Posts by Nicholas Myers

vividcrane24 said:To whom it may concern,

My apologies for the imprecise summary earlier.
The low neutrophil counts aren't a new development:

Relative % (44 - 72) from my current labs:
02/22 - 28.9
2018 - 40.4
2014 - 37.0

Absolute count 10*9/L (2.06 - 6.49)
02/22 - 1.40
2018 - 1.90

There’s no history of neutropenia in my family. Regarding my general health—fatigue, anxiety, bloating, constipation, irregular cycles—these symptoms align with both Hashimoto and PCOS. My medication history includes Emaner and Normabel pp over the years, plus Gynositol recently for gynecological reasons.
Since everything is still being investigated, I'm wondering if this neutropenia could be linked to Hashimoto, especially considering EBV as a potential trigger? I've read that long-term neutropenia (and certain viral infections) can be tied to the Epstein-Barr virus, which is also considered a possible cause of chronic thyroiditis.
On a side note, what is your take on starting hormone replacement therapy for thyroiditis when symptoms persist despite normal TSH levels?

Thanks for the response; I will certainly insist on those tests.

Based on what you've shared, the neutropenia has persisted for several years. It appears to coincide with the diagnosis of an autoimmune thyroid disease. In this light, there is a lower probability of an underlying serious pathology causing the neutropenia (though nothing can be ruled out entirely). As you suggested, it is quite possible the neutropenia is connected to the autoimmune thyroid condition; this isn't uncommon in clinical practice, particularly with milder cases where no other symptoms of illness are present. Regardless, the neutropenia should still be fully evaluated.

It seems unlikely that EBV would be the driver behind neutropenia that has lasted for years.

If the patient is in a euthyroid state, levothyroxine replacement therapy is not indicated.

David Flores68 said:Thanks for the input. My gut feeling was also that this looks more like a skin issue than anything rheumatological. Hopefully, my doctor refers me to a dermatologist; if not, I'll just book a private appointment.

Just wanted to follow up regarding these lab results.

https://i.postimg.cc/xC3gkqsf/oba-reuma-nalaza.jpg

It all looks negative to me—is that right? And does this officially rule out any kind of rheumatic disease?

No. There are many other tests and diagnostic steps required before you can rule out an autoimmune or rheumatic condition. So, my answer is that we cannot say a rheumatic cause for your symptoms is ruled out just yet.

Hannah Stewart27 said:Thank you all for the feedback and suggestions. I've pulled the specific figures from my reports:

C3c - 1 (0.9-1.8) - assuming what you mentioned is correct...
C4 - 0.2 (0.1-0.4
Immunoglobulin A - 0.94 (0.70-4)
Immunoglobulin M - 1.51 (0.40-2.30
Immunoglobulin G - 15 (7.00-16.00)
(S)Alpha amylase 66 (23-91)
(U)Alpha amylase 374 (0-400)
Albumin/Globulin 2.13
Cholesterol 4.7 HDL cholesterol - 1.5 >1.2
LDL cholesterol - 3.2 Triglycerides - 0.6 Ferritin 106 (20-300)

The numbers look fine overall; the CBC is excellent. Still waiting on stool results. Thyroid function is normal—even had a TSH test done, which came back clear.

What has shifted compared to six weeks ago is this (previous vs. current):

Alpha-2 globulins - 7.8 : 6.5 (7.0-11.0)
Beta globulins - 7.6 : 4.9 (9.0-14.0)
Gamma globulins - 20.4 : 18.2 (12.0-20.0)
Beta globulins (subfraction) - 5.6 : 3.5 (6.0-10.0)
Vitamin D was 69.5 three months ago; now it's 14.7.

Apologies if any of this data is extraneous.

The picture isn't complete yet. We're still missing the Apple and ENA results.

Also, you should verify the units for the Vitamin D tests. Are both labs using the exact same measurement scale?

