Lab results - looking for opinions [PLEASE READ 1ST POST]

Emily Ortiz27 said:Could you elaborate on neutrophil granules? Also, these rouleaux formations pop up constantly in my smears. I’ve read they can be an artifact of poor sample prep, but at our lab, it feels like we almost always mess up the preparation. 🤔

The results are more than satisfactory. Prominent granules in neutrophils don't point to anything specific on their own. If we were seeing distinct toxic granules, that would suggest an active infection—essentially the neutrophils working overtime to devour pathogens. As for the rouleaux formation, while it can be an artifact, in this context, it's likely tied to the underlying condition and the composition of serum proteins. Children with ALS or similar spectrum disorders frequently present with findings just like yours.

Hi everyone!

I had some bloodwork done to check my MHC typing because I've been dealing with a persistent low-grade fever since May 2020. It usually hits around 99.5°F, and I've been feeling hot and sweating quite a bit. My Vitamin D is between 63-71, and my TSH looks normal.

Here are the results: (I used a vertical bar to separate the two values)

HLA-A*
02 | - (might be homozygous)

HLA-B*
08 | 41

HLA-C*
NT | NT (not typed)

HLA-DRB1*
03 | 11

HLA-DqB1*
02 | 03

I'd really appreciate it if someone could help me make sense of these!

Thanks!

So, we've got this 13-year-old kid who was sent in for some lab work because they've been running a low-grade fever for over a week now, though nothing else seems to be going on wrong.
Physically, everything looks totally normal—appetite is fine, and their bathroom habits (poop and pee) are completely regular.
Tested negative for COVID, so that's one less thing to worry about.

CBC and differential look perfectly fine.
Urinalysis is also pretty much normal.
But when you look at the urine sediment, things get a little weird: there's an elevated red blood cell count (8 when the reference range is 0-2), some mucus, a few spermatozoa, and a whole bunch of bacteria.

Moving on to the biochemistry:
Glucose is 5.3 (normal is 3.9-5.9)
Urea is 5.0 (normal is 2.7-6.8)
Creatinine is 66 (wait, the range says 25-42, so that's actually high)
Total bilirubin is 13 (6-24)
AST is 19 (11-38)
ALT is 10 (10-33)
GGT is 12 (10-27)
CRP is 0.3 (0.1-2.8)

TSH is 3.35 (right at the top end of the 0.68-3.35 range)

The plan right now is just to have them go back and redo the urinalysis.

Just for context, the kid is moderately active, but they haven't been training for the last 8 days because of the fever and they've mostly just been hanging out at home—plus, with all these restrictions lately, their usual workout intensity hasn't even been what it normally is.
All these tests were done first thing in the morning, fasting.

Maria Fisher46 said:Hi there,

Looking at these results, the only real outlier is the absolute lymphocyte count, which sits above 4.0x10*9/L, suggesting a mild lymphocytosis... though we still don't have a clear explanation for why, and there are honestly so many possibilities. It really depends on what kind of symptoms you're dealing with right now. It would probably be smart to repeat the Kaiser Permanente blood work in about two weeks, because if that lymphocyte count keeps climbing or just stays elevated, we'll need to dig deeper. Of course, a quick clinical exam and a more detailed look at your medical history might already give us a clue as to what's going on...

The rest of the values you shared don't seem to show any significant changes.

Hey everyone, I went back for a second blood panel after waiting 15 days, and here are the updates:

- LYMPHOCYTES 45.9% (normal range 20-46)
and they are currently at 5.0 10'9/L (ref 1.19 - 3.35)
- WHITE BLOOD CELLS 11 (ref 3.4 - 9.7)
- EOSINOPHILS 0.5 10'9/L (up to 0.43)

- NEUTROPHILS - have dropped down to 43.5% (normal 44-72)

My gastroenterologist told me that this blood work looks normal (?) and after doing an ultrasound on my abdomen and neck, he concluded that all my organs and my thyroid are fine... the only thing he found were two enlarged reactive lymph nodes in my neck, measuring about 35 mm. According to him, there's no need for any further testing or follow-up.

