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

Hey everyone, sorry I haven't been around the forum in a while—I actually forgot my old username, so I just went ahead and re-registered.

Age 29, weight 143 lbs.

So, I’ve been dealing with these massive headaches, and then following them up with this absolutely excruciating shoulder pain... I ended up in the ER three different times, and they've had to draw my blood three times now too.
I didn't have a fever, though I did have some trouble swallowing for maybe 2 or 3 days because my left tonsil was really stinging.
My most recent results:

I'll just list the elevated values here.

MCHC: 366 g/L
CK: 760 U/L
LDH: 285 U/L
AST: 93 U/L
ALT: 209 U/L

The specialist (an infectious disease doctor) gave me a diagnosis after looking over my labs during the exam.

- Infectious Mononucleosis

What I'm really trying to figure out is why I've been feeling like I'm dying from this shoulder pain for an entire week already.
Has anyone else dealt with mono? Does it really cause shoulder pain this intense? I mean, I guess it's possible, but it feels so extreme.

The specialist prescribed: Ibuprofen, a small dose of corticosteroids (for 2-3 days), one capsule of Ulzol, and Sumamed 500 (for 3 days).

Guys, seriously, I'm having to sleep sitting up in a chair because lying down is just impossible with how much my shoulders hurt.

I should probably mention that my right shoulder blade felt like it popped out of place. First there was the pain, and once the pain subsided, that's when it felt like it shifted. Now, my left shoulder blade and shoulder are hurting terribly.
I haven't done any heavy lifting or anything physically strenuous, either.

I totally blanked on the reference ranges, so here they are just in case

MCHC: 366 g/L ref. 320-355
CK: 760 U/L ref. 0-177
LDH: 285 U/L ref. 0-241
AST: 93 U/L ref. 8-38
ALT: 209 U/L ref.10-48

Jason Thompson said:...After intense headaches, followed by agonizing shoulder pain, I’ve ended up in the ER three times and have had my blood drawn three times already.
No fever, though swallowing was a struggle for two or three days because my left tonsil was burning.
...
The specialist (an infectious disease expert) gave the diagnosis after reviewing my labs during the exam.

-infectious mononucleosis

What I really want to know is why I've been feeling like I'm dying from shoulder pain for a week now.
Has anyone dealt with mono before? Can it actually cause shoulder pain this severe?

The specialist prescribed: Ibuprofen, a small dose of corticosteroids (for 2-3 days), one capsule of Ulazol, and Sumamed 500 (for 3 days).

Folks, I'm sleeping in a chair because I can't lie down without the shoulder pain hitting me.

I forgot to mention that my right shoulder blade shifted out of place. It hurt first, then once the pain subsided, it popped out. Now my left shoulder blade and shoulder are killing me.
I haven't done any physical labor or strained myself at all.

I wouldn't dream of telling you exactly what's happening with your case, but if you don't mind, I have a few observations regarding what you've shared:

1.) The lab results you mentioned—specifically values like LDH, AST, and ALT—can certainly align with a diagnosis of infectious mononucleosis. However, a crucial metric, the white blood cell count (WBC) and the differential, isn't listed here. Either you overlooked it, or... frankly, it seems odd that those weren't performed, or that they were normal despite an infectious mono diagnosis.;

2.) Regarding symptoms, most fit the diagnosis: headaches, general malaise, sore throat... What doesn't fit is the issue with your shoulder blades—this sensation of them "shifting"—which doesn't seem linked to mono. Also, you didn't mention swollen lymph nodes, which is a major indicator!;

3.) In the typical treatment protocol for infectious mononucleosis, the antibiotic choice seems off. While antibiotics are occasionally used in rarer cases involving secondary bacterial infections, choosing Sumamed specifically is unusual. My infectious disease textbook notes that this class of antibiotics should generally be avoided in mono patients; if antibiotics are necessary, other classes are typically preferred.

4.) If that shoulder pain persists, the smartest move is to follow up immediately with your primary care physician. After an exam, they can decide if you need a referral to an orthopedist, a physiatrist, an immunologist, or another specialist to figure this out. The ER isn't the place for a comprehensive workup on this specific issue. It should also be an unwritten rule to check in with your family doctor after an ER visit. I assume you saw your doctor to get those prescriptions, so is it possible they didn't react to the situation, or perhaps you didn't mention the shoulder and blade issues to them?!

Honestly, there seem to be several missing pieces to this puzzle.

