Today, I noticed that my thorough blood testing results were posted to my patient portal. It did say that it was entered by my doctor (if I am understanding their notation properly), so I’m assuming he has actually looked at them. However, I suppose a nurse or medical assistant could also be adding them on to previously existing notes that have his name on them.

The results I’m about to talk about are just an observation from the report, and have not actually been interpreted by my doctor.

There were two abnormal test results. There were also two test results that equaled the number at the low end of the normal range. (These four tests are marked with red on the chart below.)

Here are the full test results (range is in the same units/magnitude as the results):

Test Name	Result	Normal Range
CBC w/ Platelets & Differential
Immature Grans (Abs)	0.0 x103 / uL	0.0-0.1
Immature Granulocytes	0%	(normal)
Basophils (Absolute)	0.1 x103 / uL	0.0-0.2
Eosinophils (Absolute)	0.5 x103 / uL	0.0-0.4
Monocytes (Absolute)	0.6 x103 / uL	0.1-0.9
Lymphocytes (Absolute)	3.6 x103 / uL	0.7-3.1
Neutrophils (Absolute)	4.3 x103 / uL	1.4-7.0
Basophils	1%	(normal)
Eosinophils	5%	(normal)
Monocytes	7%	(normal)
Lymphocytes	40%	(normal)
Neutrophils	47%	(normal)
Platelets	324 x103 / uL	150-379
RBC (red cells)	4.56 x106 / uL	3.77-5.28
RDW (distribution width)	12.7%	12.3-15.4
MCHC (mean corpuscular hemoglobin concentration)	33.2 g/dL	31.5-35.7
MCH (mean corpuscular hemoglobin)	30.0 pg	26.6-33.0
MCV (mean corpuscular volume)	91 fL	79-97
Hematocrit	41.3%	34.0-46.6
Hemoglobin	13.7 g/dL	11.1-15.9
WBC (white cells)	9.1 x103 / uL	3.4-10.8
Comprehensive Metabolic Panel
ALT (alanine amino transferase)	21 [iU]/L	0-32
AST (aspartate amino transferase)	19 [iU]/L	0-40
Alkaline Phosphatase	46 [iU]/L	39-117
Bilirubin, Total	0.2 mg/dL	0.0-1.2
A/G Ratio (albumin/globulin)	1.9	1.1-2.5
Globulin, Total	2.1 g/dL	1.5-4.5
Albumin, Serum	3.9 g/dL	3.5-5.5
Protein, Total, Serum	6.0 g/dL	6.0-8.5
Calcium, Serum	8.7 mg/dL	8.7-10.2
Carbon Dioxide, Total	22 mmol/L	18-28
Chloride, Serum	104 mmol/L	96-106
Potassium, Serum	4.1 mmol/L	3.5-5.2
Sodium, Serum	141 mmol/L	134-144
BUN/Creatinine Ratio	13	8-20
BUN (blood urea nitrogen)	11 mg/dL	6-20
Creatinine, Serum	0.88 mg/dL	0.57-1.00
eGFR (estimated glomerular filtration rate)	91 mL/min/1.73	greater than 59
Glucose, Serum (fasting)	81 mg/dL	65-99
Other Tests
Phosphorus, Serum	4.1 mg/dL	2.5-4.5
TSH (thyroid stimulating hormone)	2.440 uIU/mL	0.450-4.500
Magnesium, Serum	2.0 mg/dL	1.6-2.3

That took a lot more typing than I necessarily expected it to… wow!

Anyway, as you can see, my eosinophils and lymphocytes are both elevated, and my protein and calcium are on the extreme low end of the “normal range” (they both equal the number used to denote the low end of the range).

So, what do these things mean?

Well, since I haven’t spoken to my doctor, I can’t actually tell you with 100% certainty. The best I can do is relay the information I’ve found online.

Elevated eosinophils = eosinophilia; elevated lymphocytes = lymphocytosis.

