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Forum Name: Hematology Topics

Question: Anion Gap Low, Calcium High, Crit high, WBC - confused


 maggyanne - Sat Nov 01, 2008 6:15 pm

Over the past 12 months I have had numberous blood tests which my doctors have said are fine. However, after this last test I asked for copy of the report and was annoyed to find that there were several abnormalities flagged on the test that he did not relay to me. ANA was normal. Though it has been positive in the past. Low titire. For 3 years I have suffered from various odd symptoms, chest discomfort, cough, phlegm, tight throat, tmj, breathlessness, but am feeling much better now with almost no symptoms apart from what feels like a bladder irritation. I have trace protien and blood in urine which comes and goes and which doctor is not concerned about.

My test results were:

WBC was low at 4.63
MCHC was low at 32.1
Lymphocytes were low at 1.08
Eosinophils were low at 0.6

Nothing too bad but just outside normal range.

However

My anion gap was very low at 5
Carbon Dioxide was very high at 31
Calcium was high at 10.4
Heamatocrit was high at 47
and Hb was relatively high at 15.1

In an effort to alkalize my body I have been living on a mainly fruit and veg diet and have been taking lots of supplements and Coral Calcium. (which made me feel much better and which I have now cut back on due to high blood calcium) Do you think this could have had any effect on the blood test.

I am feeling well apart from this bladder irritation, I am not short of energy and sleep about 7 hours a night. One of my sons has chronic granulomatous disorder, another is diabetic, and my mother had arthritis. In mid life she also had many strange symptoms which she had numerous tests for and which apart from her arthritis and thyroid problems came back normal. She lived to be 81. I am 58. Please help I am worried to death. I have also just had a pap smear which was boarderline - Atypia, I have discomfort in loins especially when I need to urinate. No actual pain.
 Dr. Safaa Mahmoud - Mon Nov 24, 2008 2:10 pm

User avatar Hello,
Normal values for while blood cell and its elements are:

White blood cells: 4,500-10,000 /mcl.
Neutrophils: 40% to 60%
Lymphocytes: 20% to 40%
Monocytes: 2% to 8%
Eosinophils: 1% to 4%
Basophils: 0.5% to 1%
Band: 0% to 3%

Although your lymphocyte count is relatively low, it is still within the normal range in relation to your total count. The most common cause of lymphopenia is recent infection like common cold. All types of infections can result in lymphopenia like bacterial and fungal infections.

You have mentioned that you been suffering from recurrent upper respiratory tract infection, it could be of viral infection which makes your results not alarming. As your doctor advised follow up test would be satisfactory.

As for the dysuria, it could be due to excess calcium salt excreted in urine especially if there is concentrated urine. More fluid intake would be helpful, otherwise urine analysis is essential.
Normal calcium values are in the range of 8.5-10.2 mg/dL, so you are in the high normal level.

The anion gap is calculated using this formula = ([Na+]+[K+] ) - ( [Cl-]+[HCO3-] )
The average anion gap for healthy adults using this formula is 8-12 mEq/L.
Modern analyzers use a new classification system in which a normal anion gap is between 3-11 mEq/L. Anion gap measurement is subjected to errors like improper processing of the blood sample (delay) may result in mild reduction in the anion gap.

One of the most common causes of a low anion gap is a low albumin level. Another cause is the presence of abnormal positively charged proteins that bind to cations in the blood, as in multiple myeloma.

Normal Pco2 is in the range of 35-45. Although your results show mild decrease in Pco2 level it can be seen in non pathological conditions like
Hyperventilation
Hypoxia in high altitude
Anxiety

You mentioned that your main complaints were chest and urinary troubles, so these blood results should be taken into consideration although the changes as you can see are mild.

For exclusion of serious causes like multiple myeloma, a 24 hours urine analysis would be a good initial test to confirm the presence of proteinuria, a liver function tests including serum albumin to exclude hypoalbuminia, as well as repetition of al the previous tests (CBC, KFT, Ca, Blood gases). Radiologic testing like CXR and abdominal US may be helpful to rule out chest infection and to check the kidneys respectively. Further investigations would be requested based on the new results.

Regarding the Pap smear results, most physicians consider follow up testing and treatment of any underlying infection in women with mild cellular changes.

Only by complete history and physical examination a proper management can be done. So, I would advise you to follow up with your doctor and to discuss with him your concerns.
Hope you find this information useful.
Please keep us updated.
Best regards.
 maggyanne - Fri Nov 28, 2008 8:43 pm

Thanks very much for your valued answer to my question. The issue with increased urination now seems to have resolved itself and the bladder irritation has disappeared. Also, a week ago I had a repeat pap test which was normal. At that time my urine was tested and was free of either protien or blood. (which was a great relief). I am still suffering from the cough with phlegm and chest discomfort, but it comes and goes and seems worst when I am tired. My life involves extensive travel (40 flights so far this year) and my symptoms are always worse after an international flight. I have had these chest and tight throat symptoms for the past 4 year or so, surely if it was multiply myeloma I would have known well before now. I also often feel strange pulses in places I have never felt them before, in my side, back and more recently my left knee. An EKG showed abnormal repolorisation, pulse 55 and low voltage but again the doctor didn't seem concerned. My blood pressure is now fine 110/70 or so, but that too has over the past couple of years been as high as 160/100 - it's been normal for about 6 months. Don't know what has been going on, or is going on but it's pretty confusing.
 maggyanne - Sat Nov 29, 2008 11:16 am

Just looked at latest blood test results.

BUN is 12
Total Protien in 7.4
Albumin is 4.6
ESR is 3
Creatinine Serum 0.7
Bilirubin 0.4

These numbers would not suggest multiple myeloma would they?
 Dr. Safaa Mahmoud - Sat Dec 06, 2008 6:47 pm

User avatar Hello,
These results suggest a normal kidney and liver function tests.
They also show an ESR level that does not indicate underlying inflammatory conditions.

These are not specific tests for myeloma, however, if your urinary problems and the urine proteins are no more present, urinary tract infection or stones are more likely to be the cause of the urinary symptoms rather than a myeloma.

In addition patients with multiple myeloma usually have some abnormalities in their blood tests (e.g. CBC, Ca, uric acid, B2M, total proteins and Albumin).

For these recurrent upper respiratory tract infections that seem to be of a mild form, it is possible that you are allergic and travelling many times a year with exposure to different allergens as well as the stress it carries may make you more susceptible.

I would advise you to follow up with your doctor; he would repeat your blood and/or urine tests to make sure no persistent changes are there that mandate further investigations.

Please keep us updated.
Best regards.
 yAKATYAK - Sat May 23, 2009 9:30 pm

MY LATEST BLOOD TEST RESULTS ARE BUN=29,CREAT 1.4, CA=10.4,CHOL=207,TRIGLYC=221,HDL=49, ALK PHO 14,Htsh6.21,fr t-4 = 1.08 what is going on?

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