I hope you seek help from your primary doctor as soon as possible, if you haven't already.

Best regards and wishing you the best.👍

I had some blood work done last week, and the only thing out of range is my MCHC. It’s actually keeping me up at night... if anyone could help me make sense of this. I'm 18 and pretty underweight for my height (BMI 15.8).

WBC 11
erythrocyte 4.90
hemoglobin 140
hematocrit 0.39
MCV 80
MCH 28.6
MCHC 358
platelets 191
leukocytes 5.9
CBC
seg. 0.49
non-seg.
eosinophil 0.02
basophil 0.00
lymphocytes 0.39
monocytes 0.10
prothrombin time 94.0
INR 1.0
GLUCOSE 4.8
bilirubin total 20
AST 26
ALT 15
GGT 13
ALP 68
Cholesterol 4.2

Thanks in advance

So, if anyone here actually knows their stuff, I’d be really grateful if you could take a look at these results...

Hematology:
leukocytes - 8.84 -------------- 3.4-9.7
erythrocytes - 5.04 ------------- 4.34-5.72
hemoglobin - 143 ------------- 138-175
hematocrit - 0.414 -------------- 0.415-0.53
MCV - 82.1 ------------ 83-97.2
MCH - 28.4 ------------- 27.4-33.9
MCHC - 345 ------------ 320-345
red blood cell distribution index - 13.1 -------- 9-15
platelets - 188 ------------- 158-424
MPV - 11.0 ------------ 6.8 -10.4
neutrophilic granulocytes - 58.9 ----------- 44-72
lymphocytes - 32.70 -------------- 20-46
eosinophilic granulocytes - 1.7 -------------- 0-7
monocytes - 6.6 -------------- 2-12
basophilic granulocytes - 0.1 ---------------- IG% - 0.50-------------------
luc- -
eosinophils and monocytes -
micro- -

The guy is 20 years old. Just looking for some insight from anyone who understands this kind of thing... Thanks in advance.

Douglas Flores33 said:If anyone here can make sense of these results, I’d be incredibly grateful.

Hematology:
leukocytes - 8.84 -------------- 3.4-9.7
erythrocytes - 5.04 ------------- 4.34-5.72
hemoglobin - 143 ------------- 138-175
hematocrit - 0.414 -------------- 0.415-0.53
MCV - 82.1 ------------ 83-97.2
MCH - 28.4 ------------- 27.4-33.9
MCHC - 345 ------------ 320-345
index distribution .erc - 13.1 -------- 9-15
platelets - 188 ------------- 158-424
MPV - 11.0 ------------ 6.8 - 10.4
granulocytic neutrophils - 58.9 ----------- 44-72
lymphocytes - 32.70 -------------- 20-46
granulocytic eosinophils - 1.7 -------------- 0-7
monocytes - 6.6 -------------- 2-12
basophilic granulocytes - 0.1 ---------------- IG% - 0.50-------------------
luc- -
eosinophils and monocytes -
micro- -

The patient is 20 years old. I'm looking for an opinion from anyone who actually understands this stuff. Thanks in advance.

Listen, honey, these results are absolutely fantastic!!!!
Everything is perfectly within the normal range.

Lisa Hernandez80 said:I had my blood drawn last week, and the only thing off is my MCHC. It’s actually keeping me awake at night... if anyone could help me make sense of this. I'm 18 and quite underweight for my height (BMI 15.8).

WBC 11
erythrocyte 4.90
hemoglobin 140
hematocrit 0.39
MCV 80
MCH 28.6
MCHC 358
platelets 191
leukocytes 5.9
CBC
seg. 0.49
non-seg.
eosinophil 0.02
basophil 0.00
lymphocyte 0.39
monocyte 0.10
prothrombin time 94.0
INR 1.0
GLUCOSE 4.8
bilirubin total 20
AST 26
ALT 15
GGT 13
ALP 68
Cholesterol 4.2

Thanks in advance

Looking at your blood work, everything appears to be within the standard reference ranges, with the sole exception being a slightly elevated MCHC.

MCHC measures the average concentration of hemoglobin (the oxygen-carrying molecule) within a red blood cell. Generally speaking, MCV, MCH, and MCHC are collectively referred to as red blood cell indices. These parameters define specific characteristics of your erythrocytes. When evaluating them, you have to look at them alongside your actual red blood cell count and hemoglobin levels.

