Posts by Nicholas Myers

Emily Ortiz27 said:Sorry for the delay; those results were a bit unsettling.

The kid seems perfectly healthy.
For several years now, he’s had chronic lymphadenopathy across all neck regions, abdominal, inguinal, and recently axillary.
Eighteen months ago, a biopsy of a lymph node conglomerate showed nothing dramatic—the conclusion was mixed reactive tissue (I can transcribe the report tomorrow), though there was an elevated lymphoproliferative index. We're monitoring him due to suspected ALPS, which an immunologist actually hasn't confirmed, alongside a primary immunodeficiency involving IgA deficiency, which doesn't cause any major issues.

I recall these details. They don't change my previous assessment.

In the last six months, he hasn't had a fever or any other signs of infection. He attended preschool regularly right up until COVID, stays active, and appears fine, though he's been slightly more tired lately, despite his usual high energy and temperament.
We won't have the peripheral smear results until next week—that's just how our labs work, especially with the holiday approaching. It's a standard lab turnaround.
The rest of the CBC, including red and white cell counts, tumor markers, and liver function tests, are all within normal limits, aside from slightly elevated eosinophils (the little guy has atopic dermatitis).

Understood. What we have here is an automated CBC with a differential; the manual cytological peripheral blood smear is still pending. As I mentioned in a prior post, a microscopic review is much more reliable, particularly when the automated readings show deviations. My remaining stance remains unchanged.

Emily Ortiz27 said:Along with the usual one atypical cell, we found one metamyelocyte in the kid.
The rest of the CBC looks standard—sed rate, LDH, ferritin are all fine.
Thoughts?
(I won't list everything else since you already know... if needed, I can

Hello,

I always prefer to see the full panel before weighing in. Assuming everything else is steady, seeing a metamyelocyte in peripheral blood isn't standard. Think of them as immature neutrophils; they typically pop up during an infection or inflammation. You might also see them during pregnancy or when the bone marrow is being pushed hard—like recovering from myelosuppression or correcting anemia. Of course, a significant increase in myelocytes can signal malignancy, which I realize is understandably heavy on your mind given your child's diagnosis.

The child's hematologist definitely needs to be looped in on this. My guess is they’ll want a repeat blood smear to track the progression of these immature cells. They will likely want to examine the child to check for signs of infection or inflammation, ask if there's been an acute illness, check the CRP levels, or look for a fever. They'll also want to know about any recent symptoms—cough, sore throat, nasal congestion, vomiting, diarrhea, or urinary issues—that might explain this.

Naturally, if the child is showing any actual symptoms or distress, an urgent evaluation is necessary to rule out an infection that requires immediate treatment.

placidrider48 said:Age: 29, M

Before my first appointment with a gastroenterologist, my doctor suggested running a full blood panel to speed up the diagnostic process.

I went in because of bloating, occasional heartburn, strange sounds in my throat, and some stubborn weight loss (it took two months of staying home just to put on 2 lbs).

The blood work showed a few deviations from the norm.

Relative neutrophil percentage 38.8% (ref. 44- 72)
Relative lymphocyte percentage 51.4% (ref. 20- 46)

Basophils 0.10 (ref. 0.00- 0.06)
Lymphocytes 3.80 (1.19- 3.35)

Could this simply be a side effect of an autoimmune condition? (I have psoriasis.) My gastroenterologist also ordered a Celiac test.

Hello,

I wouldn't call these significant deviations. Absolute values matter more than relative ones. A lymphocyte count of 3.80 and neutrophils at 2.86x10*9/L—based on my math, assuming a total WBC of about 7.39x10*9/L—don't strike me as worrying. Since autoimmune diseases involve the body producing antibodies against itself, and those antibodies come from plasma cells derived from B lymphocytes, lymphocytosis can certainly occur.

Laura Thomas55 said:I could use some help analyzing these results.😉

We're talking about an 80-year-old woman who had a total knee replacement two years ago.
It was a rough recovery; she dealt with a bacterial infection in the wound that took several months of treatment to finally clear up. Her CRP stays slightly elevated—most recently at 10.7.

The latest blood work looks fine across the board, except for her kidney indicators: creatinine 99, eGFR 47. Her doctor suggested she just needs to stay better hydrated. Mobility has also taken a hit; she’s much less active now and refuses to leave the house for walks since the surgery.

What would you recommend? Should we look into further testing, or should we just focus on getting her moving more, keeping her hydrated, and monitoring her bathroom habits?

