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Non IBD kid lab results

Clash

Clash

So I was able to look at J's lab results,. This was the doctor notation:

vitmain b12 def
supplement with weekly shots for 8 weeks then monthly (or nascobal)
she should have an egd and colonoscopy. she has diarrhea and a family history of Crohn's. Ileitis is possible.
Click to expand...
So I have a few pages of results but wanted to list the ones I see on here most often as well as the High and Low ones. So here goes:

WBC - 4.8 (3.4-10.8)
RBC - 4.44 (3.77-5.28)
HGB - 13.7 (11.1-15.9)
HCT- 43.4 (34.0- 46.6)
MCV- 98 (79-97) High
GLUCOSE(SERUM) - 115 (65-99) High
AST - 20 (0-40)
ALT - 10 (0-32)
TIBC - 359 (250-450)
UIBC - 189 (150-375)
IRON(SERUM) - 170 (35-155) High
IRON(SATURATION) - 47 (15-55)
B12 - 111 (211-946) Low

So a few questions, her glucose being high, could that be from eating or drinking before the test?

What would cause the iron serum to be high?

And why is with her HGB being where it is the nurse would say it wasn't significant anemia, looks normal to me. And that number was also C's exact number on his lab work with rheumy and she noted slight anemia, what is that all about?

So any thoughts?

Anyone one one throw out some ideas of what else could cause b12 deficiency?

If there are other results anyone's wants to know about just ask, I have them just didn't post them all. Thanks in advance guys.

Oh and this doc usually uses movieprep but I requested Miralax, right choice?
 
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Catherine

Catherine

Moderator
Do you have a ferritin level? Or folate?

Glucose maybe needs to repeat with next bloods as a fasting test. Yes it is effected by food.

Serum Iron is unreliable, varies due to time of day.
 
Catherine

Catherine

Moderator
If HCT is high due Dehydration which is one cause. This could mean that the haemoglobin level is not an high as it is testing.
 
Clash

Clash

I asked why they didn't test ferritin and she said they will usually test ferritin if the HGB(i think) comes back low. She asked for my reasoning wanting it tested and I explained C's labwork showing low normal HGB but low ferritin. She said she'd ask if I wanted it tested but I didn't know if it would make a difference or not with a colonoscopy/endoscopy coming up. Should I?

J said she had a biscuit and two Mt. Dew before going for the test so maybe that would affect it? I'll get our GP to run a fasting one how long should I wait before testing again?

Thanks for all the info.
 
Clash

Clash

I'm so sorry that was wrong that should read

MCV 98 High 79-97

HCT 43.4. 34.0-46.6

Sorry! I'll edit the OP too!
 
FrozenGirl

FrozenGirl

Glad your doc is serious about finding the cause given family history. The WBC,RBC and haemoglobin are goods signs as anemia is common. The rest I'm no use on but I hope all goes well.

Ps I have heard Miralax is much more tolerable.
 
Maya142

Maya142

Moderator
Staff member
M has only done Miralax and had no problem with that. I've heard people say that it's the easiest one.
According to Medscape, the high MCV would be in line with the B12 deficiency:
The common causes of macrocytic anemia (increased MCV) are as follows:[3]

Folate deficiency anemia
Vitamin B12 deficiency anemia
Liver disease
Hemolytic anemias
Hypothyroidism
Click to expand...
We were also told the same thing about hemoglobin, that being dehydrated would make it appear higher. The range is different for males and females, which is why 13.7 might be on the low side for C but ok for J.
 
Clash

Clash

I knew there were differences in the norms by gender but they were both in the normal ref range yet both of their docs said slight anemia. That just doesn't make sense to me.
 
Maya142

Maya142

Moderator
Staff member
That is sort of weird. M's is usually 11.6 or so, and her doctors don't get concerned unless it's in the 9-10 range.
 
Clash

Clash

Exactly! That is how C's GI was, the doc that stated slight anemia with normal number was the rheumatologist. Baffles the mind some times.
 
Catherine

Catherine

Moderator
I think they are talking about mild B12 anemia.

MCV is normally high with B12 anemia
MCV is normally low with IDA anemia

You can't work out whether there is a problem with iron levels without the ferritin.

I don't think there any hurry about having the glucose re-test but they should be retesting the B12 levels in a couple of months. I would test at next blood draw and get ferritin as well.

