Need some educating please

Until recently I've been a bit of a head stuck in the sand type of bloke throughout the 10 years I've had RA, with the mindset that.. the less I now about my disease the better.. if only for my mental well being. :) Anyway, I'm sat here looking at my methotrexate blood test monitoring booklet with little idea of what the readings mean. Think it's about time I learnt, so much appreciated if someone would be kind enough to enlighten me on the following...

Hb - is it hemoglobin?

MCV - ?

WBC - I know this is white blood cells.

Platelets - something small children eat their dinner off?

Neutrophils - ?

Lymphocytes - something to do with lymph glands?


Creatinine - kidneys?

CRP - inflamation

ESR - inflamation

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19 Replies

  • I'm the total opposite, bit of a dog with a bone as far as RD's concerned! Copied this for you from the back of my Drug Monitoring Book, not sure if yours has it but here it is anyhow -

    Hb: The oxygen carrying protein pigment in the blood, specifically in red blood cells.

    MCV: The average volume of a red blood cell.

    WBC: White blood cells.

    Platelets (PLAT): An irregular, disc shaped element in the blood that assists in blood clotting (not kiddies plates ha ha!)

    Lymphocytes (LYMPH): A small white blood cell that plays a large role in defending the body against disease. They are responsible for immune responses.

    Neutrophils: Type of white blood cell filled with enzymes used to kill and digest micro-organisms.

    ALT: An enzyme normally present in the liver and heart cells that is released into the blood stream when the liver or heart is damaged. Rising blood ALT levels may indicate liver damage.

    ALK phos: An enzyme made in the liver which is usually released into the blood during injury. Abnormally high levels may indicate liver damage. Some patients with RA may have high levels due to inflammation.

    CRP: A plasma protein that rises in the blood with the inflammation of certain conditions.

    ESR: A blood test that detects and monitors inflammation in the body. The rate increases with more inflammation.

    Urea: A substance normally cleared from the blood by the kidney. Increased blood levels of urea indicate a problem with kidney function.

    Creatinine (CREA): A substance normally cleared from the blood by the kidney. Increased blood levels of creatinine indicate a problem with kidney function.

    There's also the Normal Values list. If you would like to know them too just ask.

  • Well I'll be!..just checked the back of my mtx monitoring booklet and it's all in there to..just goes to prove what I said about having my head stuck in the sand, duh!

    Thanks ever so much heelsy. Can't see a normal values list in the booklet, so if it's not too much trouble...

    I've just had a look at my old mtx blood monitoring booklet, which has the date and dosage for the very first time I started taking mtx.. 15/04/04, 7.5mg.

    Interestingly, the only things listed in the booklet to be monitored are - Hb, WCC (?), Platelets and ESR. As there's no ALT or ALK I'm puzzled how my liver was monitored back then, unless WCC is liver related?

  • Just noticed that ALT/ALK readings were included (hand written) in the booklet in late 2007, 3+ years after I started taking mtx, which seems a bit odd?

  • Hb= haemoglobin level; generally higher is better.

    MCV= mean cellulay volume of the red blood cells; new cells are bigger so higher indicates that because the average size of the red blood cells is bigger then while you may be anaemic, your body is building new red blood cells= good news.

  • WBCs, white blood cells that deal with infection and indicate inflammation is in process when the level is high.

    Platelets, essential for blood clotting, come from the same source as RBCs. Lymphocytes created in the lymph nodes and inflammatory cells, dealing with different aspects of inflammation compared to other white blood cells. B-lymphocytes are the source of antibodies.

    ALT is mainly aliver enzyme released into the blood id the liver is damaged. ALKP is an enzyme related to bony tissue but can increase with liver damage if the liver is swollen.

    CRP - C-reactive protein, a marker in the blood of rheumatoid inflammation, broadly the level correlates with the amount of inflammation going on.

    ESR: erythrocyte[=red blood cells] sedimentation rate. Indicates how quickly or otherwise the red blood cells pass through the liquid part of the blood. Think of marbles dropping through water or through gel. A lot of inflammation makes the liquid part of the blood, the plasma, thicker, so more solid bits like the RBCs don't settle as quickly.

    Note also, that these and the liver enzymes should not be assessed simply on the numbers; other factors always need considering, e.g.Urea and creatinine are waste products from metabolising protein and are normally excreted via the kidneys. Kidney damage tends to cause them to be retained in the body, but note urea especially is affected by level of hydration/dehydration. ALT can also come from muscle tissue.As noted ALKP can be raised in bony diseases.

    Copied and pasted from my brain; I'm qualified!

  • Morning wishy. I did send you a message first to tell you where I found them then thought maybe others may benefit from listing them if they don't have a Bloods book.

