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

I need some advice—my kid is 9 years old and just tested positive for strep via a rapid swab. It’s day three of this whole thing, and they've been dealing with fevers, vomiting, and diarrhea. I'm attaching the blood work that we took to the ER, but honestly, when we got there, they just asked what was wrong and told us to grab Amoxicillin (we couldn't find any, so we had to get a substitute from a different pharmacy). Aside from the fever spikes, they seem okay... but are these high leukocyte counts actually normal when you're fighting strep?

Hey everyone, can someone please help me make sense of these HLA typing results?
I’m asking for my mom. She’s 69 years old, and she is dealing with this absolutely unbearable itching all over her body. We had a biopsy done, but all it really told us was that the skin irritation is a direct result of the intense itching, so we're still completely in the dark regarding an actual diagnosis.
On top of that, she’s battling oral lichen planus, knee arthritis, vein issues, spinal problems, and thrombocytopenia.
I’m trying to figure out how these HLA markers tie into everything
she's going through.

HLA Class I. A. A2. A3
B. B51(5). B56(22)
Bw. Bw4. Bw6
C. Cw1
HLA Class II. DRB1. *08. *12

Hey Nicholas Myers, here I am with yet another symptom, and I still haven't figured out why my lips are turning pale blue...

So last night, I wake up just like every other night—you know, gotta hit the bathroom and check on my kid. I open my eyes, but my left eyelid just starts drooping on its own. I’m rubbing at it with my fingers, trying to force the eye open. It’s just not happening. The lid keeps dropping. I'm sitting there thinking, "Please, God, not today, I can't have a stroke right now!" I'm finally supposed to be heading back to work after my sick leave and I'm actually looking forward to sitting in my office... I spent a good thirty minutes trying to lift that lid, but nothing. It kept falling down, and honestly, it felt like someone had literally taped a weight to it...

Once I finally managed to see again, I went back to sleep. But then this morning, and all through the day, my eyelid just feels weak. I haven't gone to the doctor yet. Fingers crossed it's nothing big...

I'm looking for some input here.
I'm in my mid-30s and recently had my thyroid levels checked due to a few symptoms—some more pronounced than others, but nothing extreme: dry skin, constant fatigue, feeling cold all the time, heavy periods, and slightly elevated cholesterol (diet is fine, triglycerides are normal). The hardest part for me, though, has been the weight gain—this happened right after a stressful period and two nasty viral infections.
My results are listed below.


It looks to me like everything is within range except for T3.
I’ll definitely be following up with my primary care physician, but I would love to hear your thoughts and perspectives in the meantime.
Thanks.

The TSH level isn't low enough to ring any alarm bells just yet. Honestly, T4 and T3 aren't even the real dealmakers here—you really have to look at the free T4 and free T3 levels. Even so, nothing is low enough to start pointing the finger at the thyroid for everything you're feeling. You absolutely need to consider all the other potential illnesses, conditions, or random life stressors that could be causing these symptoms.

If T3 is what suppresses TSH (or TRH), then how on earth is her TSH so low when her T3 is actually below the normal range?

Sam Taylor22, you mentioned on some other thread that this isn't exactly "rocket science," so why don't you go ahead and answer your own question?

Maybe he’d get some actual answers if he just went and tested his TSH. In my opinion, low TSH might point toward secondary or central hypothyroidism.
(There is such a thing as a TSH stimulation test, but I don't know much about it—and unfortunately, maybe they don't even do it here in the States either.)

So, apparently you need help with both "rocket science" and basic reading comprehension. I mean, let's start with the fact that you actually have to read for understanding here—we are talking about *her*, not him. And by extension, we have to consider the endocrine implications of a very powerful paired organ that can trigger these exact same symptoms. Only if that specific organ is cleared should we mmmmmmaybe turn our attention back to the thyroid. At the end of the day, every organ is interconnected in some way, so besides doing a mountain of reading, actually interacting with people is just as vital.

