Posts by Nicholas Myers

Joseph Taylor3 said:Interpret these results—does this mean I don't have any autoimmune diseases?

Systemic lupus is ruled out since the ANA is negative. Those facial skin changes likely point toward seborrheic dermatitis.

If this is a new onset of seborrheic dermatitis in an adult male, an HIV test should be performed.

Finding Candida in stool isn't unusual; it often colonizes the digestive tract mucosa. One needs to check the colony count and perform a mycological throat swab to see if there are signs of oral candidiasis, which would definitely be a pathological finding in an adult man.

The attached results rule out systemic lupus and likely celiac disease, though they don't exclude all autoimmune conditions.

Karen Stewart46 said:Excuse me,

Can someone tell me how far these results deviate from the norm?

This is for a 41-year-old male.

It’s been three weeks since a severe, prolonged viral infection. He had a comprehensive systemic checkup, and from an extensive blood and urine panel, these are the values that deviate: (everything else is within normal limits)

MCHC 361
platelets 144
TIBC 44
alkaline phosphatase 53

Otherwise, his kidneys aren't performing optimally (though hormones are fine), and other "issues" include stress (fatigue, occasional insomnia...).

Thanks in advance!

The tests should be repeated in 3–4 weeks. The deviations aren't major, but it's necessary to compare the new values against the previous ones.

Emily Morgan3 said:I've had a viral sore throat for two weeks now. My doctor sent me for blood work. Does that automatically include serology, or does one have to request that specifically?

Certainly not. Serology is performed at a limited number of labs and requires a specific referral; it must be requested separately.

Hannah Murphy11 Asks:
Could I get some insight on these OGTT results and the three-point insulin levels? Insulin I was 38.6 pmol/L (ref: 17.8 - 173.8), Insulin II hit 490.2 pmol/L, and Insulin III came in at 238.5 pmol/L (no reference ranges provided for II or III). As for glucose, the first reading was 5.1 mmol/L (ref: 3.3 - 5.2), the second was 6.9 mmol/L, and the third was 5.8 mmol/L (again, no reference ranges listed for the second and third readings). Clinic Thanks!

Assuming these values were taken at the 0, 60, and 120-minute marks, the results fall within the acceptable range—essentially normal. That said, context is everything. It all depends on what you're actually feeling, why the test was ordered in the first place, or if there’s any possibility of pregnancy involved.

swiftgull37 said:Could tea influence a drop in platelet counts? I'm trying to pin down what might be triggering this decline.
The only thing that comes to mind is what I started taking. Herbal teas.

Anything is possible. It might be wise to cut out those specific teas, but looking at the big picture, I'm not convinced that's the smoking gun.

Since you're actually dealing with bicytopenia—meaning both your platelet and red blood cell counts are low—you really ought to get a full hematology workup done.

Jason Vaughn482 As specified by:
Thanks. The specialist ran some tests, and while everything seems okay, I’m getting mixed signals. One moment it's hyperechoic, then it shifts to normoechoic, and now they're calling it inhomogeneous. It feels like a moving target. My theory? It’s just more fatty tissue, which messes with the readings. Honestly, I don't even grasp the nuance between echogenicity and homogeneity here—but regardless of the terminology, does it just mean there's more fat involved in both scenarios?
What exactly are immunoglobulins? I haven't had my blood drawn yet, but I've already circled that part on the lab order.

I don't see why everyone is getting so worked up over immunoglobulin levels. They're just proteins designed to defend the body against infections, mainly bacterial ones. Fluctuations in immunoglobulin values can pop up in all sorts of conditions—liver disease, autoimmune disorders, kidney issues, hematological diseases, and so on. It's just one piece of the puzzle.

Addressing the remaining questions:
Quote : Felix the Cat

David Mitchell4 Asks: The antibiotics have already been prescribed. I’m struggling to see what’s missing from the diet—it's strictly meatless, heavy on vegetables, and that sort of thing. So, it’s definitely not a nutrition issue; there's no snacking involved, and no soda either.

