Posts by Nicholas Myers

Karen Smith34 said:I have a question regarding my platelets:

Back in October 2012, they were at 220.
A recent lab result shows 80.

Everything else is within range (cholesterol is 7), I am 53, and I have no symptoms.
My blood pressure is usually normal, though it drops when I stand too long. I get occasional headaches (they last a few hours, then nothing for days). About 2.5 years ago, I had uterine cancer (uterus and ovaries removed); no therapy was needed then, and all follow-up results have been fine. I wonder if high stress could be a factor right now—I occasionally take a herbal calming tablet, Persen, but no other medications. I don't drink or smoke.

Should I be worried?

I've scheduled an appointment with an internist who also specializes in hematology to interpret the results, but I would appreciate some insight here as well. Thanks in advance.

Dear lady,

It would certainly be wise to repeat the platelet count; a reading of 80×10^9/L needs confirmation.

A platelet count of 80×10^9/L definitely warrants investigation (some clinicians set the threshold for follow-up at 100×10^9/L), but this level isn't immediately alarming in terms of bleeding risk. Significant bleeding—usually appearing in the skin or mucous membranes—is the primary sign of low platelets. This risk typically increases once the count drops below 50×10^9/L, though many patients remain asymptomatic even with much lower numbers.

One critical next step will be a blood smear. This allows us to see the ratio of platelets to other blood cells.

If the smear shows only a decrease in platelets while all other cell types are normal in number and structure, and a physical exam shows no signs of systemic illness, the most common culprit is immune thrombocytopenia. Essentially, this is a condition where platelets are being destroyed prematurely by the immune system for reasons we don't always fully understand.

It is important to consider a few things: Is there a family history of similar issues? Have you experienced any spontaneous bleeding, such as bruising, nosebleeds, gum bleeding, or heavier menstrual cycles? Also, have you recently taken any medications (you mentioned Persen), had vaccinations, or anything else? I won't go into exhaustive detail here on the forum.

If it turns out you are asymptomatic and everything else looks healthy besides the low platelet count, we are likely looking at immune thrombocytopenia. This can be primary (where the underlying trigger remains elusive) or secondary (where an external factor triggers the immune response, such as an infection). We might need to test for certain viruses or H. pylori, check immunoglobulin levels, or screen for systemic autoimmune diseases if suspicion arises.

In such cases, treatment usually doesn't begin until the count hits a lower threshold (for instance, some doctors wait until it reaches 30×10^9/L), unless there is an elevated risk profile.

The logical question follows: why bother with the workup at all? The answer is simple: we need to identify the underlying cause, because the drop could be a symptom of a treatable condition, like an infection.

Best regards. 🙂

Hannah Kelly said:Nicholas Myers, thank you so much for all the help. I feel like I’ve given you more information than my actual immunologist. Is there any way I could actually come in for an appointment?

Unfortunately, that isn't an option right now.

The skin issues started about two years ago, and the sun-induced headaches probably go back to puberty.
The skin changes—specifically the halo nevi—showed up about ten years ago (when I was 20), and I seem to spot at least one new halo nevus every year.

Setting aside the halo nevi and the "burst capillaries," how would you characterize the rest of the skin reactions? Are we talking redness, blisters, acne-like bumps, or more like rough patches? And is there a pattern regarding sun exposure—for instance, appearing minutes or hours after being out, then vanishing once you're out of the sun?

Excessive capillary breakage can simply be a matter of fragile vessel walls. It's often hereditary, particularly in women whose families have a history of similar issues. In those cases, there isn't a specific treatment.

No sample was taken from the leg.

Given the skin symptoms you're describing, it might be worth seeing a specialist at a major dermatology clinic, perhaps specifically at an autoimmune skin disorder unit.

I constantly feel like there's sand or dryness in my eyes, and my mouth always feels parched. My gums also bled quite a bit for a long time without any signs of inflammation; I used a topical treatment on them and the bleeding stopped.

Make sure to mention these symptoms to your immunologist. It would also be useful to verify the actual degree of ocular and oral dryness through clinical testing (ophthalmology exam, Schirmer test, BUT test, or Rose Bengal test).