There are fluctuations in the Alpha-2 and gamma globulin levels, though they might still fall within an acceptable range (it would be helpful to see both percentages and values in g/L for a better assessment). The only consistent trend here is the significant drop in beta globulin levels.

Hannah Stewart27 said:To whom it may concern,

Thanks for clearing that up. The issue is the waiting list is massive; nobody seems able to provide concrete answers right now. I decided to follow up after getting my latest test results, though I'm still stuck waiting months for a specialist review. As for the vitamin D levels, this is my first time seeing them mentioned in this light—I didn't realize they were relevant from a gastroenterology standpoint.

Thanks again.

Ma'am,

While you wait for those appointments, it might be prudent to run a few tests: ANA, ENA, C3, C4, CH50, immunoglobulin levels (IgG, A, M, E), thyroid antibodies (unless already covered), and a fecal fat test for malabsorption.

What does the CBC look like? SED rate? CRP? Iron status? Electrolytes like Mg, Ca, Na, K, and Cl? Pancreatic enzymes (amylase, lipase)? Lipid panel (cholesterol, triglycerides)? Serum proteins? albumin? Coagulation factors (PT, PTT, fibrinogen)?

Since doubling the dose of Claritin didn't do the trick, I’d suggest talking to your primary care physician about switching antihistamines. You could try Xyzal at 5 mg twice a day. If there's no improvement after a week, try 5 mg in the morning and 10 mg at night. If that fails after another week, you could move to a full double dose of 10 mg twice daily.

vividcrane24 said:Respectfully,

I'd appreciate some perspective regarding shifted lymphocyte counts—specifically, elevated levels paired with a drop in others.
Neutrophil count and what follow-up tests are actually necessary.

I was diagnosed with Hashimoto's about ten years ago.
I’m skipping the medication for now. My TSH levels are still sitting within the normal range.
I wonder if this condition could lead to low levels:
Neutrophil granulocytes.
sada: 28.9% relative. (44-72) A few years back: 98.6, 104.7.
1.40 10*9/L A few years back, looking at the range between 2.06 and 6.49: it was sitting at 1.90.
Those elevated levels. Lymphocytes at 55.5%. (20 - 46), a few years back: 50.0

The doctor didn't actually provide a link like that. He just made a passing comment about neutropenia—specifically regarding some potential triggers.
They also sent me for a urine culture. I’m still dealing with that frequent urge to go, and frankly, I still don't know what's driving it. Previously, I was prescribed Ninian Nolicin because my white blood cell counts kept spiking—hitting levels like 10-15, 10-12, or even 12-17.
Everything looked fine from a gynecological standpoint, but my doctor is sending me back for another appointment. Apparently, they need to run some swabs since they weren't taken during the initial visit.

To whom it may concern,

If neutropenia becomes a long-term issue, you need a full workup. Don't bother listing specific absolute neutrophil counts or dates; those percentages don't tell us much in this context. Just get the investigation started.

Any medications currently in your rotation? Any specific health issues you're dealing with? Or perhaps someone in your family struggles with neutropenia?

A full workup is necessary. This should include a thorough physical exam—focusing specifically on the lymph nodes, liver, and spleen—alongside a CBC, metabolic panel, ESR, and CRP. You'll also need to check B12 and folic acid levels, run ANA, ENA, and RF tests, perform serum protein electrophoresis, and test for antineutrophil antibodies. Complete immunophenotyping of peripheral blood lymphocytes and HIV serology are also required. Once those results are in, schedule an appointment with a hematologist to determine the next steps. Depending on what the clinical exam and history reveal, you might also need to have your blood counts monitored two or three times a week for the next six to eight weeks.

The processing is sufficiently accurate.

Harold Garcia60 said:@Nicholas Myers Thanks for the reply. Please excuse my previous post; it was a bit blunt. I’m attaching my son's lab results from his distal renal tubular acidosis diagnosis, along with his most recent ones. That redness mentioned in the last discharge summary has completely cleared up.

