looking for someone to look at my test results please.

[Milsean]

hi, I have been a member of tge pernicious anemia site for my years and put my first post on today. Someone suggested I should also put in on this site as you are all so knowledgeable and helpful.

Apologies this is a long post. I have copied what I put on the other site

Hi, I am a long time member but first time poster. I really enjoy reading all the post on this site and people are so genuinely helpful. I would love if someone could have a look and explain them to me.I am 64 and have pernicious anemia over 40 years. I am with a new surgery over 1.5 years and have never seen a GP face to face. I have had two days phone appointments during that time only apart from my B12 every 3 months with the nurse. Any test results I get is a text message saying results ok but no one explains them to me,Family history includes pernicious anemia, several family members including my own daughter have under active thyroid. My daughter had 1/3 of her kidney removed due to diseased kidney. Family members have died of cancer.Bone profileEGRF using creatinine (CKD-EPI) per 1.73 square metresErythrocyte sedimentation rateSerum ferritin levelHaemoglobin A1c level - IFCC standardisedLiver function testsRenal profileThyroid function testSerum urea levelit said results BorderlineBone profile  Serum albumin level 42 g/L [35.0 - 50.0]Serum calcium level 2.38 mmol/L [2.2 - 2.6]Serum adjusted calcium concentration 2.34 mmol/L [2.2 - 2.6]Serum alkaline phosphatase level 69 u/L [30.0 - 130.0]Serum inorganic phosphate level 0.91 mmol/L [0.8 - 1.5]eGFR using creatinine (CKD-EPI) per 1.73 square metres  eGFR using creatinine (CKD-EPI) per 1.73 square metres 58 mL/min [> 60.0]; Renal function probably normal when eGFR >60 withno other evidence of kidney damage.Interpret with caution in elderly, pregnant andamputees. Advice by e-mail from:[e-mail] orrenal.orgProvided acute kidney injury has been excluded -this eGFR is consistent with CKD stage G3a Below Recommended RangeErythrocyte sedimentation rate  Erythrocyte sedimentation rate 13 mm/hour [0.0 - 20.0]Serum ferritin level 127.0 ng/mL [13.0 - 150.0]; PLEASE NOTE: There has been a change in Ferritinreference ranges for some age groups.Ferritin results should be interpreted togetherwith the clinical picture.Haemoglobin A1c level - IFCC standardised  Haemoglobin A1c level - IFCC standardised 34 mmol/mol [0.0 - 41.0]; HbA1c >=48 mmol/mol is diagnostic of DiabetesMellitus (DM). If asymptomatic repeat HbA1c within2 weeks for confirmation. If repeat <48 mmol/molnon-diabetic hyperglycaemia is present, please seebelow.HbA1c 42 - 47 mmol/mol indicates 'Non-diabeticHyperglycaemia' (NDH) with high risk of developingType 2 DM. Lifestyle changes are advised andrecheck progression to Type 2 DM. If NDH resultis within the last year, please consider referralto the National Diabetes Prevention Programme.HbA1c < 48 does not exclude diabetes in patientsdiagnosed with plasma glucose testingHbA1c < 42 mmol/mol does not exclude ongoing riskof diabetes. If patient is clinically high riskfor developing DM, suggest repeat in 1 year.*** Please note anything that alters red bloodcell turnover will make HbA1c results unreliableeg anaemia, B12 deficiency, renal failure, recentblood transfusion ***Liver function tests  Serum total protein level 69 g/L [60.0 - 80.0]Serum globulin level 27 g/LSerum bilirubin level 7 umol/L [0.0 - 20.0]Serum alanine aminotransferase level 14 u/L [0.0 - 32.0]Renal profile  Serum sodium level 143 mmol/L [133.0 - 146.0]Serum potassium level 5.0 mmol/L [3.5 - 5.3]Serum creatinine level 90 umol/L [44.0 - 80.0]; Above high reference limitThyroid function test  Serum free T4 level 19.3 pmol/L [11.0 - 22.0]Serum TSH level 1.37 miu/L [0.27 - 4.2]Serum urea level 5.2 mmol/L [2.5 - 7.8]Full blood countFull blood count  Total white blood count 6.1 10*9/L [4.0 - 11.0]Haemoglobin concentration 130 g/L [120.0 - 160.0]Platelet count - observation 226 10*9/L [150.0 - 450.0]Red blood cell count 4.1 10*12/L [4.0 - 5.2]Haematocrit 0.38 L/L [0.36 - 0.46]Mean cell volume 93 fL [80.0 - 100.0]Mean cell haemoglobin level 32 pg [27.0 - 32.0]Mean cell haemoglobin concentration 340 g/L [280.0 - 355.0]Red blood cell distribution width 13.5 % [11.8 - 14.8]Neutrophil count 3.78 10*9/L [2.0 - 7.0]Lymphocyte count 1.71 10*9/L [1.0 - 3.0]Monocyte count - observation 0.46 10*9/L [0.2 - 1.0]Eosinophil count - observation 0.12 10*9/L [0.0 - 0.4]Basophil count 0.04 10*9/L [0.02 - 0.1]Nucleated red blood cell count < 0.5 10*9/L [0.0 - 0.5]Mean platelet volume 10.5 fL [7.8 - 11.0]I am so sorry it is such a long post. I am so tired lately and had hoped the blood tests would tell me something but all I got from GP was test results ok.I have tried to Google but it only confused me more. I live in UK.Thank you for taking the time to read this.