In rare instances, though it is possible, an ANA test might return negative even if anti-Ro/SSA and anti-La/SSB antibodies are positive.

I should also mention that many patients don't meet the full diagnostic criteria for a systemic autoimmune disease and end up in a sort of limbo.

In those situations, it is often better to avoid a premature diagnosis rather than rushing to one. Waiting until every single criterion is met can sometimes take years.

Joshua Roberts38 said:Hello,
could someone please interpret these results?

HLA-A 28 29
HLA-B 44 51
HLA-DR 1 4

thanks in advance

Hello,

First, it’s important to understand why you requested this specific testing.

Before we dive in, a quick refresher in case you missed my previous posts regarding HLA typing interpretations.

The core concept here is that certain HLA antigens appear more frequently in people suffering from specific diseases than they do in healthy populations.

Essentially, having certain antigens is linked to a slightly higher risk of developing a particular condition. This does not mean that possessing an HLA antigen guarantees you will get sick. Likewise, one can develop a disease without having that specific antigen.

I should also mention that interpreting these types of tests has become more complex lately. For instance, knowing someone has HLA-DR4—as you or the esteemed Hannah Kelly might—doesn't tell us much without identifying the specific subtype.

Take HLA-DR4, for example; there are over 30 subtypes within it (labeled HLA-DRB1*0401 through *0433).

Only certain subtypes are actually linked to an increased frequency of diseases, such as rheumatoid arthritis. Just seeing "HLA-DR4" on a report makes it impossible to determine which subtype is present or if there is any actual elevated risk.

That distinction is vital when discussing how HLA markers relate to disease risk.

Since your results don't provide those granular details, I will stick to a general interpretation, though please keep in mind this may not reflect your individual reality.

As mentioned, HLA-DR4 can be associated with an increased risk of rheumatoid arthritis (up to four times higher than those without it).

Furthermore, you have HLA-A29, a subtype of which can be linked to an increased risk of a type of retinochoroidopathy known as Birdshot, a chronic eye condition involving painless vision impairment.

From the perspective of systemic autoimmune issues, HLA-B51—which you possess—is quite significant. Certain subtypes are linked to a higher risk of Behçet's disease, which typically involves mouth and genital sores, eye issues, skin changes, and joint inflammation in many patients.

I hope this doesn't cause undue alarm. Please don't assume you are destined to develop these conditions; a vast number of people carry these HLA antigens and never fall ill. Only a small fraction of carriers actually develop the disease.

Best regards. 🙂

edit: Hannah Kelly, I haven't forgotten about you, but I'll write my response once I have enough time to give it proper thought. 😉

swiftbear86 said:I should note that diabetes isn't being managed well (glucose levels are 8-10), plus there's extreme fatigue, joint pain, muscle cramps, and frequent diarrhea.
Alcohol consumption is 2-3 times a week, physically active, but no strict diet.
In that sense, I understand the situation; my main concern is the erythrocyte count and its distribution.
Would it be wise to stop Metformin due to its impact on the liver and swap it for something else?
Will the hematologist make the call, or the endocrinologist—or will they both act independently?

Thanks to everyone for the effort.
I hope the results are legible.

Hello,

A few thoughts here, though nothing concrete can be said based solely on this data.

It’s impossible to gauge the full extent of the diabetes from just a single glucose reading—as you likely know 😉—so an HbA1c should definitely be checked before any major decisions are made. We also need to see how glucose fluctuates throughout the day in relation to meals, check body weight, and consider everything else our esteemed colleague mentioned earlier. All of this dictates what kind of therapy or adjustments are actually necessary.

Regarding diabetes management, approaches vary widely. Often (though not always), doctors try managing with at least two oral hypoglycemics first (for instance, per U.S. guidelines if HbA1c is under 7.5%) before transitioning to insulin, which is usually paired with an oral medication. Some might even push for a combination of three oral drugs, even if that isn't the most optimal path.

I see you've provided lab results from what looks like a primary care clinic. At that level, they can certainly test for HbA1c, alkaline phosphatase, and bilirubin.

Both alkaline phosphatase and bilirubin would be very useful metrics to look at when interpreting an elevated GGT level.