Hello,

I've reviewed the labs. At this stage, the condition appears well-managed, and the results are satisfactory. It seems the child is receiving excellent care. Everything has been handled according to standard clinical best practices.

With proper management, normal growth and development are achievable while preserving kidney function. Depending on what the genetic testing shows, there is a possibility of extra-renal complications—specifically sensorineural deafness or, occasionally, hemolytic anemia. Has the genetic report come back yet?

Hannah Stewart27 said:Hello, I am looking for some clarification on why a gastroenterologist would order a 25-OH Vitamin D test. Following a diagnosis of iron deficiency anemia and abdominal pain, I underwent a full workup with a specialist. This included a colonoscopy, endoscopy, and an MR enterography; none showed anything abnormal aside from GERD, gastritis, and a hiatal hernia. I started iron supplementation, which successfully resolved the anemia. All tumor markers have been normal for ten months, and remain so after three months. In short, my blood work is mostly fine, except for these specific values:

25-OH vitamin D - 14.7 (ideal range: 75-100)
Alpha 2 globulins 6.5 (7-11)
Beta globulins 4.9 (9-14)
Beta globulin part II - 3.5 (6-10)
ALT 44 (10-36)

My thyroid has been stable and under control for three months since stopping medication following a hyperthyroidism diagnosis. Urine tests are normal. I have dealt with daily hives since August and am waiting for my first dermatology appointment; all immunoglobulins are within normal limits. Stool tests were negative for H. pylori. Currently awaiting stool culture results and calprotectin levels.

I am at a normal weight (leaning toward thin), don't drink alcohol, don't consume caffeine, and I don't smoke. My current medications are Elice 1 x and Letizen 1-2x for the urticaria.

Apologies for the long post, and thanks in advance.

Ma'am,

A low beta fraction in serum protein electrophoresis is typically linked to malnutrition or inadequate protein intake. That said, it can also be tied to liver or kidney issues, or perhaps hypolipoproteinemia. A decreased alpha-2 fraction often stems from similar causes—malnutrition, intestinal loss, or liver disease.

The common denominator for this profile, especially when paired with low Vitamin D, could be malabsorption.

I believe you may have asked this before, and I gave a similar answer.

David Flores68 said:It lasted about a week before it subsided, then these lumps with swelling started popping up around them. The lumps would fade after a few days, but just as one batch cleared, a new set of 3 to 8 would show up.

It’s a complex situation, but nothing here points clearly toward a single diagnosis. It’s time to start the diagnostic process. If you aren't dealing with joint swelling right now—as I mentioned previously—I’d say the smartest first move is seeing a dermatologist, followed likely by scheduling a biopsy.

David Flores68 said:Since January 2020, I've been dealing with red bumps appearing and disappearing on my right fingers, accompanied by swelling around them. My doctor has sent me for blood work several times to check for things like rheumatoid arthritis or something similar—I can't recall the exact terminology she used.

Anyway, here are these two lab results. Do they point toward some kind of arthritis or anything else in general?
https://i.postimg.cc/xC3gkqsf/oba-reuma-nalaza.jpg

This is what the bumps look like:
https://i.postimg.cc/VsgTNsHs/prst-3.jpg

More photos here:

View on imgur

Hello,

The changes in these photos don't look like typical rheumatoid nodules, nor do they resemble Heberden's or Bouchard's nodes.

A differential diagnosis is quite broad here, especially without an in-person examination. Your best move might be seeing a dermatologist first, then scheduling a biopsy of the area to identify the cause. Given the location on the fingers, you'll likely need a surgeon to perform it.