Carol Edwards81 said:Looking for some input—child, 9 years old, rapid strep swab came back positive. Third day of illness involving fever, vomiting, and diarrhea. Attaching the blood work used when we went to the ER; they asked what was going on and suggested Amoxicillin (they didn't have it, so we got a substitute from a local pharmacy). Otherwise, the general condition seems okay during the breaks between fevers. Are these high leukocyte levels normal for strep?http://uploads.tapatalk-cdn.com/203...70e2071433.jpg

Yes, that’s a textbook result.

Emily Bailey78 said:Hi everyone, could someone help me make sense of these HLA typing results?
It's for my mother, 69. Her main issue is unbearable itching all over her body. A biopsy only confirmed it's pruritus, so we still don't have a definitive diagnosis.
On top of that, she has oral lichen planus, knee arthritis, vein issues, spinal problems, and thrombocytopenia.
Could you explain the HLA findings in the context of everything
mentioned?

Class I HLA-A. A2. A3
HLA-B. B51(5). B56(22)
HLA-Bw. Bw4. Bw6
HLA-C. Cw1 Class II
Class II HLA-DRB1. *08. *12

Hello,

The results indicate a predisposition to primary biliary cirrhosis, as well as lichen sclerosus and Behcet's disease. Regarding the itching, the predisposition for primary biliary cirrhosis is the most significant factor here.

Kimberly Morris said:Dr. Nicholas Myers, here I am with yet another symptom, and I still haven't even fixed the pale blue lips issue...

Last night, I woke up just like any other night—to use the restroom and check on my kid. I opened my eyes, but my left eyelid just kept drooping on its own. I tried rubbing it with my fingers, forcing the eye open. It wouldn't work. The lid just falls. My first thought was, "Please, don't let this be a stroke!" Not today. I’m finally about to head back to work after medical leave and can barely wait to get back into my office... For about half an hour, I fought to lift that lid, but no luck. It kept dropping, and it felt like someone had placed a literal weight on it...

Once I finally managed to see clearly again, I went back to sleep. But by morning, and through the whole day, that eyelid just felt weak. I haven't seen a doctor yet. I'm hoping it's nothing....

Ma'am,

What you described could be part of an ophthalmoplegic migraine. Given your previous diagnoses—if I recall correctly, migraine is one of them—this fits. However, as a colleague already mentioned in another thread, we have to rule out other potential causes, which simply isn't possible via an online forum.

brightgull95 said:So, I guess you actually need help with both the "rocket science" and basic reading comprehension. I mean, you have to start by actually understanding what you read—we're talking about her, not him. And while we're at it, there's this incredibly powerful endocrine organ involved that can cause those exact symptoms too. Only if that organ turns out to be innocent should we, mmmaybe, look back at the thyroid. All organs are connected somehow, so besides doing a ton of reading, working with people is just as important.

At least I actually tried to give a real answer, unlike your convoluted responses that seem designed to hide (or maybe just show off) your arrogance.

brightgull95 said:There’s also a very powerful endocrine gland—another paired organ—that can trigger these exact symptoms. Only after we rule out that organ being the culprit can we mmmmmmight reconsider focusing back on the thyroid. Every organ is interconnected in some way; beyond just reading up on it, a lot of hands-on work with patients is essential here.

For what it's worth—my history includes two easy conceptions and two full-term pregnancies; my cycles have always been regular.

My primary care physician assessed everything and determined the results were normal—no further investigation is needed. ☕

Chris Mitchell4 said:If anything, I can say that behind me there were two easy conceptions and two school pregnancies—and my cycles have always been regular.

Of course, we’re looking at PCOS—a condition that any seasoned clinician would instinctively jump to, almost reflexively crossing it off their list of differential diagnoses before even finishing the intake. The ovaries aren't to blame, the thyroid isn't the culprit—at least, not for now. There really isn't much else left on the table. But honestly? That's probably for the best.

Chris Mitchell4 said:My primary care physician evaluated the results and concluded that everything looks perfectly normal—there’s absolutely no need for any further testing or investigation. ☕

The LOM assessment was actually quite spot on, and—unless those symptoms I mentioned earlier are seriously eating away at you—I’d say their conclusion is perfectly valid.

Kyle Nelson2 said:At least I actually made an effort to provide a real answer, unlike those convoluted ramblings of yours used to mask (or maybe not) your sheer arrogance.

