Blood test interpretation - b9, serum urate and Erythrocyte sedimentation rate

[IceSpike]

Hi, newbie here. Hoping someone can help me with something... It took me I think 7 blood tests and a year of crying for help for many health issues that have actually changed my life quite drastically, for the drs to realise I have "very low folic acid" - 2.3.So I feel worried about other out of range results that were deemed 'satisfactory'. Hoping someone can help me... Also, anyone know how quickly can this level of folic acid deficiency come on?

These results are from Aug and I've had 2 more blood tests since then but the following were not rechecked

The satisfactory results out of range are

📈Serum urate levels -113

Internet suggests they should be 155-357

Doctors suggest they should be 140 - 360

📈Erythrocyte sedimentation rate - (SAH) - 2

Internet suggests they can be okay from 0?

Doctors suggest 5-10

Can't really understand how docs and net aren't suggesting the same levels to be okay but maybe I have just misinterpreted 🤔 I'm not very good at this kind of thing. I have bad brain fog and between being sick, work and trying not to ignore everyone in my life, things are difficult right now.

Also can't work out why doctors would no be considered about levels not meeting expectations when I am complaining of so many health issues. Sure they think I am making it all up, does not feel good.

Thanks so much for any advice. Hope everyone has had a lovely Christmas 🎄

[Orchard33]

Low but within range levels that are considered acceptable by medics indicate complacency rather than good medicine, in my view. If there is a range of eg. 20-300 and my reading is 21, how can that possibly indicate optimal functioning of my body? Surely I should at least be aiming for mid range. Maybe this is one reason that we age as we do and become chronically unwell.

[FlipperTD]

Scientist, not medic.

Folate: we don't have huge body stores of folate, so a low level can be seen within weeks of reduced folate intake.

Urate: high urate levels are more significant, but low urate levels? I'm not sure it's anything to worry about.

ESR: It's a good indicator of inflammation. Don't worry about a result that appears to be low, as it doesn't indicate anything.

I hope this helps. Have a good New Year.

[IceSpike in reply to FlipperTD]

Thank you for taking the time to answer. Why is there a lower level stated if going under doesn't matter? I don't understand this. I have been having these folate deficiency issues for almost a year, such as pins and needles, pains, hair loss, sleep issues, mood issues, brain fog. They have severely impacted my life. I work night shifts instead now because I can't manage the day shift but everything is so difficult. It took them 6 blood tests to actually test for the right thing. It's hard to have faith in drs ATM which is why I have come here.

Do low ESR levels suggest lack of inflammation? I feel have a lot of it due to my symptoms but I know that I can't really know. They have been saying for about 8 months they think I have fibromyalgia but how can they make that suggestion before even taking the correct blood test... 🙈 Not really expecting an answer here sorry. Guess I am just ranting as very fed up. They only did it eventually due to the hair loss. I am only 33 and finally got myself into a position where I can think about having children. I want them and worry my body is already going in the other direction.

Again, thanks for taking the time to respond.

[FlipperTD in reply to IceSpike]

Hi IceSpike.

I can answer this one from a science and maths basis. [By disclosing this, I may have to track you down and 'silence' you... but I won't. I know you won't talk.]

We study population results, and that involves taking large numbers of results. If we take very large numbers of results, it doesn't even matter if there are a few abnormal results in them. Then we look at the mathematical distribution of the numbers. We can plot them as a histogram, and we see that there is a 'central tendency' as in 'there's a hump in the middle of the results'. So that gives us an indicator of the commonest numerical result value. If the results fit a Gaussian distribution [that's a Bell-shaped curve] then it follows some numerical rules. Most result distributions don't really fit a Gaussian distribution, but often it's near enough and it's the best we've got, so it's usually the approach we follow.

The arithmetic mean [the 'average'; add the results up and divide by the number of results] gives us the mean. By some fairly straightforward mathematics, we can derive the Standard Deviation [SD] from the results. So, the 'Mean minus two SD' gives us the bottom of the range, and 'Mean plus two SD' gives us the top of the range. This range covers 95% of the normal results. 'Mean +/- 1SD' gives us 67% of the results, and 'Mean =/- 3 SD' gives us 99.7% of the normal results. So, the quoted result ranges 'normal ranges' or more accurately, 'reference ranges' are typically 95% ranges. This means that 5% of normals will be outside the 95% range whilst still remaining 'normal'. Obviously the further out they are then the less likely they are to be 'normal'. So, with the ESR, it can't be less than zero, but it can be much more than the upper limit. So, we will see actually results that are less than the lower limit, but these are of no consequence except in some very unusual circumstances, and are in all probability ''normal'!

I hope this isn't too confusing.

[FlipperTD in reply to IceSpike]

I meant to say that the ESR is affected by the plasma proteins, and specifically the ratio of albumin to globulins. If the globulins [IgG, IgM, IgA and other Igs] increase then the ESR increases. Globulins tend to increase in infections and inflammations, and consequently the ESR increases. Plus it's worth remembering that a good doctor treats the patient and the symptoms, not the numbers from Pathology. Despite me spending many years issuing numbers from Pathology!

[Nackapan]

Bloods never really do show up how ill you feel

My ESR was 29....told okay ??

Even B12 at 106 nog considered 'that low ' to bd causing such severe symptoms.

I'd srard ag printed off results looking for clues to ask about

Also comparison to bloods when felt okay

Blood tests are a mystery to me alot of the time as even if the lab comments ;

Not normal

Gp's dont act on them ??

It's the whole picture

[FlipperTD in reply to Nackapan]

Scientist, not medic.

The ESR is a great test, as a normal result means nothing, but a raised one means something, although we don't always know what. Any inflammatory process will put the ESR up. Convalescence after, say, a chest infection, usually shows that the ESR will continue to rise, and then gradually return to normal but that can take months.

When folks back in history were looking for tests that would give us some indication of what's going on, the ESR looked like it might be useful as a pregnancy test. In pregnancy, the ESR tends to rise. It looked like a winner, but when checked against other conditions, the ESR was raised in them too. We eventually developed better pregnancy tests, but that's another story.

That's all for today's history lesson.

[helvella in reply to FlipperTD]

Why does it appear that there has been a move away from ESR towards CRP over the years?

[FlipperTD in reply to helvella]

Oh, that's an easy one!

A 'proper' ESR as in a Westergren ESR uses just short of 2millilitres of blood, in Sodium Citrate anticoagulant. The test takes an hour, once it's been set up. Then the blood is discarded. It should be performed within a couple of hours of blood collection. For our friends in the USA they may still be using the Wintrobe ESR, which still takes an hour but uses only half the amount of blood and it doesn't need to be citrated. EDTA is the common anticoagulant used. CRP is automated, uses a tiny volume of blood, and so is far more use for 'scaling up' processing. CRP rises quicker than ESR, and comes down quicker than ESR too. They're used interchangeably, and whilst they reflect one another, they're not measuring the same thing. There are other 'ESR surrogates', such as Plasma Viscosity. That's automated too, but is performed on centrifuged blood, so the sample isn't much use for any other tests afterwards. The ESR has been automated too, but it still takes an hour. There are other tests out there that claim to be true ESR surrogates, but being an old-fashioned stick-in-the-mud, then I still maintain that the 200mm column of a Westergren ESR, stood vertical for 60 minutes, is 'the only ESR worth using'.

There may be others reading this who are now fuming, but fume away, folks, and Happy New Year!