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

[knackers323]

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?

I'm fed up with hearing about these useless arrogant Drs who think they know everything, won't listen to any alternatives or options, won't try anything and just want to sit there and play god and get paid top dollar to do f&@k all.

If they were losing their life's to an illness you could bet they would get every test they wanted done.

What ham would it cause this dr to run those infection tests?


Do your job and investigate a bit more thoroughly and you may find there are many people that are needlessly sick or dying.

This kind of thing seems to be not only rife in our illness but the medical profession in general.

It's not all of them but it seems the majority are lazy, greedy, egotistical, know it all w$!kers

 

[heapsreal]

It would be good to get those lymphocyte tests done again in a few months. Generally they are suppose to return to normal after an infection and many docs will just brush u off as having a recent viral infection and tell you not to worry, heres some prozac. But if u get these tests several months apart and a few of them they can see a pattern of that it never returns to normal and may consider a chronic infection that your immune system cant handle.

This is similar to what i did prior to antivirals in that i did several lymphocyte sub set tests a few months apart and used a few herbal supps and got no improvements in tests results or how i felt. Than we decided to try antivirals, which took time but did show these test results improve.

But because its outside the scope of there thinking and training, many doctors will ignore it and pass the buck until you find a good one who will atleast try to help you with some common sense?

 

[JeanneNeedsAnswers]

The first set of Lymphocytes were taken in September 2013, and the second set was taken in 2014
I do not know how I pasted this here, and if it is readable...
I will wait to see the EBV results and then I don't know what I will do after that.

CD16/56 % Lymphs

14

13

CD16/56 Absolute Count

96-241 cell/cu mm

227

233

CD19 % Lymphs

14

16

CD19 Absolute Count

141-448 cell/cu mm

238

294

CD3 % Lymphs

70

71

CD3 Absolute Count

980-2393 cell/cu mm

1179

1319

CD3/CD4 % Lymphs

56

57

CD3/CD4 Absolute Count

599-1662 cell/cu mm

944

1059

CD3/CD8 % Lymphs

11

12

CD3/CD8 Absolute Count

394-1150 cell/cu mm

178

215

CD4/CD8 Ratio 0.9-2.1

 

[JeanneNeedsAnswers]

My CD4/CD8 Ratio was 5.3 and 4.9 (in 2013 and 2014 respectively). This test result was cut off when I pasted the results above.

 

[halcyon]

Sorry, I meant do you have any other CBC results other than the one you posted above?

If you let us know what part of the world you live in we might be able to recommend a nearby doctor that specializes in ME/CFS.

 

[JeanneNeedsAnswers]

This is the best way I can paste the results...
The doctors have told me my CBC has been normal for years...I do not believe them...
I live in Ohio.

Name
Standard Range
4/24/08
2/15/11
11/23/11
10/2/12
3/12/13
9/19/13
9/29/14
Basophil #
0.00-0.20 K/uL
0.03
0.02
0.03
0.03
0.02
0.03
Basophils
<=1.9 %
0.4
0.3
0.5
0.4
0.3
0.4
Eosinophil
0.1-4.0 %
3.2
4.2
3.9
4.2
1.7
3.6
Eosinophil Absolute
0.00-0.70 K/uL
0.22
0.29
0.22
0.28
0.12
0.25
Hematocrit, spun
36.0-46.0 %
42.2
43.3
42.6
41.5
42.6
41.6
42.6
Hemoglobin
12.0-15.0 g/dL
13.8
14.3
14.1
13.6
14.2
14.2
14.1
Lymphocytes
24.0-44.0 %
27.1
27.7
25.6
25.4
23.3
27.0
Lymph Absolute
1.00-4.80 K/uL
1.84
1.90
1.44
1.70
1.60
1.85
MCH
26.0-34.0 pg
29.9
30.5
30.9
30.0
30.2
30.9
30.6
MCHC
32.0-35.9 g/dL
32.7
33.0
33.1
32.8
33.3
34.1
33.1
MCV
80-100 fL
92
92
93
92
91
90
92
Monocyte Absolute
0.20-1.00 K/uL
0.48
0.74
0.53
0.61
0.65
0.64
Monocytes
2.0-11.0 %
7.1
10.8
9.4
9.1
9.5
9.3
MPV
8.5-11.5 fL
10.2
10.1
9.8
9.2
9.8
9.4
9.7
Neutrophil #
1.50-8.00 K/uL
4.21
3.92
3.41
4.07
4.48
4.09
Neutrophils
31.0-76.0 %
62.2
57.0
60.6
60.9
65.2
59.7
Platelet
150-400 K/uL
323
268
302
333
321
256
285
RBC
4.00-5.20 M/uL
4.61
4.69
4.56
4.53
4.70
4.60
4.61
RDW-CV%
11.5-14.5 %
13.2
13.8
13.3
13.4
13.4
13.0
13.4
WBC
4.5-11.5 K/uL
6.8
7.2
6.9
5.6
6.7
6.9
6.9