The only question you’ve actually—and I mean correctly noted here—put any effort into answering is one about yourself that has absolutely nothing to do with the original inquiry. Precisely. But when I was actually stuck in a bind, you didn't give me a single useful thing.

Go ahead, feel free to insult me. I know that's the kind of hit you need in life just to feel even remotely better for a split second. Honestly? I'll just laugh it off because watching this is actually entertaining. 😳

Kyle Nelson2 said:I at least made an effort to provide a useful answer, unlike your convoluted responses that seem designed to mask—whether intentionally or not—your own arrogance.

brightgull95 said:Feel free to insult me. I know that’s exactly what you need in life just to feel a little better—even if only for a second. As for me, I’ll just give a wry little laugh. It’s entertaining. 😳

Insults are off-limits. Kyle Nelson2 keeps pushing his provocations, spreading them far beyond the Health PDF.

My patience isn't infinite either, Kyle Nelson2, so don't push it. It’s already more than enough that I let you air your "opinions" here on this PDF.

Spent eight days in the hospital. Not like I’m any smarter now, but at least I have some info they tossed my way... (Suspected Fibromyalgia, Sjögren's syndrome M35.0, Polyarthralgia M13.0).
Here’s what I have from my lab results.
Thanks to everyone for all the lab results I've read through so far... and, obviously, thanks for this one in advance. 🙂

So, about Celiac disease—do you actually need a gastroscopy to rule it out for good? I wasn't referred for one, so now I'm stuck wondering what my next move should be.
And then there are these X-ray results from those heavy-duty scans they’ve run a hundred times already... everyone seems to read them differently every single time. 😢 I had them done in Naples, Chicago, and Indianapolis.

Results
EKG: Sinus rhythm, heart rate 75 bpm. Normal electrical axis. Right bundle branch block (RBBB). No ST or T wave changes suggesting ischemia.
Lab results (01/31/2023):
WBC 3.4, RBC 4.54, Hemoglobin 132, Hematocrit 0.399, MCV 87.9, MCH 29.1, MCHC.
Hemoglobin 331 [g/L], RDW-CV 12.7 [%], Platelets 221 [x109/L], MPV 9.8 [fL], Eos 2 [%], Baso 2 [%], Neutro 57 [%].
Lymphocytes 27%, Monocytes 12%, SE 5 [mm/3.6 KS], AST 21 U/L, ALT 18 U/L, ALP 52 U/L, GGT 13 U/L, CK.
ALT 93 [U/L], LDH (s) 167 [U/L], ALP 3.5 [U/L], Glucose (s) 5.0 [mmol/L], Urea (s) 4.4 [mmol/L], Creatinine (s) 71 [umol/L].
URAT 145 [umol/L], T-BIL 7 [umol/L], PROT (s) 74.6 [g/L], ALB 44.4 [g/L], CRP 0.5 [mg/L], ASL-O 295 [U/ml].
Sodium (s) 143 [mmol/L], Potassium (s) 4.1 [mmol/L], Chloride (s) 103 [mmol/L], Iron 14.3 [umol/l], UIBC 53.4 [umol/l], TIBC.
Iron: 16 [ug/l], Transferrin Saturation: 21 [%], Total Cholesterol: 0.69 [mmol/l], HDL: 1.58 [mmol/l], Potassium: 4.30 [mmol/l].
LDL 96 mg/dL, HDL/CO 37%, Appearance (clear), Color (pale yellow), Specific gravity (unspecified)
Specific gravity 1.005, pH 6.0, Nit negative, Prot negative, Glu negative, Ket negative.
Negative for parasites, normal for worms, negative for bile, negative for blood, and 3-5 eosinophils per high power field. Leukocytes present.
(US) 0-1 [Lkc/HPF], Epithelial cells slightly increased [descriptive], Mucus slightly increased [descriptive], Bacteria slightly increased [descriptive], TSH 1.303 [mIU/L], FT3
TSH 4.39 pmol/L, FT4 12.64 pmol/L, Anti-TPO 0.73 kIU/L, IgG 12.10 g/L, IgA 3.07 g/L, IgM 0.80 g/L, C3c.
0.89 g/L, C4 0.24 g/L. No monoclonal proteins detected in the immunofixation. RF 8 IU/ml, total protein 74.6 g/L, A/G ratio 1.49. Protein electrophoresis breakdown: Albumin 44.61 g/L (59.8%), Alpha-1 2.76 g/L (3.7%), Alpha-2 6.86 g/L (9.2%), Beta 8.58 g/L (11.5%), Gamma 11.79 g/L (15.8%). MgB 40 ug/L.