But I still can't shake this sensation of a "lump in my throat," plus there's this dull ache right where those lymph nodes are located on my neck and under my jaw. On top of that, my sleep has been a mess lately—I keep waking up after only three or four hours and just can't drift back to sleep... Do you think it's worth seeking a third opinion, and is this blood work actually "normal" like the specialist claims?

Thanks in advance 😁.

Peter White80 said:Good day, everyone.

I had blood drawn to analyze my MHC system because I've been dealing with a persistent low-grade fever since May 2020. My temperature regularly hits 99.5°F. I'm also dealing with heat sensations and sweating. Vitamin D levels are between 16-18. TSH is normal.

Here are the results: (the numbers are listed in two sets, separated by a vertical bar)

HLA-A*
02 | - (possible homozygosity)

HLA-B*
08 | 41

HLA-C*
NT | NT (not typed)

HLA-DRB1*
03 | 11

HLA-DqB1*
02 | 03

I would be very grateful if someone could look over these results!

Best regards!

Sir,

I hope you have already undergone a thorough medical evaluation. This shouldn't be one of the first complex lab tests performed, because based on your clinical history, this HLA typing won't provide the clarity you might expect.

I won't delve into the specifics of why through an online forum.

From the HLA typing, we can see a genetic predisposition toward systemic autoimmune diseases. Specifically, there is an increased risk for systemic lupus erythematosus (primarily HLA-DRB1*03, which increases the risk by two to three times compared to the general population), juvenile dermatomyositis (you also carry HLA-B8, which is more prevalent in patients with inflammatory muscle diseases within overlap syndromes), and unfortunately, HLA-DRB1*03 could also signal an elevated risk for juvenile systemic scleroderma (further complicated by your HLA-DRB1*11, which is linked to systemic scleroderma risk), as well as a higher risk for Sjogren's Syndrome. Additionally, HLA-DRB1*03 is associated with a slightly increased risk for multiple sclerosis, though the margin is quite small.

You are just short of the threshold for an extremely high risk of systemic lupus erythematosus. If you possessed the HLA typing combination of A1-B8-DR3 (whereas you have A2-B8-DR3), your lifetime risk of developing that disease would be ten times higher, which would also significantly spike the risk for other systemic autoimmune conditions.

Furthermore, you have an increased genetic predisposition for autoimmune thyroid diseases, Type 1 diabetes, and celiac disease (with the caveat that the typing was not performed with enough "granularity").

None of these conditions are a certainty; you may never develop any of them. We are strictly discussing predispositions.

I should also note that my entire response is qualified by the fact that the typing wasn't done with enough detail—specifically at a four-digit resolution. In your case, it was done at a two-digit resolution, often referred to as low-resolution typing.

I hope my opening sentence makes sense: this specific test creates more questions than answers, and it certainly shouldn't be used as the starting point for evaluating a patient with vague symptoms.

Good luck.

Emily Ortiz27 said:A 13-year-old was sent for lab work due to a low-grade fever lasting just over a week. No other symptoms reported.
Normal build, appetite, bowel movements, and urination patterns.
COVID test negative.

Blood counts look fine.
Urinalysis: physical and chemical properties are normal.
In the urine sediment, there's an elevated red blood cell count (8 vs. ref range 0-2), some mucus, some spermatozoa, and quite a few bacteria).

Biochemistry:
Glucose 5.3 (3.9-5.9)
Urea 5.0 (2.7-6.8)
Creatinine 66 (25-42)
Total Bilirubin 13 (6-24)
AST 19 (11-38)
ALT 10 (10-33)
GGT 12 (10-27)
CRP 0.3 (0.1-2.8)

TSH 3.35 (0.68-3.35)

The doctor ordered a repeat urinalysis.

The kid stays moderately active, but hasn't trained in the last 8 days because of the fever. He's mostly stayed indoors—training intensity has been lower than usual anyway due to recent restrictions.
Tests were done in the morning, fasting.

Hello,

The child should probably have a chest X-ray. It would also be wise to check ESR, CK, LDH, electrolytes, and run a urine culture. Beyond that, testing for atypical infectious agents that might present this way—specifically Mycoplasma pneumoniae or certain viruses—would be prudent. If you haven't already, I’d suggest contacting the Mayo Clinic.