 

[halcyon]

Your lymphocyte count does seem to be pretty consistently on the lower end of the scale. Everyone is different, but mine usually is between 2.3 and 2.6. When I was acutely ill with the virus that precipitated this mess my lymph count dropped to 1.4.

Have you felt sick going back to 2008 or were you well then?

There are definitely others on the forum here from Ohio. @caledonia is one, perhaps she might have some good ME/CFS doctor recommendations. You can also do a Google site search to find past threads on the subject. Otherwise you could start a new thread asking for current recommendations.

 

[JeanneNeedsAnswers]

I have felt sick since 2001, when I first went to the doctor with aching in my legs when I walked. (I still have no diagnose of what is causing that.) But now...today, my legs are swollen and I think it has to do with my blood vessels...

I live in Cleveland, Ohio.

I get so tired all the time, and then I'll feel less ill, then a few days later I feel ill again. Some days are better than others. But I usually feel the worst when I first wake up. Around 2002 or later, I had a terrible rash on my stomach and really felt ill and was in bed for a day or two...this was after I had the tick bite in 2001.

FYI: There are 100,000 deaths each year from medical errors that are not reported to the family...the Institute of Medicine (IOM) wrote a report about this to the President in 1999 called "To Err is Human." But these facts and statistics do not seem to reach the mainstream public or news. So...I am one of the undiagnosed, with medical errors, I am not dead yet.

You really did a lot to help me, and I appreciate it. I will follow up with all three of your recommendations listed in your reply. But I am also waiting for my EBV results. If I had the money, I would order and pay for some blood tests for myself. I go to the government hospital. I lost my job because I can not stand too long, anymore.

There are some good places to order blood tests. Am I allowed to post websites on this forum. I could tell you the names of these places. Here is one of them. I did not write it as a website. I do not know the rules of this forum too well. (healthcheckusa)

Were you ill with EBV? How were you diagnosed and treated? I have about 45 minutes left at the library computer and have to do other stuff now...

 

[Jonathan Edwards]

I'm fed up with hearing about these useless arrogant Drs who think they know everything, won't listen to any alternatives or options, won't try anything and just want to sit there and play god and get paid top dollar to do f&@k all.

If they were losing their life's to an illness you could bet they would get every test they wanted done.

What ham would it cause this dr to run those infection tests?


Do your job and investigate a bit more thoroughly and you may find there are many people that are needlessly sick or dying.

This kind of thing seems to be not only rife in our illness but the medical profession in general.

It's not all of them but it seems the majority are lazy, greedy, egotistical, know it all w$!kers

That seems a bit rude to me. I am, as you know, a retired doctor. The only interest I have in medical matters is trying to make some sense of ME to help people get their lives back. I spend hours on this site trying to glean details that might help. I have even volunteered to be on the board of directors. I have absolutely no interest in missing something important or sending people away empty handed. But as far as I can see these test results are either normal or at least there is absolutely no reason to think they are the cause of any symptoms. I have every sympathy for Jeannne but my opinion would be that she is ill for reasons that have absolutely nothing to do with these tests. It might be microglial activation or viruses or mitochondria or whatever but as a retired immunologist I am pretty certain that the test result are irrelevant.

I am desperately trying to help PWME get their message across to the high level scientific community - and we are pushing on an open door because some very high powered people are getting interested - but muddled pseudoscience isn't going to impress people I fear. If PWME really want to find a scientific basis for their disease then we need to stick to the validated science they use in cancer or I used to use in RA. Trying to find abnormalities where there aren't any is not going to help much!!

