Please Help Me Figure Out These Labs!

[e&j0304]

I just picked up blood test results from my son, which were taken a year ago when he was 12 months old. He had terrible diarrhea then and we put him on a gluten-free diet although his tests were neg with good results. We are now challenging the gluten-free diet and he is back to having diarrhea. I decided to get a copy of his tests and here are the results.

Gliadin IgG 3.45 expected value = 20.0 in the "reference range" section it says "EU"

Gliadin IgA 0.5 expected value = 20.0 in the reference range section it says EU

Tiss. Transglutaminase Ab, IgA 0.1 reference range is neg. is less than 5

IgA, Quant,Serum 75 reference range 82-453

Does his low IgA quat, serum test mean that he is IgA deficient? Does that throw anything off? I can't figure out those first two tests either. I'm assuming that anything less than 20 is ok?

It also says: "Because the Endomysial Ab, IgA screen was negative, the Endomysial Ab, IgA titer was not performed."

Any insight? I guess these tests clearly show that he doesn't have celiac? Oh, he also had a endoscopy and colonoscopy done and that report stated that there was evidence of reflux esophagitis and chronic nonspecific colitis. It stated that he took "a couple of biopsies from the duodenum for histology and to rule out celiac disease." Those were normal.

Thanks for any advice on this.

[Ursa Major]

Your son might be IgA deficient, in which case the other values are meaningless. Also, in children that young the tests (both blood and biopsy) are extremely unreliable, and yield many false negatives. Obviously, there was damage to his bowels, just not what the lab thought meant celiac disease.

With his sister being diagnosed through Enterolab, and having a positive response to the gluten-free diet (which is the most reliable test in young children), I suspect that he also should be gluten-free for life. Especially with him having diarrhea again now that you reintroduced gluten foods.

Why don't you just do the Enterolab tests with him as well?

[e&j0304]

Your son might be IgA deficient, in which case the other values are meaningless. Also, in children that young the tests (both blood and biopsy) are extremely unreliable, and yield many false negatives. Obviously, there was damage to his bowels, just not what the lab thought meant celiac disease.

With his sister being diagnosed through Enterolab, and having a positive response to the gluten-free diet (which is the most reliable test in young children), I suspect that he also should be gluten-free for life. Especially with him having diarrhea again now that you reintroduced gluten foods.

Why don't you just do the Enterolab tests with him as well?

Thanks for responding. We did test him through enterolab and his results were negative.

I was also going to ask about his other labs. He had a metabolic panel run and well as a CBC. He had 8 different things come back as either low or high on those screenings. I was never informed of that so I'm assuming that means it's not a problem? I am wondering why they even bothered to screen him and have reference ranges if it doesn't even matter and they won't bother telling me or doing anything about it?

The tests that were abnormal were his creatinine was low, his AST was VERY high, his ALK phosphatase was about 230 points HIGHER than the upper range of normal (it was 265), his WBC was low his mono % was high, lumph# low and momo# low.

I am confused about why they even ran these tests if they weren't going to follow up on the abnormal ones. Why bother and what is the point of reference ranges if they are ignored?

This was all done a year ago though and he has been healthy for the most part. He is now having diarrhea again (has had it 5 times already today) so will that flare up colitis?

Sorry for all the questions. I want to be well-informed next time we see a dr.

[happygirl]

e&j,

Based on his IgA results, it could very well mean that he is IgA deficient.

It doesn't mean that his other tests don't matter, it means that his IgA numbers will be worthless. Which makes tests like the tTG even more important.

This might be a situation where you don't know why it works (the gluten free diet), but if it gives you good results for your little one, it might be worth it.

I would bring the labs with you and ask your doctor about them. When I have high or low numbers, I make my doctors explain the reasonings, and why/why not they matter. Sometimes they do. Sometimes they don't.

I hope his diarrhea stops...five times in one day is awful.

Good luck,

Laura

[Nancym]

If he is IgA deficient then the enterolab results will be negative. You might want to double check with them however. They're very responsive to emails.

I think the dietary challenge is enough to prove it, IMHO.

[LisaJ]

From my Immunology book from college:

Blood serum levels for IgA deficient persons are usually found to be 7 mg/dl or less

[chrissy]

your son is not IgA deficient, he just has levels that are a little low. my son is IgA deficient and his level is <6. it looks like your son does not have celiac disease according to those tests, but if being gluten free helps him, it really doesn't matter if he doesn't have celiac, just keep him gluten free.

as far as the other tests, less than 20 is normal, they did not do an endomysial titer because there was nothing to do a titer on, and colitits is an inflamation of the colon----celiac disease is manifested in the small intestine.

sometimes children that young do not make Ttg antibodies. you may want to continue to have him tested periodically as he gets older.

did they consider eosinophilic problems?

[e&j0304]

Thanks to everyone for your help. We are going to just continue on with the gluten challenge and try to figure out how to help his reflux as well. I really think our main problem right now is the fact that he refluxes into his mouth and swallows it back down multiple times per hour all day long. We know that is had caused damage a year ago when he had his endoscopy so I'm hoping that the damage isn't too terrible by now. We are going to get a second opinion from another GI to hopefully get it all figured out and solved for him.

Thanks again

[rez]

Good luck and I've logged back in, only my third password. Why am I having these issues? Hang in there and I know you will find a GREAT doctor! They are out there, but sometimes very hard to find. Find one that's in it for the right reasons. You're a great mom and doing everything you can to make your kids well. I'll say a prayer for you all tonight.