Ronald Kern78 said:Hi, following my second blood panel (taken 15 days later), here are the shifts:

- LYMPHOCYTES 45.9% (ref range 20-46)
and they are at 5.0 10^9/L (ref 1.19 - 3.35)
- WHITE BLOOD CELL COUNT 11 (ref 3.4 - 9.7)
- EOSINOPHILS 0.5 10^9/L (up to 0.43)

- NEUTROPHILS - have dropped to 43.5% (ref 44-72)

The gastroenterologist claimed this blood work is normal (?) and after an ultrasound of my abdomen and neck, concluded all organs/thyroid look fine. He did find two enlarged reactive lymph nodes in my neck, measuring 35 mm. In his view, no further follow-up is required.

However, I still have this "lump in my throat" sensation and a dull ache where those lymph nodes are located on my neck and under my jaw. I've also been struggling with sleep lately (waking up after 3-4 hours and being unable to drift back off). In your opinion, is it wise to seek a third opinion? And is this blood work really "normal" as the gastroenterologist suggests?

Thanks in advance 😁.

Hello,

You should pursue further testing. While your differential white cell percentages look standard, you have absolute lymphocytosis paired with enlarged cervical lymph nodes labeled as reactive. As a starting point, it seems reasonable to order a peripheral blood smear, ESR, CRP, liver function tests, CK, LDH, and serology for CMV and EBV. Depending on clinical indications—based on a detailed history (including sexual history) and physical exam—further screening for other infectious agents may be necessary.

Maria Fisher46 said:Hi there,

The kid probably needs a chest X-ray to check out those lungs, plus some blood work—ESR, CK, LDH, electrolytes—and a urine culture. You really ought to look into testing for those atypical infectious bugs that can cause this kind of clinical picture, specifically Mycoplasma pneumoniae, though viral stuff is on the table too. If you haven't already, I’d suggest heading over to the Mayo Clinic.

Thanks so much for getting back to me.
In the meantime, we went ahead and did another urine test, and my doctor said everything came back totally clean. She reviewed it, and nothing showed up.
Also, the ESR result just came in: it's sitting at 6.

So now we're basically stuck waiting without any clear next steps, just hanging tight for the viral panels, the throat swab, and the AST results.
We figured we'd wait until those results land early next week before having another sit-down with the doctor if this fever keeps lingering (it hasn't topped 99.1, but it won't drop below 98.4 either, and we're on day 13 now), especially since the kid feels fine and—thanks to all these pandemic restrictions—isn't even missing school or sports anyway.

I don't think we have a pediatric infectious disease specialist here in San Francisco, so I assume we'd need a referral to go see someone at the clinic in Washington, D.C.?

Bonus question: should we be monitoring the thyroid after a while given that borderline TSH level? There's a history of thyroid issues in our family—my grandma and uncle both have it, and I've dealt with thyroid fluctuations after every pregnancy that just seemed to settle down on their own.

Emily Ortiz27 said:I don't think we have a pediatric infectious disease specialist here in San Francisco. I assume we'd need a referral to go to the Mayo Clinic in Washington, D.C.?

No, there shouldn't be any need to travel to Washington, D.C. just for that. You can handle everything right here in San Francisco.

The child doesn't meet the criteria for AST-O titer testing.

Bonus question: given that borderline TSH value, should we monitor the thyroid after a while? There's a history of thyroid issues in the family—my grandmother and uncle both had them, and I personally dealt with thyroid fluctuations after every pregnancy that eventually settled on their own.

In my view, setting the upper limit for TSH at 3.35 mIU/L for a child this age is overly restrictive. I wouldn't classify a TSH at the top end of the normal range as a cause for alarm. As for whether monitoring is necessary or how frequently it should happen, that’s a conversation for the primary pediatrician. They'll determine if there's a clinical indication for follow-up and set the appropriate intervals.

Maria Fisher46 said:Hi there,

I hope you've already been through a thorough medical workup, because if this isn't one of your first complex lab tests, then the HLA typing might not actually give us the clarity we’re looking for based on your history.

I won't get too deep into the specifics here on a forum, though.

