Test Results! Need Help Understanding

[mmcc54]

So My one year old is waiting to see the GI she had some blood work done and her IgG was positive..I received a copy of her blood work and some of the results were alarming..her pedi said not to be concerned since it could all be from the celiacs, if that's what she has. I don't know if I should believe since every question I have he awnsers with Im not to sure the Gi will have better awnsers ehhhh we don't see him till the 3rd!!!! If anyone could help me figure out what the heck these results indicate that would be awesome! Like I said shes one..she was marked as failure to thrive for not gaining weight in 3 months, she is up ALL NIGHT long in pain, gas, lots of loose BMs so that's the history of symptoms.

 

TSH: High 3.69 (range 0.34-3.00)

AST: High 54 (range 14-36)

Alkaline Phosphates: Low 179 (range 230-300)

Creatine: Low .5 (no range given)

CRP: Low .03 (no range given)

MCH: Low 26.8 (range 27-33.5)

Platelets: High 502 (range 140-350)

neutrophils relative: Low 11 (range 13-33)

lymphocytes relative: High 86 (range 46-86)

lymphocytes absolute: High 8600 (range 2185-6045)

Ab, IgG: high 16.1 Positive if over 6

IgA: Negative 1.2

 

as you can see that's a lot of "flags" on blood work for a tiny baby..im pretty concerned!

[nvsmom]

(((hugs))) to you mom.

 

She had a positive tTG IgG right? I'm assuming that was on a different lab panel.

 

I know a bit about these tests, but I wouldn't trust my knowledge on all these tests.

 

TSH - A high TSH means her pituitary thinks her thyroid isn't making enough hormones. She most likely is hypothyroid. I know that I do not feel well at 3.5.  Ideally her TSH should be near a 1. Request free T4 and Free T3 tests, which will tell you how much available hormones are in her blood (and if her pituitary is correct). The free T3 and T4 should be in the 50-75% range of your lab's normal reference range. TPO Ab will let you know if her thyroid is under an autoimmune attack. My guess is that she might need some T4 and T3 supplements from the doctor.  Most doctors are very wait and see on this area though... mine made me wait 15 years. 

 

AST -assesses liver function. The liver is often affected by celiac disease - usually reverses.

 

Alkaline Phosphates - liver tests. i believe low levels will show nutritional deficeincies - could be celiac disease linked.

 

Creatine - this could show her liver being affected again.

 

CRP - low levels would show very little inflammation... I don't know of any way this is bad.

 

MCH - I would assume this means she is anemic which many celiacs are.

 

Platelets - high numbers probably mean her spleen is underfunctioning (enlarged underfunctioning spleens are common in celiacs) but it could also show infection or just be a result of anemia.

 

She has negative IgA which means that any celiac tests she had run that used an IgA (tTG IgA, EMA IgA, DGP IgA) would probably end up with a false negative.

 

I'm sorry you and your little one are going through so much. i hope she feels well soon.

[mmcc54]

(((hugs))) to you mom.

 

She had a positive tTG IgG right? I'm assuming that was on a different lab panel.

 

I know a bit about these tests, but I wouldn't trust my knowledge on all these tests.

 

TSH - A high TSH means her pituitary thinks her thyroid isn't making enough hormones. She most likely is hypothyroid. I know that I do not feel well at 3.5.  Ideally her TSH should be near a 1. Request free T4 and Free T3 tests, which will tell you how much available hormones are in her blood (and if her pituitary is correct). The free T3 and T4 should be in the 50-75% range of your lab's normal reference range. TPO Ab will let you know if her thyroid is under an autoimmune attack. My guess is that she might need some T4 and T3 supplements from the doctor.  Most doctors are very wait and see on this area though... mine made me wait 15 years. 

 

AST -assesses liver function. The liver is often affected by celiac disease - usually reverses.

 

Alkaline Phosphates - liver tests. i believe low levels will show nutritional deficeincies - could be celiac disease linked.

 

Creatine - this could show her liver being affected again.

 

CRP - low levels would show very little inflammation... I don't know of any way this is bad.

