What does CD4/CD8 Low Ratio & CD3/CD8 High Absolute mean?

[JeanneNeedsAnswers]

My immunologist ordered some T-Cell blood tests and some of them were abnormal.

My CD4/CD8 Ratio is High (5)
CD3/CD8 Absolute Count is Low (<250)

Please, does anyone know what my tests mean? I have attached my test results to this question.

I am a female in my 60's and have been ill for years, with no diagnosis. I feel sick and ill, with severe ongoing daily fatigue. My muscles (in my legs and arms) will ache when I use my muscles, and this makes difficult for me to walk too long. Sometimes I am so tired I fall asleep during the day for short times (about 30 minutes) and wake up feeling a little less tired. I have trouble thinking, because I can not remember things quickly anymore.

 

[maryb]

Sorry to hear you are so ill - its so hard dealing with something we don't have a name for...
Hope your immunologist can help. I'm sure others more knowledgeable than me will chip in with their views on your results. I have had these tests done but don't have them to hand, I'll dig them out tomorrow.
Oh - and welcome

 

[halcyon]

Hi Jeanne,

The CD4/CD8 ratio test is most often used on HIV patients where the virus causes destruction of CD4 lymphocytes. Otherwise it's also used as an indication of immune health. In your case, your CD4 count looks good, but your CD8 count is low.

CD8+ T cells are also known as cytotoxic T cells. These are T cells that recognize and attack cells that are infected with a pathogen like a virus or bacteria and also cancer cells. Your low CD8 count might indicate some amount of immune deficiency.

Have you had your immunoglobulin levels tested? How is your overall lymphocyte count? Which pathogens have you been tested for?

 

[JeanneNeedsAnswers]

Thank you for your reply. I had these similar results last year, and my immunologist told me they were normal.
He retired and now I have a new doctor...but I think she will not tell me anything about these tests.

My Immunoglobulin and Lymphocytes levels, and CBC and MET results are pasted below.

IgM, Quantitative44-279 mg/dL128
IgG, Quantitative768-1632 mg/dL779
IgA, Quantitative78-391 mg/dL
290

ComponentStandard RangeYour Value
WBC4.5-11.5 K/uL6.9
RBC4.00-5.20 M/uL4.61
Hemoglobin12.0-15.0 g/dL14.1
Hematocrit, spun36.0-46.0 %42.6
MCV80-100 fL92
MCH26.0-34.0 pg30.6
MCHC32.0-35.9 g/dL33.1
Platelet150-400 K/uL285
RDW-CV%11.5-14.5 %13.4
MPV8.5-11.5 fL9.7
Neutrophils31.0-76.0 %59.7
Lymphocytes24.0-44.0 %27.0
Monocytes2.0-11.0 %9.3
Eosinophil0.1-4.0 %3.6
Basophils<=1.9 %0.4
Neutrophil #1.50-8.00 K/uL4.09
Lymph Absolute1.00-4.80 K/uL1.85
Monocyte Absolute0.20-1.00 K/uL0.64
Eosinophil Absolute0.00-0.70 K/uL0.25
Basophil #0.00-0.20 K/uL0.03

ComponentStandard RangeYour Value
Glucose80-116 mg/dL85
Sodium135-148 mmol/L138
Potassium3.3-5.3 mmol/L4.2
Chloride97-111 mmol/L102
Carbon Dioxide21-30 mmol/L32
BUN8-22 mg/dL8
Creatinine0.70-1.50 mg/dL0.54
Calcium8.4-10.4 mg/dL9.4
Anion Gap5-138
Estimated GFR115

I was NEVER tested for any pathogens. (I thought I could have Lyme, or be ill from from flea bites - because I was bitten a lot in 2006 when an unused garage had SEVERE FLEA infestation from a dead rodent.) I also picked up a dead crow many years ago when there was West Nile Virus in my neighborhood.

My doctors have tested me for HIV two years in a row, and the test was NORMAL...
So I wonder why the doctors do not look for what is causing me to feel ill.