The LDL cholesterol level is far more concerning. There is a strong suspicion that we might be looking at familial hypercholesterolemia, which means we need to run a full workup and likely start a regimen of statins. These numbers aren't a result of diet; that much is certain. As for the urinalysis, I have my doubts—the high concentration of epithelial cells suggests a poor quality sample, so the test should be repeated. The results don't clearly point to a urinary tract infection, so it's unclear why antibiotics were prescribed immediately without a follow-up test or a culture.

Kate Mitchell87 said:I’m looking for some clarity on what a low GGT actually means. My lower limit is 9. Everyone seems to tell me that a low GGT isn't clinically significant, but is that really an accurate interpretation? Two years ago I was at 9, last year I was at 8, and now I've hit 6.
What does a low hematocrit actually mean? Mine is sitting just slightly above the lower limit. I don't have any chronic illnesses, and I'm definitely not pregnant. These tests were just routine prep for an upcoming surgery, and everything else on my blood work looks perfectly normal. Thanks.

Exactly. Low GGT levels aren't worth worrying about. As long as the hematocrit is even slightly above the lower limit, you can consider the results normal.

Kevin Bishop9 said:Please provide the blood work results for review.
Red blood cell count: 2.96.
Hemoglobin: 83
Hematocrit: 0.243
Platelets: 94
Neutrophils: 0.49L
Neutrophils: 7.4%
Lymphocytes: 83%

The results are for a one-year-old. Both IgG and IgM anti-leukocyte antibodies came back positive.

Doctors are claiming a virus caused this. Is that actually plausible?

It's possible, but you'd expect those levels to normalize pretty soon. Of course, the real answer depends on how the kid is actually feeling and what else the clinical results are showing.

Noah Cook13 said:Hi. Is this lab report looking normal?

It’s plain to see. The issues you've described in other threads aren't necessarily just about low testosterone. You have to look at the broader hormonal picture—everything from thyroid function to the adrenal glands plays a role here.

Betty Murphy50 said:What’s your take on this? Are we looking at just some mild inflammation—which, if so, I assume you can't pinpoint the location without imaging—or could this be something more serious?

Based on what you've shared, your mother is dealing with serious symptoms. Even if her blood work shows only minor deviations for now, those numbers don't rule out the possibility that there's a significant underlying illness—or perhaps several—brewing beneath the surface. She definitely needs more thorough testing to get a clear picture.

Chloe Garcia10 said:Good day.

Can someone help me make sense of these lab coagulation results?

Clean results!

Sophia Brooks50 said:The inhomogeneous part is bothering me... is it possible my liver looks fatty because I ate a bunch of pastries and greasy food the day before the UTZ?

An inhomogeneous—or uneven—liver structure on an ultrasound can be subjective, depending on the technician's perspective, or it could indicate changes like fatty liver or inflammation.

If we're talking about fatty liver, it wouldn't be caused by what you ate just one day prior to the scan. That's typically a long-term process; it doesn't happen in a 24-hour window.

Since the gastroenterologist performing the abdominal ultrasound didn't seem overly concerned, this finding regarding the inhomogeneous structure probably isn't something you need to worry about right now.

As for the immunoglobulin, I don't have much to add—you requested the tests, you got the results, so now you simply follow through with them.

swiftgull37 said:Dear Nicholas Myers,

I was wondering if I should be concerned. For about a year now, I've been doing regular CBC tests due to iron deficiency. So far, everything else related to that hasn't been worrying. However, in this week's results, my platelets are 153 (range 158-424). On its own, that wouldn't bother me—even though it's below the minimum—except that they have dropped drastically from my last result in August, where platelets were 200. In March and May, they were 170, and back in late December 2015, they were 207, while in late November 2015, they were 276.

Is it normal for them to drop this much, or rather, to be in a constant decline?

Ma'am,

Thrombocytopenia is defined as a platelet count below 150x10*9/L, so strictly speaking, you don't have low platelets yet.

On the other hand, as you mentioned, you have iron-deficiency anemia. Platelet counts and erythrocyte counts can be linked. Typically, iron-deficiency anemia is associated with an increased platelet count, or thrombocytosis, though cases with low platelets have been described, albeit extremely rarely.

Have you identified the cause of the anemia? Heavy menstrual bleeding? GI bleeding?

Have you had a peripheral blood smear done?

