Conflicting lab results

[Infinte]

The most recent lab results for my son (15yrs) were conflicting & even the doctor to an extent was surprised. Wanted to see if anyone here had similar experience and have recommendation for next steps

Blood work - all numbers within normal range
ESR - 4
CRP - 2
Hemoglobin - 13.5
CBC - all normal

General health - does everything what a 15 yr old does....sports, studies etc...
Weight - Steady. No drop.

What confused us is the Calprotectin number which was 1130.

One important note here is that the lab initially was refusing to take the stool sample as they (nurses) thought it was not enough (quantity). Not sure too little of sample can cause any aberration in the results!

For now GI doctor has advised to repeat the test in 4-6 weeks.

 

[Scipio]

A too small stool sample would more likely lead to an erroneously low test result rather than an erroneously high one. So I doubt that is the answer.

Assuming the test was performed accurately, your son's fecal calprotectin is significantly elevated and suggests that there is active inflammation in the gut. The other numbers, by contrast, look normal and suggest there is no big inflammation when measured systemically (as opposed to locally).

These two results could be conflicting but not necessarily. Your son could certainly have local inflammation confined to the gut that could drive up the calprotectin but not the CRP. CRP does not always elevate for Crohn's inflammation - my case being a good example. No matter how fiercely the inflammation was raging in my ileal Crohn's lesions, my CRP was always perfectly normal. As an inflammation marker, CRP simply doesn't always work.

And the normal hemoglobin indicates that your son is not anemic and therefore not losing blood. Which is good news, but again, not that does not necessarily preclude gut inflammation.

So I agree with your doc. Let it go for while longer and repeat the test. It may have been a bad run in the lab or there may be inflammation lurking in your son's gut. the retest could serve as a sort of deciding vote.

 

[my little penguin]

My kiddo is proof normal bloodwork doesn’t mean no inflammation
He gets normal all the time
But even at dx when they found inflammation
The key is the second test
If it’s still high and repeat bloodwork .
Fecal cal means inflammation but not what caused it
Any nsaids ?
Any GI infections ?
Any allergies ?
Fecal cal is not specific to crohns
But can indicate crohns
You can be symptom free and still have active crohns it’s a weird disease
Fingers crossed next fecal cal is under 50

 

[Guerrero]

Sometimes with crohns you just have to accept inflammation is there , even with biologics, and enjoy the best life you can though without overthinking, over reacting, as there is nothing you can really do at this stage. That’s my best conclusion after almost 25 year with it…

 

[Infinte]

@my little penguin @Scipio @Guerrero Thanks for providing insight.

@my little penguin - Allergies could be a possibility. Unfortunate thing is based on blood work we were thinking of moving to Humira (now Hymiroz) every 10 from currently every 7 days....Let's see what we find in the repeat tests.

 

[my little penguin]

That’s a big difference if he already has Crohn’s disease and is on humira .
Definitely repeat fecal cal
If still high
Scopes /imaging
At least for my kiddo when in the right med combo -his fecal cal stays under 50 -typically less than 15 .
So it is possible to stay nice pink and healthy .
If he has the right med but not high enough frequency
Then his fecal cal goes up but his blood work is unremarkable

I think bloodwork is better to look at over time
So you know your kids normal
Mine is a sed rate of 8 or 9 when it’s up near 18 (still below normal of 20) we know his inside will be inflamed and fecal cal goes up )
So just good to know your kids numbers

 

[Crohns dad]

Our son (10) is on Avsola (Infliximab). His ESR is 34, his Albumin is low, and his Calpro is almost 3000. His Calpro has been over 1500 for almost a year. He had an endoscopy, colonoscopy and CT scan last year and all of those showed huge improvement since his first scopes/scans in ‘21. This disease is very frustrating.

 

[my little penguin]

@Crohns dad
How often is he getting infusions/dose ?
Did they add methotrexate and een ?
Fecal cal should not be over 1500 for a year and sed rate shouldn’t be 34.
If the higher doses /frequency are not getting inflammation under control he needs a different med .
Or surgery and a different med.
Please get a second opinion at another pediatric ibd center
Chop , Boston childrens , Cincinnati etc…

High levels of inflammation unchecked for long periods of time are just doing damage .

There are treatments that work
Leaving it inflamed is not acceptable.

 

[Crohns dad]

@Crohns dad
How often is he getting infusions/dose ?
Did they add methotrexate and een ?
Fecal cal should not be over 1500 for a year and sed rate shouldn’t be 34.
If the higher doses /frequency are not getting inflammation under control he needs a different med .
Or surgery and a different med.
Please get a second opinion at another pediatric ibd center
Chop , Boston childrens , Cincinnati etc…

High levels of inflammation unchecked for long periods of time are just doing damage .

There are treatments that work
Leaving it inflamed is not acceptable.

The have not added any meds. He started out on 10mg/kg in the hospital in Nov ‘21 and rapidly improved and did well. Then they lowered the dose to 7.5mg/kg (every 8 weeks) and he still did well but his trough levels were in the 30’s. Since he was doing well and trough levels were supposed to be between 5 and 10 they dropped him to the standard dose of 5mg/kg at 8 weeks. At his next infusion we saw changes in his labs and ever since have been asking about the dose/med.

They kept him on the 5mg dose and as his labs continued to trend towards inflammation they did the scopes and scans. All 3 showed no signs of serious inflammation and massive improvement over his initial scopes/scans in ‘21 but the biopsies did show signs of chronic inflammation in line with Crohn’s.

Initially, there was some minor doubt that he had Crohn’s because he lacked all the common symptoms like bloody stool, diarrhea, etc. He did have constant fevers, weight loss, anemia, etc and serious inflammation in his small bowel.

We have a referral to the GI at Duke for a 2nd opinion and we will begin seeing a new doctor at UNC but that doctor is already involved in his care.