Do you have Vitamin D?
 
Sascot

Sascot

Lab results always manage to confuse me. As for the Moviprep, it was a good idea to choose a different one - it is truly awful to drink! I found it quite hard on the system too. Hope the colonoscopy gives some solid answers. Maybe they could draw blood while she's under anaesthetic and test the ferritin then?
 
Clash

Clash

Spoke with GI nurse again today, because we have still not received the px with coupon for the vitamin b12 nose spray. I asked if her level was deemed slight deficiency in regard to her vitamin b12 number. She said the normal range was wide and there was a lot of controversy about what the optimal and low level should be. This GI seems to be of the opinion that US low normal range is too low and the GI nurse mentioned other courntries haven raised their low to the 500's. Regardless, he feels in J's case her level coupled with easy bruising, fatigue and something else I cant recall deems her severely deficient. The colonoscopy and endoscopy will be scheduled as well as some other tests about b12.

The nurse stated that the GI thought the shots best for J bit he also wanted compete compliancy so he would allow her to trial the prescription nasal stuff and monitor.

She wasn't detailed in all the aspects of what could cause this but said if they could not determine a bowel cause she would be directed to other specialists. All I know for now
 
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Catherine

Catherine

Moderator
B12 what I remember from reading here.

David believes the B12 range is way too low. I think Japan has increased what they consider low.

I do feel better personally when my B12 level is higher.

A lot of doctors recommend to supplement the other B vitamin by using a B Multi when taking B12 supplements. Something about its not goods to supplement only one B.

"Two steps are required for the body to absorb vitamin B12 from food. First, hydrochloric acid in the stomach separates vitamin B12 from the protein to which vitamin B12 is attached in food. After this, vitamin B12 combines with a protein made by the stomach called intrinsic factor and is absorbed by the body. Some people have pernicious anemia, a condition where they cannot make intrinsic factor. As a result, they have trouble absorbing vitamin B12 from all foods and dietary supplements"


http://ods.od.nih.gov/factsheets/VitaminB12-Consumer/
 
Tesscorm

Tesscorm

Moderator
Staff member
Just sending hugs... I hope you get answers and firm plans soon for both C and J. :ghug: :ghug:
 
David

David

Co-Founder
Location
Naples, Florida
With a family history of Crohn's, diarrhea, and B12 level of 111, I am concerned. Sure, there are other possible causes of B12 deficiency ranging from pernicious anemia to SIBO, but Crohn's has to be the top suspect I'm afraid.

Clash said:
Regardless, he feels in J's case her level coupled with easy bruising, fatigue and something else I cant recall deems her severely deficient. The colonoscopy and endoscopy will be scheduled as well as some other tests about b12.
Click to expand...
Easy bruising? What was the platelet level?

Clash said:
said she had a biscuit and two Mt. Dew
Click to expand...
That needs to stop. It's time to educate J about the importance of a healthy diet. With that kind of crap diet, I guess I have to ask if they are consuming any food that even contains vitamin B12? Vegans, some vegetarians, and people on absurdly terrible diets can become deficient in B12.
 
Clash

Clash

David
Easy bruising? What was the platelet level?
Click to expand...
Platelets, nurse said they were lower end of normal at 180 not low is 150.

That needs to stop. It's time to educate J about the importance of a healthy diet. With that kind of crap diet, I guess I have to ask if they are consuming any food that even contains vitamin B12? Vegans, some vegetarians, and people on absurdly terrible diets can become deficient in B12.
Click to expand...

This isn't J's usual diet fare. Most of what she eats is veg and chicken with beef and pork coming in 2nd and third. I would have to say that there is a lot more poultry in her diet than other meats. She is also a food tracker for a healthy fit thingy with her roomie. But as of late(last few weeks) she has no energy, so any early morning activities have resulted in her using caffeine or sugar in hopes to get going. I'm not saying her diet is great she does enjoy froyo and refuses water for these weird lemon water things. But she's not a big processed snacky kid, it was never an option as a kid because she played travel ball and so it was fruit and nuts and seeds to prevent them from loading up on chips and sweets between games.

She went through the whole pizza every night because I'm a college freshman phase but burnt out fast. She also use to love any type of spicy, Mexican, Indian, Thai but can't tolerate anymore.
 
