Blood Test Results HELP!!

[Msawyer]

Hello Everyone,

I am 22 years old and have had the following symptoms for two years:

bloating

constipation

Irregular periods 

Anemia 

My doctor suspected celiac and sent me for the blood tests to which I got the following results:

TTG IGA: over 250

EMA IGA: postiive

 EMA IGA Titer: 1:40

 

i am really hoping to get a final diagnosis of celiac disease. I had an endoscopy done last week and am anxiously anticipating the results. It’s been an exhausting two years, I was falsely told I had anorexia, checked for ovarian cancer, or had IBS so I am thrilled at the possibility of having a positive diagnosis of celiac. I am just wondering, what does it mean to have a EMA IGA titer of 1:40? Is that high? And are my blood test results really indicating celiac? Any input would be appreciated, this is all new information to me.

thanks 

[trents]

Welcome to the forum, Msawyer!

Perhaps this will help you understand the blood tests that were run and their results: https://celiac.org/about-celiac-disease/screening-and-diagnosis/screening/

The tTG-IGA test is the centerpiece of the celiac panel. It combines good specificity with good sensitivity. Your numbers seem to be quite high but we cannot tell for sure since you did not include reference ranges in your post. Could you do that please? Different labs use different reference ranges. We need to know what scale this particular lab uses to determine what is negative and what is positive.

[Msawyer]

No problem:

TTG IGA:

reference range: less than 15 is negative

my result: above 250

EMA IGA

Reference range: negative, abnormal tigers are above 1:50

my results: positive for EMA; titer of 1:40

thanks for the help

[trents]

Your tTG-IGA is strongly positive and the symptoms you list are classic for celiac disease. Even the irregular menses I believe is not uncommon among pre menopausal women with celiac disease. There is no doubt in my mind that you have celiac disease. How long have you been experiencing these symptoms?

Edited November 15, 2021 by trents

[Msawyer]

I’ve been experiencing these symptoms for two years now. I’ve been constipated and bloated daily . Out of curiosity, what does the “EMA Titer” mean? I know I’m positive for the EMA antibodies but was confused as to what the Titer indicated. Any knowledge is appreciated. 

[trents]

titer = "the concentration of an antibody, as determined by finding the highest dilution at which it is still able to cause agglutination of the antigen."

So I take it that the term refers to the lowest concentration which can be detected. I'm assuming that would correlate to "0" on the negative/positive scale.  Other than that, I cannot help you out as I have not seen that parameter before in reported celiac panel test results.

I think the most important thing for you to focus on is the high tTG-IGA result. 

[RMJ]

EMA = endomysial antigen.  This was the original blood test for celiac disease.    (It is done with tissue, not an agglutination assay). Serum is diluted and put onto a microscope slide with endomysial tissue - a type of connective tissue.   Then other solutions are added so that IgA antibodies binding to the tissue can be detected under a microscope. Titer refers to how dilute the serum can be and still show a positive result.  If the serum can be diluted a lot and IgA antibodies are still detected, that is a high positive.  Thus 1:160 (one to 160 dilution) is a higher positive than 1:10 (one to ten dilution).

Labs seem to vary a bit in what they call a positive.  Some say any dilution more than 1:5, others say it has to be more dilute. The results you posted are confusing because you say your titer was positive at 1:40, but that abnormal has to be more dilute, 1:50.  Could you have mistyped a 40 as 50?  1:50 would be a strange dilution for this test as they usually do the first dilution as 1:5 then serial 1 to 2 dilutions to get 1:10, 1:20, 1:40, 1:80, 1:160.

The EMA has now been determined to be the same molecule as Tissue Transglutaminase, TTG.

I hope I’ve explained clearly, if not please feel free to ask questions!

[Scott Adams]

I just want to point out that in Europe if your ttg score is 10x or higher than the cut off for celiac disease, then no biopsy is needed to make the diagnosis. Yours appears to be well over 10x.

[Msawyer]

37 minutes ago, RMJ said:

EMA = endomysial antigen.  This was the original blood test for celiac disease.    (It is done with tissue, not an agglutination assay). Serum is diluted and put onto a microscope slide with endomysial tissue - a type of connective tissue.   Then other solutions are added so that IgA antibodies binding to the tissue can be detected under a microscope. Titer refers to how dilute the serum can be and still show a positive result.  If the serum can be diluted a lot and IgA antibodies are still detected, that is a high positive.  Thus 1:160 (one to 160 dilution) is a higher positive than 1:10 (one to ten dilution).

Labs seem to vary a bit in what they call a positive.  Some say any dilution more than 1:5, others say it has to be more dilute. The results you posted are confusing because you say your titer was positive at 1:40, but that abnormal has to be more dilute, 1:50.  Could you have mistyped a 40 as 50?  1:50 would be a strange dilution for this test as they usually do the first dilution as 1:5 then serial 1 to 2 dilutions to get 1:10, 1:20, 1:40, 1:80, 1:160.

The EMA has now been determined to be the same molecule as Tissue Transglutaminase, TTG.

I hope I’ve explained clearly, if not please feel free to ask questions!

Thanks for the helpful information! I was also confused about the EMA IGA tiger results. It says abnormal is above 1:50. Although my results say 1:40, it still says I’m positive for the antibodies. I attached my results below for clarification. I greatly appreciate the input. 
 

 

reference range EMA iga (titer over 1:50)

my results: positive for EMA; titer is 1:40

 

[trents]

17 minutes ago, Msawyer said:

Thanks for the helpful information! I was also confused about the EMA IGA tiger results. It says abnormal is above 1:50. Although my results say 1:40, it still says I’m positive for the antibodies. I attached my results below for clarification. I greatly appreciate the input. 
 

 

reference range EMA iga (titer over 1:50)

my results: positive for EMA; titer is 1:40

 

I can see why you are confused. Your numbers for that test would seem to indicate a negative rather than a positive. Unless I misunderstood the explanation of the titer from my research and from RMJ's posgt, it would seem that a higher titer ratio indicates a higher concentration of antibodies since it takes more dilution to zero it out.

[RMJ]

32 minutes ago, Msawyer said:

Thanks for the helpful information! I was also confused about the EMA IGA tiger results. It says abnormal is above 1:50. Although my results say 1:40, it still says I’m positive for the antibodies. I attached my results below for clarification. I greatly appreciate the input. 
 

 

reference range EMA iga (titer over 1:50)

my results: positive for EMA; titer is 1:40

 

Maybe the typo was in your results and they meant 1:5 instead of 1:50.  A lot of labs use above 1:5 as the cutoff. That would make sense. It would also fit with your TTG results which are also way above the cutoff.  

I hope you get a clearcut answer from your endoscopy biopsies.

[Msawyer]

20 minutes ago, RMJ said:

Maybe the typo was in your results and they meant 1:5 instead of 1:50.  A lot of labs use above 1:5 as the cutoff. That would make sense. It would also fit with your TTG results which are also way above the cutoff.  

I hope you get a clearcut answer from your endoscopy biopsies.

Yes thank you for the input I was reading the results incorrectly! The reference level is 1:5 instead of 1:50 which would make more sense for my result of 1:40. I am also hoping to get more answers from the biopsy. It’s been a log diagnosis process. 

[trents]

Then 1:40 would definitely be a positive result.

[Msawyer]

3 hours ago, Scott Adams said:

I just want to point out that in Europe if your ttg score is 10x or higher than the cut off for celiac disease, then no biopsy is needed to make the diagnosis. Yours appears to be well over 10x.

Interesting, thanks for the info.