URINE CULTURE (01/31/2023): Sterile
(2/3/2023): Urine tests came back—Ureaplasma: negative; Mycoplasma: negative; Chlamydia: negative.
Negative; Urine - Neisseria: Negative.

Chest and lung X-ray (02/02/2023):
I don't see any signs of fresh inflammatory infiltration or congestive changes in the lungs. The Hilum looks physiologically normal.
Branching. The domes are sharply outlined and very clearly defined. F.C. sinuses are clear. Heart shadow looks normal.
Size and shape.
X-ray, imaging, and hand scans (Feb 2, 2023):
The mineralization of the bone structures shown here looks appropriate. Joint surfaces are congruent, and everything seems normal.
Joint space width. I don't see any obvious morphological changes in the bone structures shown.
Soft tissue structures and patterns. On the ulnar side, there's a visible shadow of a brown ileum.
Right hand.
Standard X-rays of both knees (2/2/2023):
The knee joint surfaces look consistently shaped and congruent, with a normal width.
The joint space looks fine. There's a femoropatellar dislocation with a smooth patellar contour.
FOOT X-RAY (2/2/2023):
Bone structure mineralization and morphology look appropriate. The articular surfaces of the joints shown are
well-formed, with regular and sharp contours and congruent articular bodies, except for both calcanei
where entheopathic changes at the Achilles tendon insertion are visible. No signs of intra- or periarticular
calcification. Soft tissue appearance is within physiological limits.
LUMBAR SPINE X-RAY (2/2/2023):
The bone structures shown have normal morphology. The shape and height of all lumbar vertebral
bodies are normal, maintaining a straight physiological lordosis. The posterior intercorporeal lines are continuous.
Intervertebral spaces in the lumbar segment are of normal width. Small intervertebral joints show normal
morphological appearance. Normal SIJ.
SALIVARY GLAND SCINTIGRAPHY (2/8/2023):
Applied activity: 3 mCi IV.
On the sequential scintigrams taken after radioisotope application, there is symmetrical and normal
activity uptake in both parotid glands and both submandibular salivary glands.
After lemon juice stimulation at the 10-minute mark, there is abundant salivation from all glands.
Conclusion: Scintigraphic function and salivation of all salivary glands are normal.
Status
VOD cc 1.0
VOS cc 1.0
Schirmer II test: right eye 23 mm, left eye 5 mm
AT both eyes: 14/14 mmHg
BM both eyes: eyes calm, no irritation, film is slightly unstable, cornea negative for fl, transparent, AC clear, without
pathological content, Tyndall negative, lenses transparent.
FOU: Clear fundus boundaries, macula is normal, periphery is normal, retina is attached; no
ruptures or hemorrhages noted.

Blood culture: pending.
Results pending: ANF, anti-dsDNA, ENA-screen, CCP, celiac testing, blood culture.

So, I’m kicking off the AC chemotherapy protocol this coming Monday, which means we've been running around like crazy getting everything ready.
Most of my labs look pretty decent.
I could upload photos, but honestly, there's enough info floating around already and I don't want to clog up everyone's feed.
My hemoglobin is actually back to normal—two months in a row now—even though I'm still going through my treatment cycles and have stopped taking iron supplements.

My Vitamin D came back at 46.1, while they really want to see it above 75.

Everything else looks mostly fine.

However, my white blood cell count is hovering right near the bottom limit. It's sitting at 3.8 (with a reference range of 3.4 - 9.7)—I'll find out what the verdict is on Monday since they scheduled a sit-down with my doctor before we start the therapy.
In terms of absolute values, my neutrophils are slightly low (1.90, ref: 2.06 - 6.49), though the percentage looks totally fine (49.8%, ref: 44 - 72).