Furthermore, are you experiencing any symptoms?

Elevated Factor VIII levels can appear during inflammation, infection, pregnancy, or when taking oral contraceptives, but they can also be congenital, occurring without a specific underlying cause.

Aside from a potential link to the anemia (the cause of which you haven't specified), the drop in platelets could be entirely independent of your anemia—a separate issue altogether.

The most common cause of mild, isolated thrombocytopenia in adults is immune thrombocytopenia. Usually, in these instances, routine follow-ups include a peripheral blood smear and testing for HIV and hepatitis C, with other tests performed as indicated.

Since it isn't clear from your inquiry what symptoms you are having or what is driving the iron-deficiency anemia, I cannot say for certain whether you need further diagnostic workup or if simply monitoring the platelet count—perhaps at monthly intervals—would suffice.

I notice plenty of questions have been posted here, yet very few answers. Even though there's a significant backlog, I’ll address some unanswered queries now, though I suspect most posters have likely found their own conclusions by now.

mellowmoose11 said:Could someone please explain the EMG results a bit better and what they might indicate?

The findings suggest nerve compression. This might partially account for symptoms like pain and tingling, but perhaps not at the intensity you're describing. Further investigation is necessary to clarify these issues—especially considering the point our esteemed colleague already made: your age doesn't align with such pronounced degenerative changes typical of an elderly patient. You aren't elderly.

steeleagle152 said:Yesterday was my third trip to the lab (I also did a microbiology urine test in the meantime and everything looks fine), but my CRP is still at 24. Can anyone tell me what this could be or what my next steps should be?

It depends on where your initial CRP level was. If it started very high, it takes time to settle back to baseline. There isn't much point in repeating the CRP test over too short an interval, as it takes several days to see any meaningful shift. If the CRP fails to return to normal levels, further testing would be required to rule out a lingering, hidden site of infection.

frozenheron53 said:So what now? Why was the fecal occult blood test positive and why is my iron low?☕ Where do I go from here?

Given the low iron levels combined with a positive stool bleeding test—and since both colonoscopy and endoscopy failed to pinpoint the source—you need to consult a gastroenterologist. They will likely want to explore other diagnostic options to search the rest of the digestive tract (primarily the small intestine) to find the potential source of the bleeding.

wearyhawk7 said:My eye is red. My doctor took a swab and this is what the report says:

Sample, testing: CONJUNCTIVAL SWAB - bacteriological
right eye swab
MICROBIOLOGICAL TEST RESULT: GRAM + COCCI

What does this actually mean?

It means bacteria were found. Most likely, they'll identify one of the following: Staphylococcus aureus, pneumococcus, or streptococcus. All three are common culprits in conjunctivitis and fall under the category of Gram-positive cocci (spherical bacteria).

analogpilot28 said:Hi there!

I just got my cortisol results back (post-1mg dexamethasone test), but they didn't list the reference range. My doctor won't see me until the rest of the labs come in. My level is 16 nmol/L. Is this considered a good result? Thanks. 🙂

Yes, it’s a normal result if the cortisol value is under 50 nmol/L.

brisknomad6 said:How long does it take for blood work to normalize after a cold?

thx 🙂

A complete blood count doesn't necessarily have to be off during a cold. If it is, things should stabilize within a few days. Usually within a week, at most two weeks.

Megan Jones27 said:It looks like I have no choice but to take all my records to a private specialist, regardless of the cost.

Switch doctors and save some money!

Megan Jones27 said:To add some context...

Iron/Fe: 10 (8-30)
TIBC: 64 (49-75)
UIBC: 53 (26-59)

Symptoms... Still dealing with intermittent digestive issues—mostly loose stools and strange pains. Last year, I constantly had this dull ache spreading from my abdomen to my back and vice versa. (Had an abdominal ultrasound and stool tests done back then; everything supposedly came back normal). Then there are those mornings where I wake up with tremors, intense hunger, weakness, and nausea accompanied by an urgent need for bowel movement #2.

Occasionally, my face gets itchy and breaks out in bumps, almost like mosquito bites. (Same thing happened last year; my scalp was pretty itchy too, along with my face. Back then, my eosinophils were also above the upper limit.