Hello,

I hesitated on whether to weigh in here. While this is clearly an elderly patient, the estimated glomerular filtration rate—even accounting for age—points toward diminished kidney function. Given that roughly 50% of seniors have an eGFR below 60 ml/min/1.73m², and clinical consensus suggests discussing chronic kidney disease in patients over 65 once the eGFR drops below 45 ml/min/1.73m², this lady is sitting right on that threshold. It’s also vital to check for protein in her urine; if it hasn't been done, determining the albumin-to-creatinine ratio would be a logical next step.

As for how to proceed, there isn't one definitive playbook. Most older adults live with some degree of chronic kidney impairment, yet only a small fraction ever progress to end-stage renal disease.

What can certainly be advised is preventing malnutrition, which is a common pitfall in the elderly, and ensuring she avoids dehydration. It’s also worth reviewing her entire medication list, as many drugs—like ibuprofen or certain antibiotics—can take a toll on kidney function. Encouraging physical activity whenever possible is also key.

Ultimately, the decision regarding further diagnostics or intervention depends on her overall health, her frailty, any comorbidities, and her life expectancy. These calls must be made individually and in direct consultation with her primary physician.

Elizabeth Sullivan23 said:Hey everyone.
The X-ray results say... Sclerosis of irregular edges, measuring 14 mm, located in the right ilium.
Does anyone know what this implies? My doctor ordered some blood markers, but could there be any other reason behind it?

Sclerosis essentially means bone density has spiked in a specific area. It’s a thickening caused by a breakdown in the natural remodeling process.

There isn't just one reason for this. The primary factor is context: why was the imaging ordered in the first place? We have to look at whether this was a random finding or if the patient actually presented with specific symptoms—like localized pain—along with their medical history and the nature of those complaints.

The clinical picture can vary wildly. You might be looking at anything from standard bone healing after an injury to issues with blood supply—like a bone infarct—or even infections. Then there are congenital conditions, benign or malignant tumors, and ultimately, metastasis.

In other words, the shift is vague.

The description of the change lacks sufficient detail. Without more specifics, it’s impossible to determine if we're looking at a homogeneous or heterogeneous shift, nor can we pinpoint whether it's localized within the cortex, the medulla, or sitting right on the boundary between the two.

The shift clearly exceeds one centimeter, and those jagged edges mean we’re going to need some serious corrective work. It would be a huge help if an experienced orthopedic specialist could take a look at the displacement on the scan to guide how we handle the next steps.

fadedsailor17 said:Bilateral neuronal lesions in both visual pathways... what does that actually imply?

I assume this is an FBI test result (visual evoked potentials). The finding points to damage within the optic nerves, though it doesn't pinpoint the culprit. It could be anything: MS, a tumor, ischemia—basically a circulation issue—and so on.

Angela Johnson5 said:Can someone please explain these HLA typing results?
HLA-A 2 HLA-A
HLA-B 8 HLA-B 57(17)
HLA-Bw 4 HLA-Bw 6
HLA-Cw 6 HLA-Cw

HLA-DRB1*03 HLA-DRB1*07

HLA-DQB1* HLA-DQB1*
HLA-DQA1* HLA-DQA1*

Thanks in advance!!!

The results show a genetic predisposition for psoriasis (HLA-Cw6) and systemic lupus erythematosus (HLA-DRB1*03).

Having these markers doesn't mean you'll ever actually develop either condition, though it is possible to develop both.

These findings need to be viewed alongside your actual clinical symptoms.

Best regards.

nimblesurfer302 said:Hello, I was hoping someone could explain these typing results. This is for a 14-year-old girl. Her doctors haven't explained anything yet. ANA negative, RF 41, AST 0. Se-6, creatinine—all normal. Urea, creatinine, liver panel, CK, LDH, AC, uric acid—everything else is within the standard reference ranges.
Typing:
HLA-A 3/32
HLA-B 7/61
HLA-DR 1/15
DR 51;52;53 51/NT
HLA-DQ 1/NT

Note: ICD diagnosis code: M05 Annotation
Annotation: DR1 positive

Thanks in advance for any help!

Based on what you provided (the M05 diagnosis code refers to rheumatoid arthritis with a positive rheumatoid factor), it’s clear the physician suspects rheumatoid arthritis. They ordered this testing to determine if there is a genetic predisposition to the condition.