The HLA typing shows a genetic predisposition toward systemic autoimmune diseases. For instance, HLA-DRB1*03 increases the risk of systemic lupus erythematosus by about two to three times compared to the general population. You also have HLA B8, which is seen more often in patients with inflammatory muscle diseases within overlap syndromes, specifically juvenile dermatomyositis. That unfortunate HLA-DRB1*03 could also mean a slightly higher risk for juvenile systemic scleroderma (especially since you also carry HLA-DRB1*11, which is linked to increased systemic scleroderma risk), and it carries an even higher risk for Sjogren's Syndrome. Now, HLA-DRB1*03 is also tied to a slightly increased risk for MS, but that's very minimal.

You're still quite far from having an extremely high risk for systemic lupus erythematosus. If you had the HLA typing combination of HLA typing (A1-B8-DR3), your lifetime risk would be ten times higher, and that would significantly bump up the risk for other systemic autoimmune issues, too. But you have A2-B8-DR3.

Additionally, you have a genetic predisposition for autoimmune thyroid diseases, type 1 diabetes, and celiac disease—though I should mention that this assumes the typing was done with enough detail.

It's important to remember that you don't necessarily have to develop any of these conditions. It's just a predisposition.

I should also point out why I mentioned that the typing needs to be "detailed." In your case, the testing was done at low resolution using only two digits, rather than the full four-digit precision.

I hope my opening sentence makes sense now; this specific test can sometimes create more questions than answers, and it definitely shouldn't be the starting point for evaluating a patient with unclear symptoms.

Good luck!

Hi,

thanks so much for such a detailed response!

Unfortunately, I've already had a pretty thorough workup and everything seemed fine. My diagnoses so far include LPR/GERD and esophageal motility issues, plus some bouts of constipation (though my colonoscopy was normal). I've also dealt with some vertigo, slight thickening of the carotid arteries, and systolic hypertension. Looking at my labs, I had an ECP of 18.0 ug/L, ASO at 243 IU/mL, and triglycerides at 3.3 mmol/L. Also, there's a 4 mm cyst on the upper left third of my thyroid lobe.

I'm not sure if this matters, but I'm extremely sensitive to the sun—I get a rash on my back just being in the shade during the summer.

In your opinion, is there anything else I should look into, or should I just stick to a healthy lifestyle and hope nothing develops?

Thanks again for the help!

Best regards

Peter White80 said:Dear sir,

Thank you so much for such a thorough response.

Unfortunately, I've already undergone extensive testing and everything was relatively orderly. The only outliers were: GERD/LPR plus esophageal issues, bouts of constipation (though my colonoscopy was clear), some vestibular issues, slight thickening of the carotid arteries in the neck, and systolic hypertension. Key findings to note: CRP 18.0 mg/L, ASO 243 IU/mL, triglycerides at 3.3 mmol/L. Also, a 4 mm cyst on the upper left third of my thyroid lobe.

I'm not sure if this matters, but I am extremely sensitive to sunlight—even staying in the shade during summer causes a rash on my back.

In your opinion, should I pursue further testing, or simply focus on a healthy lifestyle and hope that no actual disease develops?

Thanks for getting back to me.

Best regards,

Dear sir,

Given the collection of data and the various specialist opinions you've gathered, it makes sense to consult a rheumatologist or a clinical immunologist. You need someone to synthesize all these disparate pieces into a single clinical picture.

To be blunt, I doubt you'll walk away with a definitive diagnosis at this stage.

Maria Fisher46 said:Hi there,

It looks like you really need some follow-up testing done. Even though your differential blood count looks normal in terms of percentages, you’ve got an absolute lymphocytosis paired with swollen lymph nodes in your neck that were flagged as reactive... To get started, it seems pretty reasonable to run a peripheral blood smear, an ESR, CRP, a liver panel, CK, LDH, and then check your serology for CMV and EBV, plus whatever other infectious causes might be indicated based on a full clinical history—including sexual history—and a physical exam.

Hi,

Is there any chance that this absolute lymphocytosis and the swollen lymph nodes could actually be coming from a toothache I've been dealing with for the last few weeks? I just had a small cavity filled recently, but about a week later, the pain started up... It isn't constant, though, just kind of comes and goes every few days...

Best,

Ronald Kern78 said:To whom it may concern,

Is it possible that my absolute lymphocytosis and swollen lymph nodes are a result of the toothache I've been dealing with over the last few weeks? I recently had a small cavity filled, but about a week later, the pain started. It isn't constant—just hits every couple of days.

