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

Maria Fisher46 said:Dear Hannah Kelly,

I see the immunologist was looking at this from a few different angles.

First off—systemic lupus. However, based on the tests done so far, the evidence just doesn't support systemic lupus erythematosus (ANA was weakly positive, then negative, anti-dsDNA is negative, complement activity is normal; anticardiolipin antibodies are negative...). That’s good news.

They also considered systemic vasculitis (due to skin changes paired with general symptoms), but again, the current findings don't really point toward that diagnosis either.

Of course, the logical question that immediately comes up is whether EVERY possible test has been performed, and the answer is—no—because there are so many of them (well, not literally infinite, but you get my point).

Some of the changes you're experiencing might not be linked to an autoimmune disease at all; for instance, those halo nevi. They could potentially be tied to vitiligo.

Looking at your post, it seems you have quite a few skin manifestations along with sun sensitivity. Did that start suddenly, or has it been there since childhood?

When you go out in the sun, do the skin changes happen immediately or shortly after?

Have they taken any biopsies from those skin lesions or the sores on your leg you mentioned?

Do you experience dry eyes, burning, or a gritty feeling like sand is in them? Any dryness in your mouth or frequent dental issues?

First, let me address what I said about the CBC. I actually asked a lady who works in a lab the same thing, and she told me a CBC and a peripheral blood smear are the same thing. 🙂My apologies if I passed along incorrect info. 🙂

Nicholas, thank you so much for the effort. Honestly, I feel like I've given you more information than the immunologist! Is there any way I can actually schedule an appointment with you?

The skin issues started two years ago, and I think the sun-induced headaches have been around since puberty.
The halo nevi appeared about ten years ago (when I was 20), and I seem to find at least one new one every year.

No biopsy was taken from the leg.

My eyes definitely feel dry and gritty. My mouth has always felt dry, too. My gums bled for a long time without any obvious signs of inflammation; I used a specific rinse on them and the bleeding finally stopped.

Hey everyone,
can someone help me make sense of these results?

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

thanks in advance...

Update: I noticed today that my capillaries are looking really burst. Also, I didn't mention that my right eyelid droops a bit—it gets pretty bad sometimes, though today it was just a tiny bit, maybe even unnoticeable.

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. 🙂

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. 😉

Thanks, the Cat 🙂

Vomiting (or at least intense nausea), diarrhea, and general malaise—these were the symptoms I presented to my primary care physician, who subsequently ordered a complete blood count, an electrolyte panel, and a urinalysis. There was some suspicion regarding a viral infection or perhaps an issue with my thyroid, which has been a persistent struggle for me, given that I have been on Euthyrox for about a year and a half due to hypothyroidism. The results arrived, and while the doctor didn't offer much specific commentary, stating simply that there are no inflammatory processes, that my hemoglobin and sedimentation rates are fine, and noting a slightly low potassium level, I decided to examine the urinalysis more closely myself. In the parentheses, you will see the reference intervals:
appearance- clear.
color- yellow (light yellow)
pH- 5.0 (5.0-9.0)
rel. vol. mass- 1.030 (1.002-1.030)
glucose- negative (normal)
bilirubin- negative (0/neg)
ketones- negative (0/neg)
erc/hb- trace (0/neg)
proteins- negative (0/neg)
urobilinogen- normal (normal)
nitrites- negative (0/neg)
leukocyte esterase- negative (0/neg)

leukocytes- 8-10 (0-2 x 400)
erythrocytes- 5-7 (0-2 x 400)
pl. epithelium- some (0-1 x 400)
bacteria- many (0/neg x 400)
mucus- many (0/neg x 400)

Should these final findings be a cause for concern, and ought I to demand further testing, even though I am currently feeling quite alright and am not experiencing any active symptoms?

swiftbear86 said:I am asking doctors to please review my case and advise me.