I know my muscle soreness might be related to something else, because it only happens when I walk, and a female relative has the same symptoms and has vein disease.

But I feel really ill. So please tell me if I should ask my doctor for any specific tests when I have my follow-up with her to discuss my current test results. Could I have an infection or cancer?

Thank you for any help you can provide.

 

[halcyon]

I'm not a doctor, but I wouldn't call test results outside of lab ranges "normal", especially in the context of your probably debilitating illness. I hope you can convince your new doctor to take these results seriously.

Kind of as I expected, your IgG is low and you're bordering on lymphocytopenia. More signs of diminished immune health. Have you had your IgG subclasses tested as well? If not, ask for this test. A lymphocyte subset panel may also be useful to pinpoint exactly which cell types are deficient.

With low immunoglobulin levels you become a candidate for IVIG treatment. You can bring this up with your doctor.

Regarding where to go next, there is an excellent document put together by a forum member here: https://sites.google.com/site/cfstestingandtreatmentroadmap/

The general idea is that ME/CFS can be caused by so many different things. You have to work with your doctor and rule them out one by one until you find the culprit. Testing for some pathogens can be kind of tricky and sometimes requires specific tests done at specific labs. That document outlines a lot of this, and we can help you out as well if anything is confusing. I hope this is enough to get you started.

 

[JeanneNeedsAnswers]

Bless you. I have been struggling with this illness for some time, and it is getting worse. I am feeling hopeful that you actually listened and gave me advice, and did not dismiss me. Although, my new doctor did ask me if anyone ever told me I had Chronic Fatigue Syndrome, so maybe she thought I had this.

I have NEVER had IgG subsets, or lymphocyte subset tests, and will ask for these tests. But I am scared to ask questions, because the doctors seem not to listen.

Which immunoglobulin test has low levels, is it the IgG test with mg/dl779? And what is IVIG treatment? (Right now as I was typing this, I felt like I would pass-out.) It was momentary, and happens sometimes.

I KNOW something is wrong, even if the doctors do not know or believe me. (I get broken down emotionally, after an appointment, where my symptoms are ignored, and I am really upset afterwards.)

Example: A few years ago, I had monoclonal gammopathy, (and I wanted to know what it was, and what was causing it, but the doctor said I asked too many questions.)

I will now look at the link you gave me. I am using a library computer because I do not have a computer at home.

My follow-up with the immunologist is next week Monday. I hope things go better this time.

 

[JeanneNeedsAnswers]

Sorry to hear you are so ill - its so hard dealing with something we don't have a name for...
Hope your immunologist can help. I'm sure others more knowledgeable than me will chip in with their views on your results. I have had these tests done but don't have them to hand, I'll dig them out tomorrow.
Oh - and welcome

I want to thank you, also, for your kind words and encouragement.

 

[halcyon]

Bless you. I have been struggling with this illness for some time, and it is getting worse. I am feeling hopeful that you actually listened and gave me advice, and did not dismiss me. Although, my new doctor did ask me if anyone ever told me I had Chronic Fatigue Syndrome, so maybe she thought I had this.

That's good that she's aware of the possibility, but don't let her focus on this. There is a tendency for doctors to believe that there is nothing that can be done for CFS and to stop helping you once that diagnosis is made. Instead just help her focus on your specific symptoms and abnormal test results and make sure they are all addressed.

I have NEVER had IgG subsets, or lymphocyte subset tests, and will ask for these tests. But I am scared to ask questions, because the doctors seem not to listen.

I know it can be hard to get answers out of doctors. A lot of them just want to talk down to you and not answer your questions. Just remember that this is your health at stake and you are paying them for a service. Get your money's worth out of every appointment.

Which immunoglobulin test has low levels, is it the IgG test with mg/dl779? And what is IVIG treatment? (Right now as I was typing this, I felt like I would pass-out.) It was momentary, and happens sometimes.