Best regards,

To whom it may concern,

Swollen lymph nodes in the neck can certainly be linked to odontogenic infections—essentially, dental issues. However, lymphocytosis typically doesn't fit that picture. Bacterial infections generally don't trigger lymphocytosis (flu is an exception, but that’s a different matter entirely).

In any case, you need to investigate the cause of both the rising absolute lymphocytosis and those enlarged cervical lymph nodes.

Linda Gray said:I would appreciate some insight regarding my OGTT results. My fasting insulin was 42.6, and at the 120-minute mark, it climbed to 260.3. Beta cell function is sitting at 67.2%, peripheral insulin sensitivity is 104%, and my insulin resistance index is 1.0.
My fasting glucose was 5.8 mmol/L, which rose to 7.0 mmol/L after 120 minutes. Thank you in advance!

I am repeating this inquiry, provided anyone actually possesses the knowledge to answer...🤔

Maria Fisher46 said:To whom it may concern,

You really need some follow-up testing done on this... You’ve got a normal differential blood count when you look at the percentages, but there's an absolute lymphocytosis paired with swollen lymph nodes in the neck that have been flagged as reactive. To get a clear picture, it seems reasonable to start with a peripheral blood smear, an ESR, CRP, a liver panel, CK, and LDH, along with serology for CMV and EBV... and depending on what the clinical history shows—including sexual history and a physical exam—you'll likely need to screen for other infectious agents too...

To whom it may concern,

I ran those searches we talked about, and here are the links to everything I found...
I honestly don't even know where to start with this whole situation... it just feels like everything is spiraling out of control lately, and I can't help but wonder if anyone is actually paying attention to what's happening right under our noses... https://app.box.com/s/fwp3y4gbids9s7tgzyqoxvja1u3hmu5c
Liver enzymes... https://app.box.com/s/gaj5r5kyev5yvxvhs0axmw2i99k3r00u
C-reactive protein levels... if they’re running high, it really just means there’s some kind of inflammation going on somewhere in your body that needs looking into... https://app.box.com/s/p26bk9066frhu9i2funrgh3u4pplcazi
I was looking over my latest blood work results, specifically those LDH and CK levels, and I can't help but wonder what they're actually trying to tell us about what's going on under the hood... It feels like just more numbers to stare at without a clear roadmap, though I know they're supposed to be indicators of tissue damage or muscle strain, which makes me think about how much our physical activity really impacts these readings... https://app.box.com/s/5wz4f2cvni8t23tysg2m8uaxcydfuebs

So... I was just sitting here thinking about how much we tend to overlook the tiny, invisible battles happening inside our own bodies every single second... specifically those little white blood cells known as lymphocytes that act like our internal security detail, constantly patrolling the bloodstream to hunt down anything that doesn't belong there... it’s honestly kind of wild when you really stop to consider the sheer complexity of how they recognize a threat and then mobilize an entire defense system just to keep us standing... They've dropped down almost to their baseline levels... 3.4 (1.19-3.35)
My erythrocyte sedimentation rate came back a little lower than normal, but from everything I've been reading up on lately, it doesn't seem like anything to worry about...
Everything else stayed right within the standard reference ranges...

The only thing that actually came back elevated in the results were the liver enzymes, which is... ALT - 64 (12-48).
I started taking Zoprax (20 mg pantoprazole) about a week ago because my doctor suspected I was dealing with some acid reflux... Is there any chance this medication is actually what's causing my elevated lab results? I noticed in the prescribing information that if liver enzymes spike, you're supposed to stop taking it immediately...

Do you think it's worth digging deeper with more testing, or would it be better to just keep an eye on liver enzymes after a certain point and see how things settle...
I'm actually feeling pretty good right now, and I can really tell that those swollen lymph nodes in my neck have finally started to shrink down...

Thanks for all the help and for clearing things up for me...

Linda Gray said:Repeating my question here, if anyone actually knows🤔

Hello,

To make sense of these numbers, I’d need to know which specific units were used for the insulin measurement. Even without that detail, though, the insulin levels look elevated—particularly at the 120-minute mark.