65-year-old patient
Diagnoses:
Diabetes
Hypertension
Gout
Arthritis
Current medications:
Aglurab 850 1,0,2
Allopurinol 1x1
Aspirin 1x1
Plendil 5 mg 1x1
Atacand 8 mg 1x1

Two years ago, I had a B12 and folic acid deficiency (treated with IV B12 and oral folic acid; levels returned to normal after treatment and medication was discontinued).
Note that my diabetes is poorly controlled (blood glucose 8-10), and I am experiencing extreme fatigue, joint pain, muscle cramps, and frequent diarrhea.
I consume alcohol 2-3 times a week, stay physically active, and do not follow a specific diet.
In that regard, I understand most of my situation; my main concern right now is the erythrocyte count and its distribution.
Would it be wise to discontinue metformin due to its effect on the liver and switch to something else?
Will the decision fall to a hematologist, an endocrinologist, or will they handle it separately?
Thank you all for your effort.
I hope the results are legible.

The assessment here is incomplete—even at the PZZ level.
Honestly, I’m siding with Nicholas Myers regarding the introduction of insulin.
Personally, I would suggest starting Janumet or Eucreas, though we could also consider repaglinide or Reodon.
It wouldn't hurt to introduce a lipid-lowering agent as well, such as Torvas 10 mg.
The CBC isn't catastrophically deranged.

Regarding the workup, it would be prudent to perform an EGD with biopsies, an eventual colonoscopy with deep ileoscopy, a fecal occult blood test, and a repeat of general biochemistry, HbA1c, creatinine clearance, and 24-hour microalbuminuria.
Plus an abdominal ultrasound.
Check B12 and folic acid levels,
and continue IV B12 at 500 mcg every two months—or rather, depending on what the GI evaluation reveals about the cause of the deficiency.

Rachel Bishop93 said:appearance—cloudy (clear).
color—yellow (pale yellow)
ph- 5.0 (5.0-9.0)
rel.vol. mass- 1.030 (1.002-1.030)

leukocytes- 8-10 (0-2 x 400)
erythrocytes- 5-7 (0-2 x 400)
pl. epithelium- some (0-1 x 400)
bacteria- many (0/neg x 400)
mucus- many (0/neg x 400)

Should I be worried about this last part and maybe look into further testing, even though nothing is bothering me and I don't have any symptoms?

These results point straight toward a urinary tract infection. You could get a urine culture done, or just go ahead with empirical treatment—maybe something like cephalosporins. If there's clinical reason to do so, you should probably get a kidney ultrasound or check up on things like CRP, creatinine, and urea.

I have a quick question about my platelet count:

Back in October 2012, my levels were at 220
But a recent test just showed 80

Everything else seems to be within the normal range—my cholesterol is 7, I'm 53, and I'm not really feeling any symptoms,
My blood pressure is usually fine, though it does tend to drop if I stand for too long—plus some occasional headaches that last a few hours and then vanish for days. About two and a half years ago, I had surgery for uterine cancer (had my uterus and ovaries removed), but I didn't need any follow-up treatment after that, and all my post-op results have been totally normal. I wonder if high stress levels right now could be playing a part? I occasionally take an herbal supplement for calming down—Persen—but I don't take anything else. I don't drink or smoke either.

Should I be worried?

I've already scheduled an appointment with an internist who also specializes in hematology to go over these numbers, but I’d love to hear what you guys think here too. Thanks in advance!

...if you recall, you suggested recently that I should get my calcium levels checked, especially since I've been taking high doses of Vitamin D for about a year and a half now to manage my MS.

My first Vitamin D reading was around 35 nmol/L, the second was about 75, and my most recent one shows 99 nmol/L (I'm aiming for 150, as research suggests that level is ideal for MS management).

At the same time, my calcium—which I’m measuring for the first time—came back at 2.44 mmol/L (with a reference range of 2.14 - 2.53). So, even with daily doses of 5,000 IU and that initial mega-dose of 150,000, it hasn't pushed past the normal range.

I assume this is perfectly fine?
Does anyone know how high calcium would actually need to be to trigger hypercalcemia?