Since you mentioned other symptoms like muscle cramps and frequent diarrhea, it makes perfect sense to dig deeper into the underlying cause of those issues.

From my own experience—when dealing with overlapping conditions across different specialties—subspecialists often tend to "stick to their lane." Unfortunately, reaching a unified decision on treatment (when handled in an outpatient setting rather than a hospital) is quite rare.

Best regards. 🙂

Hannah Kelly said:Thanks so much for the reply, Nicholas Myers 🙂

My ENA panel was canceled because the ANA came back weakly positive.
I’ve had C3 1,000 and C4 0,190 done; I haven't done CH50 (not even sure what that is).
Results included: Anti-proteinase 3 (pr-3): Anticardiolipin antibodies IgG: 3.3, IgM: ANCA: negative
Gamma protein electrophoresis was at 17.3 then—not sure if such a minor jump past the reference range actually matters.

As for symptoms: skin lesions on my elbows—suspected psoriasis, though a biopsy didn't confirm it. Right now, my elbows are clear, but they flare up suddenly (even a toe lesion won't clear up despite using Diprosalic). Then there's joint issues in the dead of winter when my fingers get cold (Raynaud's), and sun sensitivity: potentially eyes, headaches immediately upon stepping into the sun, especially without glasses. Tachycardia, fatigue in my limbs, frequent bowel movements, nausea, urge to vomit, splenomegaly (2cm)—I think all my lymph nodes are slightly enlarged, or maybe it's just my thin build making them palpable.
Physical changes: broken capillaries on my face and chest, small sores on my toe, halo nevi around moles and in areas without moles. A red crusty growth (about 6mm) formed and then simply fell off (I thought it was a mole). Lower back pain, burning in the left side of my abdomen under the ribs, lower abdominal pain. That's mostly it, I suppose—though I'm never quite certain since there's so much going on. It's been over a year of testing, waiting, more tests...

I also had an echocardiogram; everything looks fine, just trace mitral regurgitation. Is there anything else I should get done before my appointment with the immunologist, just so I can settle this as quickly as possible?

Thanks again for your patience.

Dear Hannah Kelly,

It seems the immunologist's reasoning has branched in a few directions.

First—systemic lupus. However, the tests performed so far don't support a diagnosis of systemic lupus erythematosus (weakly positive ANA that later became negative, negative anti-dsDNA, normal complement activity, negative anticardiolipin antibodies...). That is good news.

Systemic vasculitis was also considered (given the skin changes paired with general symptoms), but again, the findings don't currently point toward that diagnosis.

Naturally, the question arises: have ALL the necessary tests been completed? The answer is— no—because the list of possibilities is vast.

Some of your changes aren't necessarily linked to a potential systemic autoimmune disease; for instance, halo nevi might be related to vitiligo.

Looking at your description, you have significant skin manifestations alongside sun sensitivity. Did this start suddenly, or has it been present since childhood?

When you go out into the sun, do skin changes appear immediately or shortly after?

Have biopsies been taken from the skin changes or the sores on your foot that you described?

Do you experience dry eyes, stinging, or a gritty sensation? Any dryness in the mouth or frequent dental issues?

Ashley Morris84 said:Apologies in advance if I'm asking this in the wrong place, but I couldn't find a more relevant thread.
Is a peripheral blood smear the same thing as a CBC?

They aren't the same test.

When running a CBC, the sample goes into an automated machine—an electronic cell counter—which then spits out the data.

With a peripheral blood smear, the process involves spreading the sample on a slide and preparing it so that a person examines it under a microscope rather than a machine doing the heavy lifting.

Hannah Kelly said:I received more lab results:

Serum protein electrophoresis.

Albumin at 57.6% (range: 55.8–66.1). Total protein stands at 40.9 g/L (range: 40.2–47.6).
Alpha 1. 4.6% (range: 2.9–4.9%). 3.3 g/L (range: 2.1–3.5). Everything looks steady.

Alpha 2. 8.8% (Range: 7.1–11.8). 6.2 g/L (Range: 5.1–8.5).

Beta levels: 9.7%. (Range: 8.4–13.1). 6.9 g/l (Range: 6.0–9.4).
Gamma levels are at 19.3%. Reference range is 11.1–18.8. Protein is sitting at 13.7 g/L, compared to the standard 8.0–13.5.