If you don't mind me asking, what is your profession? Are you frequently exposed to cold or other physical stressors?

ironpanther42 said:Hi there...
I'm dealing with some symptoms related to electrolyte imbalances. I had COVID about a month ago, and since then, I've been under a lot of stress and struggling with sleep. Generally, I deal with constant anxiety and occasional panic attacks, which COVID likely amplified. Migraines accompanied by vertigo are a constant in my life, but during this bout of COVID, I felt this pressure in my head, so my neurologist sent me for an EEG. I'm asking if anyone can help interpret these results, as I won't see my specialist for a few months. One thing to note: I had a mild panic attack while waiting for the exam—could that influence the results?
The findings are:

Low to medium voltage baseline cerebral activity is present within the local alpha frequency.
Reaction to visual stimulation is weakly expressed.
During recording, sharpened peaks occur bilaterally in the temporo-occipital regions.
No paroxysms observed.
No analogous changes on HV.

Conclusion: Findings show slight irritative changes bilaterally in the posterior regions.

Hello,

This EEG result is non-specific. It suggests heightened irritability in the posterior areas of the brain, which aligns with the clinical picture you've described (insomnia, anxiety, recent viral infection...). I don't see any reason for urgent intervention based on this report. Because the findings are non-specific—meaning they could be attributed to a wide range of conditions or disorders—they should only be interpreted as part of your total medical evaluation.

ironsurfer10 said:To whom it may concern,
thanks for the reply. The bit about the Federal Reserve was a relief. My father passed away from an aneurysm, and my mother dealt with "blood clotting issues" for years—her words, anyway. I assume she had thrombophilia, which explains my anxiety.
Regarding the nephrologist, everything looks normal except for the urinalysis and the presence of those dysmorphic erythrocytes.

Attaching the Fe and saturation levels here; I didn't realize they failed to upload in the last post.
Sent from my SM-G770F using Reddit

To the lady,

you have sideropenia (I'll assume hemoglobin levels are normal since they weren't provided). Given the urogenital bleeding, that's likely the culprit.

With ferritin concentrations sitting below 15 ug/L, it meets the WHO definition for deficiency.

As for treating sideropenia, the first step is dietary adjustment. Aim for meat, poultry, or fish at least five days a week, supplemented by legumes and leafy greens. After that, we look at iron supplements.

Henry Ross88 said:To whom it may concern,

My doctor referred me due to persistent neck pain and pulsing sensations in the cerebellum. I also live with ulcerative colitis, an autoimmune condition.

I would argue that HLA typing won't provide an answer regarding the cause of constant pain. You'll need to pursue other avenues, such as seeing a physical therapist or a neurologist. Looking at the HLA results, I don't see anything linked to the symptoms you described.

Henry Ross88 said:Hi there, could you please interpret and explain these results for me?
HLA TEST RESULTS

Class I/HLA-A *03 *24
Class I/HLA-B *40 *55
Class I/HLA-C *03
Class II/HLA-DRB1 *08 *13
Class II/HLA-DQB1 *04 *06

Thanks in advance for the help.

Hello,

What specific condition are we looking for, or why was this test ordered in the first place? Looking at these markers alone doesn't point to a definitive diagnosis. While certain profiles might suggest a predisposition to certain issues, almost any HLA marker can be linked to some level of increased risk. Without knowing the clinical context, I have nothing concrete to focus on. Please provide more details on what we're investigating.

ironsurfer10 said:I’ve previously mentioned issues with my urine and dysmorphic erythrocytes (which made up 85% of my last result). Recently, during routine checks, items that used to be negative keep popping up, and there's always something new. A few months ago it was proteins, and now it's ketones.
I don't see a nephrologist for another six months. Should I do anything in the meantime before my appointment? Blood tests for systemic diseases came back negative.

Ma'am,

In this report, the only significant finding is the persistent erythrocyturia—essentially microhematuria—and likely borderline proteinuria. This warrants the nephrological follow-up you have scheduled, but it isn't an emergency. You don't need to take any immediate action, though you might consider a 24-hour urine protein test along with creatinine clearance and eGFR if those haven't been done yet.

A single ketone cross in your urine could simply indicate fasting, especially since glucose is negative; there are no signs here suggesting diabetes.

