For us seasoned ITP campaigners one of the things we get used to pretty quickly is rolling up our sleeves to undertake regular blood tests. Over my eleven year purple career, I would hate to estimate the number of times that I have had the needle but I would imagine that it is well over five hundred. Obviously the only way to check the platelet count is by having a blood test but what else can our doctors or specialists possibly be looking at when they analyse our blood test results ? What other important information can they glean from our blood ?
In this episode, I thought that it would be useful to break down the various things that I have learned that my specialist looks at when reviewing my blood test results. As with all things ITP, I would remind anyone reading this that these are the things that my specialist looks at with me. All of our cases are completely unique so what my specialist will look at may well be different to that which another specialist will investigate with another patient. Our individual medical histories , previous treatments, current drugs, and other medical conditions will determine what our specialists, specifically want to look for.
One general thing to say about blood and blood tests is Water. What I mean by this is that one thing we can all do to help our blood is drink plenty of water. Keeping hydrated is so important. For starters it helps the phlebotomist get our blood sample easier. Basically if we are dehydrated it is more difficult for them to get a sample of our blood. It doesn’t flow so to speak. Drinking plenty of water also means that our platelets will be less likely to clump. If our platelets do clump, when we have a blood test, it is difficult to get a clear platelet reading. The suggestion is that we should drink about 2 litres of water per day, so I am certain that we all have room to do more. Gulp !
My last blood test was done on August 21st 2017 and the following detail was listed at the top of the print out of my results .
1) HB - 160 , 2) WCC - 6.5, 3) NEUT - 3.00, 4) CREAT - 97, 5) LFTS - Normal , 6) PLT - 205
What does all this mean, exactly what are the abbreviations and are the numbers good, bad, normal or concerning ? Before, I go on to explain them all in a bit more detail, I can say that the numbers are all good news. As to what they are, why they are important and what the specialists are looking for, I will try to explain. Many of the terms and information some readers may already be familiar with but I have assumed that I am explaining all this to somebody completely new to ITP, so please bear with me.
- HB - 160
HB is an abbreviation for HAEMOGLOBIN the protein in our RED BLOOD CELLS which carries oxygen to the organs and tissues in our bodies and carries carbon dioxide away from them back to our lungs. A lower than normal HB (HAEMOGLOBIN) level means you have a low RED BLOOD CELL count and maybe Anemic.It means that your tissues and organs are not being oxygenated properly or carbon dioxide not expelled correctly.
What is a normal HB level ?
The normal HB range for men is 13.5 to 18.0 grams of Haemoglobin per decilitre of blood, and for women the normal range is from 12.0 to 16.0 grams per decilitre of blood. In children the normal range varies depending on age. So my own recent blood test showed me at 160 meaning that at 16.0, I was exactly within the normal HB range for a man of between 13.0 and 18.0 grams of Haemoglobin per decilitre of my blood. So far, so good but what is a low HB level and why does it matter ?
What is considered to be a low HB level ?
This is generally defined as less than 13.5 grams of Haemoglobin per decilitre of blood for men, so expressed as a figure of 135, and 12.0 grams per decilitre of blood for women, expressed as a figure of 120 in any blood test results. A low HB level may indicate that the patient has Red Blood Cell problems. Our bodies produce fewer Red Blood Cells than normal if any of the following conditions are evident - Aplastic Anemia, Cancer, Certain medicines such as anti-retroviral drugs for HIV infection, and Chemotherapy drugs for cancers and other conditions.
Why do our specialists look at our Red Blood Cell Count ?
Our specialists look at our Red Blood Cell situation because they want to check that in addition to our ITP there are no other issues going on with production of our Red Blood Cells and our general bone marrow health. In addition, where treatments for our ITP have been used, our specialist wants to double check that these drugs may not be having a detrimental impact on our HB levels ( Red Blood Cell count). Some of the drugs used to treat our ITP may have some impact on our ability to produce healthy Red Blood Cells so it is something that our specialists will keep an eye on over time to check for any changes. Prednisolone can for example lower the Red Blood Cell count in some cases.
What are the symptoms of a low HB level ?
If the patient has a low HB level they may experience some or a combination of the following symptoms.
A. General Fatigue
C. Pale skin
D. Shortness of breath
F. Strange cravings to eat items that are not food (for example dirt, ice,clay)
G. Tingling or crawling feeling in the legs
H. Tongue swelling or soreness
A low HB level maybe experienced because of an iron deficiency which causes Anemia. Women in child bearing years are at a higher risk of suffering from iron deficiency because of blood loss during menstruation. Anemia can be caused by ulcers, cancer, use of some pain relievers such as Aspirin and heavy menstrual bleeding.
Can you have an HB level that is too high ?
YES - this is absolutely possible and is often experienced in patients who may have heart or lung problems. In cases of high HB levels the patient has Red Blood Cell production which is too high as it compensates for lower blood oxygen levels often reduced because of heart or lung problems. Another potential reason for high HB levels is a bone marrow dysfunction that results in increased Red Blood Cell production.
What does our body need to produce healthy Red Blood Cells ?
We need Folate and Vitamin B12 to enable our system to produce healthy Red Blood Cells. Folate is found in dark leafy green vegetables like spinach, kale, cabbage, broccoli. It is also found in asparagus, citrus fruits, lettuce, strawberries, raspberries, almonds, beets, celery, squash, carrots, corn, sprouts, peas and lentils.