In this case, there is. The presence of HLA-DR1 indicates a genetic predisposition to that disease.

Furthermore, the patient carries HLA-DR15, which can be associated with an increased risk for multiple sclerosis, systemic lupus erythematosus, and Goodpasture syndrome.

It is important to note that none of these conditions are a certainty; having these HLA alleles simply suggests a slightly elevated risk, not a guaranteed diagnosis.

It seems like lately, this thread has been flooded with questions, yet we’re seeing very few actual answers. 👎

I’ll try to tackle the questions coming in this month. I figure the veterans around here have likely already hunted down their answers, or they simply aren't relevant anymore.

Emily Ortiz27 said:Adding a follow-up to my previous questions...:
How long does one typically wait before reactive lymphocytes show up?
A month after the initial findings, the kid still shows 8% reactive lymphocytes in the bone marrow.

Given everything we’ve discussed—starting with how long these swollen lymph nodes have been present (definitely more than a month), their actual size (exceeding 2 cm), and the fact that standard blood work hasn't provided a definitive diagnosis or an explanation for the swelling—this child meets the criteria for a needle aspiration. A biopsy or even a full excision of the node for pathology is likely the next logical step. It’s also clear that the CBC and differential counts haven't stayed within normal ranges during this entire period; there’s always some sort of deviation. Without a tissue sample from those nodes to analyze, we're essentially guessing at the underlying cause. While atypical lymphocytes can show up during viral infections—where you'd expect them to disappear once the illness clears—they can also persist if an infection becomes chronic. That said, atypical lymphocytes aren't exclusive to viruses. Given the circumstances here, further diagnostic testing isn't just an option; it's necessary.

Good luck!

Ronald Jones5 said:Male, 24. Got some labs done out of anxiety regarding STIs.
page 1 View on imgur
The conversation continues here. View on imgur

If you're running these tests solely because you're worried about an STI, I have some bad news: these results won't give you the peace of mind you're looking for. They don't rule anything out. You need to get targeted testing for the specific infections you're actually concerned about—think HIV or syphilis. A standard blood panel, basic biochemistry, or even a clean urinalysis can look perfectly normal even if someone is carrying HIV or syphilis.

Sarah Wells23 said:Can GGT levels spike while taking Esperal?

A 34-year-old male. Alcohol consumption was sporadic but heavy. Three months ago, all lab results were within range. Since starting treatment, his gamma levels have been climbing month after month. He started at 35 (normal up to 55), moved to 50, then 68, and now he's sitting at 98.

The answer is yes. Disulfiram can independently cause an increase in GGT and other liver enzymes. It can even lead to liver damage. Regular monitoring of labs is essential. There is also the possibility that the individual is still consuming alcohol...

Adam Clark50 said:Could someone explain these results:
lymph node in the axilla.
female, 54 years old. Has dealt with anemia for several years.

immunophenotyping
https://s17.postimg.org/47lsay5kv/IM...409_111629.jpg

cytology puncture

https://s17.postimg.org/cd3u9awgf/IM...409_111644.jpg

Unfortunately, I can't view the images.

Alex Foster6 said:I'm worried about how low these White Blood Cells are... the doctor said we should come back for more blood work in a week, assuming things have stabilized by then.

Is it typical for them to drop that much during the flu?

Oh, absolutely. They can actually dip even lower than that. I'm fully on board with whatever the attending physician suggests here.

brightgull13 said:Hey everyone, I could use some help here. I just got my ferritin results back today and it came in at 13, while the standard range is listed as 22–122. Any insights?
Any advice on what I should take to get my iron levels up?
Iron is at 13... ref range is 8-30.
UIBC 47.9... ref range 26-59.
TIBC 61 (Reference range: 49-75).

It’s clear you're running low on iron. Whether that actually qualifies as anemia depends entirely on your hemoglobin and hematocrit levels. While supplements like Heferol, Ferrum Sandoz, or Legofer can address the deficiency, they aren't a cure-all. You have to find out why the iron is disappearing in the first place. If there's bleeding in the digestive tract—even if it's subtle enough to go unnoticed—you need to identify the source. Treating the iron shortage without finding the root cause risks overlooking a much more serious underlying condition.

vividtiger42 said:Hey everyone,

Lately, I've been dealing with some occasional cloudy urine at the end of urination. It’s most noticeable when I'm not staying properly hydrated. This happened back in my younger years too, so I didn't panic initially, but I started feeling a slight ache—just a bit of discomfort—near my right kidney. That prompted a trip to the doctor. My urinalysis came back clean, but my creatinine was slightly elevated; the reference range is 64–106, and I clocked in at 110. Urea and PSA levels are both normal.