Total protein at 71 g/L. A/G ratio sits at 1.36.

Rheumatoid factor is over 10—up to 14.

Ana: negative.
(Six months ago: 1:160)

Immunoglobulin G at 12.8. Reference range is 7–16. Within normal limits.
0.84 (Range: 0.7–4)
M 1.18 (Range: 0.4–2.3)

Circulating IgG immune complexes at 202. Normal range goes up to 130.
IgM at 132. Normal range tops out at 100.
Six months ago, my immune markers were sitting at IgG 134 and IgM 86.

Serum immunofixation results: no monoclonal immunoglobulin detected.

Thyroid levels look normal (TPO 5.5, TGA IgE tTg-IgA levels are under 0.6. Negative is anything less than 20.

Could someone please provide an interpretation of these results? Thanks.

Dear Hannah Kelly,

Looking over these results, nothing stands out as a major deviation, with the exception of the circulating immune complexes.

Let’s start with Ana. She’s the most interesting case here because her results just flipped from positive six months ago to negative now. While a 1:160 ANA titer is technically positive, we have to keep things in perspective. About 5% of healthy young people—and even more as they age—show a result like this without having any underlying autoimmune disease at all. A 1:160 titer isn't considered a high positive, though it's worth noting that the titer level doesn't necessarily track with how active a disease might be. It is entirely possible for a follow-up test to come back negative. It's also worth remembering that ANA levels can be transiently positive due to things like a simple viral infection before settling back to negative.

When determining if a patient's symptoms align with systemic lupus erythematosus, checking for ANA is vital. With modern diagnostic tools, that figure climbs as high as 98% of patients at the time of diagnosis.

For other conditions within that spectrum, an ANA test carries significantly less weight when it comes to establishing a diagnosis.

Regarding Raynaud's, ANA levels are a key metric for us. It’s worth noting that only about 19% of people dealing with Raynaud's go on to develop a systemic autoimmune condition—think Lupus, scleroderma, or rheumatoid arthritis. For the other 81%, it's "just" Raynaud's.

If you test positive for ANA, the odds that Raynaud's isn't just an isolated issue—but actually part of some other underlying condition—jump from 19% up to 30%. If the result comes back negative, those odds drop from 19% down to a mere 7%.

Did you get an ENA panel done about six months ago? Any other antibody tests? Anything come back positive?

The rising titer of circulating immune complexes is a red flag, certainly, but one that demands caution. It’s easy to jump to conclusions, yet we have to be careful about overreacting. It should be noted that autoimmune diseases aren't the only reason these levels spike. It's like seeing a sudden surge in consumer spending; while it might signal an overheating economy, it doesn't always mean there's an underlying crisis. Careful monitoring is the priority here.

If you've had them done, what did your C3, C4, and CH50 levels look like?

It’s crucial that the electrophoresis results don't show any monoclonal protein. Its absence helps rule out malignant changes—for instance, non-Hodgkin lymphoma is more prevalent in patients with Sy Sjögren than in the general population. So, this is a positive finding.

Any skin changes or rashes? Joint pain? Sun sensitivity? Any sores appearing on the body, or perhaps issues with breathing or heart palpitations? Also, any trouble with urination or similar symptoms?

Limačica., I've moved your post over to the Ear - miscellaneous issues thread. Otoscopy and tympanometry aren't considered lab tests.

The same logic applies to your question about an abdominal ultrasound, though I missed that one initially.

For imaging—think ultrasound, MRI, CT scans, X-rays—we have dedicated threads for those. This space is strictly for interpreting blood work, fluid analysis, biopsies, and similar results.

Thanks for understanding.

Hannah Kelly, I didn't miss your post; I'm just in a rush right now and will get back to you shortly. 🙂

Donna Taylor5 said:Best regards!

My mother is 50 years old and has been battling lupus for 20 years.

The latest lab work shows her CH50 is low. Normal range is 50-150, but hers is at 36.
Are there any experts here who could explain this result? The doctors we've asked aren't entirely sure what it actually signifies...
All we know is that it involves the kidneys.🤷.

Thanks!