    It just shows how things change, for the better mostly! WCC is white cell count & would think as it's used to detect inflammation others are more specific of the ones taken cover that nowadays, though can still be used in a normal full blood count. Not sure about ALT/ALK phos as I have only been tested since 2008 so always been performed but maybe only thought useful around the time it appeared on your results?

    Anyway here are the Normal Values -


    ESR: 1 - 7 mm/hr

    CRP: <6 mg/L


    HAEMOGLOBIN (Hb): 11.5 - 18.0 g/dl

    PLATELETS: 150 - 400 x 10˚/L

    WHITE CELL COUNT: 4.0 - 11.0 x 10˚/L


    NEUTROPHILS: 2.0 - 7.0

    LYMPHOCYTES: 1.0 - 3.0

    MONOCYTES: 0.2 - 1.0

    EOSINOPHILS: 0 - 0.5

    BASOPHILS: 0 - 0.1


    AST: 7 - 40 IU/L

    ALK phos: 30 - 125 IU/L


    UREA: 2.5 - 6.5 mmol/L

    CREATININE: 60 - 120 μmol/L

    These are of course could depend on how the lab analyzes, these are the ones for the lab my bloods are sent to. They may differ as not all labs test the same. For instance, it's completely different to the ranges I was used to in Spain so had to reboot my brain to these loll!!

  • Okay NMH (prefer Heelsy!) and all - can you help me then by telling me what Total Protein is and why mine might always be a bit too high (by about 3 or 4 points above lab range). Twitchy x

  • Hiya Twitchy. As I said to helix once I don't mind what you call me so long as it's not names!

    As I understand it a Total Protein test is exactly that, a test to check albumin & globulin often used to determine problems with the liver & kidney but also useful for identifying other conditions. It's normally the primary test & if results are not within Normal range usually more specic tests are done to identify the exact reason for an abnormal result, though I don't know how much outside normal range it needs to be before further investigations are performed.

    Rather than going into the specifics & possibly missing something out this will tell you more reliably.

    Hope you had a better night last night. x

  • Thanks Heelsy - you are a gem. Not a better night no :-( but more anon about latest apt this morning - neurology et al. Got a meeting at school now about youngest son's exam results (a bit dire) Tx

  • No probs. Sorry about that. In a rush, carrot cake due out of the oven! Pm me if you wish to spill about either. x

  • No worries - one good thing (re weightloss) is I've lost my appetite just now so even the smell of your delicious carrot cake can't tempt me!

    I've just dumped a post offloading - badly in need as uncertainty is doing my head in. X

  • That's a shame as it's untried recipe & worked so really pleased. It's so light & yummy! My friend in the US sent me a recipe book with the best one ever in & can I find it?....can I heck!

    I'll take a look at your post now before I dose off. x

  • Might be an idea to 'collect' some credible websites for reference. I think this is the best site for explaining blood results:

    Though there might be a similar but better one (must follow my own advice and bookmark stuff).

    I think the more you know the better, sort of. I've been an ardent student of my own flipping body and its problems for the last 3 years. Along the way I've found that a little knowledge can be a bad thing and that when I put 2 + 2 together anything can happen! And that the internet needs to be used very, very advisedly. Basically cross-reference everything you hear again and again. Over time I think I've acquired a working knowledge of my disease and that has proved very useful to me, but it does take time.

    I've come full circle now, I feel I know enough to be going on with and am now working on forgetting about it as much as possible. All I need is for it to just stay quiet and let me ignore it!

  • I want to know about the methotrexate book. I never seen oe heard of it. Been on methotrexate 5 years now

  • I have one as I have my monthly bloods taken at my GP Surgery. I hold it & take it with me for the Practice Nurse to write up the previous months results when she takes my bloods. Not all health authorities work the same way, some do printouts & the patient doesn't aways have access to the results. You are entitled to know your results if you wish to keep a log if yours doesn't use this type of blood monitoring.

  • Hi pipcat15

    I would like to know about it too!

  • Rheumy supplied me with a booklet in 2004 when I first started taking mtx. I stopped taking mtx about 18 months ago, and started taking it again recently, when I was given my current booklet.

    I thought everyone was given a booklet when they start mtx, surprised to hear that this is not always the case.

  • Thanks for filling me in everyone - I'm certainly a lot wiser now.

    Going by heelsy's values list, most of the readings in my last blood test are within the norm, the exception being AST, which is up at 100. My rheumy nurse said everything was fine when she looked at the results, so my AST level can't be of much concern. Also, no CRP or ESR tests were taken for some reason, so nurse said I need to make sure that I have them done from now on as they've been quite high (tell me about it!) and I've recently started taking enbrel, which is working fine for me BTW. :)

  • Useful booklet on the national patient safety site- at the end place to record results for people who haven't been given a booklet.

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