Yes, your IgG was very close to being low. This means that your body is not producing normal amounts of antibodies and you may be more prone to getting sick. IVIG is basically pooled antibodies from the blood of other people that are injected into you.

That feeling can be caused by orthostatic intolerance or POTS. These are both very common in people with CFS/ME. If this happens often make sure your new doctor is aware of it.

I KNOW something is wrong, even if the doctors do not know or believe me. (I get broken down emotionally, after an appointment, where my symptoms are ignored, and I am really upset afterwards.)

Example: A few years ago, I had monoclonal gammopathy, (and I wanted to know what it was, and what was causing it, but the doctor said I asked too many questions.)

I know it's hard but don't give up. Our bodies are very good at telling us when something isn't right. This should never be ignored.

A doctor should never say that to anyone, that's just absurd. Fire any doctor that treats you that way and find another immediately.

Regarding monoclonal gammopathy, this needs to be taken seriously and followed up on regularly. It can be caused by a cancer of the blood among other things. Make your new doctor aware of this and make sure that it was/is investigated properly to rule out cancer.

 

[JeanneNeedsAnswers]

Thank you. I am trying to get my nerve up for my appointment, and will take notes of everything the doctor says to my questions and abnormal tests, and post her answers here.

 

[Jonathan Edwards]

Dear Jeanne,
The IgG level is very normal - it is in the normal range and that is all it should be. You do not need IVIG. (I am an immunologist.) To be a problem IgG levels need to be down at about 300, not 700. You do not need IVIG. That does not mean there is nothing wrong, simply that it will not show up on the tests we currently understand.

 

[JeanneNeedsAnswers]

I forgot to say that I was told my blood tests were abnormal, and I was being sent to a specialist, but I did not know what for. When I arrived, and found the building, it was the hematology department! I had no idea why or what for. The doctor did not tell me anything and I had to order a copy of my blood tests to find out it was called monoclonal gammopathy. I had to go back every 6 weeks for more blood tests and urine tests. Then the doctor said the gammopathy was gone, and I still did not know what it was or what was causing it. So I called his supervisor and said I wanted answers, and my doctor said he would not see me any more, and to find another doctor. And I never went back.

This is the first result from 3-4-2009 (I copied and pasted it from the "My Chart." The hospital calls this online program an interactive health record, where they post test results, and patients can e-mail their doctor.)

Result (UMPA)
PROTEIN ELECTROPHORESIS: A definitive M protein is not seen. Albumin is seen.
Alpha 1, alpha 2, beta and gamma fraction migrating proteins are also seen. IMMUNOFIXATION ELECTROPHORESIS: Immunofixation is negative using antiserum to
IgG, IgA, IgM, Kappa and Lambda.
INTERPRETATION: No evidence of monoclonal gammopathy in urine.

Thins is from 3-21-2009
Protein, Total6.96.0 - 8.4g/dL
Albumin4.113.80 - 5.00gm/dL
Alpha 1 Globulin0.230.11 - 0.22gm/dLH
Alpha 2 Globulin0.810.50 - 1.00gm/dL
Beta Globulin0.830.50 - 1.00gm/dL
Gamma Globulin0.920.60 - 1.35gm/dL
Interpretation (Prot Electro)Possible M-protein present.

Later he said the gammopathy was gone.


Protein, Total6.76.0 - 8.4g/dL
Albumin3.853.80 - 5.00gm/dL
Alpha 1 Globulin0.250.11 - 0.22gm/dLH
Alpha 2 Globulin0.880.50 - 1.00gm/dL
Beta Globulin0.820.50 - 1.00gm/dL
Gamma Globulin0.900.60 - 1.35gm/dL
Interpretation (Prot Electro)No definitive M-protein is identified on protein electrophoresis.
Essentially normal electrophoretic pattern.
Monoclonal protein analysis to follow.

 

[JeanneNeedsAnswers]

Thank you. I will ask my immunologist what to do at my appointment.

