Help me understand my labs

[McFly]

Hello everyone. Yesterday I received some blood tests ordered by an immunologist doctor. I would like you guys to help my find some underlying abnormality, because I'm pretty sure the doctor will give some generic explanation like "You have low vitamin D. There's the culprit!" when I show her the results. Here's what I've got so far:

• WBC and RBC: Everything within normal range. OK!
  
• Glucose: 91 mg/dL (range from 70 to 90 mg/dL) OK!
• IgE: 138 UI/mL (range anything below 100 UI/mL) HIGH!*
• IgA: 361 mg/dL (range from 61 to 348 mg/dL) HIGH!**
• IgG: 1274 mg/dL (range from 700 to 1600 mg/dL) OK!***
• IgM: 190 mg/dL (range 40 to 230 mg/dL) OK!
• IgG1 subclass: 7430 mg/L (range from 4050 to 10110 mg/L) OK!
• IgG2 subclass: 5890 mg/L (range from 1690 to 7860 mg/L) OK!
• IgG3 subclass: 397mg/L (range from 110 to 850 mg/L) OK!
• IgG4 subclass: 395 mg/L (range from 30 to 2010 mg/L) OK!
• Complement C3: 128 mg/dL (range 90 to 180 mg/dL) OK!
• Complement C4: 24 mg/dL (range 10 to 40 mg/dL) OK!
• Total complement (CH-50): 122 u/CAE (range anything above 60 u/CAE) OK!
• Vitamin D: 21.26 ng/mL (below 20 means deficient, values between 20 and 20.9 mean insufficiency) INSUFFICIENT
• T4: 1.44 ng/dL (range 0.93 to 1.70 ng/dL) OK!
• TSH: 1.530 nUI/mL (range 0.400 to 4.500 nUI/mL) OK!
• CD4: 1311 cells/mm³ or 48.6% (range 456 to 1492 cells/mm³ or 24.4% to 54.2%) OK!
• CD8: 710 cells/mm³ or 26.3% (range 272 to 1144 cells/mm³ or 12.8% to 40.2%) OK!
• CD4/CD8 ratio: 1.85 (range 0.98 to 3.24) OK!

* The same test was done one year ago, and the result was within range.
** The same test was done one year ago, and the result was also HIGH.
*** The same test was done one year ago, and the result was HIGH.

As you can see, most of my results are well within range, so I'm pretty sure the doctor will blame the low Vitamin D levels (although nowadays most people have low levels of Vitamin D due to lack of sunbaths). And let's be fair, it's not as if my Vitamin D levels have dropped all of a sudden with no reason, and I started having these symptoms...

Any thoughts? I also had a few different tests a couple of months ago (ESR, rheumathoid factor, AST, ALT, C-reactive protein), everything within range. So, I'm totally lost here. I'm tired of being told by doctors that symptoms are "all in my head"...

 

[valentinelynx]

Your slight elevations in IgE and IgA may be indicative of ongoing allergies.

One test that often turns up abnormal in ME/CFS is "Natural Killer Cell Function". In some patients (myself) the number of NK cells is also low (test for "Natural Killer Cells"). But, remember, this illness is not defined by lab tests. And some things that many of us have, such as MCAS (mast cell activation syndrome) are very hard to catch on lab tests.

I've had low Vitamin D. Taking Vitamin D didn't make me feel better.

Medicine relies far too much on lab testing these days. Labs should be used to confirm findings on history and physical, not as fishing expeditions for diagnoses. If you can find your way to an ME/CFS expert, you will have a better result. Granted that takes money & energy that can be hard to come by!

Best of luck...

 

[pamojja]

Any thoughts? I also had a few different tests a couple of months ago (ESR, rheumathoid factor, AST, ALT, C-reactive protein), everything within range.

With other severe chronic conditions and without much help from physicians (except for getting labs tested) I took it in my own hands and found regular lab-testing very helpful for guidance - along with interventions, symptoms, etc. - in this process. Thereby I could reverse a 60% walking-disability and other chronic conditions, even by just nudging the lab results in the right direction, still being far from 'normal'.

One thing one has to understand with lab-results is that a 'normal' range most commonly is a statistical construct, by claiming the middle 95% percent of all tested 'normal'. But realistically, most who get tested are because they already have health issues, and the value of such a statistical construct therefore questionable. That's also one reason different labs have different normal reference ranges.

I always compare to 'optimal' values too, either from functional medicine practitioners, who base them on clinical observations or specific studies. One inexpensive online-service who provides the later would be https://www.labtestanalyzer.com (use with caution, since the literature to sieve through is so large, and they just have started earlier this year)

Just as examples for liver enzymes:

         norm. | optimal  | labtestanalyzer.com
AST |   < 38   | 10 - 30  | 18 - 33
ALT |   < 46   | 10 - 30  | 17 - 30
GGT |   < 60   |   < 30   | 9 - 50
APH | 40 - 129 | 70 - 100 | 30 - 80
LDH |   < 248  | 140 - 200 | 100 - 250
CPK |   < 171  |   ≤ 100   | 22 - 196

Or inflammation:

                 norm. | optimal
ESR          |  3 - 10 | 0 - 15
CRP          |   < 5   | ≤ 1
Fibrinogen   |  180 - 350 | 250 - 300
Homocysteine | 6.3 - 10 | 4 - 8

Or CBC:

           norm. | optimal
RBC | 4.6 - 5.7  |    ~ 5
WBC | 3.7 - 10.8 | 5.5 - 7.5

Therefore 'everything in range' could even hide some difficulties with some important body-system (as for example the liver, kidney, hormones, electrolytes, etc. etc.). And also always have to be seen in the context of repeated testing. Lab markers can change too much already within a day. And of course, what could be optimal for one person isn't for the next. Therefore only repeated testing really shows where you're at, in which direction it is moving (if in the wrong direction to be counteracted before even symptoms show up), and where your optimal might be.

