Crohn’s, juicing and blood results?

[DustyKat]

Crohn’s, juicing and blood results?

Well……

The past couple of weeks we have had a horrendous gastro bug go through the house. I have missed it thus far but Mr Kat and the kids didn’t. They are all over the worst of it but still have some lingering urgency.

At the outset I was beside myself as Sarah was the one that kicked it off and was on her own with it for quite a few days. It was hard not to think that it may be Crohn’s rearing its ugly head again…diarrhoea, stomach pain, headaches and nausea with the odd vomit. She asked to go to the GP so off she went for tests last Monday. My mind was somewhat at ease as Mr Kat developed the same symptoms Sunday and Sarah was pretty sure that it doesn’t didn’t feel like Crohn’s.

Anyway, the upshot of all this is I have been privy to Sarah’s blood results (with her permission), the first for years. As many of you would know Sarah has been vegan/raw vegan for some time now, although she has pulled back from that a little since being home, and she also had quite an extensive (about 70cm) ileocaecal resection 8 years ago. Apparently she has not been supplementing with B12 or anything else for that matter except for Vit D once a week. Not my ideal by a long shot but there is nothing I can do about that except advise her, which I continually do mind! :lol: So to cut a long story short, and with all that in mind, doubting Thomas here fully expected there to be issues with Hb, Iron Studies, Folate and B12….WRONG???!!! I can only put it down to juicing/eating loads of leafy greens and veg???

Hb - 17, with 17 being the highest value of normal.
Iron Studies - all solidly mid range of normal.
Folate - Solidly, but not excessively, above the normal value of >630
B12 - Lower end of normal, 237, about where Matt sits but this is the one I fully expected to be awful.

CRP and ESR solidly normal as were all other results including FBC, LFT’s, UEC’s and other vitamin/minerals except Vit D (46), as a result she has decided it might be best if she supplemented daily instead of weekly.

The only other blood test that was ordered was ASCA?? I have no idea why the GP ordered this when we are 8 years down the track but I guess it will be interesting to see if it is a match for Crohn’s and indicative of the phenotype she has. It can take up to 4 weeks to get those results.

Dusty. xxx

 

[my little penguin]

Very good news on the B-12.
Prior to dx did her blood work ever indicate there were any issues ?
I thought her bloods stated normal right up until the exploratory surgery.

 

[xmdmom]

17 seems oddly high for a woman . You wrote it was the high end of normal-- for women? Our high is 15.1. Wouldn't worry about one value but wondering if it's a lab error (the way blood is drawn, or stored etc can affect the value) or slight dehydration (from the gi illness). Does she live at high altitude?

B12 levels don't always show b12 deficiency; homocysteine and/or methylmalonic acid levels are more sensitive.

"Use of methylmalonic acid and homocysteine levels in the diagnosis of vitamin B12 deficiency has led to some surprising findings. If increased homocysteine or methylmalonic acid levels and a normalization of these metabolites in response to replacement therapy are used as diagnostic criteria for vitamin B12 deficiency, approximately 50 percent of these patients have serum vitamin B12 levels above 200 pg per mL.1 This observation suggests that use of a low serum vitamin B12 level as the sole means of diagnosis may miss up to one half of patients with actual tissue B12 deficiency. Other studies have shown similar findings, with the rate of missed diagnosis ranging from 10 to 26 percent when diagnosis is based on low serum vitamin B12 levels alone.3" http://www.aafp.org/afp/2003/0301/p979.html

 

[DustyKat]

Don’t burst my bubble mlp! :lol:

You are right though, aside from the bloods drawn in casualty the night before surgery they were normal. The bloods she was having back then were baseline, so not as extensive as what she has now. She wasn’t having the Iron Studies and the vitamin/mineral tests etc.

She had an episode of acute adbo pain back in early 2011, I think that was when i started up the worried club :ybiggrin:, and I ironically clung onto normal blood results then too! :ylol:

 

[DustyKat]

Thanks xmdmom.

The Hb, your values pretty much equate with ours, both range and gender wise, and I am putting it down to likely dehydration.

She has no obvious signs of B12 deficiency and it is certainly something i would much prefer she was supplementing. If push comes to shove I will be pushing for her to have her MMA done. I don’t have an issue with being proved wrong but if I’m not at least it will prove to her that she needs to do something about it.

The thing I have found the hardest with older children is that what might seem normal on paper isn’t always the case. *sigh*

 

[xmdmom]

yes "sigh"...

I wonder how dehydration might affect other labs including B12. (It raises total prot/alb/BUN/Cr) Not trying to burst your bubble and probably overthinking....but may want to repeat when she is well hydrated.