Strictly speaking, based on these results, there isn't insulin resistance present at the time of the test. An HOMA index of 1.0 is essentially textbook perfect, suggesting good insulin sensitivity. Where things get a bit inconsistent is the combination of those relatively high insulin values alongside the somewhat low activity from the pancreatic beta cells responsible for producing it.

Depending on why this testing was ordered in the first place, it might be worth repeating the process down the road.

Ronald Kern78 said:Hello,

I’ve completed the requested tests. Here are the links to the results:
CBC - https://app.box.com/s/fwp3y4gbids9s7tgzyqoxvja1u3hmu5c
Liver enzymes - https://app.box.com/s/gaj5r5kyev5yvxvhs0axmw2i99k3r00u
CRP - https://app.box.com/s/p26bk9066frhu9i2funrgh3u4pplcazi
LDH and CK - https://app.box.com/s/5wz4f2cvni8t23tysg2m8uaxcydfuebs

Essentially, my lymphocytes have dropped and are nearly within the normal range - 3.4 (1.19-3.35)
The ESR is slightly lower, but from what I've read, that shouldn't be an issue.
Everything else falls within the standard reference ranges.

The only elevation is in the liver enzymes, specifically ALT at 64 (normal is 12-48).
A week ago, following my doctor's suggestion regarding suspected gastro reflux, I started taking ZOPRAX (20 mg pantoprazole). Is it possible this medication is causing the elevated levels? (The patient information leaflet notes that if liver enzymes increase, usage should be discontinued)

In your opinion, do I need more testing, or would it be sufficient to just recheck the liver enzymes after some time?
On a side note, I feel fine right now; it feels like the lymph nodes in my neck have shrunk.

Thanks for the guidance and explanations!

Hello,

Given your history of lymphocytosis, the enlarged lymph nodes in your neck (though I am unsure if they are still present), and the altered liver function tests, an infectious cause—specifically infectious mononucleosis syndrome—seems likely. I stand by my previous assessment: we really need to identify which specific infection we are dealing with. It is a positive sign that the lab work is improving. You can recheck the liver panel in two weeks to a month.

Hello,

I have been struggling with aching joints, bones, and muscles for about two months now. It started out pretty minor, but I guess it has been getting worse over time. Some of my joints are swollen, and even some of my muscles feel inflamed. On top of that, an ultrasound confirmed I have reactive lymph nodes in my neck, armpits, and groin area. My abdominal ultrasound came back normal, though.
I had Strep A in my throat maybe four or five times, if not more, and now I’ve also tested positive for Group B Strep.

Back in December, my CBC and peripheral smear were both within the normal range.
Earlier this month, I had a CBC, ESR, CRP, and ASO titer done. My monocytes were slightly high (12.2, with 12 being the limit), my MPV was elevated at 12.5 (normal is under 10.4), and my ASO was quite high at 695 (normal is under 200).

An immunologist has ordered testing for RF, CCP, and HLA-A, B, and DR loci. My radiologist even suggested a lymph node biopsy to figure out what's going on and recommended I get some serology done, but I am not sure which specific tests to ask for.

I am thinking about getting a CBC, peripheral smear, liver enzymes, ALP, LDH, CRP, and ASO checked again, and perhaps testing for EBV and Cat Scratch Disease.
If anyone has other suggestions for tests I should consider, I would be grateful.

Thank you.

Maria Fisher46 said:Dear Madam,

To properly interpret these lab results, one would ideally need to know which specific measurement units were used for the insulin levels. However, even without that clarification, it appears to me that the insulin values are elevated, particularly at the 120-minute mark.

Strictly speaking, based on these test results, there is no evidence of insulin resistance at the exact moment the testing was performed, given that an insulin resistance index of 1.0 is considered optimal, suggesting healthy insulin sensitivity. What does seem somewhat inconsistent, however, are the relatively high insulin readings coupled with the relatively low activity of the pancreatic beta cells responsible for producing that insulin...

Depending entirely on the clinical reason why this testing was ordered in the first place, it might be worth considering a follow-up test after some time has passed.

Thank you very much🙂

Got my HPL levels back.
Basically, it's that human chorionic somatomammotropin (HCS)... and apparently, when mom is a bit insulin sensitive, it sends those blood glucose levels climbing.
Has anyone else here actually dealt with this specific test before?