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Dr. Thomas, MD
Dr. Thomas, MD, Board Certified Physician
Category: Medical
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Experience:  Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
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My first blood test was RBC Morph Normal. WBC 11.6, Platelets

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My first blood test was RBC Morph Normal. WBC 11.6, Platelets 111, MPV 11.3 (Seg Neutrophil 67%, Lymph 15%, Mono 11%, Eosin 6%, Baso 1%), Neutrophil 7.8, Monocytes 1.3, Eisonophil 0.7 were all indicated as being high. My second blood test was RBC Morph Normal but now Giant Platelets were noted as being present. WBC 13.5, Platelets 116, MPV 11.1 (Seg Neutrophil 75%, Lymph 16%, Mono 4%, Eosin 5%, Baso 0%), Neutrophil and Eosinophil were indicated as high again, at 10.1 and .7 respectively. My third blood test came back with RBC Morph Abnormal. Giant Platelets still present, Microcytes 1+ and Macrocytes 1+, WBC 13.6, Platelet 111, MPV 11.3 (Seg Neutrophil 78%, Lymph 14%, Mono 6%, Eosin 1%, Baso 1%), and only Neutrophils were indicated as being high at 10.6. This testing has been over the course of two months. I have taken a liver, Kidney and Hepatitis panel and they all came back as negative/good. I have been experiencing diarrhea after eating Pasta/wheat so I requested to begin testing for Celiac Disease. My first and only test so far is the Anti Tissue Transglutaminase IgA Ab and my value came back at 3.6 which indicates negative. All of this testing began because I was extremely fatigued for almost two weeks. I have been extremely stressed and worrying about what is giving me a high WBC and an upset stomach is not helping. I truly feel like I have some sort of gluten intolerance or Celiacs but the testing so far has not indicated that directly. I really have not gotten a thorough explanation of what my blood panel numbers could indicate and I was hoping you would be able to lead me in the right direction. I am 25 years old and I have had consistent bowel movements my entire life until a month or two ago. I am genuinely baffled and it seems so are my Doctors. I am hoping to find further insight here. Thank you!
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. Thomas, MD replied 1 year ago.
Hello
Welcome to JA
Please take your last results, most recent, and put in the lab reference ranges
Customer: replied 1 year ago.
Reference Ranges are as follows: WBC 3.5 -11.0, Platelet Count 150-400, MPV 7.4-10.4, Neut 1.5-7.5, Lymp 1.0-4.0, Mono 0.2-0.8, Eosin 0.0-0.5, Baso 0.0-0.2. I forgot to add previously that the rest of my CBC was normal all three times (RBC, HGB, HCT, MCV, MCH, MCHC, and RDW).
Expert:  Dr. Thomas, MD replied 1 year ago.
OK
What is the hemoglobin
Customer: replied 1 year ago.
First test was 13.6, Second 13.5, and third is 14.2. Reference Range is 11.0-15.0 G/DL
Expert:  Dr. Thomas, MD replied 1 year ago.
OK
The platelets are clearly low.
The other labs are non-descript.
Not out of bounds enough to really be concerning.

This set of findings is not specific but some of the things that need to be considered are

ITP..idiopathic thrombocytopenic purpura....this would ultimately cause bruising and other symptoms.
Lupus [no symptoms]
Myeloproliferative and lymphoproliferative disorders [your test does not really fit the picture on these as I said].
Rare hereditary problems.

What I would suggest at this point is seeing a hematologist to see if further testing is warranted.

ITP is the most common and is treated with prednisone.

Let me know if you have further questions.