 

[Ema]

Total IgG levels aren't everything...and your level is very close to the bottom of the range. On subsequent testing, it might easily drop below range.

Also, I agree that you should ask to have your subclasses tested. My total IgG levels were just below range, like yours, but my subclasses 1 and 3 were low so I was indeed put on immunoglobulin replacement therapy and it made a big difference to my overall health. I use Hizentra though, which is subcutaneous replacement, as opposed to intravenous replacement (IVIG).

My immunologist feels that IgG levels below about 600 are indicative of total immune system failure. I can't imagine waiting until 300 to treat (unless I was an insurance company that had to pay for it!). That is well outside the guidelines given by the Immune Deficiency Foundation as well for treating PID.

It's not *just* about the numbers, though they can provide important clues. It's also about your response to infections (or lack thereof) and ability to form antibodies.

I think you should also pursue testing for common infections like EBV, CMV, HHV-6 etc as well as Lyme and mycoplasma if you can.

Good luck!

 

[JeanneNeedsAnswers]

I am so lost, here. Thank you so much for replying to me. (The doctor who responded above tells me my tests are normal, and my doctor says the same things...)

But I feel sick...like I am really ill, and so tired, too. I will see what my doctor says on my follow-up on Monday, and then ask her about subclass tests for IgG and also for EBV, CMV, HHV-6, Lyme and mycoplasma, and see what she says. Then I will post her answers here for everyone to see.

You are lucky to have a good doctor, because he/she did further testing, and got you a diagnosis.

 

[halcyon]

I forgot to say that I was told my blood tests were abnormal, and I was being sent to a specialist, but I did not know what for. When I arrived, and found the building, it was the hematology department! I had no idea why or what for. The doctor did not tell me anything and I had to order a copy of my blood tests to find out it was called monoclonal gammopathy. I had to go back every 6 weeks for more blood tests and urine tests. Then the doctor said the gammopathy was gone, and I still did not know what it was or what was causing it. So I called his supervisor and said I wanted answers, and my doctor said he would not see me any more, and to find another doctor. And I never went back.

Good riddance, you don't need doctors like that taking care of you. It would have taken 5 minutes for him to explain what they were testing you for and why. I'm glad that it went away though. Still make sure your new doctor is aware of this history.

 

[Ema]

I am so lost, here. Thank you so much for replying to me. (The doctor who responded above tells me my tests are normal, and my doctor says the same things...)

But I feel sick...like I am really ill, and so tired, too. I will see what my doctor says on my follow-up on Monday, and then ask her about subclass tests for IgG and also for EBV, CMV, HHV-6, Lyme and mycoplasma, and see what she says. Then I will post her answers here for everyone to see.

You are lucky to have a good doctor, because he/she did further testing, and got you a diagnosis.

You really have to have a clinical immunologist with specialized training in immunodeficiency diseases to get a diagnosis. Most typical allergist/immunologists just aren't familiar enough or up to date with the current standards and miss many cases. I learned this the hard way and then got a referral through the IDF to a doctor experienced with immune deficiencies who was willing to do the appropriate testing and provide treatment. But it's a struggle many people experience, unfortunately.

Good luck!

 

[JeanneNeedsAnswers]

PS: I use the library computer, and will not be able to get back to the library until next week. Thank you everyone. for your support and help so far...

 

[JeanneNeedsAnswers]

My follow up visit with the immunologist did not give me any answers about my about my abnormal test results.
Here is a brief account of what was said between us: (When the immunologist started talking, I wrote everything down, and she was watching me with a strange expression.)
DR: “Well I took a look at your test results and your lab work looks good...are you still having problems?”
ME: Yes, I still feel sick.
DR: “What do mean by sick?”
ME: Like I am ill, with the flu, and real tired. I am really sleepy, too.
DR: Your Vitamin D is low, and could be causing this. (She gave me a prescription for Vitamin D.)
ME: If my tests are normal, why is my T-Cell count so low and what it means?
DR: “That is a cell that fights infections, and it is still OK.”

