4.5-13.0

RBC     4.94      4.45-5.75

HGB     12.6L    13.0-16.0

HCT     37.7       37-49

MCV     76.4L    80-98

MCH     25.6L    26.7-33.7

MCHC  33.5      32.5-36

RDW    13.8      11.6-15

PLT      1161      140-420

MPV     7.5        7.0-10

LYMPH% 41.1   27-47

MONO%  6.0     3.0-13

NEUT%  40.4    33-63

EOS%   11.4H   0-7.4

BASO%  1.1      0-2.6

LYMPH#  2.1     1.2-5.2

MONO#  0.3      0.2-0.9

NEUT#   2.0      1.8-8.0

EOS#     0.6H    0-0.4

BASO#   0.1      0.1-0.2

 

ESR       3          0-15

 

CMP

GLUCOSE  95   60-100

BUN       15        6-23

CREAT.  0.64L   0.7-1.3

BUN/CRE RATIO   23.4       7-25

SODIUM  141     136-145

POTASS  4.5      3.5-5.1

CL          102       98-107

CO2        23        22-29

OSMOLALITY  293       277-308

CALCIUM  10.1   8.6-10.2

ALBUMIN  5.0     3.5-5.2

ALT          12       0-41

AST          22       0-40

ALK PHOS  157H   40-129

TOT BILI   0.2      0-1

 

IRON

IRON       82        37-158

 

MISC

ANION GAP   16      7-16

T PROTEIN    7.4     6.6-8.7

TRANSFERR  230   200-360

PREALBUMIN  20    14-33

GFR-AA         TNP

GFR-NAA       TNP

IBC         329         286-515

IRON SAT%   25      15-50

 

 

Here is the link to the original thread with the previous lab tests

https://www.celiac.com/forums/topic/111049-need-help-for-possible-celiac-child/

[cyclinglady]

I. am not a doctor, but I can tell you that the lows in his blood cell size and hemoglobin could be a result of Thalssemia. I have it. Just means I have tiny red blood cells. Tiny enough to prevent cells filing up with oxygen and keeping me, like your son, just out of range for hemoglobin which makes me slightly anemic. Nothing bad, but it is the one reason I never made the Olympic team! Ha!

Seriously, it should be no big deal. It can become a big deal if he marries and has kids with another Thals person. I did not get a definitive diagnosis until after my daughter was born. She has it too. Her future partner will need to be screened. Full-blown Thals requires life-long blood transfusions. Infants in the old days never survived. The good news, is that Thals carriers are supposed to be resistant to malaria! Have not personally tested that yet! Most Thals folks never have any issues at all.

I can not speak about the other tests. You might try googling them.

[jaggirl47]

I would agree with that if he didn't test negative during his screenings. That was one of his required newborn screenings before leaving the hospital.

[cyclinglady]

My kid tested negative too when she was born. Her Ped at the hospital said she was normal but "could not rule out Thalassemmia at this time." I keep ALL lab tests and health docs!

[jaggirl47]

I haven't received the ferritin results back as of yet so I am interested in seeing what the result is compared to the rest of his panel.

 

I hate waiting!

[cyclinglady]

Newborn blood counts and cell size are significantly higher that older children or adults. My daughter's (she is 14 now) were very high -- higher than an adults. That is probably why the Ped did not rule out Thals at that time. Here is some research:

Open Original Shared Link

[cyclinglady]

But isn't that the Iron result? Ferritin is iron stores.

[cyclinglady]

And...you have the weekend to wait! So sorry!

[cyclinglady]

Ah, my bad! I did say I was not a doctor. I guess Iron is what is circulating in his blood. So, yeah, you still need to see the ferritin level. My iron tests were all good except for ferritin. So, I have two anemias -- now just the Thals since the iron-deficiency one resolved on a gluten-free diet!

[jaggirl47]

The thalassemia was completely ruled out in infancy for him. My younger one had to be tested twice but this one was a conclusive no. Who knows though. I know I suffer from iron deficient anemia frequently.

 

I am very impatient for the ferritin to come back. We dropped the stool sample off this morning and I have 2 more weeks to wait on the genetic tests. I really have no nails anymore.

