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

Maria Nguyen93 said:vividsailor7, I'd love your take on this. Is there anything I should tweak in my diet or anything else I can do to feel better?
I've got a gastroscopy coming up soon—I've been taking Nexium because they suspect cirrhosis... My abdominal ultrasound was fine, except for the fact that my liver looks a little enlarged...
My blood and urine work came back, and my MCH and GGT are slightly elevated, but everything else seems normal. I don't drink (maybe some wine at weddings or birthdays here and there), I don't smoke, and I don't do drugs. I stay away from soda and fast food too; I mostly just eat home-cooked meals. The only thing I'm wondering about is if GGT could be up because of Ibuprofen. I take it every month when my period gets really painful—it's the only thing that actually helps me. So yeah, I take it monthly...
MCHC is 361 (320-345)
AST 13
ALT 16
ALP 75
GGT 41 (9-35)

My urine results were perfect, and my cholesterol and triglycerides are totally fine.
Should I be worried about this GGT level? About a year and a half ago, I had the flu and did blood work then; my GGT was 35 back then.

A lab result by itself isn't an absolute indicator of pathology unless it's paired with the actual symptoms that prompted the test in the first place.
If you aren't having liver issues—meaning no pain, nothing palpable during an exam, and you're being careful with your lifestyle like you mentioned—there’s really no reason to stress over a borderline GGT value.
That said, definitely keep an eye on it. Pay attention to how your liver reacts to certain medications, foods, or drinks, and make sure to mention this to your doctor before starting any new treatments.

It’s not about some blood work or a lab test... we're talking ultrasound here. I’m honestly not even sure where to start asking about this...

So, I just went in for an abdominal and kidney ultrasound...

Everything looks fine, mostly. But then there's this note about my kidneys:

Kidneys are in the right spot, normal size, and the parenchyma thickness looks standard.
In the middle third of the left kidney sinus, there's a hypoechoic zone that matches the parenchymal echogenicity, which corresponds to a hypertrophied Bertin column.
At the junction of the middle and proximal thirds of the left kidney, there's a parenchymal cyst measuring up to 12mm.

What does any of this actually mean? Thanks!!

Hello everyone,

I’m looking for some advice—I’ve been on a course of antibiotics for seven days now, and things have just been rough. Two days ago, I actually ended up in the ER because I was having serious trouble breathing; I had a fever for several days, and this whole ordeal has been dragging on for ten days straight. They ran a full battery of tests on me, but I finally received my microbiology results today. My Antistreptolysin O came back at 648 of ref, where the normal value is 200. Also, my Basophils are at 1.672% and 0.116 10e9/L, and my Alkaline Phosphatase is 53.

I just got more results back:

Serum Protein Electrophoresis

Albumin 57.6 % (55.8-66.1). 40.9 g/L (40.2-47.6)
Alpha 1. 4.6. % (2.9-4.9). 3.3 g/L (2.1-3.5)

Alpha 2. 8.8 % (7.1-11.8). 6.2 g/L (5.1-8.5)

Beta. 9.7 %. (8.4-13.1). 6.9 g/L (6.0-9.4)
Gamma. 19.3%. (11.1-18.8). 13.7 g/L (8.0-13.5)

Total protein 71 g/L. A/G 1.36

Rheumatoid factor >10 (up to 14)

ANA: negative
(6 months ago was 1:160)

Immunoglobulin G 12.8 (7-16)
A 0.84 (0.7-4)
M 1.18 (0.4-2.3)

Circulating immune complexes IgG 202 (up to 130)
IgM 132 (up to 100)
(6 months ago circulating immune IgG 134, IgM 86)

Serum immunofixation: no monoclonal immunoglobulin detected

Thyroid is normal (TPO 5.5, TGA IgE tTg-IgA
Please, if anyone can provide any kind of interpretation for these results. Thanks.

steelgull55 said:A lab result by itself isn't some absolute smoking gun for pathology—not unless it actually matches the symptoms that made you go looking for the test in the first place.
If your liver isn't acting up—meaning no pain, nothing palpable during an exam, and you're watching what you eat like you said—then there's zero reason to freak out over a borderline GGT reading.
That said, keep an eye on it. Watch how your liver handles different meds, food, or drinks, and definitely give your doctor a heads-up before starting any new prescriptions.

thanks

Update: the rheumatoid factor is actually LOWER than 10 (div>

Hey there, I’m not entirely sure if this is the right place to ask this since I haven't seen anything quite like it here.
Basically, a friend of mine—she's 56—just underwent surgery to remove a tumor from her colon. They ended up taking out about 4 inches of the bowel. The pathology report on the removed tissue says:
"tubular adenoma with alternating malignant features." Could someone please help me make sense of what that actually implies? Specifically, I'm wondering if she should expect follow-up treatments like radiation or something similar.
Thanks.

Maria Mitchell23 said:It’s not about blood work... it was an ultrasound... honestly, I’m not even sure where else to ask...