Do you think there’s cause for concern?

Thanks in advance.

It depends on your age. You’ll need imaging for the urinary tract—starting with a renal and bladder ultrasound—along with follow-up urea and creatinine tests. It would also be wise to run some other standard biochemical panels, calculate your GFR, and potentially perform a 24-hour urine collection to check protein levels and the protein-to-creatinine ratio. For now, the priority is repeating the urea and creatinine along with electrolytes, plus getting that ultrasound done.

Emily Miller32 said:I’d appreciate some insight on these results: View on imgur

My throat is killing me. It’s so inflamed I can barely swallow, let alone talk.
Running a fever of 98.6°F... unfortunately, this has been happening more frequently lately, though never with this kind of intensity. I haven't had my tonsils removed.
Any advice?

The results might point toward a strep infection, but being unable to speak or swallow changes the stakes entirely. You need to see an ENT specialist immediately. At this stage, we have to rule out the development of a peritonsillar abscess or even a parapharyngeal abscess—essentially a soft tissue abscess in the neck. That can become dangerous very quickly. Get an urgent evaluation by an ENT right away. If everything looks stable, they’ll likely take a swab and then decide whether to wait for the culture results or start you on antibiotics immediately, depending on how you're holding up.

shadowwalker11 said:Enlarged liver and spleen. The only outliers are low ceruloplasmin, low blood copper, iron, and ferritin. Currently waiting on Gaucher results and an appointment for a follow-up liver biopsy; the first one showed mononuclear infiltration in the portal areas.

Hello,

In this instance, the situation is somewhat more nuanced. Specifically, the ANA was tested to either confirm or rule out autoimmune hepatitis. Mononuclear infiltration in the portal areas can be indicative of autoimmune hepatitis, particularly if it presents as lymphoplasmacytic infiltration. Even a titer lower than 1:100 could be significant here, though we typically see 1:160 or higher. Depending on your doctor's clinical judgment, they might request the lab to re-test even such a low titer.

shadowwalker11 said:Felix, since you're here, what does an ANA result mean?

Result: speckled

Unit: titer

Ref. range: <1:100?

The testing was done at Johns Hopkins Hospital.

Essentially, this means those antibodies are present, but at a low titer. In most cases, such a finding carries no clinical significance. It’s common to see this in healthy individuals—particularly older adults—or as a side effect of certain medications.

What prompted the test?

Kimberly Thompson56 said:If these results were to repeat, could you please tell me if such low values should be taken into account?

Negative values aren't factored in, and often, even low titers are disregarded depending on the suspected condition.

Nowadays, we generally assume there is no systemic lupus erythematosus diagnosis without a positive ANA.

As for what the future holds, it's largely uncertain; one cannot predict the course of any rheumatic disease with absolute certainty.

Looking at the list of symptoms provided, it appears you may have oligoarthritis (?) and possibly Raynaud phenomenon/syndrome, which warrants more detailed investigation.

What is the sedimentation rate? Have you had any radiological imaging done on those joints (X-rays, ultrasound), and what were the findings?

Regarding the changes in your hands (fingertips)—do they worsen when exposed to cold, or during periods of emotional distress or stress?

nimbleotter8 said:Saw a specialist today. Got an antibiotic prescription and orders for some blood work and a urinalysis.
I've already picked up the antibiotics and started the course, but I can't get my bloodwork done for another two or three days due to waiting on the referral paperwork. Does taking antibiotics mess with the test results?

It will.

Kimberly Thompson56 said:Cleveland Clinic

In my opinion—and I know many of my colleagues feel the same way—you can't exactly bank on the immunology lab over there. They aren't reliable. On the flip side? The rheumatologists and immunologists are top-tier.

boldnomad45 said:I got my nasopharyngeal swab results back, and it says "Culture showed no growth."
Does that mean the results are fine? I haven't seen that wording before, so I'm not entirely sure.🤔

To use your own terminology, the result is OK.

Kimberly Thompson56 said:Hello. I'd appreciate your thoughts on these lab results.

First off, where you had your ANA and ENA tested matters immensely. For cases like this, the Mayo Clinic is certainly your best bet; their results are the gold standard and highly reliable.