Clash

Clash

Also she reminded me today she has been eating these gummi vitamin things. I told herb to check the vitamin b12 level because she has been eating them since the first of the year. And literally in the beginning I had to scold my 20(at the time) year old daughter to only eat recommended dose as the child craved them!

But I doubt they are high in b12, right? Because don't most people take a b12 stand alone supplement?

Edit to add:

Just looked them up 10mcg what ever that means.
 
David

David

Co-Founder
Location
Naples, Florida
I'm glad that's not her normal diet. :)

While many multi-vitamins aren't going to be high in B12, they're usually going to have enough for a healthy person with a normal diet. We don't need all that much and a healthy body does an outstanding job of storing B12 for times of famine. Having a B12 of 111 means something is very off I'm afraid. Hopefully it's not Crohn's and something easier to deal with, but I'm concerned.
 
Clash

Clash

I'm concerned too. I looked on a couple of medical sites for causes of vitamin b12 deficiency and most have to do with the digestive tract. I just wonder if there are things outside of that?

I know this sounds horrible but CD is the monster I know, kwim.
 
Clash

Clash

Thanks David and just for reference is poultry a good source of b12? Because that is most always her meat source for every meal.
 
David

David

Co-Founder
Location
Naples, Florida
The best reason to have B12 deficiency is due to improper diet as that is very easy to remedy. Beyond that, it is usually not due to inadequate intake but malabsorption. Issues like pernicious anemia are the easiest to deal with as they can be remedied by supplementation. Beyond that, you get into issues like Celiac and Crohn's disease. Celiac is obviously preferred over Crohn's. There are other potential causes such as AIDS and pancreatic insufficiency, but in this case, as you say, the monster we're going to suspect the most is Crohn's :(

*hugs*
 
David

David

Co-Founder
Location
Naples, Florida
Clash said:
Thanks David and just for reference is poultry a good source of b12? Because that is most always her meat source for every meal.
Click to expand...
It doesn't have much, but it does have some. The link I provided and this one http://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/#h3 contain numbers for some sources of B12.

The thing is, with just those gummy vitamins and the chicken, the statistical probability of her ending up with a B12 level of 111 due to insufficient intake alone is pretty much 0 :(
 
David

David

Co-Founder
Location
Naples, Florida
I should add that I've read that Diabetes mellitus can potentially lead to B12 deficiency. However, it's not something I know much about. I don't know if her elevated blood glucose could be an indicator there, but it may be worth researching. I can't comment further on it as I'm not well-educated on it, sorry :(
 
Clash

Clash

I just read through the first link I'm assuming they are including Crohns under the malabsorption syndromes as I don't see it mentioned else where.

I had h. pylori and gastritis from it. I'm really hoping we are dealing with that but the GI said that wouldn't cause these bouts of D and her blood work came back negative. I'm still going to ask that he test a stomach biopsy for it though.

I guess I will know more soon enough, I appreciate the links, I think I may forward the sources info along to J so she can see how diet plays a role in vitamin intake.
 
DustyKat

DustyKat

Super Moderator
I’m sorry I haven’t had time to thoroughly read through your threads Clash so I apologise if I am repeating what has already been said.

I agree with having a fasting blood glucose done. I would also request a Schilling test be done to to gauge if the body is absorbing B12.

I see that the GI issues are being pursued and with one child already diagnosed with an autoimmune disorder then I think it won’t hurt to stray from the IBD path and rule in or out other autoimmunes such as Diabetes and Pernicious Anaemia.

Dusty. xxx
 
Clash

Clash

Dusty, the forum wiki says the shilling test has largely been replaced by another, something to do with intrinsic factor and parietal cells? What exactly is pernicious anemia?

I know absolutely nothing about diabetes except one is genetic and the other isn't? I have no one on either side of the family with the genetic one. I do have a half brother that has the non genetic one, the doc said due to obesity but he has since lost weight and now does not require meds or considered diabetic.

How would I know what are risks for the non genetic one besides obesity? J is 5'7" and 121 lbs. Or was at the doc week before last.

This is all so confusing.

He had one normal bm today, vomited after lunch and had D this afternoon. She says she doesn't feel bad, no fever, pain or anything. It's really hard to gauge fatigue because of the hours she keeps and living the college life. She has said that she no longer sleeps through the night but starts waking up every hour starting about 4am, not that that relates to anything!ha!
 