I can’t say I’m 100% surprised that my eosinophils are elevated; I do have eosinophilic esophagitis after all. The lymphocytosis was a bit more of a surprise, however.

Potential Causes for Eosinophilia (from Mayo Clinic & Lab Tests Online)

• Parasitic and fungal diseases
• Allergies (including to medications or food)
• Asthma
• Adrenal conditions
• Skin disorders; inflammation of the skin
• Toxins
• Autoimmune diseases
• Endocrine disorders
• Tumors/Cancer
• Inflammatory disorders
• Hypereosinophilic myeloid neoplasms

Examples of Specific Conditions That Could Cause Eosinophilia

• Acute myelogenous leukemia (AML)
• Ascariasis (a roundworm infection)
• Churg-Strauss syndrome
• Cholecystitis (gallbladder inflammation)
• Eosinophilic esophagitis
• Eosinophilic leukemia
• Hodgkin’s lymphoma
• Hypereosinophilic syndrome (HES); also idiopathic HES
• Lymphatic filariasis (a parasitic infection)
• Ovarian cancer
• Primary immunodeficiency
• Trichinosis (a roundworm infection)
• Eczema
• Dermatitis
• Celiac disease
• Inflammatory bowel disease (IBD) (like Crohn’s Disease or Ulcerative Colitis)

Potential Causes for Lymphocytosis (from Mayo Clinic & Lab Tests Online)

• Acute viral infections
• Some bacterial infections
• Cancer of the blood or lymphatic system
• An autoimmune disorder causing ongoing (chronic) inflammation

Examples of Specific Conditions That Could Cause Lymphocytosis

• Lymphocytic leukemia, acute or chronic
• Cytomegalovirus (CMV) infection
• HIV/AIDS
• Epstein-Barr Virus (EBV); Mononucleosis
• Hepatitis
• Chicken Pox
• Herpes
• Rubella
• Tuberculosis (TB)
• Vasculitis
• Pertussis (whooping cough)
• Lymphoma

The low-ish levels of protein and calcium were surprising to me. I try to get enough protein in my diet, and I definitely wouldn’t expect low calcium due to my diet. Out of all of the blood tests, these were the levels I was probably the least concerned about!

Low Protein Level (from Lab Tests Online)

• A low total protein level can suggest: a liver disorder, a kidney disorder, or a disorder in which protein is not digested or absorbed properly.
  • Low levels may be seen in severe malnutrition and with conditions that cause malabsorption, such as celiac disease or inflammatory bowel disease (IBD).
• Certain drugs can also cause a low protein level, such as estrogens and oral contraceptive (birth control pills).

After reading the part about the pill possibly causing low protein, I’m not quite as surprised as I was initially. I take an estrogen birth control pill, and I have taken it for about 8 years now, due to ovarian cyst issues. However, I am not a vegetarian/vegan, and I eat some sort of meat at least once a day (usually). I also drink Ensure Original every single day, which contains 9 grams of protein per serving (18% of recommended daily value for a 2000 calorie diet). I will have to ask my doctor what he thinks about that, and if there is anything I should do about it. My guess is, he may suggest switching which Ensure I drink, or switching to a different drink product.

Low Calcium Level (from Lab Tests Online)

• The most common cause of low total calcium is:
  • Low blood protein levels, especially a low level of albumin
    • These can result from liver disease or malnutrition
    • Low albumin is also very common in people who are acutely ill
• Some other causes of hypocalcemia include:
  • Underactive parathyroid gland (hypoparathyroidism)
    • Inherited resistance to the effects of parathyroid hormone
  • Extreme deficiency in dietary calcium
  • Decreased levels of vitamin D
  • Magnesium deficiency
  • Increased levels of phosphorus
  • Acute inflammation of the pancreas (pancreatitis)
  • Renal failure

Well, I do not have a low albumin, but I do have a fairly low protein level (though still in the normal range); I am not entirely sure if these two things could be related. The Ensure Original also has 30% daily value of calcium, and I try to drink at least one glass of milk most days. I also eat one Babybel cheese wheel most days, and I eat cheese on the days I am allowed to… I have a bit of a dairy love, so I don’t think my diet is lacking in calcium. Oh, and the margarine I buy is Country Crock Plus Calcium. Yup, I really don’t think my diet is entirely responsible for the low calcium level.