 

[halcyon]

That seems a bit rude to me. I am, as you know, a retired doctor. The only interest I have in medical matters is trying to make some sense of ME to help people get their lives back. I spend hours on this site trying to glean details that might help. I have even volunteered to be on the board of directors. I have absolutely no interest in missing something important or sending people away empty handed. But as far as I can see these test results are either normal or at least there is absolutely no reason to think they are the cause of any symptoms. I have every sympathy for Jeannne but my opinion would be that she is ill for reasons that have absolutely nothing to do with these tests. It might be microglial activation or viruses or mitochondria or whatever but as a retired immunologist I am pretty certain that the test result are irrelevant.

I am desperately trying to help PWME get their message across to the high level scientific community - and we are pushing on an open door because some very high powered people are getting interested - but muddled pseudoscience isn't going to impress people I fear. If PWME really want to find a scientific basis for their disease then we need to stick to the validated science they use in cancer or I used to use in RA. Trying to find abnormalities where there aren't any is not going to help much!!

I am 99.9% sure that knackers wasn't directing that towards you in any way Dr. Edwards and was just general venting of frustration.

I agree that her results could be totally normal and mean nothing in the context of her illness, but you have to understand the frustration of feeling so ill and being turned away as "normal". Getting a doctor to take your concerns seriously is the first step to getting anywhere with this illness. Yes, maybe those tests aren't the right tests but with a doctor taking them seriously, combined with her symptoms, this could lead to the right tests being ordered and some answers being found.

I'm sure I speak for everyone here as well that we very much appreciate your help and interest in this disease. We don't mean to be offensive but as a patient group we're a bit like a dog that has been kicked around too much. We have a tendency to be snappy.

 

[halcyon]

I have felt sick since 2001, when I first went to the doctor with aching in my legs when I walked. (I still have no diagnose of what is causing that.) But now...today, my legs are swollen and I think it has to do with my blood vessels...

I live in Cleveland, Ohio.

I get so tired all the time, and then I'll feel less ill, then a few days later I feel ill again. Some days are better than others. But I usually feel the worst when I first wake up. Around 2002 or later, I had a terrible rash on my stomach and really felt ill and was in bed for a day or two...this was after I had the tick bite in 2001.

FYI: There are 100,000 deaths each year from medical errors that are not reported to the family...the Institute of Medicine (IOM) wrote a report about this to the President in 1999 called "To Err is Human." But these facts and statistics do not seem to reach the mainstream public or news. So...I am one of the undiagnosed, with medical errors, I am not dead yet.

You really did a lot to help me, and I appreciate it. I will follow up with all three of your recommendations listed in your reply. But I am also waiting for my EBV results. If I had the money, I would order and pay for some blood tests for myself. I go to the government hospital. I lost my job because I can not stand too long, anymore.

There are some good places to order blood tests. Am I allowed to post websites on this forum. I could tell you the names of these places. Here is one of them. I did not write it as a website. I do not know the rules of this forum too well. (healthcheckusa)

Were you ill with EBV? How were you diagnosed and treated? I have about 45 minutes left at the library computer and have to do other stuff now...

Would you describe the pain in your legs as joint pain or is it more like muscle pain? My understanding is that the bacteria that causes lyme disease has a tendency to take up residence in joints, among other places. Was it a bullseye rash on your stomach? Can you follow up with your normal GP and try to get a western blot test for lyme?

Yes, you can post URLs here. The most affordable online blood test site I have found is Walk-In Lab. Another good one is DirectLabs, though most of the same tests are cheaper at Walk-In Lab.

My EBV panel only showed evidence of a past infection. I self-diagnosed an enterovirus based on symptoms and ruling out other possible causes. This was later confirmed via stomach biopsy and the proper blood test. I've just started treatment a few days ago with Equilibrant.

 

[knackers323]

That seems a bit rude to me. I am, as you know, a retired doctor. The only interest I have in medical matters is trying to make some sense of ME to help people get their lives back. I spend hours on this site trying to glean details that might help. I have even volunteered to be on the board of directors. I have absolutely no interest in missing something important or sending people away empty handed. But as far as I can see these test results are either normal or at least there is absolutely no reason to think they are the cause of any symptoms. I have every sympathy for Jeannne but my opinion would be that she is ill for reasons that have absolutely nothing to do with these tests. It might be microglial activation or viruses or mitochondria or whatever but as a retired immunologist I am pretty certain that the test result are irrelevant.

I am desperately trying to help PWME get their message across to the high level scientific community - and we are pushing on an open door because some very high powered people are getting interested - but muddled pseudoscience isn't going to impress people I fear. If PWME really want to find a scientific basis for their disease then we need to stick to the validated science they use in cancer or I used to use in RA. Trying to find abnormalities where there aren't any is not going to help much!!