Some comments on individual results: I would never be satisfied with only a TSH and T4 to access thyroid status, at least freeT3 and fT4, along with thyroid antibodies should be tested to get a better picture. A IgE of 138 isn't really that high, if I compare it to my average of 1157 for the last 4 years. Only anaphylactic shock was after a bee sting, and only allergy is rhinitis each spring. Keep watching how it moves over time. One isolated fasting glucose says virtually nothing about glucose metabolism..

"You have low vitamin D. There's the culprit!"

Not the culprit. But all body system not functioning optimally might contribute to disease processes. Also those now flagged 'normal', or those not even tested yet.

 

[McFly]

Your slight elevations in IgE and IgA may be indicative of ongoing allergies.

This is funny, because I did a quick test in the doctor's office, in which she applied several common allergens in my arm and everything was negative.

One test that often turns up abnormal in ME/CFS is "Natural Killer Cell Function". In some patients (myself) the number of NK cells is also low (test for "Natural Killer Cells").

I actually asked the doctor to order this test, but she said it wasn't necessary. ¬¬

I've had low Vitamin D. Taking Vitamin D didn't make me feel better.

No surprises there... It's not as if we woke up suddenly with a vitamin D deficiency, right?

Medicine relies far too much on lab testing these days. Labs should be used to confirm findings on history and physical, not as fishing expeditions for diagnoses. If you can find your way to an ME/CFS expert, you will have a better result. Granted that takes money & energy that can be hard to come by!

Yeah, I couldn't agree more. This generation of doctors are too lazy to investigate whatever diseases that don't fit in the commonplace.

 

[McFly]

One thing one has to understand with lab-results is that a 'normal' range most commonly is a statistical construct, by claiming the middle 95% percent of all tested 'normal'. But realistically, most who get tested are because they already have health issues, and the value of such a statistical construct therefore questionable. That's also one reason different labs have different normal reference ranges.

I always compare to 'optimal' values too, either from functional medicine practitioners, who base them on clinical observations or specific studies. One inexpensive online-service who provides the later would be https://www.labtestanalyzer.com (use with caution, since the literature to sieve through is so large, and they just have started earlier this year).

Thank you for your insights. I will check this online service, it seems very interesting (however, if this is only some kind of spreadsheet, I would rather do it myself on Excel. Also, I beg to differ about your opinion on how the statistics are made. The reference ranges are not based upon people who get tested because of health issues. The statistics is based upon studies with blood donors or volunteers.

A IgE of 138 isn't really that high, if I compare it to my average of 1157 for the last 4 years.

That's scarily high! What kind of symptoms do you have with those levels of IgE?

One isolated fasting glucose says virtually nothing about glucose metabolism.

You're right, but I've been checking my glucose levels for a long time, and it seems to be stable. But I will definitely keep following up my other levels, to see if there is some sort of trend.

 

[pamojja]

(however, if this is only some kind of spreadsheet, I would rather do it myself on Excel. Also, I beg to differ about your opinion on how the statistics are made. The reference ranges are not based upon people who get tested because of health issues.

There are reference ranges made by cohorts of healthy individuals. However, not all labs have the financial means for such costly evaluations. And as a consumer one simply can't be sure the reference range of one's lab is from whom.

The online service, along with overview spreadsheets of all your results you entered, also gives an article for each lab marker all well referenced with literature: What a lab markers means, what your results means, and how it could be modified by lifestyle and supplements.

I myself rely more on my own collection of optimal values gleaned from functional practitioners and entered in an spreadsheet.

What kind of symptoms do you have with those levels of IgE?

As already posted:

Only anaphylactic shock was after a bee sting, and only allergy is rhinitis each spring.

 

[Research 1st]

Your high IgE is fine, it's only a bit raised.

Mine is 10x higher than yours and other than
documenting it, doctors ignore mine too and put it down to hayfever and asthma then walk off.

They do this as IgE is non specific. Unless you're crippled by allergy symptoms, at that level I'd ignore it and I doubt you are as your Igg4 is normal.

Having said that you can have allergy type symptoms with normal IgE, so conversely it's not the only thing to look at. Lots of other markers you can look for related to allergy or related immune system activation.

Your tests look great but in CFS they usually are. Next time if you feel awful, inflamed, infected etc but have a normal WBC, try getting your T Cell, B Cell NK Cell activation markers tested. The cheapest all in one test is called a Lymphocyte Subset Test.