[beth01]

Has his platelet count been addressed? With a platelet count over a million, he should probably be seen by a hematologist. His MCV and MCHC are low based on the fact that his hemoglobin is low, they're calculations. His MCV is the size of the cells, slightly microcytic ( small), and based on the MCH, have more central pallor ( there is usually a faint indentation in the red cells that looks like a faint white circle. The lower the MCH, the more white showing in the red cell. These could all be affected also if the specimen wasn't properly mixed before it's run through the analyzer. His percent eos is showing that he has an allergic reaction going on, does he have environmental allergies? His ALKP is high, which coupled with his platelet count should also send him to a hematologist, his other liver enzymes are normal, ask for a fractionated ALKP. But, I'm not a doctor, just a lab tech. I also looked over his labs from your other post... Calcium oxalate crystals can be present in children without the presence of a kidney stone if they drink a lot of juices or koolaid. The mucus could be present just due to the fact that he's a pubescent teenaged boy, they are just finding out that their penises can be used for things other than peeing, and the mucus most often are protein threads..... sorry mom. Did they say if it was a small/medium/large amount of mucus? The anion gap is a calculation also, usually isn't even a result that is on most lab reports. Don't worry about the low creatinine, if he has some kidney disfunction, his BUN and creatinine would be high, not low, he is also a smaller stature, a low creat can be seen in lower muscle mass.

Hope some of this helps and good luck with the doctor.

[jaggirl47]

The platelet was a mistype and I accidently put in an additional 1. Thank you for pointing that out and I apologize! His platelet count is 161, not 1161. I always tell my kids to proof read and I totally failed on that!

 

For the mucus, he isn't in puberty yet. Hasn't even started it. Would that make a difference on whether there is mucus or not?

 

The last time he had a CBC was a few years ago. I will have to dig through his paperwork to find the results but I do remember he had similar results with the eosinophils and the RBC's. They sent blood panels for allergies and he showed no allergies to anything at that time. I'm not sure what they tested for as far as for allergies though. That was when they had him on asthma treatments for sleep apnea but it turned out he wasn't asthmatic, he had kissing tonsils that wouldn't go down. Once he had a tonsillectomy/adenoidectomy he never had those issues again.

 

He rarely gets juice and never drinks Kool-aid. I prefer the kids eat fresh fruit for their fruit servings. He does drink a lot of milk though. Basically only milk or water. Would the milk increase the risk of crystals? He has quite a few issues with his teeth so I am very strict about excess sugary items. He has defects in his 6 year molars that have had to get fillings redone 3 times. Not cavities, just really bad defects. The dentists said something went on and that was how they formed.

[beth01]

Good about the mistype on the platelet count, I was worried.

If on his repeat UA there wasn't any mucous, I wouldn't worry about it. If he didn't properly wipe, if it wasn't a "clean" catch, it can be present and is actually present in a lot of urine samples. We listed mucous as small/medium/large amounts present. The calcium oxalate crystals are the most commonly seen crystals in UA's, if they weren't there on the repeat UA, I wouldn't be worried about them either. I've had them on a few occasions in the absence of a kidney stone and there were never addressed.

I would still ask for a fractionated ALKP. I can't remember which liver enzyme is the first to increase, but many celiacs have issues with their liver enzymes being high, which then normalizes on a gluten free diet. I'm assuming your going to ask for an endoscopy? Are they going to repeat his celiac panel after a gluten challenge? Sorry, I might be asking questions you don't have answers to.

My daughter, who is a celiac also, has had a lot of problems with her teeth, so did I. Some of them are malformed and a lot of issues with enamel.

I'm sorry your son is having so many issues and I hope you get some answers soon.

[jaggirl47]

He had mucous on both September and January UA's so that's 2 in a row. They didn't specify the amount, just that it's there.

 

GI wants to do an endoscopy regardless. He feels that if my son doesn't have celiac, he has some other malabsorption issue. We go back at the beginning of April and my son will get scheduled an endoscopy at that time. We are looking at late April/early May.

 

I really wish we had a baseline CBC from before going gluten free. He was gluten free for 1 1/2 months when this last blood draw was done. If his anemia is iron deficient anemia, wouldn't his iron levels start to correct themselves by the time this lab was done? Could he be iron deficient but we just wouldn't know? He is back on gluten now in preparation for his endoscopy.

 

I will definitely bring up doing further tests on the liver enzymes. The repeat high levels of alkaline phosphatase does concern me.

[jaggirl47]

I just went and picked up a lot of labs from our hospital to try and compare results. Unfortunately, they only gave me his CBC from 2014 and I wanted it back to 2006. I am trying to compare his results. However, the CBC from September 2014 is as follows to compare with his March 2015 test.

Wbc 5.9

Rbc. 5.2

Hgb. 12.8L

Hct. 38.4

Mcv. 73.9L

Mch. 23.6L

Mchc 33.3

Rdw. 13.8

He was also positive on the genetic test for "one half of the DQB1-02" gene.