I’m naturally thin, but I’ve lost even more weight recently (currently at about 95-97 lbs / 43-44kg).

What tests should I look into? Nephrology, hematology, infectious disease? There has to be an explanation for these abnormal neutrophil and lymphocyte levels that have been hanging around for nearly two years now.

Thanks.

It’s unlikely an infectious disease specialist will be the answer, given you've been dealing with this for two years already. Honestly, it's surprising you haven't seen a gastroenterologist yet for a full workup, including a colonoscopy, considering the symptoms you described (abdominal pain, changes in bowel rhythm and consistency, etc.). Furthermore, it's surprising you haven't pursued endocrine testing (thyroid hormones, sex hormones, adrenal hormones, glucose levels...)!

If you're planning to handle all of this through private specialists, be prepared—you'll need a significant amount of cash for that!

Sandra Hernandez9 said:Hepatitis markers
Hepatitis B surface antigen - non-reactive
Anti-HBsAg antibodies - 0.05 mIU/ml
Anti-HBc antibodies - non-reactive
Anti-HBc IgM antibodies - non-reactive
Anti-HBe antibodies - non-reactive
Hepatitis B e antigen - non-reactive
Anti-HCV antibodies - non-reactive

Enzymes
AST 39
ALT 77
yGT 59
Alkaline phosphatase 94 (ref. range 60-142)

It’s clear that the liver enzymes, which are only mildly elevated, seem to be trending downward. The question is whether follow-up liver function tests will be performed in the near future. It isn't as if the enzymes are at 1000 or higher, requiring constant monitoring. I suspect waiting at least a month would be the ideal window for a new check.

Since some diagnostic workup has already begun, it appears that viral hepatitis (B and C) is not the culprit behind this deviation.

There are numerous reasons why liver enzymes might spike. Often, these elevations are transient, and in many instances, the underlying cause is never even identified.

If you're wondering what could trigger a result like this, I'll tell you right now: it's a massive spectrum of possibilities. We're talking everything from medication or herbal supplements, sodas, dietary excesses, fatty liver, iron or copper storage diseases, autoimmune liver issues, thyroid problems, celiac disease, adrenal gland disorders, heart-related congestion, or enzyme deficiencies (like alpha-1 antitrypsin), among others. A vast array of different conditions.

If a full investigation proceeds, they will have to rule out these conditions one by one.

Mark Anderson90 said:Thanks for getting back to me.
My spirometry results were normal—115/126/92. They haven't checked my bilirubin lately, but twice before, it was elevated at 29.7 and 22. They didn't check my haptoglobin. Sorry to be a nuisance, just a layman's question: Does hemolysis actually happen during anemia? If so, how is it that my Erc and Hgb aren't sitting at the bottom end of the scale?

The thing about my tonsils—I only mentioned it because I heard they can act as breeding grounds for all sorts of health issues, much like teeth.

Apologies for the delay; life got in the way and I couldn't get to the forum.

You're right to ask. Usually, with hemolysis, you'd expect Erc and Hgb to be at the low end or even below it.

There are, however, some very rare instances where you might see pathological hemoglobin alongside both erythrocytosis and hemolysis. That's why, as part of a full workup, a hemoglobin electrophoresis should probably be performed.

Best regards.

Susan Smith said:Mr. Felix the Cat, if you wouldn't mind, could you clarify one blood result? A little context on the patient would help too.

First off, you can't rule out Wilson disease—that copper buildup issue—just by looking at serum copper or ceruloplasmin levels. Both can sit right in the "normal" range even when the disease is present. To get a real picture, you need to check copper in a 24-hour urine collection and schedule an ophthalmology exam.

Second, regarding the elevated ferritin and concerns about hemochromatosis (iron overload): we first need to look at transferrin saturation—which is calculated using serum iron and TIBC—as well as the SE and CRP levels. High ferritin isn't a smoking gun for iron issues alone; it can spike due to infection, inflammation, metabolic syndrome, or even malignancy.

Third, on the serum protein electrophoresis: seeing low albumin paired with high gamma-globulin is a classic pattern in patients with liver cirrhosis. Albumin levels drop because they are produced exclusively by the liver, and in cirrhosis, that synthetic function is compromised. Gamma-globulins can climb for several reasons in cirrhosis patients; you'd also need to check immunoglobulin levels to see if it’s specifically IgG or IgM that's elevated.