Chloe Garcia10 said:Do I have any reason to worry if the MRI came back clean?

Regarding those concerns about "spinal bone cancer"—there’s really no reason to worry. The imaging results came back completely normal.

x said:Is HIV a possibility? I had a risky encounter with a foreign national a few months back.

Based on the lab results you posted, I can't confirm or rule out an HIV infection as the cause of your symptoms. A standard CBC just doesn't provide enough information to answer that question. The only way to get a definitive answer would be through specific HIV testing.

Typically, an acute HIV infection presents with lymphopenia, though you'll usually see leukopenia, thrombocytopenia, and occasionally anemia as well—none of which apply to your case. It’s also worth noting that these tests were taken very shortly after your symptoms first appeared. Results like these are often uninformative because blood counts frequently don't have enough time to shift significantly in such a short window. Furthermore, it isn't entirely clear why a brief fever of 102.2°F—which isn't even considered a high fever, as we generally look for anything north of 104°F—warranted an emergency room visit.

What you’ve described could just be symptoms of a harmless viral infection.

When it comes to HIV, testing is the only answer. Nothing else matters.

Michelle Bennett52 said:I could use some help interpreting these lab results.
A friend of mine had this lump on the inside of her upper arm. She was already making plans to have it surgically removed.
She went in for an ultrasound yesterday. The radiologist didn't mince words—immediately flagged a suspicion of sarcoma. She was sent for an urgent biopsy right away.
The biopsy results are in:
Dimensions: 50x30x30mm.
The biopsy results show a gelatinous consistency.
The puncture biopsies revealed scattered cells featuring round or oval nuclei and well-organized chromatin structures. The cytoplasm appeared moderately abundant and spindle-shaped. Also noted were phagocytes, significant amounts of myxoid extracellular matrix, and red blood cells.
We’re heading to the plastic surgeon for a biopsy in just a few days.
That lesion has been there for a few years now; it’s been growing steadily.

Based on what’s written here—though I'm wondering if this is the complete report or if something was left out—these biopsy results don't definitively point toward malignancy. However, if there's clinical suspicion, the entire lesion needs to be removed and sent for a full pathology analysis. That’s the only way to get a reliable final verdict on what we're actually dealing with.

Chloe Garcia10 said:Could it be either a bacterial or a viral infection?
When you suggest it could be something else, what exactly are we looking at?
Lp

It could be an incomplete recovery from a bacterial infection—something lingering or just barely cleared—but a mild elevation in neutrophils can also show up at the onset of a viral illness before lymphocytes eventually rise. So, yes, it could be either.

Given the wide array of various symptoms you've described across several different threads here, there is a possibility that low-grade fevers and these lab results could signal the start of a non-infectious condition, such as a rheumatological issue. However, a few days of low-grade temperature is far too short a window to diagnose something like that.

Jessica Baker69 said:The doctor insists there’s nothing to worry about—that it isn't anything serious. But I'm still dealing with symptoms, and I can't just live like this without a definitive diagnosis. There is some very mild atrophy present, though. She actually measured it, but since she doesn't believe it confirms any pathological changes, she dismissed it as mere natural asymmetry.

It’s highly probable the physician is correct. This sounds like benign fasciculation syndrome, perhaps coupled with a slight, natural bodily asymmetry, which is hardly unusual. If you're still feeling uneasy, get a second opinion from another neurologist.

Chloe Garcia10 said:Hi,
I've had a low-grade fever, up to 99°F, for the past few days.
I had bloodwork done today.
Here are the results:
WBC 11, CRP 1.7, BILIRUBIN 13, CREATININE 70, UREA 46, AMYLASE 67, Red Blood Cell 4.73, Hemoglobin 137, Hematocrit 0.397, Platelet 197, White Blood Cell 9.61, Neutrophils 76.2 H (44-72), Lymphocytes 17.2 L (20-46), Monocytes 5.9, eosinophils 0.1, basophils 0.3, neutrophils (abs) 7.32 H (2.06-6.49), lymphocytes (abs) 1.68.

My bloodwork from Monday was normal, except for a urine test that suggested a UTI. I was prescribed antibiotics/urosepsis treatment and have been taking them since Monday evening.
Why the change in my blood counts?
Best regards,

Essentially, it suggests some level of inflammation—possibly an infection—is lingering in your system. It could be an infection that hasn't been fully cleared by the medication, or it might not be an infection at all, but something else entirely.