Help with blood test results please (pics)

[Claw001]

Could someone please help with these results?

I’m not an expert, however what Paediatrician has wrote in his covering letter, seems to conflict with actual results and comments?

Yes that was suggested on the other thread I have about his skin condition!

I don’t know! Maybe I’m clutching at straws, putting 2 and 2 together and making 5!

Maybe I need to have faith in professionals and trust what they say. They just don’t seem to have the answers.

My ds is suffering, can rarely attend school etc. I’m just desperately trying to help him.

I don’t know about your area, but the blurb regarding the ferritin etc at the end of the results is added on automatically by the computer system here, it’s not a comment by the dr or consultant, it’s standard blurb from the labs.

Our health board class anything 20 or above as normal limits for ferritin. I saw someone comment on another post that their locality class anything below 50 as outside normal limits. Mine was 19 and I felt awful, but they said it was normal. They didn’t tell me what level it was, just that it was now normal and no need to take the iron anymore. Wish I hadn’t blinking listened to them. I struggled on for another 6 months before getting my bloods repeated and that’s when the nurse mentioned it.

I hope the vit D helps your son. It’s very frustrating when your child is ill (or yourself) but people don’t really seem to care about getting to the bottom of it all.

The blurb at the end, only addresses the areas which had an arrow for being high or low in this report.

Google isn’t helping!

“Who has low or high blood creatinine levels?

Muscular young or middle-aged adults may have more creatinine in their blood than the norm for the general population.
Elderly persons may have less creatinine in their blood than the norm. Infants have normal levels of about 0.2 or more, depending on their muscle development.

In people with malnutrition, severe weight loss, and long standing illnesses, the muscle mass tends to diminish over time and, therefore, their creatinine level may be lower than expected for their age.

My son has a severely restricted diet to his ASD.

Does DS have any sores in his mouth? Hair loss at all? Swollen joints? Low fever?

Severely restricted diet would explain low ferritin and potentially borderline B12

Also, it's not ridiculously high, but raised eosinophils can be a marker for lupus.
The notes didn't mention eosinophils. I really do think the bit about T4 and biotin is just standard for all results reporting.

No sores in mouth, hair loss, fever. No swelling of joints, but severe pain, particularly in his legs for a very long time. Good/bad days. Bad days, just moving hurts. Good days, tired and aches after walking a short distance. Wants to sit down after standing for a short time etc.

Don't worry about the creatinine. You've got a dermatology appointment coming up haven't you? Explain the background and other symptoms to the dermatologist.

the blurb regarding the ferritin etc at the end of the results is added on automatically by the computer system here, it’s not a comment by the dr or consultant, it’s standard blurb from the labs. This made me laugh a bit. It is indeed put on in the lab, but by a doctor (or automatically added by the software and checked by a doctor). But yes, not a doctor who has any knowledge of DS other than what has been supplied as the reason for the tests. They are messages from one doctor to another, and are not intended to be interpreted by the patient or parents. The bit about recommending clinical review means that the results should be reviewed by a clinician in the context of the patient's history and presentation.

Eosinophilia likely related to skin rash. Correct vitamin d as might be contributory to aches and tiredness. Skin rash needs a diagnosis As might tie it all together as an inflammatory condition. creatinine is measured as part of renal function and a low level is not of concern.

Yes Dermatologist appointment as a matter of urgency. His skin isn’t responding to typical ‘eczema’ treatments or following the typical pattern of ‘eczema’ related skin complaints.

What worries me, is like so many other professionals, they only deal with their ‘remit’. And everything gets overlooked. So Dermatologist might conclude not a skin condition, discharge!! Speak to x service!

CAMHS not a mental health problem (although suffering with high anxiety) not our ‘remit’, discharge! Speak to x service.

Dietician no physical course why he his diet is restricted, discharge. Speak to x service.

And so on and on. No one looks at the whole picture! It’s left to parents to try and piece together the symptoms!

I'd be keeping a food diary and asking for coeliac test too, lots of his issues could be linked to this.

Actually now seeing he has ASD I'd be demanding a coeliac screening,

Dermatologists must have MRCP (requires difficult postgraduate exams in general medicine) and will be very aware of the skin manifestations of systemic disease. It's one of the things they will be looking out for. It's a competitive specialty, hence they tend to be a pretty bright bunch.

Don't write them off before you even get there.

I've got hashimotos and if my TSH goes above 1 I'm fatigued to the point I can't function. Had to go to see a private endo before the GP would agree to go my meds. Could be worth a visit to an endo? Thyroid issues are uncommon in kids his age, but definitely not unheard of. Hope he gets sorted OP.