Since both your red blood cell count and hemoglobin levels are normal, and your MCHC is only marginally high, I don't believe there is any clinical significance here. In my personal view, there is no reason to lose sleep over it.

The rest of your results are also within normal limits.

What stands out, however, is your extremely low BMI, which indicates significant undernutrition. Based on your previous inquiry from July 19, 2010—where you mentioned bone density concerns, using Ensure shakes, and being sent for specific tests by a specialist—it seems you are already under medical supervision. I certainly hope so. Your densitometry results suggested osteopenia, or reduced bone density, which is a common consequence of malnutrition. If bone density continues to decline, it can progress to osteoporosis. Whatever the underlying cause of your weight loss may be, it needs to be managed aggressively under consistent medical care.

Stay determined and follow your doctors' guidance.
Best regards, 😉

Sophia Moore38 said:Honey, those results look amazing!!!!
Everything is right within the normal range...

Thanks... but I don't know, these lymphocyte numbers seem a bit weird to me. After a week of sleep, it was 35.4, then 34.6, and now it's down to 32.2... I mean, they just keep dropping. Is that actually good or bad? What does this say about my immunity? Can we even draw any conclusions from this...

Maria Fisher46 said:Looking at your blood work, everything seems to be within the normal range, except for a slight deviation in your MCHC.

MCHC measures the average concentration of hemoglobin (the oxygen-carrying molecule) inside a red blood cell. Generally speaking, MCV, MCH, and MCHC are grouped together as red blood cell indices. These values describe specific characteristics of your red blood cells. Any changes here should always be looked at alongside your actual red blood cell count and hemoglobin levels.

Since both your red blood cell count and hemoglobin levels are normal, and your MCHC is only marginally elevated, I don't think there's anything clinically significant going on there. In my opinion, you shouldn't worry about that part.

Your other results look fine too.

What does stand out is your very low BMI, which points toward being underweight. However, based on what you mentioned in your previous question back in July (when you asked about bone density and noted you were drinking Ensure shakes because your specialist ordered certain tests), it sounds like you're already under medical supervision. I hope that's still the case! Your bone density scan shows osteopenia, which means lower bone density. That can often be a side effect of being underweight. If bone density keeps dropping, it leads to osteoporosis. I'm not sure what's causing the weight issue, but it definitely needs active treatment under steady medical care.

Stay strong and stick to your doctors' advice.
Best regards 😉

Thanks so much for putting my mind at ease regarding the blood work. 😁
Yeah, I've been under medical supervision for five years now, but I was only prescribed Ensure a month ago. To be honest, I don't really like the taste, but I manage to get it down. 😁 I have no idea what's causing me to stay so thin...
It's not anorexia; I actually have a huge desire to gain weight, it just won't happen. 😢
Neither my endocrinologist nor my gastroenterologist seems to pay much attention to the fact that I have an irregular heartbeat that hasn't been managed for five years. Maybe that has something to do with my weight? I don't know...
Bye

What does the abbreviation "distr. erythrocyte" actually mean?

Jessica Davis66 said:What does the abbreviation "distr. erythrocyte" mean?

I assume this refers to the distribution of erythrocytes by volume, typically denoted as RDW. Put simply, it’s a value that tells us whether the red blood cells in the bloodstream are roughly uniform in size, or if there is significant variation between them. It's a key metric when diagnosing, monitoring, or treating conditions that impact red blood cells, such as anemia.

I had some blood work done yesterday and everything came back fine, except for one thing: my GGT is quite high, sitting at 130... My AST and ALT levels are both well within the normal range. I'm 22 years old, and I dealt with mononucleosis back when I was 15—though I'm not sure if there's any connection there. I actually had my blood checked about six months ago, and my GGT was elevated then too, though not nearly this much. Back then, they told me it might just be due to the birth control pills I was taking, blah blah blah. But now? I'm not on any contraceptive, nor have I taken any medication recently. I have an appointment scheduled with my doctor tomorrow morning, but I'm feeling a bit impatient. If anyone would care to share their thoughts... thanks! Best regards.

Hit the ER this past Thursday. Here are my lab results:

L 4.65
E 4.96
Hb 145
Hct 0,406
MCV 81.92
MCH 29.2
MCHC 357
CBC: segmented 65.8%
monocytes: 12.7
eosinophils: 1.1
AST 33
ALT 21
LDH 197
glucose 5.3
urea 3.5
creatinine 92
bilirubin 13.8
direct bilirubin 2.7
Na 140
K 4
Cl 105
CRP 27.3

(I only transcribed the bolded parts from the report)

Diagnosis: St. febrilis, edema in both ankles, polyarthralgia, thrombocytopenia. They told me to see an immunologist immediately.