As for some of the other potential causes of low blood calcium:

• My dad has (had?) Grave’s Disease, and they ended up killing his thyroid (or something similar; he has to take artificial thyroid now). I have had my thyroid levels checked frequently, and the TSH levels in this latest test is normal. However, I have no idea what, if any of this, is related to the parathyroid gland – I may need to see about having this tested (possibly again).
• My magnesium levels are pretty much right in the middle of the normal range, so I doubt that is it.
• My phosphorous is towards the high end of the normal range, but I wouldn’t expect it to really impact the calcium. However, since both levels are technically in the normal range, these may be related. If he suggests that my calcium is low and I should do something about it, then I’ll ask about my phosphorous levels.
• I have not had my vitamin D levels checked recently (at least not that I recall) but I have had tests before that have shown a low vitamin D level; now that it’s winter it may not be a bad idea to get these retested. I have taken vitamin D supplements before, for mood and fatigue, and they did seem to help me feel a bit better. This could very well be the cause of the low-ish calcium.
• All the kidney tests in the blood panel show that I do not have renal failure. I do not believe I have ever had my pancreas checked, but it may have been looked at in a fairly recent abdominal ultrasound my doctor had performed.

I am a little concerned about what could be causing these four numbers to be a little out-of-whack, especially the lymphocytes. Actually, I’m very concerned about the lymphocytes. I have been spending the day trying not to worry about the numbers, and what they may mean, but the lymphocytes are quite concerning. I probably wouldn’t be quite as worried if my main symptoms (fatigue, pain, etc) couldn’t also be cancer symptoms… yes, I realize everything points to cancer if you Google it, but I recently had a friend die from cancer (I don’t know what kind) that was discovered simply because he found it odd he couldn’t finish his entire Chipotle burrito. All over pain and severe, constant fatigue are definitely far more indicative of something that could be quite serious than not being able to eat the last two bites of your burrito. However, since my doctor didn’t call me, I’m trying to reassure myself that it’s nothing serious. (He is a good enough doctor that I trust he would call me if the results were overly concerning, instead of waiting for the follow-up appointment.)

My follow-up with my GI, the doc that ordered these tests, is on January 6th. However, I do have an appointment with a dietitian on December 27th. The dietitian works in the same medical group, and my GI said that he would make my chart visible to her (or at least send her a note with some of my most recent information on it). I’ll print out a copy of these blood tests, however, to take with me just in case she can’t see them. Since managing diets to make sure the patient is getting adequate nutrition is a large part of a dietitian’s job, she will probably have some ideas about the protein and calcium, if nothing else.

Dan and I are also glad that I have blood tests showing an abnormal eosinophil count (since those are allergic cells) because I have an appointment with National Jewish Health – Immunology on January 23rd. National Jewish is one of the nation’s leading hospitals for immune disorders (specifically allergies and asthma), so I’m very excited that they were willing to take my case (on the recommendation of my ENT). My appointment is primarily to check for MCAS, since I believe I have it but my ENT/allergist doesn’t know anything about it. Now, however, I’m wondering if it’s MCAS or some other sort of complex allergy condition caused by eosinophils. At least I’ll be going to the right place to hopefully figure out my complex allergies, if I actually have asthma or not, and if I have any other sort of complicated immunology thing going on!

Keep your fingers crossed for me that nothing is horribly wrong! (Comments of support are always welcome and always greatly appreciated!)

Have any of you experienced levels like this? What did your doctors say about them? Did you figure out what was wrong, and if so what was it?