Yes I'd be asking for an endocrinologist , rheumatology opinion , ask the dermatologist about Mast Cell activation syndrome which is where the body has severe allergic reactions . Does he ever faint or have low blood pressure ?

I see a few others have mentioned coeliacs, I'd be pushing for a ttg blood test to check that. It can cause skin issues too.

My daughter didn't have any gastro symptoms just tirdness/leg pain. She had a positive blood test and biopsy and is doing so much better now she's gluten free. I can see now just how bad she was before. It had been such a slow decline we didn't really notice at the time 🙁

If be pushing for coeliac test too. Lots of low in range vitamins. Would be v worried about that b12 result. Results under 500 have been shown to cause symptoms of b 12 deficiency (does he have any symptoms). I would go over to the Pernicious Anaemia society website for more info (or their health Unlocked forum). Please make sure you get some further advice before supplementing b vits as this can skew some b12 related tests.

Ideally you want vitamins to be mid range. Lot vitamin d can cause muscle pain and fatigue.

The ferritin range is odd but I know I feel terrible when my ferritin is below range. Can barely get up a flight of stairs. Low ferritin can cause the same symptoms as being anaemic. Odd that it is low in a male. Women often struggle with ferritin due to menstruation. I would ask for his serum iron to be checked with a view to putting him on iron supplements 210mg ferrous fumarate 3 times a day with vitamin c (to aid absorption and reduce constipation). It's possible to have high serum iron and low ferritin so important to check this first.

Biotin is a b vitamin. Does he take a b complex?

If he's had an out of range TSH a few tunes (if I've understood you correctly) I would still suspect thyroid. Hypothyroidism is associated with low vitamin levels. TSH and thyroid hormone levels can rise and fall while the disease progresses (assuming it is cause by hashimotos).

Also you should be careful to always have his blood tests fasting and early morning. TSH is highest then and as it rises and falls throughout the day testing at the same time means results are more comparable. What were his out of range thyroid results?

my son is a lot younger but he had low iron stores I havnt seen levels but he got prescribed liquid iron to raise levels. I would want to discuss further with the doctor

That B12 result is pretty low and I'm not convinced by that lab range. Mine was at 180 and that was still lower than optimal, it's better to be above 500.

His Vitamin D, B12 and ferritin are all below optimal levels. I'd supplement them all and retest in 2-3 months to see if they have improved and to see if the B12 is being absorbed.

I would have said the same regarding thyroid except that I believe children / teens have different normal levels to adults and I'm not sure what they are.

Ask to see endocrinologist. I'd suggest ferritin needs to be higher but again not sure what's good in young people, over 70 was on my tests once.

Adequate iodine and selenium needed to help thyroid. Does he take a multivitamin? Does he have any dairy?

Low vitamin d can definitely make you feel extremely unwell.

Does he ever faint or have low blood pressure? he doesn’t usually. However, on Tuesday, one of the scattered days, he has been ok to attend school, I was asked to collect him, as he was feeling unwell.

Ds said he felt strange, as if he was going to pass out and vomit. He thought it was because he was hungry, as his stomach ‘felt funny’. The teacher gave him a biscuit. School phoned and asked me to collect.

Biotin is a b vitamin. Does he take a b complex? no he doesn’t.

What were his out of range thyroid results I don’t have the full test results. Paed wrote in a letter to my GP prior to the one in the picture ‘you recently did some blood tests that showed borderline elevated TSH 4.77. I am not too worried about this level, it is within normal limits. I have repeated a full set of bloods today’

So previously elevated TSH 4.77, which is what retesting was for. Next test was 1.76.

Maybe explains the comments ‘free T4 falsely high results may be observed in patients on biotin therapy’? (Although ds doesn’t have biotin therapy!)

Bit confusing!

No Claw just ignore that biotin therapy comment. It's not really relevant to the TSH level.
Like other pp have suggested, ask the GP to test him for coeliac, I have a vague recollection of reading something about it often going hand in hand with ASD. Or at the least ASD people often do better generally on a GF diet. But you mustn't change anything until he's been tested.
The low ferritin is strange in a boy. But could be due to nutrient depletion due to coeliac. In a female, it would be dismissed as 'due to heavy periods dear' with little regard to any exhaustion, hair falling out or whatever no I'm not bitter and generally feeling awful, which I'm guessing is how your DS feels.

A referral to an paediatric endocrinologist rather than a general paediatrician might be worthwhile if the coeliac test is negative.

Yes ignore the biotin thing.

Thyroid levels could be responding to illness or very possibly, if he's got a restricted diet, it's struggling a bit. But I'm
Sure I read somewhere that tsh can be higher in children.

It's encouraging it has gone down though, but worth future monitoring.

Maybe do the vit d and see how he is after a couple of months on this?