In the electrophoresis results, the values are listed as both a percentage and in g/L (absolute amount), which is why they appear twice.

Mark Anderson90 said:Felix the Cat, can you interpret this for me regarding polycythemia?

First off, we have to ask if we're even looking at polycythemia here. For an American man, hemoglobin levels around 170 g/L are still technically within the range that covers 95% of the population (the upper limit for men is usually around 174 g/L).

That said, once hemoglobin climbs past 165 g/L (or above 170 g/L depending on which medical textbook you follow) and you start seeing symptoms linked to Polycythemia Vera—things like an enlarged spleen, aquagenic pruritus, high platelets, thrombosis, leukocytosis, headaches, or tingling—it makes sense to suspect the disease and start testing. That’s exactly what happened in your case.

However, since your erythropoietin levels are sitting in the normal range and the JAK2V617F test came back negative, Polycythemia Vera is looking unlikely. It’s practically ruled out.

It is worth noting there is another mutation (specifically in exon 12 of the JAK2 gene) that can show up positive in patients who are negative for JAK2V617F and have low erythropoietin.

Essentially, one or the other mutation is present in almost all patients diagnosed with Polycythemia Vera.

Given that your hemoglobin isn't elevated enough to definitively call it polycythemia rather than just being at the high end of the normal spectrum, it might be wise to first determine your total red cell mass to clear things up.

Furthermore, as Paul Walker5 pointed out a few pages back, because of those shortness of breath issues, you should probably undergo pulmonary function tests—spirometry, and maybe even a DLCO test. If this happens while you sleep, we could be looking at intermittent hypoxia caused by sleep apnea.

Also, your reticulocyte counts are slightly elevated, which raises the question of hemolysis. It would be smart to check your haptoglobin, bilirubin, and LDH levels to see if there are signs of increased red blood cell breakdown.

An electrophoresis of hemoglobin might also be worth considering to rule out any pathological hemoglobin variants.

As for infectious causes for your symptoms, I'd say the probability is slim. Your serology results point toward a past EBV infection that has already cleared.

That "white stuff" accumulating in your tonsil crypts is likely just debris—food particles and dead cells—and shouldn't be confused with a strep infection.

The nasal swab doesn't particularly support an allergic cause, though you can't entirely rule out allergic rhinitis based on that alone.

To wrap this up: the main question is whether this is actually polycythemia at all. Even if it is, Polycythemia Vera is a long shot. We need to look for answers elsewhere (starting with potential hemolysis and lung function).

Bradley Anderson52 said:Hi everyone. Just had some blood work done and got these results back. Is everything looking okay? Thanks. Lp

http://www85.zippyshare.com/v/pwKlIUhJ/file.html

The report looks clean.

Thomas Wells5 said:Best regards
I was hoping Nicholas Myers could help me make sense of these lab results. Because of my job, I won't be able to see my own doctor for another two days.
For context on why I went in—I've been feeling pretty listless lately. Not just tired, but lacking any drive. Most importantly, whenever I get hungry, I feel terrible. I get weak, I start shaking, but after a few bites of anything, I feel better almost immediately.

A slightly elevated total leukocyte count paired with a normal differential doesn't look concerning to me. It would be wise to repeat the test in a week or so to track the trend.

Regarding the symptoms you mentioned (anxiety, tremors, hunger)—they mirror what we call autonomic or neurogenic symptoms of hypoglycemia (low blood sugar). However, the real question is whether hypoglycemia is actually occurring at the exact moment those symptoms strike.

Unfortunately, this glucose reading isn't valid for fasting levels since you had a bite of bread within two hours of the draw. The data isn't reliable for that purpose.

It would be best to coordinate with your doctor to check your plasma glucose concentration right when the symptoms manifest. If the level is above 3.9 mmol/l, then these symptoms aren't tied to hypoglycemia, and you'll need to investigate other causes.

As far as I can tell, the rest of the results are normal.

Casey Doyle3 said:...something definitely isn't right. My doctor just casually concluded I have polycythemia and sent me on my way.