[Jazzw]

It never ceases to amaze me that doctors will test so many things but not the things that might help get to the bottom of an issue.

I’ve reformatted as copying and pasting has turned your results into a wall of fairly impenetrable text. (Not your fault—it’s almost like the labs don’t want to be helpful to us mere mortals )

And I’ve turned the only thyroid blood test results in there bold.

On the face of it, your thyroid function is ok but there’s no test for Free T3 or thyroid antibodies so it’s not definitive.

========

Serum albumin level 42 g/L [35.0 - 50.0]

Serum calcium level 2.38 mmol/L [2.2 - 2.6]

Serum adjusted calcium concentration 2.34 mmol/L [2.2 - 2.6]

Serum alkaline phosphatase level 69 u/L [30.0 - 130.0]

Serum inorganic phosphate level 0.91 mmol/L [0.8 - 1.5]

eGFR using creatinine 58 mL/min [> 60.0]; (Provided acute kidney injury has been excluded -this eGFR is consistent with CKD stage G3a)

Erythrocyte sedimentation rate 13 mm/hour [0.0 - 20.0]

Serum ferritin level 127.0 ng/mL [13.0 - 150.0]

Haemoglobin A1c level - 34 mmol/mol [0.0 - 41.0]

Serum total protein level 69 g/L [60.0 - 80.0]

Serum globulin level 27 g/L

Serum bilirubin level 7 umol/L [0.0 - 20.0]

Serum alanine aminotransferase level 14 u/L [0.0 - 32.0]

Serum sodium level 143 mmol/L [133.0 - 146.0]

Serum potassium level 5.0 mmol/L [3.5 - 5.3]

Serum creatinine level 90 umol/L [44.0 - 80.0]

Serum free T4 level 19.3 pmol/L [11.0 - 22.0]

Serum TSH level 1.37 miu/L [0.27 - 4.2]

Serum urea level 5.2 mmol/L [2.5 - 7.8]

Total white blood count 6.1 10*9/L [4.0 - 11.0]

Haemoglobin concentration 130 g/L [120.0 - 160.0]

Platelet count 226 10*9/L [150.0 - 450.0]

Red blood cell count 4.1 10*12/L [4.0 - 5.2]

Haematocrit 0.38 L/L [0.36 - 0.46]

Mean cell volume 93 fL [80.0 - 100.0]

Mean cell haemoglobin level 32 pg [27.0 - 32.0]

Mean cell haemoglobin concentration 340 g/L [280.0 - 355.0]

Red blood cell distribution width 13.5 % [11.8 - 14.8]

Neutrophil count 3.78 10*9/L [2.0 - 7.0]

Lymphocyte count 1.71 10*9/L [1.0 - 3.0]

Monocyte count - observation 0.46 10*9/L [0.2 - 1.0]

Eosinophil count - observation 0.12 10*9/L [0.0 - 0.4]

Basophil count 0.04 10*9/L [0.02 - 0.1]

Nucleated red blood cell count < 0.5 10*9/L [0.0 - 0.5]

Mean platelet volume 10.5 fL [7.8 - 11.0]

[Milsean in reply to Jazzw]

Thank you so much Jazzw. Iam using an IPad and unfortunately when I copied it across it went in a Jumble! I need to do more reading and investigating. Thank you so much for taking the time to reply to me too.

[SlowDragon Administrator in reply to Milsean]

currently anyone using an iPad seems to be loosing all formatting, line spacing and even word breaks

I have raised it as an issue …..still waiting for IT suppprt to try to resolve

[SlowDragon Administrator]

welcome to the forum

There’s no vitamin D, folate or thyroid antibodies tested

Suggest you test vitamin D here

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

Are you currently taking any vitamin supplements apart from B12 injections

was test above done early morning, this gives highest TSH

Your Ft4 levels look good….but you could consider getting

FULL thyroid and vitamin testing

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high thyroid antibodies 

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis. 

Both are autoimmune and generally called Hashimoto’s.