The one thing bugging me is that my glomerular filtration rate is still low. This has been an issue for me since last year, and my primary doctor ordered a whole battery of kidney function tests, but nothing unusual ever popped up; even my abdominal ultrasound from four months ago showed everything was perfectly fine, just like always.
(eGFR CKD-EPI mL/min/1.73m2, GFR categories: G1: >= 90, G2: 60 - 89)

I also went to see the cardiologist. They told me everything is okay, even though they can hear a tiny murmur, but apparently, that's normal and won't get in the way of treatment. My EKG was fine. The ultrasound looked good too, aside from a note about the Doppler showing some mild mitral regurgitation and a trace of tricuspid regurgitation.
Hopefully, I won't totally crash and burn.

Emily Ortiz27 said:I’m starting the AC chemotherapy protocol this Monday, so we’ve been doing quite a bit of prep work.
Most results look okay.
I could upload the images, but I don't want to clutter the thread since there isn't much else to see.
My hemoglobin has been steady for two months now, despite staying on my cycle and stopping the iron supplements.

Vitamin D is at 46.1, while the reference range is >75.

Everything else looks fairly decent.

However, my white blood cell count is hovering near the lower limit. It's at 3.8 (ref: 3.4 - 9.7). I'll find out what the doctor thinks on Monday; they mentioned I'd have a consultation before starting treatment.
The absolute neutrophil count is low (1.90, ref: 2.06 - 6.49), though the relative percentage is fine (49.8%, ref: 44 - 72).

The only other thing is that my glomerular filtration rate is low. This has been an issue for a year, and my specialist ran a mountain of kidney function tests, but nothing unusual turned up. An abdominal ultrasound from four months ago was also completely normal, just like always.
(eGFR CKD-EPI mL/min/1.73m2, GFR categories: G1: >= 90, G2: 60 - 89)

I also saw a cardiologist. They said everything is fine despite a slight murmur, noting it's normal and shouldn't interfere with treatment. EKG was normal. The ultrasound was also clear, aside from a note regarding the Doppler: mild mitral regurgitation and trace tricuspid regurgitation.
Hopefully, I won't crash and burn.

Hello,

To answer your questions in order:

1. Vitamin D — It’s clearly a deficiency. You should discuss this with your oncologist, as concentrations are expected to drop further during and after chemotherapy. Supplementation is standard in these cases, provided you consult your oncologist first and get their approval.

2. Leukocytes/neutrophils — As long as the neutrophil count remains above 1500/mcL (or 1.5x10*9/L), starting chemotherapy is not contraindicated.

3. Glomerular filtration — You didn't specify the exact value, but generally speaking, as long as levels are >60 ml/min/1.73 m2, there are no contraindications, nor is there usually a need to adjust medication dosages.

4. Cardiac Ultrasound — The findings you described do not suggest any barriers to beginning chemotherapy. The critical factor here is heart function—specifically the Left Ventricular Ejection Fraction (LVEF). With anthracycline treatments like the ones planned for you, there is a higher risk for patients with an LVEF < 50%. That said, cardiology isn't my specialty, so I won't dive into the granular details.

Wishing you all the best!

Good luck!

placidangler13 said:I was hospitalized for 8 days, but I don't feel any smarter, especially regarding the information they shared... (suspected Fibromyalgia, Sjögren's syndrome M35.0, Polyarthralgia M13.0)
these are the results I have
thanks to everyone for the results read so far... and naturally, thanks in advance for this one🙂

And a question about celiac disease: is a gastroscopy necessary to rule it out completely? They haven't referred me for one yet... I need to know what my next move should be.
Also, regarding these X-ray results they've done a hundred times... everyone has interpreted them differently so far... 😢 (I had them done in Naples, Chicago, and Indianapolis).
Pending results: ANF, anti-dsDNA, ENA-screen, CCP, celiac testing, blood culture.

Ma'am,

Given that the key results are still pending, it isn't possible to answer your questions yet. Based on what has been provided so far, the findings aren't definitive for a systemic connective tissue disease, which I assume is why such an extensive workup is being conducted.

In certain instances, an endoscopy isn't required; it’s better to wait for the current lab work to come back first.

More can be said once those results arrive, so please feel free to check back in here then.