Melissa James70 said:...if you recall, you recently suggested I check my calcium levels, since I've been taking high doses of Vitamin D for MS for about a year and a half now.

My first Vitamin D result was around 35 nmol/L, the second was roughly 75, and the latest shows 99 nmol/L (the goal is to hit 150, because according to the research, that’s the sweet spot for MS).

At the same time, my calcium—which I'm measuring for the first time now—is 2.44 mmol/L (reference range is 2.14 - 2.53). So, despite daily doses of 5000 IU and that initial massive mega-dose of 150,000, it hasn't even broken out of the normal range.

I assume that's fine?
How much calcium would it actually take to trigger hypercalcemia?

I remember🙂
The calcium is totally normal. Hypercalcemia usually kicks in when Ca hits above 2.8-2.9 mmol/L.
But regardless, I still advise that whenever you're getting your Vitamin D levels checked, you should get your Ca checked too.

Does anyone happen to know when I was admitted to the ER? I was feeling pretty rough and they weren't quite sure what was going on at the time, so they ran a full blood panel.
Now I’m sitting here wondering if my liver enzymes were included in those results, since I can't seem to find the report anywhere.
Basically, I'm just trying to figure out if checking liver function is part of a standard blood workup, or if that's something they usually only order if they're looking for something specific.

I just got my thyroid hormone results back, and everything looks totally normal except for my T3, which is running a little low at 1.48. Should I just keep an eye on it for now, or is it worth getting some more testing done?

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.

Here are my results—my doctor is currently on vacation 🙂

ferritin 9.53 (15-150)

IgG 9.12 (7-16)

IgA 2.45 (0.7-4)

IgM 3.03 (0.4-2.3)

EMA (IIF) negative titer (
tTG wasn't done (
fibrinogen 2.9 (1.8-4.1)

Lactate dehydrogenase 155 (
Calcium total 2.57 (2.14 - 2.53)

Phosphorus inorganic 1.42 (0.79 -1.42)

Female, 24 years old. For the last 10 years, I've dealt with recurring keratitis from unknown causes (swabs always come back sterile). About 6-7 years ago, I was sent to Dr. Sentić, who put me through a massive battery of tests—blood work, X-rays, dentist, dermatologist, gynecologist, thyroid, rheumatologist, basically everything under the sun. She kept theorizing about all these different diseases and predicting grim outcomes, but nothing ever actually proved anything since all my results were perfect... except for being HLA B27 positive and having elevated IgM back then. Honestly, I used to be in great health, almost never even caught a cold. People used to wonder how I, as a woman, had such high iron levels (though apparently, that's not the case anymore). Anyway, after a short experimental stint on Decortina, they concluded my issue was likely immunological, though local steroid eye drops achieved the same effect—so the doctor and I went our separate ways. It only hits my right eye, and usually, it follows this pattern where one year is a total disaster and the next is calm. They never found a cause for why it fluctuates like that. The only thing is, summer, the heat, the beach, and the sun are terrible for my eye (but allergies have been ruled out; it's definitely not allergic conjunctivitis). I only see my ophthalmologist now.

I was ordered these specific tests because I dealt with "pyoderma" twice last year (summer and fall). It also popped up a year before that, but my doctor just told me it was acne. Since it happened once before and I normally deal with acne, I didn't pay much attention. But when it flared up again last year—one patch after another, inflamed, hot skin specifically on my chin area—it lasted about two months from start to finish. The rest of my face looks totally fine, like it’s a completely different person. That's when I went to a different dermatologist 🙂. After all the swabs came back negative and my gynecological exams were perfectly normal, the dermatologist decided this was part of a larger systemic issue given my keratitis. She sent me for this full workup thinking maybe it's Celiac or Crohn, and told me to see a gastroenterologist. Celiac because it runs in my family (and everyone seems to talk about it lately), and Crohn because I get occasional stomach cramps and diarrhea. I avoid the sun like a vampire, so I suspect my Vitamin D might be low. Haven't had any kidney issues so far. I don't eat much dairy, but I go heavy on nuts.