Maya142

Maya142

Moderator
Staff member
Clash, have you asked her about back pain or stiffness? The reason I ask is that her sleeping schedule sounds like both my daughters' and waking up in the early hours of the morning is typical with SpA.

My older daughter had gotten so used to stiffness that once she started a biologic she could not believe how good she felt. Being stiff had become her "normal" and so she never complained about it.
 
Catherine

Catherine

Moderator
Pernicious anemia is now used to refer to any anemia caused by low B12.

But true Pernicious anemia is where the body cannot convert B12 into the useable form as the individual doesnot produce intrinsic factor.

This easily treated with life time B12 injections.
 
Catherine

Catherine

Moderator
M

Malice67

Catherine said:
I think they are talking about mild B12 anemia.

MCV is normally high with B12 anemia
MCV is normally low with IDA anemia

You can't work out whether there is a problem with iron levels without the ferritin.

I don't think there any hurry about having the glucose re-test but they should be retesting the B12 levels in a couple of months. I would test at next blood draw and get ferritin as well.

Do you have Vitamin D?
Click to expand...
I agree... anemia isn't always due to the iron. Good luck!
 
DustyKat

DustyKat

Super Moderator
Doh! Yes me using older terms re Schilling’s test. :redface:

Type 1 diabetes is early onset and results in complete loss of the ability to produce insulin and so insulin is required. It’s cause is thought to be a mix of genetics and environmental, much like all these auto-immune diseases. Grrrr.
Type 2 diabetes is mature age onset. It also often has familial tendencies and can be related to obesity but not always. Lifestyle for some can result in a reverse of the condition or many others will only require oral control. Some will progress to needing insulin.

Pernicious anaemia is normally referred to B12 deficiency due to a lack of intrinsic factor, which means you can’t obtain B12 when food is broken in the stomach. But a deficiency of B12 by any means will lead to Pernicious Anaemia if left untreated. This thread is very interesting and loaded with info:

Is pernicious anemia low vitamin B12 or Intrinsic Factor

Dusty. xxx
 
Clash

Clash

Ok so spoke with GP today and once the oscopies are done he"lo do the fasting blood test. He didn't seem to concerned and was actually calling to check on C and how the surgery consult went.

J still hasn't done the fc test, first schedule interfered now she hasn't had a bm for two days. We'll probably have the scopes done and results back before I can get this child to get a sample! Ha

She started classes today so I'm hope for an uneventful semester!
 
Clash

Clash

Soooo while I've had my hands full with C my daughter has skipped out on doing the FC test. She states she can't poo on schedule(refuses to store for the next day). I knew with her not being underfoot the test may be difficult to pin her down on but seriously!

She does now have her endoscopy/colonoscopy scheduled. It will be the 22nd at 7:30 in the morning. She isn't real happy with this whole process. I'm just ready to get it behind her so she'll stop complaining about it.
 
Sascot

Sascot

Ah the joys of kids. It took me over a month to get a stool sample off my 11yr old. She isn't regular either and seemed to forget to tell me she was going, or tell me on a Friday when GP is shut, or she just can't go with the little hat under her bottom :ybiggrin:. Finally managed yesterday.
Hope the scopes go okay!
 
Tesscorm

Tesscorm

Moderator
Staff member
It's a whole different set of issues when kids are older. :ack: Poor you, you've had a lot to deal with recently. :ghug:

Hope the scopes go smoothly!
 
Maya142

Maya142

Moderator
Staff member
:lol: The joys of young adults! Personally, I think they shouldn't be allowed to make any decisions until 25.
Hope the scopes go well!
 
Clash

Clash

So J is not feeling well.
She thinks she has fever(they've lost the thermometer!).
She has chills, aches all over.
She had one normal bowel movement then diarrhea.
It is her time of the month so she is cramping but says she has middle lower back pain.

I can't believe they can't find the thermometer and her roommates aren't home. She has taken something for the fever twice. She has such a bad habit of letting things go too far before getting checked out which always makes me twitchy.

She did do her nasal b12 yesterday, that couldn't play a role right?

I know this is most likely a virus but it seems I'm always waiting for the other shoe to drop!
 