 

MCH - I would assume this means she is anemic which many celiacs are.

 

Platelets - high numbers probably mean her spleen is underfunctioning (enlarged underfunctioning spleens are common in celiacs) but it could also show infection or just be a result of anemia.

 

She has negative IgA which means that any celiac tests she had run that used an IgA (tTG IgA, EMA IgA, DGP IgA) would probably end up with a false negative.

 

I'm sorry you and your little one are going through so much. i hope she feels well soon.

Thank you! Your response was very helpful!!! Thank you for answering!

[mmcc54]

Yes the tTG was a different panel...her IgG was positive and her IgA was neg..someone said that would mean she is in fact celiac with intestinal damage?!?

[greenbeanie]

It might be worth faxing a copy of the blood work directly to the GI's office yourself (even if her doctor already sent it electronically). I was able to get my daughter into a backed-up office much sooner that way. When I called they told me repeatedly that the first available appointment was in ten weeks, and that there was no way we could get in sooner. But when they saw her test results, a nurse called me back the same day and got us an urgent appointment a few days later. It seems like part of the receptionist's job is to be a gatekeeper (in a well-meaning way) and filter out the appointment requests that aren't really so urgent. If you can just make sure they actually see the test results right away, they may realize that a more urgent appointment really is justified. Then again, it may not work...but it seems like it couldn't hurt to try.

Good luck - I know it's difficult to see your little one suffering and have to wait so long for help.

[cyclinglady]

Excellent advice, Greenbeanie!  

 

When my daughter woke up with an itchy rash after a course of antibiotics for strep, she needed to see a doctor.  Our doctor's office doesn't pickup the phone for appointments until 9:00 am.  Having once had an early appointment at 7:30 am, I knew the office was open and that some doctors (maybe not ours) would be in.  We walked in and asked for an appointment.  They only had an opening at 11:30 am, so I took it and explained that we were going to sit in the lounge until then.  I explained that I have had some serious allergic reactions and not knowing if my daughter has the same traits, I'd feel better just sitting in the office, (plus, the hospital was right across the street).  A nurse came by and took us in immediately.  So, it's worth trying to figure out a way to work around the system!  

 

Mmcc54,

 

My heart goes out to you and your baby.  Be your daughter's advocate and fight!  

[nvsmom]

Yes the tTG was a different panel...her IgG was positive and her IgA was neg..someone said that would mean she is in fact celiac with intestinal damage?!?

Both tTG tests will test for intestinal damage, and if positive, they most likely indicate celiac disease.

 

The IgG and IgA tests are Immunoglubulin tests. These are not celiac tests but measures of the immune responses (antibodies) in various areas throughout the body.  The IgA is at work in the intestines, so that is why IgA based tests are often used for celiac testing. This site has a basic run down on the immunoglubulins: Open Original Shared Link

 

Because her IgA levels are low, any celiac tests using IgA (like tTG igA, EMA IgA, or DGP IgA) will most likely appear negative even if there is celiac disease involved. About 5% of celiacs are low in IgA, it appears your daughter is one of the 1/20 that's low... don't worry, I do not believe there are any health problems associated with that.

 

Hang in there. 

[mmcc54]

Thank you all!!! I put yet another call in this morning...talked to a really sweet nurse told her I would take her to the ER tonight or switch to gluten free myself because I cant bear to see my baby screaming in pain all night long again..not sure if her stomach hurts or what it is..its scary and frustrating..she was super nice and promised the dr would review her results asap and squeeze her in...rewind time in the past two weeks since her results have come in her pedi said the GI was reviewing her results and when I called stating she couldn't be seen until July 3rd he said well the dr looked at her results and must not be concerned with them....fast forward to today the nice nursed called back saying they don't have lab results on her..only a referral and her pedi notes...I was so MAD! Here I am for 2 weeks thinking "well at least her results have been looked at by a specialist they must not be as bad as I thought." Nope! So yet again im waiting...to hear back...

[mmcc54]

They just called after finally getting her test results and want to see her tomorrow :/

[nvsmom]

Yeah!!! 