ME: But it is lower than the 'low normal range.'

DR: "It can be low, that is just a range"
ME: Well, can you tell me why my CD4/CD8 Ratio is so high?
DR: “When one is low the other is high.”
I was feeling ignored, and talked down to, so I changed the subject and started asking about my IgG test which was a little low, and she said it was normal. She then told me to follow up with my Primary Care Physician (PCP).

So I told her he ignored me last time. I also decided to show her the swelling in my legs, and she saw the edema around my ankles where my socks were. She said to get a new PCP is my previous one did not help me…
I felt like I was treated with apathy. So, I showed her a paper print out from her hospital's website describing the T-Cell test, that said “Lower than normal T-Cell Levels may be due to: Acute Viral Infections…” and I also showed her another print-out from the hindwai website that says Low T-Cells can be caused by a reactivated EBV infection.

I also asked if I could be tested for CMV and Lyme (because I was bitten by a tick in 1991.)
She said I do not need those tests, but she DID order an EBV Panel test.
So, that is what happened. And now I will see if my EBV is normal or not. What else can I do?

 

[JeanneNeedsAnswers]

Why are my CD3/CD8 Absolute Counts Low, at 215 (when the reference range is: 394-1150)?

 

[halcyon]

My follow up visit with the immunologist did not give me any answers about my about my abnormal test results.
Here is a brief account of what was said between us: (When the immunologist started talking, I wrote everything down, and she was watching me with a strange expression.)
DR: “Well I took a look at your test results and your lab work looks good...are you still having problems?”
ME: Yes, I still feel sick.
DR: “What do mean by sick?”
ME: Like I am ill, with the flu, and real tired. I am really sleepy, too.
DR: Your Vitamin D is low, and could be causing this. (She gave me a prescription for Vitamin D.)
ME: If my tests are normal, why is my T-Cell count so low and what it means?
DR: “That is a cell that fights infections, and it is still OK.”
ME: But it is lower than the 'low normal range.'
DR: "It can be low, that is just a range"
ME: Well, can you tell me why my CD4/CD8 Ratio is so high?
DR: “When one is low the other is high.”

Good job on taking notes and asking good questions. I'm sorry that her answers weren't very satisfactory. You can definitely try to bring your vitamin D levels up and this might help but it's unlikely to make you feel 100% better. I have low vitamin D as well and every doctor I've asked about it has shrugged it off saying it's unlikely to be causing me any problems.

So I told her he ignored me last time. I also decided to show her the swelling in my legs, and she saw the edema around my ankles where my socks were. She said to get a new PCP is my previous one did not help me…

That last bit sounds like the only good advice she gave you. You sound like you're stuck in a horrible care system like Kaiser or something. I'm not sure where you live and if one is available, but your next best bet might be to find an ME/CFS specialist.

I felt like I was treated with apathy. So, I showed her a paper print out from her hospital's website describing the T-Cell test, that said “Lower than normal T-Cell Levels may be due to: Acute Viral Infections…” and I also showed her another print-out from the hindwai website that says Low T-Cells can be caused by a reactivated EBV infection.

It is true that viral infections can cause transient lymphocytopenia, but the count should go back up once you are past the acute stage of the infection. When was that last lymphocyte count taken and do you have any others to compare it to?

I also asked if I could be tested for CMV and Lyme (because I was bitten by a tick in 1991.)
She said I do not need those tests, but she DID order an EBV Panel test.

I don't understand why she would order an EBV but not CMV test. They both can cause mononucleosis and similar symptoms. It's also hard to understand why she wouldn't order at least a western blot test, especially given your past exposure to a tick bite.

So, that is what happened. And now I will see if my EBV is normal or not. What else can I do?

Well, I'm sorry that the appointment was a bit fruitless, but don't give up. As I said above, perhaps you can find a local ME/CFS knowledgeable doctor.