So, I just had an abdominal and kidney ultrasound...

Everything looks fine, except for the kidneys part where it says:

Kidneys are in normal position, normal size, with appropriate parenchymal thickness.
In the middle third of the left kidney sinus, there is a hypoechoic zone isoechogenic with the renal parenchyma, corresponding to a hypertrophied Bertin column.
At the transition from the middle to the proximal third of the left kidney, a parenchymal cyst measuring up to 12mm is visible.

What does any of this mean? Thanks!!

The "Bertin column" thing is basically just a term for a mass of cortex that somehow connects—or divides, if you prefer—the renal pyramids. Usually, that column isn't supposed to pop out like that on imaging like a CT scan or an ultrasound, but in your case, it shows up clearly. Doctors have to note it because it can sometimes look like other types of kidney growths that require totally different medical approaches.
As for the cyst, it’s just a cyst—a structure with a wall and some thin fluid inside. They can stem from all sorts of things, but if you aren't feeling any other symptoms, there’s usually no reason to panic. Most people just keep an eye on them through follow-up scans.
Of course, like anything in medicine, you've got to keep track of changes. If the size or consistency shifts, or if you start noticing clinical symptoms that point toward kidney issues, you definitely need to sit down with your doctor to figure out the next steps.

@stormygull21/">@@stormygull21

An antistreptolysin titer basically measures antibody levels against Group A Beta-hemolytic Streptococcus. This is the kind of stuff that doesn't typically build resistance to antibiotics, so it usually needs to be cleared out with beta-lactam antibiotics, like penicillin or similar ones.

Which antibiotic were you on during those seven days?
Do you have any allergies to antibiotics or medications in general?

@Rebecca Sullivan77/">@@Rebecca Sullivan77
The wording you used here describes a carcinoma based on its histological type. It sounds like it was likely a villous tubular adenoma (which is a name for a primarily benign growth) that underwent malignant alteration—meaning the cells changed from benign to malignant or invasive carcinoma cells.
It's hard to say what the treatment plan will be. That mostly depends on your family history and, more importantly, whether the resection margins are clear.
Your best bet is to have a straight conversation with your medical team. Generally speaking, with carcinomas, if the surgery wasn't radical enough or if the margins come back positive, they go with adjuvant chemotherapy. But again, that’s not a guarantee for your specific situation.

@Hannah Kelly/">@@Hannah Kelly
Don't think I'm ignoring you; I just don't know your full medical history. Immunology is a pretty deep rabbit hole, so I'd rather leave those specific questions to a colleague who specializes in it.

Best,

steelgull55 said:A Bertini column is essentially just a strip of cortical tissue that somehow manages to bridge—or separate, if you prefer—the renal pyramids. Under normal circumstances, this wouldn't pop out on imaging like a CT scan or an ultrasound; it should blend right into the rest of the parenchyma. However, since it’s showing up here, it needs to be noted. Why? Because it can easily be mistaken for an actual kidney mass with a completely different cause and clinical management strategy.
It’s a cyst, plain and simple: a lesion with a defined wall containing thin fluid. These can stem from various causes, but if there aren't any other clinical red flags, there’s usually no reason to panic. Typically, these kinds of findings are just monitored through follow-up scans.
Of course, medicine isn't an exact science, so one must stay vigilant. If you notice changes in size or consistency, or if any symptoms arise that point toward renal pathology, you need to sit down with your doctor to figure out the next steps.

@stormygull21/">@@stormygull21

An antistreptolysin titer measures the antibody levels against Group A beta-hemolytic Streptococcus. This particular bug doesn't usually develop resistance to antibiotics, so the standard move is to eradicate it using beta-lactams, like penicillin or its relatives.

Which antibiotic were you on during those seven days?
Do you have any known allergies to antibiotics or medications in general?

@Rebecca Sullivan77/">@@Rebecca Sullivan77
The terminology you used describes a carcinoma based on its histological type. Essentially, we are likely looking at a villous tubular adenoma (which is a primary benign growth) that has undergone malignant alteration—meaning the cells have transitioned from benign to malignant or invasive carcinoma cells.
Predicting the next steps in treatment is tricky. It depends heavily on family history and, most importantly, whether the resection margins are clear.
The best move is to have a candid conversation with the medical team. Generally speaking, if a carcinoma surgery isn't radical enough or if the margins come back positive, adjuvant chemotherapy is considered. Of course, that isn't a guarantee for your specific situation.

@Hannah Kelly/">@@Hannah Kelly
Don't think I'm ignoring you; it's just that I don't know your specific case details. Immunology is a massive, complex field, so I'd rather defer to a colleague who specializes in it to answer your questions.

Best,

Thanks for the response.

steelgull55, thanks a ton for the reply. 🙂

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. 🙂

Thanks everyone, looking forward to hearing back 🙂

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?