The Goldman Sachs results still fall within a range considered normal (according to medical literature, an INR of 0.8 - 1.1 is standard for someone not on anticoagulant therapy). I'm not sure why both of your parents required anticoagulants—perhaps atrial fibrillation?—but based on this specific data, there's nothing to suggest you are headed down that same path.

I can't comment on iron or ferritin because the values aren't listed.

Drew Rivera41 said:Thank you for the response. I get checked about every six months. Comparing my last three reports to this current one, I see that immature granulocytes were elevated in the previous results just as they are now. Also, ESR was slightly low in the previous report, much like it is today. Similarly, reticulocyte hemoglobin has been high in all three prior tests. My PT and INR levels were also low in those three previous instances. Potassium is consistently low. Both IgG and IgM have also remained consistently low. Urinary creatinine is quite low across all old reports. Squamous epithelial cells are also elevated in every test. Finally, the serum albumin/globulin ratio has also been consistently high. Is there anything you can gather from this blood work?

Ma'am,

I prefer seeing the full set of values. I've been burned too many times by relying solely on someone else's interpretation. I need to look at the raw numbers myself and compare them before forming an opinion.

Based strictly on what you've shared—and with significant caveats—here is my take. If those immature granulocytes have been present in similar numbers previously, there isn't much reason for concern. The slightly higher reticulocyte hemoglobin might point toward low iron stores; if you haven't already, I'd suggest looking into that (iron, UIBC, TIBC, ferritin). As for the lower immunoglobulin levels—provided IgG stays above 8 g/L—they could be linked to previous chemotherapy. B lymphocytes can take some time to recover after such treatment, so while I wouldn't worry yet, it’s worth monitoring. Potassium is a bit low, but we don't talk about hypokalemia until it drops below 3.5 mmol/l. It's hard to say why it's slightly low right now; it occurs to me that certain chemo drugs can affect the renal tubules, leading to increased potassium loss, though that usually resolves once the medication stops. Finding a few white blood cells in the urine along with squamous epithelial cells likely just means the sample wasn't collected perfectly—skin contact during collection often causes this—so that doesn't worry me either. PT and INR are within normal range; the values in parentheses are typically meant for patients on anticoagulant therapy. That's the short version, provided with a massive disclaimer: since I don't have the complete lab reports or your full medical history and treatment plan, your attending physician may very well disagree with my assessment.

Drew Rivera41 said:So, there it is. These are all the values that fall outside the normal range. I've included the reference values in parentheses. Could someone with actual expertise take a look and help me make sense of these results? 🙂

To whom it may concern,

It is impossible to comment on these specific lab results, particularly regarding the white blood cell differentials. Since you’re undergoing regular checkups, I would also need to see your previous reports to compare them against the current ones. Without that baseline, there is no way to provide an answer.

Harold Garcia60 said:Hello. I already posted once regarding our son. He’s been diagnosed with distal renal tubular acidosis (dRTA). He is 6 months old. These are his latest acid-base status results. Blood was drawn from both a vein and a finger prick. Thanks in advance for any help you can offer.

https://ibb.co/Wc2tVrJ

Look,

To actually evaluate these labs, I need to see how they compare to the previous ones—especially since, if memory serves, medication dosages were increased during the last checkup. Also, I noticed you "wiped" this post. Unlike the previous one (which was deleted and is now gone), there are no recommendations here, no medical history, and some other details seem missing (like some redness, etc.).

The data you're providing is incomplete, so frankly, it doesn't feel fair play to ask for a second opinion this way.

Sophia Hughes90 said:Thanks for the input.
It wasn't COVID-19. I have to get tested regularly for my job.
Just speaking off the cuff here, I don't think I rested enough. As soon as I felt even slightly better, I was out walking in the cold and stuff. That’s when things took a turn—I felt this pressure in my lungs and just total weakness. It seems fine now, though. I haven't gone back for any follow-up testing.

If you're feeling better, further tests might not be necessary. However, if symptoms return or you don't reach a full recovery, it would be wise to expand the diagnostic workup.