Having PA makes other autoimmune disease more likely

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis 

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

Recommended on here that all thyroid blood tests early morning, ideally just before 9am

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

List of private testing options and money off codes

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Only do private testing early Monday or Tuesday morning.

Watch out for postal strikes, probably want to pay for guaranteed 24 hours delivery 

[Milsean in reply to SlowDragon]

Thank you so much Slowdragon. My tests were done at 8.50a.m. Thank you for taking the time to reply. I will read through your links.

[humanbean]

I know Jazzw has already posted your results, but I prefer having them right in front of my nose if I comment on something...

Serum albumin level 42 g/L [35.0 - 50.0]

Serum calcium level 2.38 mmol/L [2.2 - 2.6]

Serum adjusted calcium concentration 2.34 mmol/L [2.2 - 2.6]

Serum alkaline phosphatase level 69 u/L [30.0 - 130.0]

Serum inorganic phosphate level 0.91 mmol/L [0.8 - 1.5]

eGFR using creatinine (CKD-EPI) per 1.73 square metres 58 mL/min [> 60.0]

Erythrocyte sedimentation rate 13 mm/hour [0.0 - 20.0]

Serum ferritin level 127.0 ng/mL [13.0 - 150.0]

Haemoglobin A1c level - IFCC standardised 34 mmol/mol [0.0 - 41.0]

Please note anything that alters red blood cell turnover will make HbA1c results unreliable eg anaemia, B12 deficiency, renal failure, recent blood transfusion

***

The eGFR is showing that your kidneys aren't as good as they could be. My husband had a similar result in his 50s and his doctor said it was absolutely fine and nothing to worry about. In your shoes I would do some research online on how to improve kidney health. But it is worth pointing out that poor thyroid hormone levels will have a detrimental impact on the kidneys. For example, if you have low Free T3, then improving your Free T3 levels might have good effects on your kidneys.

You can get more info from this link :

labtestsonline.org.uk/tests...

The ferritin level is well in range, and suggests that you are not suffering from anaemia, and you aren't suffering from iron deficiency.

***

Liver function tests

Serum total protein level 69 g/L [60.0 - 80.0]

Serum globulin level 27 g/L

Serum bilirubin level 7 umol/L [0.0 - 20.0]

Serum alanine aminotransferase level 14 u/L [0.0 - 32.0]

***

Liver function, all fine.

***

Renal profile

Serum sodium level 143 mmol/L [133.0 - 146.0]

Serum potassium level 5.0 mmol/L [3.5 - 5.3]

Serum creatinine level 90 umol/L [44.0 - 80.0]; Above high reference limit

Serum urea level 5.2 mmol/L [2.5 - 7.8]

***

Creatinine is used in the calculation of eGFR (kidney function), so the eGFR being lower than ideal is probably because creatinine is high.

You can get more information on this link :

labtestsonline.org.uk/tests...

***

Thyroid function test

Serum free T4 level 19.3 pmol/L [11.0 - 22.0]

Serum TSH level 1.37 miu/L [0.27 - 4.2]

***

I'll let others comment on thyroid.

***

Info on FBC can be found here : labtestsonline.org.uk/tests...

Full blood count

Total white blood count 6.1 10*9/L [4.0 - 11.0] *** No obvious signs of infection

Haemoglobin concentration 130 g/L [120.0 - 160.0] *** Not anaemic

Platelet count - observation 226 10*9/L [150.0 - 450.0] *** Fine

Red blood cell count 4.1 10*12/L [4.0 - 5.2]

*** Red blood cell count is low in range. Reasons for low levels are given on this link :

labtestsonline.org.uk/tests...

"A low RBC count may indicate anaemia, bleeding, kidney disease, bone marrow failure (for instance, from radiation or a tumour), malnutrition, or other causes. A low count may also indicate nutritional deficiencies of iron, folate and vitamin B12."

Haematocrit 0.38 L/L [0.36 - 0.46] *** Fine

Mean cell volume 93 fL [80.0 - 100.0] *** Fine

Mean cell haemoglobin level 32 pg [27.0 - 32.0] *** Okay

Mean cell haemoglobin concentration 340 g/L [280.0 - 355.0] *** Fine

Red blood cell distribution width 13.5 % [11.8 - 14.8] *** Fine

Neutrophil count 3.78 10*9/L [2.0 - 7.0]

Lymphocyte count 1.71 10*9/L [1.0 - 3.0]

Monocyte count - observation 0.46 10*9/L [0.2 - 1.0]

Eosinophil count - observation 0.12 10*9/L [0.0 - 0.4]

Basophil count 0.04 10*9/L [0.02 - 0.1]

Nucleated red blood cell count < 0.5 10*9/L [0.0 - 0.5]

Mean platelet volume 10.5 fL [7.8 - 11.0]

Any result with no comment should be assumed to be fine.

