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08-13-2014, 08:43 PM   #1
Clash
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Non IBD kid lab results

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.
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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Last edited by Clash; 08-13-2014 at 09:16 PM.
08-13-2014, 08:59 PM   #2
Catherine
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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.
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Small bowel to small bowel fistula

Meds: ), azathioprine 200mg, Mesalazine 1.2g x 2, seretide 250 x 2 (asthma), ventolin (as needed)

Currently no supplements.

Has previously taken Multi B, Caltrate, B12 & Iron

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08-13-2014, 09:02 PM   #3
Catherine
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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.
08-13-2014, 09:08 PM   #4
Clash
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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.
08-13-2014, 09:13 PM   #5
Clash
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I'm so sorry that was wrong that should read

MCV 98 [B]High[B] 79-97

HCT 43.4. 34.0-46.6

Sorry! I'll edit the OP too!
08-13-2014, 09:14 PM   #6
FrozenGirl
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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.
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08-13-2014, 09:29 PM   #7
Maya142
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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
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.
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08-13-2014, 09:56 PM   #8
Clash
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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.
08-13-2014, 09:58 PM   #9
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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.
08-13-2014, 10:08 PM   #10
Clash
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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.
08-13-2014, 10:57 PM   #11
Catherine
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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?
08-14-2014, 03:07 AM   #12
Sascot
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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?
08-14-2014, 08:59 PM   #13
kimmidwife
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Clash,
Also mention to the doctor testing for MTHFR deficiency. This is a recently discovered deficiency that a high amount of people have. One of the things it does is cause vitamin B12 deficiency.
Here is an interesting article about it,
http://www.stopthethyroidmadness.com/mthfr/
A second article,
https://www.counsyl.com/services/fam...fr-deficiency/
The more I read about this the more I am realizing we all need to be tested for this.
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08-14-2014, 11:11 PM   #14
Clash
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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

Last edited by Clash; 08-15-2014 at 06:18 AM.
08-14-2014, 11:43 PM   #15
Catherine
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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/
08-15-2014, 10:03 AM   #16
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Just sending hugs... I hope you get answers and firm plans soon for both C and J.
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08-16-2014, 12:25 PM   #17
David
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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.

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.
Easy bruising? What was the platelet level?

said she had a biscuit and two Mt. Dew
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.
08-16-2014, 01:29 PM   #18
Clash
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Easy bruising? What was the platelet level?
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.

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.
08-16-2014, 01:38 PM   #19
Clash
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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.
08-16-2014, 01:43 PM   #20
David
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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.
08-16-2014, 01:47 PM   #21
David
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Just looked them up 10mcg what ever that means.
The RDA for B12 is 2.4 mcg in what I assume is J's age group. Lot's of excellent reading here: http://lpi.oregonstate.edu/infocente...ns/vitaminB12/
08-16-2014, 01:49 PM   #22
Clash
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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.
08-16-2014, 01:52 PM   #23
Clash
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Thanks David and just for reference is poultry a good source of b12? Because that is most always her meat source for every meal.
08-16-2014, 01:53 PM   #24
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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*
08-16-2014, 01:58 PM   #25
David
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Thanks David and just for reference is poultry a good source of b12? Because that is most always her meat source for every meal.
It doesn't have much, but it does have some. The link I provided and this one http://ods.od.nih.gov/factsheets/Vit...ofessional/#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
08-16-2014, 02:02 PM   #26
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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
08-16-2014, 02:05 PM   #27
Clash
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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.
08-16-2014, 02:06 PM   #28
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Hmmm I'll check that out too.
08-16-2014, 03:01 PM   #29
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http://www.m.webmd.com/diabetes/blood-glucose

If she ate at all the glucose will be high including a sugary drink or biscuit .
To get in the fasting range you can't eat for eight hours .
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08-16-2014, 05:18 PM   #30
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Iím sorry I havenít 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 wonít hurt to stray from the IBD path and rule in or out other autoimmunes such as Diabetes and Pernicious Anaemia.

Dusty. xxx
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