Thanks so much for any thoughts or help, and sorry if this was too long or information-heavy. 🙂

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. 🙂

redcrane22 said:Can anyone tell me when I ended up in the ER because I felt terrible and they couldn't figure out why? They ran a complete blood count (CBC).
Now I'm wondering if liver function tests were included in that, because I can't find the results.
Basically, I'm asking if those are standard when you get a CBC, or if they are separate tests.

Ma'am,

When a doctor on a referral—whether it’s a primary care physician or a hospital specialist—writes "CBC," that order does not automatically include liver function tests. It also doesn't include bilirubin, blood sugar, lipid panels, etc.

Each of those requires its own specific order (for example, requesting a CBC plus ALT, AST, GGT, bilirubin, glucose, etc.).

However, you still haven't answered whether those liver tests were actually performed in your case.

In casual conversation, medical staff often tell patients, "We're going to run some blood work," implying a broad sweep from a CBC to a differential, liver enzymes, electrolytes, and so on. Listing every single test would take too long.

But, strictly speaking, if the written order specifies only a complete blood count, it excludes liver tests, blood sugar, or anything else beyond the basic cell counts (erythrocytes, leukocytes, and thrombocytes). 😁

brightpanther152 said:I had thyroid hormone testing done and all my levels are normal except for T3, which is a bit low (1.48)—should I monitor this or schedule more tests?

Ma'am,

It is difficult to provide a meaningful response without knowing why the thyroid panel was ordered, which specific hormones were tested, your exact values, and the lab's reference ranges, as those vary from one facility to another.

I would also suggest looking at one of the most active threads on this forum, Thyroid, where you will undoubtedly find a wealth of perspectives and personal experiences in short order.

Maria Fisher46 said:Hi there,

It would definitely be a good idea to redo the platelet count—just to double-check that 80×10^9/L reading.

A platelet count of 80×10^9/L really does warrant some follow-up (some doctors start looking into it once it hits 100×10^9/L, for instance), but honestly, this number isn't quite at an alarming level yet. It doesn't significantly bump up the risk of bleeding—usually, we see issues like skin or mucosal bleeding when counts drop below 50×10^9/L, though I guess some people stay symptom-free even with lower numbers.

One of the big next steps will likely be a blood smear, which helps see how the platelets look in relation to the other blood cells.

If everything else looks totally normal—meaning the other blood cells are fine in both structure and count—and a physical exam shows no signs of systemic illness, then the most common culprit is often immune thrombocytocytosis. That’s basically when the body somehow starts breaking down platelets too quickly, though the exact reasons aren't always clear.

It’s also super helpful to know if anyone in your family has dealt with similar things. For example, have you ever noticed spontaneous bruising or bleeding in the skin or mucous membranes—like heavier periods, nosebleeds, or bleeding gums? Also, have you started any new medications recently (you mentioned Persen) or had any recent vaccinations? I won't go into all the tiny details here on the forum, though.

So, if it turns out you aren't experiencing any symptoms and everything else checks out (besides the low platelets), it’ll most likely be immune thrombocytocytosis. This can be primary (where the underlying cause is a mystery) or secondary (where something else triggers the immune system to attack the platelets, like an infection—so they might want to run tests for certain viruses or H. pylori, maybe check immunoglobulin levels, or screen for systemic autoimmune diseases if there's any suspicion).

In those cases, treatment usually doesn't kick in until the count drops a bit further (some doctors wait until it hits 30×10^9/L), unless there's a specific high risk involved.

The logical question follows: why bother with the check-up and testing at all if we aren't treating it yet? Well, I guess it's because we need to figure out *why* the count is low in the first place, since it could be linked to something else that actually needs treatment, like an infection.

Best regards! 🙂

Thank you so much for such a thorough answer!
The hematologica specialist asked for a retest to start with, as they're assuming the initial 80×10^9/L might just have been a counting error.
Thanks again, and take care!