***

You really need to get Vitamin B12 tested (if you are not getting regular injections), also folate and vitamin D.

[Milsean in reply to humanbean]

Thank you humanbean for taking the time to reply. No I did not have my Vit D checked. I need to get this checked too. Something I should have mentioned also is I suffer with acrophobia and for past 3 years have only left the house for medical appointments . I know this could have have an effect on my readings too.

[SlowDragon Administrator in reply to Milsean]

Then you definitely need vitamin D, folate and B12 tested

[Milsean in reply to SlowDragon]

Yes I agree. I had assumed when she told me she was doing a full check on me that it would have included them also. Thank you for taking the time to reply SlowDragon

[SlowDragon Administrator in reply to Milsean]

GP’s rarely test Vitamin D…..assumption is everyone in U.K. is insufficient or deficient

Do you supplement vitamin D or vitamin B complex or B12

[Milsean in reply to SlowDragon]

Hi SlowDragon, since my GP retired and I was transferred to a new practice I have not been taking any supliments or vitamins. I have pernicious anemia and get a B12 injection every 3 months. I have asked if I can self inject as I am not finding any benefits from 3 monthly injections.I had asked the nurse each time I have had my B12 injection and either no or discuss with the Dr. I had hoped I was getting a follow up call after all my tests were done but looks like I need to chase it myself again.

[SlowDragon Administrator in reply to Milsean]

You can request injections are more frequent

Three months is an entirely arbitrary time scale

Book for 2 month intervals

Meanwhile …..As you have B12 injections it’s recommended also to supplement a good quality daily vitamin B complex, one with folate in (not folic acid) may be beneficial.

This can help keep all B vitamins in balance and may help maintain B12 levels between injections

Difference between folate and folic acid 

chriskresser.com/folate-vs-...

B vitamins best taken after breakfast

Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule) 

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate methyl folate supplement

[SlowDragon Administrator in reply to Milsean]

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

Government recommends everyone supplements vitamin D October to April

Thyroid patients frequently need to supplement continuously and at higher dose to maintain optimal vitamin D at least over 80nmol and between 100-125nmol may be better

[Milsean in reply to SlowDragon]

Thank you so much SlowDragon for all of your information. I really need to check this all out.x

[SlowDragon Administrator in reply to Milsean]

Also recommends taking good quality vitamin B complex that contains folate

b12deficiency.info/what-to-...

It is also wise to take a good vitamin B complex in addition to your B12 injection as all B vitamins need each other to work properly. Supplementing one in isolation can cause an imbalance in others. If you can increase your intake of B6 from food then there is no risk of toxicity, however some people have experienced side effects such as neuropathy from daily very high dose vitamin B6 when taken for long periods.  Please note, the folate contained in B complexes and multivitamins is commonly folic acid and this may not be the best form for you. Please see point 10 above.

[Milsean in reply to SlowDragon]

Thank you again SlowDragon for all your very helpful advice. xx

[shaws Administrator in reply to Milsean]

I also have P.A. (as well as another couple of autoimune diseases). My mother also had this condition.

I used to get an injection every 3 months but my GP told me I can have as many injections I feel I need, so I have an injection every month now.

p.s. my Mother's doctor told her after a blood test that she needed no more B12 injections. Both my sister and myself thought that was 'good' but it was a disaster as Mother died due to stomach cancer.

[Milsean in reply to shaws]

Hi Shawn, thank you so much for taking the time to reply to me. You are lucky your GP allows you to have your injections more frequently. I am so sorry to hear about your mum rip. My mother had Alzheimer’s at age 65 and died aged 69 after a clot went to her lungs and killed her. Thank you to everyone for all of your replies xx

[shaws Administrator in reply to Milsean]

I'm very sorry that your mother was diagnosed at 65 with Alzeimers and died 4 years later. It's a memory that will not resolve for us and we feel that few GPs actually know much at all about how to diagnose/treat patients who have a dysfunctional thyroid gland.

Even when my TSH was 100 GP phoned to reassure me that I had no problems at all. I had no knowledge of anything about a dysfunctional thyroid gland then.

I have met some people for whom levothyroxine works very well and am sure they wont be searching the internet for advice/help on how to restore their health.

Many GPs should enable us to recover our health but few seem to be very poorly trained about symptoms of a dysfunctional thyroid gland as a GP told me that T3 converts to T4! I said 'I'm sorry doctor that's incorrect.

It is ridiculous that the very basic symptoms seem to be unknown and I think that prescribing anti-depressants etc when the patient may need thyroid hormones is wrong.

[Milsean in reply to shaws]

Thank you Shaws for all your very helpful advice. 😘