You can't be certain that something is wrong. For all we know, everything might be fine and her assessment could be spot on—but we won't know for sure until we eliminate every doubt.

Good luck. 👍

Casey Doyle3 said:Thanks for the quick reply. I have a few more questions if you don't mind clarifying things for me. Five years ago, I went to a neurologist because of headaches, and the conclusion was an issue with my cervical spine being misaligned. Back then, all my blood work was normal, yet the headaches persisted. Is it possible we're looking at "relative" polycythemia—or "stress-induced" as I read it? My leukocyte count is 5 and platelets are 205... shouldn't the red blood cell count be elevated too if that were the case?
Could these results indicate a plasma deficiency, or would that not cause itching and headaches? From what I can gather, this is a rare condition usually affecting older people. All these classifications—primary, secondary, relative—have me pretty confused.
If you could walk me through this a bit more, I’ll definitely be consulting my doctor regardless.

Suspicion is certainly possible, though the probability of the disease itself remains, as you noted, low.

Neither a leukocyte count of 5,000 per microliter (5x10^9/L) nor a platelet count of 205,000 per microliter rules out the condition.

To give you some perspective, a study involving roughly 1,500 patients with confirmed diagnoses showed the following: leukocyte counts ranged from 3,000 (3x10^9/L) up to 172,000 per microliter, while platelet counts spanned from 70 to 2,370,000 per microliter. While the majority of patients sat around 10,000 leukocytes and 466,000 platelets, there were plenty of outliers on both ends of the spectrum.

Furthermore, to rule out secondary causes, additional testing is required. You simply can't determine that based on a standard complete blood count alone.

Hello,

I recall your inquiry from a few pages back. At that time, your family doctor suspected possible anemia due to those slightly lower MCV levels and started running tests in that direction.

Normally, I wouldn't dwell on hemoglobin and hematocrit numbers, but since you mentioned aquagenic pruritus and headaches—which, granted, could stem from other issues—these results demand a different perspective.

If you aren't hypoxic (which can be verified via oxygen saturation levels or blood gas analysis), then a hemoglobin level exceeding 165 g/L in a male (or even above 170 g/L depending on the source), combined with a hematocrit of 0.49 or higher alongside symptoms like aquagenic pruritus, is enough to raise suspicion of polycythemia vera.

I suggest seeing a hematologist to rule this out.

Gerald Nelson3 said:Hi,
my wife had blood drawn from her finger at a private doctor's office, and this is what it says:
Biochemical analysis:

P-AMYL= 14.0
HG= 6.75

Now, I assume the first one is amylase, but I have no clue what the second one, HG, is. Basically, the doctor told her her immune system was weak and gave her a B vitamin injection.
It feels totally unrelated to me—please let me know what you think!

One really needs to see the full set of labs. Claiming someone has a weakened immune system and treating it with B vitamins, as you described, doesn't follow any logical path. It sounds like a few routine tests were run showing nothing out of the ordinary, so the patient's issues were simply brushed off as "stress and low immunity." Giving B vitamins was likely just an attempt to provide *something*, though the clinical purpose is questionable.

bluebison2 said:Hello, I received my tissue typing results and would appreciate some insight.🙂
HLA-A 0203
HLA-B 08ND
HLA-DRB1* 0311

For the past year, I've been dealing with joint pain, most intense in my hands. For the last two months, there's been noticeable swelling in one finger. I've also had bouts of severe pain in my shoulder and hip. Rheumatoid factor is elevated (53) and Anti-CCP is 721.
No official diagnosis yet, but rheumatoid arthritis is suspected.
I'm 28.

Thanks in advance!

The HLA typing doesn't show a genetic predisposition for rheumatoid arthritis, though that doesn't rule the disease out entirely. When looking at rheumatic conditions, however, there is a predisposition for systemic lupus erythematosus—two of your HLA markers could be linked to that, specifically HLA-DRB1*03 and HLA-B8.

The results also indicate predispositions for other conditions, but nothing else rheumatic.

Chloe Garcia10 said:At the Breyer Clinic, they ran a Troponin I test. The reference interval is div>

That means the result is normal.