Hi Jonathan

This was in no way directed at you. I was just speaking in general. After 20 odd years you tend to lose your patients at times.

There are no words that can describe the appreciation me and the other PWCFS feel towards the effort you are making for us.

Now if there were just more people like you in your profession and in the world in general, things would probably be much better for everyone.

Thanks very much for all your time and effort.

 

[Jonathan Edwards]

Hi Jonathan

This was in no way directed at you. I was just speaking in general. After 20 odd years you tend to lose your patients at times.

There are no words that can describe the appreciation me and the other PWCFS feel towards the effort you are making for us.

Now if there were just more people like you in your profession and in the world in general, things would probably be much better for everyone.

Thanks very much for all your time and effort.

Actually, I wasn't intending to suggest it was directed at me. I was trying to make a different point. If someone like me who is only interested in trying to find out what is really going on in ME thinks these tests mean nothing then it does not seem fair to criticise other doctors for thinking the same. I appreciate that PWME are frustrated about their illness. And I appreciate that there are lots of doctors around with closed minds. However, if as a doctor I gave my honest considered opinion and was faced with a patient who insisted that I was just being lazy and unhelpful I would feel pretty frustrated too - especially if I had good reason to think there was nothing much I could do to help anyway.

What worries me about all this advice about tests is that I suspect it makes huge amounts of money for private labs who sell these tests without making any difference to anybody's health. Posting Lab websites is not against the rules but how do you know they are not just a rip off if you are not a lab technician? From what I have seen of lab data copied on PR it looks to me as if some of the labs have no understanding of basic quality control. And the doctors I get mad about are the ones who sell treatments that as far as we know do not work.

Let's put it this way. If everyone on Phoenix Rising has spent $500 on getting unnecessary tests done or as a result buying useless supplements or seeing doctors that prescribe things that do not work and there are 2,000 people on PR that is $1 million that could have been used for good research down the drain - half the way to funding a big project like Dr Lipkin's or the Norwegian study. Now, I am not suggesting that PWME should not explore options at all, but I think there will be a happy medium. My concern is that a very high proportion of PR threads seem to be devoted to members encouraging each other to pour their money down the drain. At the same time everyone is complaining about the lack of funds for research. And it is not that I am trying to drum up research funds for my own benefit either. I am retired and do not intend to write another paper or submit another CV. I get no brownie points any more, just a pension. But having seen what ME has done to friends I think it worth scratching my head over how to do something about it.

What PWME need is for the population at large to see ME as just as deserving as cancer or diabetes or Parkinson's disease or MS for funding. And to do that you need to have doctors on your side. I quite agree that many doctors have the wrong idea, but writing obs*eniti#s about doctors for saying tests are normal when they are normal does not seem likely to help!!

Maybe I am out of line making comments like this but I have been told by a number of people who use PR, including staff, that there are a lot of 'less vocal' people on PR who appreciate a little bit of this sort of thing.

 

[Sasha]

Maybe I am out of line making comments like this but I have been told by a number of people who use PR, including staff, that there are a lot of 'less vocal' people on PR who appreciate a little bit of this sort of thing.

I think it's hugely refreshing to have a doctor who is clearly on our side and clearly wants the best for us and clearly gets it about how devasting this disease is, to be willing to engage on these topics. I think that what happens in a lot of consultations (with specialists especially, I think) is that the patient goes along with a set of assumptions about what the tests mean and feels not only that the specialist disagreed with their assumptions but didn't even consider them - didn't take the patient's views seriously enough to even think about them. To be perfectly honest, the manner of some doctors (a minority, in my opinion) contributes to that impression, and in other cases, simply the time pressure that the doctor is under means that they can't go into much detail as to why they don't have the same view of those tests.

I welcome you explaining why you don't think these tests necessarily mean much. You're supplying the missing part of the conversation that we don't get in consultations.

Patients with ME turn up at every consultation fearing that they're going to be treated like a joke. Even though I've generally been treated very well by doctors, I go to every new consultation with that fear and on the alert for any hint that my concerns are being dismissed because the doctor might be assuming that my disease is imaginary and that I've spent too much time on the internet. It's very easy, under those circumstances, to come away with a bad feeling about how things went.

I think that relationships between doctors and PWME will improve rapidly once the biomedical science starts getting out and the disastrous effects of the PACE trial on doctor-patient trust fade in the rearview mirror. In the meantime, you're doing us and your clinical colleagues a great service by trying to close the gap.