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Customer: replied 1 year ago.
I am actually waiting for a referral for a hematologist to come through. Hopefully I receive that tomorrow. Do you think there is a possibility for Celiacs? Before the third and most recent blood test I cut down on gluten/wheat a lot. I just knew the adverse reactions I was having to eating it and I just couldn't force myself to eat those foods. I have heard that if you are not eating Gluten before the test I took that it affects the results, is this true? I have an blood work order to go in tomorrow for a different Celiacs test as well as an allergy panel. Should I force myself to eat some wheat tonight? I have also found mucus on toilet paper recently and I have a tiny bit of eczema on my fingers. I just really want the diarrhea/upset stomach/ill feelings to stop. I put off eating for so long throughout the day and I'm not even hungry because the thought of food makes me not pleased. Do any of these symptoms/issues tied with my CBC relate to anything else?
Expert:  Dr. Thomas, MD replied 1 year ago.
I think celiac would give you low iron and anemia.
Possible, but not commonly.
You don't need to eat wheat..you would still have the anti-bodies if you have it.

Allergy can cause a lot of your findings.
Not typically the platelets.

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Customer: replied 1 year ago.
Okay, so allergies seem like a possibility. Yes, the platelets. I am also wondering about why my RBC Morph is Abnormal now. What does the 1+ Microcytes and 1+ Macrocytes indicate? What could cause the difference in results from my previous two tests so quickly?

Also, in my research on Celiacs testing I found this: http://americanceliac.org/celiac-disease/diagnosis/ . There is a section on this page entitled " What are the different antibody tests available? Can there be errors in testing?". In this section they state that "An inexperienced lab can misread the anti-endomysial IgA test, which requires someone to read a slide through a special microscope. It is possible that a celiac patient could have a positive antibody test at one lab, and a negative test at another. This is because different labs may use different commercial test kits, which vary in their sensitivity and specificity. And lastly, a person has to be ingesting gluten at the time the antibodies are drawn. A gluten-free diet will make the antibody tests negative." This is what indicated me to believe that my lack of wheat consumption affected the results; Are you sure that I would still have the antibodies if I didn't eat wheat? I just really want to make sure that I am getting accurate results and don't receive false negatives.
Expert:  Dr. Thomas, MD replied 1 year ago.
! + of both is also non descript..it means they say a trace of variability in the Red cells
With a normal hemoglobin, it is not really meaningful...

If your celiac panel is all negative, including gliadin, then that is pretty definitive.
If the antibodies at all are positive, then you might have gluten sensitivity, overt celilac has to be determined by biopsy.
No the antibodies would be steady.
Gluten free will not make the antibody tests negative for a long time, if ever.
The gliadin is still going to be positive.
You have not been gluten free long enough to get negatives.

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Customer: replied 1 year ago.
Okay thank you for the explanation on the RBC. The only celiac test I have taken so far is the Anti Tissue Transglut IGA. I believe that that test does not include gliadin, is that correct? My next blood test is an Endomysial AB. Does that include gliadin? Will that give me more definitive results? What test should I ask for to make sure I am thoroughly ruling out Celiacs?
Expert:  Dr. Thomas, MD replied 1 year ago.
That is correct, gliadin is separate.
And it is separate from the endomysial AB.
Gliadin is the most sensitive and most false positives.

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Customer: replied 1 year ago.
Okay, Thank you. XXXXX should follow through with an allergy panel and the Endomysial AB and go from there. Could allergies be the sole cause for the abnormal stool and mucus? Also, if it's not allergies or Celiacs what would be the next logical thing that could be causing this. If I go to a hematologist, would they be able to pinpoint exactly what this is, if not allergies?
Expert:  Dr. Thomas, MD replied 1 year ago.
No just get all the celiac.
If positive correcting this would correct a lot of food allergies.
Allergies might cause abnormal stool and mucus.
The hematologist is a next step regardless, especially with these platelets.
Sometimes even a bone marrow is necessary to pinpoint what is going on.
Probably not in this case.

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Customer: replied 1 year ago.
Thank you very much for all of your answers and being patient with me. You have definitely helped me figure out almost everything I want to know. I just want to also ask if you if the low platelets is something I should overall be seriously concerned about? As in, is it extremely serious? Once again, thank you very much for your explanations and answers.
Expert:  Dr. Thomas, MD replied 1 year ago.
The platelets are not seriously low at this point.
I would not be concerned unless under 100
And not very concerned unless under 50.

You are welcome

Anytime

Any questions.

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Dr. Thomas, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 55960
Experience: Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
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