[greenbeanie]

Hooray! Good job for being persistent!

[mmcc54]

yes! Sometimes you just got to keep pushing exp when a baby who cant communicate whats wrong is crying out!

[frieze]

elevated platelets may be related to bleeding somewhere....what was her RDW? low creatine maybe lack of protein absorbtion,  lack hemoglobin, prob related to iron def ...perhaps B12 as well.   good that she is getting in earlier.  And yes the squeaking wheel gets the grease!

[mmcc54]

her RDW was 39.0 range of 37-39

[frieze]

her RDW was 39.0 range of 37-39

as you can see, that is on the high end of normal, another potential indicator of blood loss somewhere.  getting her seen quickly is important.

[mmcc54]

as you can see, that is on the high end of normal, another potential indicator of blood loss somewhere. getting her seen quickly is important.

[mmcc54]

HI! So the GI said he wasn't 100 percent convinced she has celiacs..because only her IgG test was pos and her IgA was normal...I thought a positive was a positive? Idk! Shes scheduled for a biopsy on Tuesday...he also said her blood work results weren't awful at all and I shouldn't be too worried...if he said he wasn't convinced she had celiacs..why would he reccomned a biopsy on a baby?! Do they also check for other things?

[powerofpositivethinking]

sometimes it helps me to hear others say, I can understand your frustration.  I am not IgA deficient, but the only test that was positive for me was the DGP IgG, and it was a strong positive.  I had the endoscopy done, and it was negative, but even the doctor said the damage could have been farther down.  In the article Spectrum of gluten-related disorders of which Dr. Green and Dr. Fasano were contributors it lists celiac being diagnosed if 4/5 criteria are met:

Open Original Shared Link

1. Typical symptoms of celiac disease

2. Positivity of serum celiac disease IgA class autoantibodies at high titer 

3. HLA-DQ2 and/or HLA-DQ8 genotypes

4. Celiac enteropathy found on small bowel biopsy

5. Response to a GFD

The DGP IgG test has the highest specificity of any of the celiac tests with a 99-100 percent accuracy according to the World Gastroenterology Celiac Guidelines as found on p. 12 of this report Open Original Shared Link

Yet, the Fasano/Green article says the antibodies have to be IgA based   IgA antibodies are concentrated in the GI tract and make-up about 10-15% of the bodies immunoglobulin.  IgG antibodies are the most abundant immunoglobulin in the body that account for 75-80% and are found in all bodily fluids.  With the current definition of celiac needing to create villi damage with the IgA antibodies, it doesn't seem to matter if you have an adverse reaction happening throughout the rest of your body with IgG antibodies if you're not IgA deficient 

I don't think the medical field has figured out what to do with positive IgG results in a person that is not IgA deficient, so you've got to take it into your own hands.  I think future research will lead to more clarification, but you don't want to wait for that future research for your daughter to feel better.  The EGD will be able to rule out others things like reflux and ulcers, and please make sure they take at least 6 tissue samples from her small intestine.  In the end even if the biopsy is negative a gluten-free diet is the only true test.  Good luck!

 

[nvsmom]

Show the GI the lab results you posted:

 

TSH: High 3.69 (range 0.34-3.00)

AST: High 54 (range 14-36)

Alkaline Phosphates: Low 179 (range 230-300)

Creatine: Low .5 (no range given)

CRP: Low .03 (no range given)

MCH: Low 26.8 (range 27-33.5)

Platelets: High 502 (range 140-350)

neutrophils relative: Low 11 (range 13-33)

lymphocytes relative: High 86 (range 46-86)

lymphocytes absolute: High 8600 (range 2185-6045)

Ab, IgG: high 16.1 Positive if over 6

IgA: Negative 1.2

 

I'm assuming you copied it directly and didn't leave off any words or letters, but do you know the normal reference ranges? I guessed that last one was a total serum IgG and it was negative because it was below the normal reference range.  If I guessed right, then it would be almost impossible for her to have a positive tTG IgA test.

 

Doctors like to call the biopsy the "gold standard" of celiac disease testing. That notion is slowly passing but many doctors cling to it.  He probably wants further proof before he recommends the "difficult and hard to follow gluten-free diet" for her. 