Thank you!

 

[Sasha]

Let's put it this way. If everyone on Phoenix Rising has spent $500 on getting unnecessary tests done or as a result buying useless supplements or seeing doctors that prescribe things that do not work and there are 2,000 people on PR that is $1 million that could have been used for good research down the drain - half the way to funding a big project like Dr Lipkin's or the Norwegian study. Now, I am not suggesting that PWME should not explore options at all, but I think there will be a happy medium.

Actually, $1m would fully fund the Lipkin study.

However, for patients, the dilemma is to spend money on a treatment that could pay off now and get you your life back or pay to research and, even if it gets positive results, wait years for the study to be finished, written up, confirmation studies, etc. etc....

I think we've got to do both. If there was some fantastic treatment already available we'd have heard about it by now, so most of us are just trying to get marginal gains. Those gains are hugely important in improving quality of life from its baseline awfulness but we've got to invest in a slightly longer-term, solid basis for big-guns treatments that will get us a lot better, rather than just a bit better.

One patient used to suggest that we should all donate just 1% of whatever we spent on treatments. It doesn't sound like much but added up across all of us, it would be millions of millions of dollars. We'd be rolling in it.

I donate to research every month. Some months it's not much but it's every month. If you can, please donate. Just donate to whichever research project or research charity you think is most worthwhile that month, even if it's just a few bucks/quid/euros. Wash, rinse, repeat...

 

[Sasha]

What worries me about all this advice about tests is that I suspect it makes huge amounts of money for private labs who sell these tests without making any difference to anybody's health. Posting Lab websites is not against the rules but how do you know they are not just a rip off if you are not a lab technician? From what I have seen of lab data copied on PR it looks to me as if some of the labs have no understanding of basic quality control. And the doctors I get mad about are the ones who sell treatments that as far as we know do not work.

I wonder if we need a primer written on this (actually, we probably need primers written on quite a few issues that come up frequently). You're saying some very interesting things but they might not get as wide an airing as they should on this particular thread.

 

[halcyon]

To be clear, the site that Jeanne referenced and the two I listed are by no means private labs. They simply sell COR orders for LabCorp which is one of the largest clinical labs in the world.

As much as I enjoy the discussion and debate, we should probably not hijack Jeanne's thread with it. She came here looking for help so lets try to help her.

 

[Jonathan Edwards]

Halcyon, by private lab I simply mean commercial lab rather than government health service lad. These are commercial labs. Size is not an indication of quality in the commercial world, as we all know. I do not think that I am hijacking this thread. Various people have suggested that these tests might indicate an immune abnormality. I am pointing out that as an immunologist as far as I can see they are consistent with normal health. The CD8 count is below the 'normal range' of the lab but 'normal range' simply means what falls within two standard deviations of the population mean in most cases. It does not have any special relation to being unhealthy. For some tests levels within the 'normal range' can be very unhealthy - as for serum urate or blood pressure level. For other tests being well outside the normal range is no problem - as for low IgA. In general lymphocyte subset numbers vary widely and unless there is a specific clinical reason to relate an abnormal test to symptoms they are likely not to mean very much.

We are all trying to help Jeanne. But helping Jeanne may consist of telling here that her tests are nothing to worry about, just as she has been advised, as much as suggesting courses of action that may at best leave her out of pocket and at worst make her even more ill! I am sure there is a reason for her being unwell but I very much doubt one should expect these sorts of tests to help find out what it is.

 

[Sasha]

For some tests levels within the 'normal range' can be very unhealthy - as for serum urate or blood pressure level.

Just wondering about this - is it because there are so many people with unhealthily high BP that the normal range has been skewed by them?

 

[Jonathan Edwards]

Just wondering about this - is it because there are so many people with unhealthily high BP that the normal range has been skewed by them?

It is because risk of stroke and heart disease goes up with blood pressure right from the word go (i.e. above 130/80, maybe even above 120/70) and since stroke and heart disease are so common and so much related to BP a significant proportion of the population, maybe 30% of the 'normal distribution', are at significant risk. This is not skewing of the range, it is just that being an ordinary human being includes a risk of dying of stroke and that risk is on a sliding scale with variation in BP. 'Normal' in relation to lab ranges means normal in the statistical sense, not in the health sense most of the time. Sometimes it is too narrow to be relevant to health, sometimes too wide.