Thanks for any help!

I am certainly not offering medical advice here on this forum, but since I have a two-and-a-half-month-old baby at home, my schedule is absolutely non-existent—which means I haven't been able to make it to see Dr. Miller 🙄 either. I decided to go ahead and get some private blood work done recently, and looking over the results, there are quite a few things that seem to be out of range, and honestly, I am feeling a bit lost regarding what it all means...

My neutrophil granulocytes percentage is low at 33 (normal is 55-75).
My lymphocytes are elevated (both the percentage and the absolute count, whatever that implies).
My MPV is low. My hemoglobin within the erythrocytes is also low (which I suspect might be related to having lost some blood previously).
My MPV is high.

My thyroid has been acting up lately, though I was already well aware of that.

Any thoughts would be greatly appreciated!🙂

Hello.

I had some blood drawn yesterday to follow up on my iron levels, which I’d been supplementing for about three months. The iron looks fine now, but there's a new, somewhat strange finding on the report. My non-segmented granulocytes are elevated (0.04), and the morphology section mentions toxic granules and some atypical lymphocytes. Can anyone tell me what this actually implies? I did a bit of digging online, and apparently, this can pop up during an inflammatory response, and coincidentally, I woke up today with a sore throat. Could that be the cause? :hipohondar:

Jamie Johnson6 said:I’m not looking for medical advice on this forum, but since I have a two-and-a-half-month-old baby at home, I simply don't have the bandwidth to get anywhere—not even to see Dr. Gin. 🙄Well, Sam went ahead and got some private blood work done, and looking at the results, things are definitely outside the normal range. I’m staring at this data and honestly, I don't have a clue what I'm looking at.

Neutrophil granulocytes are low at 33% (normal range 55-75).
My lymphocyte counts are up—both the percentage and the absolute count. Not entirely sure what that implies.
My average red blood cell volume is low. My hemoglobin levels are also down—I’m assuming this is linked to blood loss.
The average platelet volume is running high.

My thyroid was acting up, but that much I already know.

Here you go!🙂

Based on what you’ve shared, I can only say this: a low neutrophil count paired with an elevated lymphocyte count is often seen during viral infections, but that is certainly not the only possibility. There are other factors at play here. That said, I can't provide any real insight into your specific situation because you haven't mentioned your symptoms, nor have you provided the full lab report. Without knowing the total leukocyte count or the specific lymphocyte numbers, we're essentially working in the dark. 🤷

Low erythrocyte volume paired with low hemoglobin levels points toward microcytic anemia. This can certainly be triggered by the blood loss you mentioned, though you haven't specified the nature or timing of that bleeding. One shouldn't overlook the fact that breastfeeding—which I assume you are doing—can also lead to anemia due to the body's increased demand for iron. Anemia needs to be corrected once the underlying cause is identified, and naturally, that's something you won't figure out through an online forum. 😢

Regarding platelet volume, there isn't a specific value provided to indicate how "high" we're talking about. Furthermore, the actual platelet count is missing—and without that number, commenting on the volume alone is like trying to judge the speed of a car without knowing if it's even running.

With all that considered, you've also got the thyroid running wild—something you'll need to rein in if you haven't already.

Take this response as you would a reading from a crystal ball—it’s little more than guesswork. There simply isn't enough data here to build a reliable conclusion.

Given all of this, my advice is simple: find the time and go consult your primary care physician. 😉

Taylor Smith3 said:Hi.

I had my blood drawn yesterday to check my iron levels, which I’ve been supplementing for three months now. The iron looks fine, but there’s something new and strange on the report. My non-segmented granulocytes are elevated (0.04), and the morphological changes mention toxic granules and some atypical lymphocytes. Can anyone tell me what this means? I did a little digging online, and it mentioned this can happen during inflammation, and I actually woke up today with a sore throat. Could that be it? :hypochondriac:

Based on what you've described, there's a possibility this could be the onset of infectious mononucleosis. That initial stage can often present with findings like yours: the gradual appearance of atypical lymphocytes and, occasionally, an increased proportion of non-segmented neutrophilic granulocytes (though, honestly, a value of 0.04 or 4% represents only a very slight elevation). And then, of course, there's the sore throat—though in that case, one would typically expect other symptoms to follow.