Hello,

A single lab value isn't enough to draw a meaningful conclusion, but broadly speaking: a low CH50 level (especially when paired with elevated anti-dsDNA) could, or might indicate that the disease is active—essentially, the "dormant" condition has flared up again. However, that doesn't necessarily mean it's the case for your mother.

It is well-documented that lupus frequently targets the kidneys, potentially causing damage. If anti-dsDNA levels are rising alongside low CH50 and C3, it might (but doesn't have to!) suggest kidney involvement.

Explaining the mechanics here is complicated. To put it simply, in immunology, two plus two rarely equals four. A single lab marker alone isn't sufficient to reach a definitive conclusion.

If physicians suspect kidney involvement and other markers are abnormal, they may opt for a kidney biopsy. This involves using a needle to take a small tissue sample for microscopic examination to determine the extent of the damage and dictate the necessary treatment.

Best regards. 🙂

Hannah Kelly said:Hi, I'm 30 years old and dealing with Raynaud's syndrome. For the last two years, I've been struggling with frequent headaches, nausea, kidney pain, issues in my hands and feet, and broken capillaries.
I had HLA typing done, and if possible, I would really appreciate someone interpreting these results. I won't be able to see an immunologist for at least another 6 months.

HLA A
1 - 9

HLA C
Nt - NT

HLA B
21 - 61

Bw4/bw6
Nt-nt

HLA DR
4 - 8

DR51/DR52/DR53

Nt- nt

HLA DQ
NT

HLA reactive antibody panel (PRA)

All boxes are empty (not sure if I should include this)

Crossmatch test results also show all empty boxes

NOTE: 173.0

Thanks!

Hello,

The core concept of this testing is based on the fact that certain HLA antigens appear more frequently in individuals with specific diseases than in the general healthy population.

Essentially, the presence of certain antigens is linked to a slightly higher risk of developing a particular condition. This doesn't mean that anyone carrying a specific HLA antigen will definitely get sick. Similarly, a person can develop the disease without having that antigen.

Regarding your specific results, I see you have HLA-DR4, which can be associated with rheumatoid arthritis.

However, the situation isn't nearly as straightforward as it looks. There are actually over 30 subtypes within HLA-DR4 (designated as HLA-DRB1*0401 through *0433), and only some of them are linked to rheumatoid arthritis—most notably DRB1*0401 and DRB1*0404.

It is believed that people carrying those specific subtypes have roughly four times the risk compared to the rest of the population. For instance, about 60% of rheumatoid arthritis patients in America carry one of those HLA-DR4 subtypes, and when accounting for all sub-variants, that figure can climb to 80%.

Your current report doesn't provide that level of granular detail because the typing wasn't performed that deeply.

The symptoms you're describing are non-specific, meaning they could point to many different things. Further investigation is required to clarify the cause.

Having a specific HLA antigen isn't a requirement for a diagnosis. Therefore, these results alone cannot tell us whether you have an autoimmune or rheumatic disease, or which one it might be.

Best regards. 🙂

Betty Bishop7 said:Hi, I have a question: is a Sedimentation of 30 concerning?

Ma'am,

Sedimentation levels depend heavily on age—the upper limit of normal tends to climb as we get older—so it’s difficult to determine how much that specific number actually deviates from what's expected.

There is also likely an underlying reason why this test was ordered in the first place.

If this is the only outlier, if all other routine LabCorp results look fine, and you aren't experiencing any symptoms (perhaps it was just part of a standard physical), then simply monitoring the value over the next two or three weeks should suffice. You'll want to see if it stays steady, climbs, or drops.

Keep in mind that certain non-pathological conditions can elevate Sedimentation, such as pregnancy, menstruation, or simply aging.

Best regards. 🙂

Jose Cruz42 said:I’ve got some kind of allergy going on—honestly, I can't quite pin it down. Basically, whenever my body temperature spikes, I break out in this stinging rash that looks just like nettles all over. I tried taking Xyzal, but it didn't do a damn thing. I play soccer, and as soon as I start warming up during a match, the rash flares up, though it slowly subsides while I keep running. It clears up once I cool down; if I just lie down and relax, it fades away. Aside from the look of it, everything feels fine—my breathing is normal and there’s zero itching, it just looks terrible when it happens. I just want to know what the hell is causing this one massive ?