CrohnsKidMom

CrohnsKidMom

I have heard that you can get diarrhea while having your period. It shouldn't be causing the other symptoms though! Hope your daughter feels better soon!
 
Maya142

Maya142

Moderator
Staff member
Both my daughters have diarrhea (or at least loose stools) with their period.
I hope it's just a virus (and that she gets a thermometer:lol:). Sending hugs!
 
Clash

Clash

She just texted, she didn't have the body aches and fever this morning and the headache was gone! She still has a bit of a backache.

She does get looser stools with her periods, I think it may have just been a perfect storm type of thing, something viral, her period and dehydration? That is what I am going with anyway.

Also, this last month she has started taking care of a toddler on her days off from school. And this kid has had something every week, the latest being hand, foot and mouth disease. So I think, it is similar to a new teacher and you pick up everything the little kids in your classroom have.
 
Clash

Clash

Ok, J had the endoscopy and colonoscopy yesterday morning.

Prep went well and the oscopies took no time at all. The doc came into recovery and said visually everything looked good and he was able to enter the TI. With the endoscopy he tested for celiac and though there was slight irritation in the stomach it wasn't enough he felt to warrant the symptoms she has been experiencing. He also tested for h. pylori. He took numerous biopsies. So hopefully the biopsies including those for celiac and h pylori will be back soon.

He said one he got the results back and went over everything then we could move forward with more testing if nothing came of these results.

The doctor's office called my daughter today while she was in class and they didn't leave a message. This has her somewhat anxious but I think it was probably a call to check and see how she was doing post endoscopy/colonoscopy. She is going to call them back in between classes.
 
kimmidwife

kimmidwife

Clash,It sounds like good news. I am glad to hear though I know that what the naked eye sees is not always what is actually going on. I will keep my fingers crossed. Oh and you are probably correct about the phone call our doctor always calls the next day to check up on Caitlyn.
 
Tesscorm

Tesscorm

Moderator
Staff member
Sorry for the late reply.... :eek: Glad all went smoothly but hope you get sme answers really soon! :ghug:
 
Clash

Clash

GIs office called J yesterday. All results came back normal on biopsies. No celieac, no h pylori. Her stomach was visibly mildly irritated. We will recheck b12 in a couple of months and go from there.
 
Clash

Clash

I feel the best way forward is monitoring her b12 and possibly and fc test. Although she never got around to taking the first one...ughh. Being 21, I hope she will come forward if she has concerning symptoms although lately her reply has been everything's good. I guess I just trust that for now.
 
Tesscorm

Tesscorm

Moderator
Staff member
Glad results were good and, hopefully, it will all resolve itself!!

Did you leave her with the FC test to do herself (I mean, submit it and all)? She might be more likely to do the test if she can do it without you knowing about it. Just going by my daughter, if I asked for her to do the test, she'd be 'OMG, mom, I'm fine. You always worry too much.' and then I think she'd avoid doing the test just to prove me wrong (in some way???) and not have to deal with my concerns! (And to annoy me! :lol:) With her, I would just leave her the test, give her instructions as to how/where to drop off, tell her the importance of taking care of her own health issues and leave it at that. Hopefully, having brothers with C, they'd both be aware enough of the seriousness to not ignore outright symptoms. :ghug:
 
Maya142

Maya142

Moderator
Staff member
See, with my older daughter, I would do the opposite! I know she wouldn't bother to do the test ("But I'm FINE Mom!"), so I told her I would ask her three times a day until she did it. She was so annoyed that I kept asking that she did it within 2 days and dropped it off by herself.
Mission accomplished!
Guess it depends on the kid ("young adult") huh?
 
Tesscorm

Tesscorm

Moderator
Staff member
:lol: All's fair in love and war... seems so applicable with teens/young adults (at least, mine! ;))!
 
Clash

Clash

Since she is at college and in another town she is the one that went by the lab got the poo hat and stool container. So she is completely in control of the test part. I did pester her for several weeks about it but honestly I finally decided with all that is going on with C she would have to make her decisions and live with her consequences.

I thi k she is a bit of the "here and now", "outta sight, outta mind" personality. If a symptom is concerning then she is all on top of with pics and descriptions and concerns but if all is going well and not affecting her life then she deems keeping track of bms, Dr. appts and tests a hinderance.

Kids.
 
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