That said, atypical lymphocytes can show up in various other conditions too. It might be a different viral infection, or perhaps something else entirely. Finding atypical lymphocytes isn't a specific diagnostic marker; you can't pin down a diagnosis based on that alone. Without a physical exam, it's impossible to say for sure what's going on. 🤷

Because of all that, you should touch base with your primary care physician. 😉

Robert Doyle4 said:I ended up in the ER this past Thursday, and my blood work is as follows:
...
My diagnosis is St. febrilis, edema in both ankles, polyarthralgia, and thrombocytopenia; I've been advised to see an immunologist immediately.

Thanks for the help!

Unfortunately, I don't have enough experience to weigh in on your case or your suspicion of an autoimmune disorder—which seems likely given the referral to an immunologist.

If anyone else on this forum decides to comment, I’d suggest you post the full report. There are significant gaps here. For instance, you mention thrombocytopenia (low platelet count) in your diagnosis, yet there isn't a single mention of platelets in the lab results you provided. Furthermore, while some values you listed fall outside the reference range, others are perfectly normal. Just because something is bolded on a lab sheet doesn't automatically mean it's pathological.

It would also be helpful to describe your symptoms in a few sentences—what actually led you to the ER in the first place? Lab numbers alone don't tell the whole story.

Even then, don't be surprised if people mostly just echo the advice to see the specialist. Immunology is a complex field; reaching a definitive diagnosis often requires a long battery of tests, and sometimes patients have to wait quite a while for the clinical picture to fully crystallize.

To find some peace of mind in the meantime, talk to your primary care physician. Gather all your records, present them clearly, and discuss your symptoms. Your doctor might need a day or two to review the literature or reflect on the data. They know your medical history best and can offer much more meaningful guidance than a stranger on an internet forum. At the very least, they can provide direction while you wait for your appointment with the immunologist.

I wish I could be of more assistance. Best of luck to you. 👍

Maria Fisher46 said:Based on what you've shared, there is a possibility that this marks the onset of infectious mononucleosis. That early stage can often be characterized by findings similar to yours: the gradual emergence of atypical lymphocytes and, occasionally, an increased proportion of unsegmented neutrophilic granulocytes (though a value of 0.04 or 4% represents only a negligible elevation in unsegmented granulocytes). And, naturally, there is the sore throat, in which case one would expect other symptoms to follow.

However, atypical lymphocytes can also be present in various other conditions. For instance, it could be a different viral infection, or perhaps something else entirely. The presence of atypical lymphocytes isn't a specific diagnostic marker, so a definitive diagnosis cannot be made based on this finding alone. Without a physical examination, it is impossible to determine exactly what is happening. 🤷

Because of all this, you should check in with your primary care physician. 😉

Thanks... and since I'm actually on vacation right now, I'll have to find coverage. 🙄

Maria Fisher46 said:Based on what you’ve shared, I can tell you that regarding your white blood cell count, having a lower number of neutrophils paired with an elevated lymphocyte count can be seen in viral infections, among other things, but there are certainly OTHER POSSIBILITIES. However, I can't say specifically what is happening with you because you haven't mentioned what symptoms you're experiencing, nor have you provided the full lab report, so I don't know what your total leukocyte or lymphocyte counts actually are. 🤷

A reduced erythrocyte volume alongside a lower hemoglobin concentration suggests microcytic anemia. This could certainly be caused by the blood loss you mentioned, though you didn't specify the nature of that loss or when it occurred. It is also worth remembering that during breastfeeding—which I assume you are doing—anemia can occur due to the body's increased demand for iron. Anemia needs to be addressed once the underlying cause is identified, which, naturally, isn't something we can determine here on this forum. 😢

As for the platelet volume, you didn't mention how high the value actually is, and without knowing your total platelet count, it is impossible to properly interpret the MPV.

On top of all that, there is the issue of your thyroid running wild, which definitely needs to be brought under control if you haven't managed to do so already.

Please view this response almost like a reading from a crystal ball, as there is simply too little data here to weave together a truly reliable answer.

Because of all this, I kindly ask you: please find some time to consult with your primary care physician! 😉

Thanks! I actually agree with you completely. My TSH is 0.01, and usually, it runs high, so I take Euthyrox. Now I just need to carve out some time to see an endocrinologist... I lost blood during childbirth.