Thanks a lot for the reply, Nicholas Myers 🙂

My ENA panels were canceled because my ANA came back weakly positive.
I had C3 1,000 and C4 0,190 done, but I didn't do the CH50 (I have no clue what that even is).
I had: Proteinase 3 antibodies (pr-3): Anticardiolipin IgG: 3.3, IgM: ANCA: negative
Gamma protein electrophoresis was at 17.3 back then—I guess I don't know if this tiny jump past the reference range actually matters.

As for symptoms: I had lesions on my elbows; they suspected psoriasis, but the biopsy didn't confirm it. Right now, nothing on my elbows, but then they suddenly flare up (on my toe, it won't go away even with Diprosalic). Then there's joint issues in the middle of winter when my fingers get cold (Raynaud's), sun sensitivity: maybe my eyes, headaches the second I step into the sun, especially without glasses, tachycardia, fatigue in my arms and legs, frequent bowel movements, nausea, urge to vomit, splenomegaly (2cm), and I think all my lymph nodes are slightly swollen or just palpable because I'm thin.
Body changes: capillaries are bursting on my face and chest, sores on my toe, halo moles around existing moles and in areas where I don't have any, and a red crusty growth (about 6mm) that just fell off (I thought it was a mole). Also back pain, burning in the left side of my abdomen under the ribs, and lower abdominal pain. I guess that's more or less everything, though I'm not even sure since there is so much going on. I've been doing tests for over a year now, waiting forever, and it's just test after test...

I also had an echocardiogram: everything looks fine, just some trace mitral regurgitation. What kind of tests could I do before my appointment with the immunologist, just so I can deal with them as quickly as possible?

Thanks again for the patience

I’m looking for some medical insight and advice here



Patient age: 65

Current diagnoses:

Diabetes
Hypertension
Gout
Arthritis

Current medications:

Aglurab 850 1,0,2
Allopurinol 1x1
Aspirin 1x1
Plendil 5 mg 1x1
Atacand 8 mg 1x1

About two years ago, I was dealing with a B12 and folic acid deficiency. I went through IV B12 and oral folic acid therapy, which brought my levels back within the normal range, so that treatment was stopped.
Just a heads-up: my diabetes isn't being managed very well right now (blood sugar stays between 8-10). I’m feeling extremely fatigued, dealing with joint pain, muscle cramps, and frequent diarrhea.
I drink alcohol about 2-3 times a week, stay physically active, but I don't really stick to a specific diet.
I understand most of my situation, but I'm mostly concerned about my red blood cell count and how they are distributed.
Would it be a smart move to stop taking Metformin because of its impact on the liver and switch to something else?
Also, will a hematologist be the one making the call, or should I be talking to an endocrinologist—or does each specialist handle their own area?

Thanks to everyone for taking the time to help.
I hope the lab results are clear enough to read.

Apologies in advance if I’m barking up the wrong tree here, but I couldn't find a more relevant thread.
Is a peripheral blood smear essentially the same thing as a CBC?

Ashley Morris84 said:Sorry if I'm asking this out of nowhere, but I couldn't find a better thread for it.
Is a peripheral blood smear the same thing as a CBC?

I can answer that for you: they're the same thing. 🙂

swiftbear86 said:I’m looking for some medical insight and advice here.



65-year-old patient

diagnoses:

diabetes
hypertension
gout
arthritis

current meds:

Aglurab 850 1,0,2
Allopurinol 1x1
Aspirin 1x1
Plendil 5 mg 1x1
Atacand 8 mg 1x1

Two years ago, there was a B12 and folic acid deficiency (treated with IV B12 and oral folic acid; levels returned to normal and treatment stopped).
Just a heads up, the diabetes isn't being managed well (blood sugar is sitting at 8-10), there's heavy fatigue, joint pain, muscle cramps, and frequent diarrhea.
Alcohol consumption is about 2-3 times a week; the patient stays active but doesn't follow any specific diet.
I understand most of this, but I'm stuck on the erythrocyte results and how they're distributed.
Would it be smart to stop Metformin due to its impact on the liver and swap it for something else?
Will the hematologist make the call, or will the endocrinologist, or does each specialist handle their own thing?

Thanks to everyone for taking the time.
Hopefully, the lab results are clear enough.

If the diabetes is poorly controlled because the patient just isn't responding to Metformin, then we should probably start looking toward insulin. How long has this patient been dealing with diabetes?
Now, if it's uncontrolled because they aren't sticking to the meds or watching what they eat, things could spiral pretty quickly into the issues I mentioned before. In that case, the fix is obvious: better adherence, diet, exercise, quitting smoking, and so on...

They really ought to decide together, though an experienced endocrinologist could likely navigate this based on seeing plenty of similar cases.

Looking at the other parameters in the labs and the history, it sounds like malnutrition might be the culprit. That would explain the low red blood cell count (megaloblastic anemia), especially given the previous B12 issues—that fits the typical pattern you see with regular alcohol use.

Just keep in mind that low red blood cell counts can have a whole laundry list of causes, but the scenario above seems the most probable.

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: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?