B12 deficiency symptoms don't appear obvious for a long time. Hope she never has them!

 

[Maya142]

Dusty - just curious but isn't 46 in the normal range for vitamin D? The reason I ask is we just got my daughter's results back and hers was 46 too and the nutritionist did not suggest supplementing.

I hope it's just a bug and Sarah feels better soon!

 

[DustyKat]

Hey Maya.

We use different values in Oz, nmol/l. So <50nmol/l is a deficiency here.

 

[Tesscorm]

Really glad all are getting over the bug! I can imagine what a scare you had. :ghug:

And, great news that Sarah's levels are good! :applause: I hope it continues that way forever!

Out of curiosity, does she take a multi-vitamin? Perhaps with a multi and her diet, she is getting sufficient nutrients.

 

[kimmidwife]

Interesting results Dusty. I too am curious about the high hgb. I hate to say it but. I agree with XMDMOM it sounds like those results may be consistent with dehydration or improper handling. Can you ask the doc to recheck in like a week or so?

 

[DustyKat]

@Tess - No multivitamin taken Tess.

@Kim - I personally think it was because of dehydration. She came down with the bug on a Wednesday and the blood was drawn the following Monday. I would only have to text the GP to get a path referral done but I think it would be easier to get blood out of a stone than Sarah going back for a blood draw so soon, especially now that she is feeling well again.
I had given the GP some background the night before she went to see him, she asked that I do so, so the following day the poor bugger voiced to her that he felt she would likely be anaemic. Sarah’s response on receiving her results? Look at me Mum, this is the definition of smug! :eek2: :lol:

Dusty. xxx

 

[Tesscorm]

I can so see the 'smug'! :rof: :rof: My kids would be the exact same!

 

[DustyKat]

Just as a FYI since these tests can be a tad iffy…

Amongst the Crohn’s disease patient population, those testing positive for ASCA appear to have a poorer prognosis than those testing negative. For example, ASCA-positive patients are more likely to develop complications (eg, internal fistulas, fibrostenosis, perianal disease) or require surgical intervention.

http://www.moavenandpartners.com/doctors/information_form/asca-testing-for-crohns-disease.shtml

With the hindsight of Sarah’s history the test was spot on. It was clearly positive and Sarah’s prognosis is in step with the quote above. I well imagine Matt would be the same.

Dusty. xxx

 

[Tesscorm]

Just curious, can a person's ASCA result change? ie from negative to positive or vice versa?

S has had it tested a number of times both ASCA - IgA and IgG and it was negative each time (or, more precisely, our 'normal' is not positive/negative, it's <20 so his was less than 5 each time). But, if you don't have the antibody, can you develop it? And have the test turn positive? (Or in reverse?)

 

[DustyKat]

I’m not sure Tess. I know with some bio markers they can change in response to disease and treatment but I don’t know about ASCA. I would lean toward no... but???

Are you still around Aussie?

Sarah’s results were...

Reference Report-

ASCA IgA: 33.2 Units

• ANTI S. Cerevisiae IgG or IgA
• VALUES =>25 U/mL are considered Positive
• VALUES 20.1 - 24.9 U/mL are considered Borderline
• A negative ASCA IgG or IgA Antibody does not rule out the presence of Crohn’s Disease.
• A positive ASCA IgG or IgA is suggestive of but not diagnostic for Crohn’s Disease.
• Positive result can occur in normal subjects and in other diseases (e.g. Coeliac Disease). Assay performance characteristics have not been established for Paediatric Crohn’s Disease or Ulcerative Colitis patients.
• The most useful distinction from Ulcerative Colitis is by considering the combination of ASCA and pANCA.
• (ASCA - / pANCA +) favours a diagnosis of Ulcerative Colitis.
• (ASCA +/ pANCA - ) favours a diagnosis of Crohn’s Disease.

ASCA IgG: 22.2 Units

IMMUNOLOGY. AUTOIMMUNE SEROLOGY -

ANCA: Negative

Screening for ANCA was negative by indirect immunofluorescence at a dilution of 1:20. 5% PR-3/MPO-positive sera may be negative on screening by IIF. Suggest specific testing for proteinase-3 and myeloperoxidase if clinical suspicion of vasculitis is high.

Added the blurb in case anyone was interested.

 

[Tesscorm]

Thanks Dusty.

I'd thought you were either positive or negative as well?? But, your post above prompted me to look at S's records and the fact that he was tested three times made me question the permanency of the result. Why else the repeated tests? However, when we once had RA concerns with my daughter, she was also tested and dr told me she was just slightly positive but that if one family member has an auto-immune disease, often other family members have slightly higher numbers (to me, this sounds like you are either positive or negative).

Was just curious...