[GottaSki]

Show the GI the lab results you posted:

 

TSH: High 3.69 (range 0.34-3.00)

AST: High 54 (range 14-36)

Alkaline Phosphates: Low 179 (range 230-300)

Creatine: Low .5 (no range given)

CRP: Low .03 (no range given)

MCH: Low 26.8 (range 27-33.5)

Platelets: High 502 (range 140-350)

neutrophils relative: Low 11 (range 13-33)

• lymphocytes relative: High 86 (range 46-86)

lymphocytes absolute: High 8600 (range 2185-6045)

Ab, IgG: high 16.1 Positive if over 6

IgA: Negative 1.2

 

I'm assuming you copied it directly and didn't leave off any words or letters, but do you know the normal reference ranges? I guessed that last one was a total serum IgG and it was negative because it was below the normal reference range.  If I guessed right, then it would be almost impossible for her to have a positive tTG IgA test.

 

Doctors like to call the biopsy the "gold standard" of celiac disease testing. That notion is slowly passing but many doctors cling to it.  He probably wants further proof before he recommends the "difficult and hard to follow gluten-free diet" for her. 

 

Hi Again MMCC!

 

I hadn't seen when you posted these results.

 

Elevated Platlets, TSH, Liver Enzymes and increased lymphocytes are all indicative of Celiac Disease -- they can be caused by things other than Celiac Disease, but together with a positive tTG IgG it certainly points towards celiac disease.  I agree with Nicole -- many doctors will not diagnose prior to the endo -- which was the "gold standard" for a very long time.

 

Hang in there

[powerofpositivethinking]

 

TSH: High 3.69 (range 0.34-3.00)

AST: High 54 (range 14-36)

Alkaline Phosphates: Low 179 (range 230-300)

Creatine: Low .5 (no range given)

CRP: Low .03 (no range given)

MCH: Low 26.8 (range 27-33.5)

Platelets: High 502 (range 140-350)

neutrophils relative: Low 11 (range 13-33)

lymphocytes relative: High 86 (range 46-86)

lymphocytes absolute: High 8600 (range 2185-6045)

Ab, IgG: high 16.1 Positive if over 6

IgA: Negative 1.2

 

on the other thread you listed these:

Tiss Transglutam AB, IgG 16.1 (over 9 pos)

Tissuse transglutaminase IGA AB <1.2

 

Is the first part I underlined actually the same tests you were referring to as the second underlined section, or is it two sets of completely different tests?  The difference I notice is that one over 6 is positive the other is over 9.   Can you clarify?  I'm just trying to figure out if all four of these tests were for Tiss Transglutam or if the first two tested the control/immunoglobulin levels.  

[GottaSki]

Is the first part I underlined actually the same tests you were referring to as the second underlined section, or is it two sets of completely different tests?  The difference I notice is that one over 6 is positive the other is over 9.   Can you clarify?  I'm just trying to figure out if all four of these tests were for Tiss Transglutam or if the first two tested the control/immunoglobulin levels.  

 

I believe these are the same two tTG antibody tests...if they were total serum they would have much different ranges/results.

[mmcc54]

Is the first part I underlined actually the same tests you were referring to as the second underlined section, or is it two sets of completely different tests?  The difference I notice is that one over 6 is positive the other is over 9.   Can you clarify?  I'm just trying to figure out if all four of these tests were for Tiss Transglutam or if the first two tested the control/immunoglobulin levels.  

Hey sorry the first was a typo on my part it is in fact over 9 is pos!

[powerofpositivethinking]

got it 

 

mmcc54, 

 

I would agree with GottaSki from the other thread and request while at the EGD:

 

Total IgA serum test to see if she makes enough IgA for her ttg IgA result to be considered valid

DGP IgA/IgG test

 

good luck on Tuesday!!

 

 

 

I believe these are the same two tTG antibody tests...if they were total serum they would have much different ranges/results.

 

 

Hey sorry the first was a typo on my part it is in fact over 9 is pos!