Sophia Hughes90 said:I went in for some lab work because I've been feeling incredibly weak following a respiratory infection. The fatigue just hasn't let up, even after the antibiotics finished their course.

My CBC came back normal.

Urinalysis
There are a few deviations from the reference range:
Appearance: cloudy
Leukocyte esterase: 15, reference interval Leukocytes: 5-7, reference interval 0-2 (x400)
Epithelial cells: many, reference interval 0-1 (x400)
Bacteria: trace, reference interval 0/neg (x400)
Mucus: rare, reference interval 0/neg (x400)

In the end, my doctor ordered a urine culture. Since I'm not experiencing any urinary tract symptoms, I'm wondering if you think these extra tests are actually necessary.

Hello,

Inquiries regarding urinalysis results like yours are quite common. When there is a high count of epithelial cells, it usually indicates the sample was contaminated by skin contact during collection. This would explain the presence of leukocytes. Based on what you've described, a urinary tract infection doesn't seem likely.

Was that respiratory infection COVID-19, or was it something else? What specific lingering symptoms are you dealing with? Aside from the CBC, have you had any other blood work done?

fadedhound7 said:I'd appreciate it if someone could help me make sense of this hand MRI. I'm in my late 20s and have been dealing with issues in several joints for a couple of years now, though I don't have a concrete diagnosis. Unfortunately, I couldn't finish the full scan due to pain, but I'm wondering if anything can be gleaned from what was completed.

Native MRI slices of the right hand—T1 and T2 weighted, plus coronal PD tse fs sequences; patient unable to complete planned examination due to pain.

From the completed sequences, signs of significant coalitional fusion are distinguishable. To the extent possible to analyze, the amount of lamellar fluid within the distal radioulnar joint and the area of the radiocarpal joint—specifically between the distal radius and the scaphoid—is non-significant. No inflammatory osteitis is present. There are no chronic structural changes, such as erosions, at the level of the distal radioulnar joint, radiocarpal levels, small carpal joints, or the visualized MCP and PIP joints. No signs of acute inflammation in the small carpal joints or the MCP and PIP joints. Minimal fluid in the MCP joints and the 1st carpometacarpal joint, which is non-significant.

The flexor and extensor tendons show maintained continuity, with no clearly visible significant tenosynovitis.

Thanks 🙂

Hello,

An MRI isn't really a lab result; it's an imaging diagnostic study.

The MRI of the right hand describes a developmental anomaly—essentially a rare anatomical variation where the capitate and scaphoid bones failed to properly segment during embryonic development, resulting in fusion. This type of anomaly is typically asymptomatic and requires no treatment. However, there are documented cases where it causes wrist pain. Since this is a rare condition, I'd suggest consulting an orthopedic surgeon specializing in hand surgery to determine if this fusion is actually linked to your symptoms. Everything else noted on the MRI appears clinically insignificant.

Kimberly Morris said:Felix the Cat, how can I ever thank you enough? Seriously, major respect. Thanks so much for the reply.

The thing that’s actually weighing on me is my poor Vitamin D levels. My endocrinologist told me to stop taking it because of hypercalcemia. Everywhere I read, people say it's absolutely vital when dealing with COVID-19. I haven't recovered from it, I haven't been vaccinated, I'm carrying some extra weight, and I have all these other diagnoses.

Do you have any recommendations on what I should take to boost my immune system, given that my Vitamin D levels are basically non-existent?

Ma'am,

Higher Vitamin D levels would certainly be ideal, I agree. That said, your reading of 19.9 ug/L is just shy of the recommended 20 ug/L—or ideally above 30 ug/L. It's worth noting the units are in ug/L rather than nmol/L, which is how concentration is most commonly expressed. That likely caused some confusion, as when using nmol/L, the recommendation is typically above 50 nmol/L.

My advice? Stick to the instructions your endocrinologist gave you. Finish your diagnostic workup first; once a definitive diagnosis is in place, you can address the Vitamin D deficiency.

Good luck.