Sir,

In cases of physical urticaria—specifically Cholinergic Urticaria—one might try increasing the antihistamine dosage beyond the standard amount, provided you coordinate that with a dermatologist.

Cetirizine (for example, Zyrtec or Cetirizine Sandoz) has worked well for many when taken at a double dose, essentially 2x10 mg daily.

If that still fails to provide relief, an older generation antihistamine might be an option.

Your first step should be consulting a dermatologist, if you haven't already, to secure an accurate diagnosis and discuss the possibility of exceeding standard dosages.

On the bright side, if this is indeed Cholinergic Urticaria, it often resolves on its own after a period of time—usually after several years, averaging about seven.

Gary Ross6 said:This winter, I’ve started dealing with what I can only describe as a cold allergy.
Every time I step back inside from the outdoors—it even happened yesterday despite it being above freezing—about five to ten minutes later, just as my body starts to warm up, these incredibly itchy hives break out on my upper legs. Nowhere else. They usually clear up within 10 or 15 minutes.
Could this actually be Cholinergic Urticaria, or specifically a cold allergy, even if it's localized strictly to my legs rather than exposed areas like my face, neck, or hands? And why would it target the upper thighs specifically? Is there any chance this could be a symptom of something else entirely...
Thanks.

Dear Gary Ross6,

There is a specific variation known as localized cold urticaria where, as the name implies, the hives appear only on a particular part of the body. If cold testing is performed, the reaction occurs solely in that specific area rather than across the whole system.

To address your second point—yes, other conditions can present similarly, but typically those illnesses don't produce classic hives, but rather different types of rashes or skin changes.

In any case, a dermatologist needs to see the physical reaction to confirm a diagnosis.

Best regards. 🙂

Kimberly Thompson56 said:Can someone explain this immunoassay result for Helicobacter: IgA negative, IgG 142 U/ml positive?

Hello,

Interpreting this isn't straightforward. To put it simply, a positive IgG can indicate an infection with this bacterium, but that doesn't distinguish between an active infection—meaning you have it right now—and a past one where you were infected previously but it's gone. Occasionally, you might even see a false positive.

Because of this, it’s vital to know if the person tested has ever undergone "triple therapy" to treat this bacterium. IgG antibodies tend to linger and stay positive long after the treatment is finished.

In modern practice, this specific test is used less frequently; it's largely being replaced by urea breath tests or checking for H. pylori antigens in stool samples. It's actually somewhat unusual that you were referred specifically for this test.

Best regards. 🙂

Dear neonheron32,

neonheron32 said:MPV 10.6 (6.8 - 10.4)

Don't let this parameter worry you. It refers to the average volume or size of your platelets. This result falls within the normal range.

Lymphocytes 0.92 (1.19 - 3.35)
With the lymphocyte percentage now at a normal level (25%).

As your Hematology specialist already mentioned, it's entirely possible for lymphocytes to drop temporarily due to certain infections, while neutrophils increase.

Once the infection clears, the blood count should stabilize. This usually happens within a two to three-week window.

Looking at the numbers, the results are nearly back to normal already.

PT - INR 1.16 (2.0 - 3.5)

Healthy individuals—those not taking blood thinners or dealing with clotting issues—typically have an INR around 1.0. Normal ranges vary slightly depending on the lab, but some data suggests a range of roughly 0.9 to 1.2.

Your result is perfectly fine.

I've heard these enzymes don't matter much if they are low, but everywhere I look, low lymphocytes are linked to some scary disease. Should I be concerned, or can this be treated as a normal finding?

You’ve heard plenty about enzyme levels, but lymphocytes are a different story. A slight dip there happens quite frequently, usually just a byproduct of a recent infection or other transient factors like stress or certain medications.

Since your numbers are trending upward and you aren't experiencing any other symptoms that would suggest an underlying issue, I’d say trust the Hematology specialist who gave you the explanation. They seem to have a handle on it.

If you need some peace of mind, you could always ask your primary care physician to run a follow-up test in about two to four weeks. That should give you a clearer picture of how things are settling.

Best regards. 🙂