Vitamin B12 is found in eggs, cheese, milk, meat, fish, poultry.
But like in all things a sensible, balanced, diet is the way to go. Obviously if you do have a low or indeed high HB level your specialist/doctor will discuss it with you and should suggest ways for it to be corrected/improved. It is certainly very important to discuss any radical change you may be thinking about making in your diet with your specialist or doctor before doing so.
So having looked at the Red Blood Cell count attention turns colour to white.
- WCC - 6.5
WCC stands for White Blood Cell Count and it is a very important part of the analysis that our specialist will want to look at. White Blood Cells are a vital part of our immune system and they are also often referred to as Leukocytes. They help fight infections by attacking bacteria, viruses, germs and infections. White Blood Cells like our Red Blood Cells and Platelets are produced in our bone marrow.
There are several different types of White Blood Cell, the main one’s being Neutrophils our most important White Blood Cells (more about them later), T-Cells and B-Cells.
What is a Normal White Blood Cell Count ?
White Blood Cells are measured in thousands per microliter of blood. So my recent blood test produced a reading of 6.5 WCC which means 6500 White Blood Cells per micrometer of blood. Now the normal range of White Blood Cell Count is anything between 4300 (4.3) and 10800 (10.8), although slight variations on these figures may be seen at different laboratories/testing centres. So my recent reading of 6500 (6.5) is well within the normal, expected range and that of course is great. But why is it great and why does it actually matter ?
If our White Blood Cell Count is below the expected normal range or at the lower end of it, our specialist may have some cause for concern or wish to investigate further. A low White Blood Cell Count often referred to as Leukopenia, may be a concern because it means that our ability to fight infections, viruses, colds, flus, bugs of all sorts may be badly reduced leaving us vulnerable to severe illness.
A low White Blood Cell Count may be triggered by some autoimmune disorders, bone marrow disorders or damage, lymphoma, HIV, severe infections, liver and spleen diseases, lupus, radiation therapy and some medications like antibiotics. So our specialists will want to keep an eye on our White Blood Cell Count as it is a good indication of our overall health, our ability to fight infections and it may also reflect any other issues apart from ITP that may be going on.
It is also vital that the White Blood Cell Count is monitored closely after any treatment for our ITP as it may be impacted by some of the treatments (Rituximab for example can reduce the White Blood Cell Count). We all respond differently to the various treatments of course so our White Blood Cell Count is a very good indicator of our overall health, immune system and bone marrow function.
But can you have a White Blood Cell Count that is too high ?
Oh yes indeed you can and this is called Leukocytosis. I had exactly this problem in Summer 2016, albeit this was a short lived spike in my White Blood Cell Count which I will explain a bit more later.
A high White Blood Cell Count can be triggered by smoking, infections like tuberculosis, tumours in the bone marrow, leukaemia, inflammatory conditions like arthritis, bowel diseases, stress, tissue damage, allergies, asthma, pregnancy and some drugs like…… wait for it …..some of you may have already guessed this one….. and BOOM !…….CORTICOSTEROIDS our old friend Prednisolone (see more about this in the next item below headed 3. NEUT).
So how do we maintain a good level of White Blood Cell Count ?
Like our Red Blood Cells and Platelets the White Blood Cells are produced in our bone marrow, so it won’t come as any surprise to learn that once again Vitamin B12 and Folate as set out in the first item above headed 1. HB (Red Blood Cell Count) are important for our White Blood Cell production. Time and time again it is the old evidence of fresh fruit and vegetables and a healthy balanced diet that is the best general advice. All this of course depends on our personal medical history and any other medical conditions and drugs we may be taking or have taken in the past. We are all different but you can’t escape the general vibe that fresh fruit, vegetables and avoiding fatty processed foods can only be good for us.
- NEUT 3.00
NEUT is an abbreviation of Neutrophils and these are a type of White Blood Cell. They are actually the most plentiful of our white Blood Cells making up somewhere between 55 and 70 per cent of all our White Blood Cells. Now our Neutrophils are especially important as they play a vital role in our immune systems and its’ ability to fight infections, viruses, bugs, bacteria etc. Our Neutrophils circulate in our blood stream and when they sense signals that an infection is present in our bodies, they are the first cells to migrate to the site of that infection to start killing off the invading microbes, In essence they are our “first responders” so to speak.
So if we have got a good number of Neutrophils it is an excellent indicator of the overall health of our immune system and its’ ability to fight off anything thrown at it. The Neutrophils in our blood are measured in our blood test and the test for them is known as the Absolute Neutrophil Count (ANC). The ANC is calculated by multiplying the White Blood Cell Count by the percentage of Neutrophils in the blood. A healthy Neutrophil count is between 2500 and 6000, so once again at my last blood test my reading of 3.0 (3000) is exactly where my specialist wanted it to be thank goodness.
So what else do we know about Neutrophils ?
Antigens are the substances which call our immune systems into action when we need them to help us ward off potentially harmful invaders like bacteria, viruses, poisons, fungi, cancer cells. Our immune system is made up of tissues, organs, and cells. It is our White Blood Cells which patrol our blood stream and lymphatic system and these White Blood Cells produce chemicals which attack and fight off the antigens (harmful substances) by going to the source of the infection or inflammation. OK that sounds fairly straightforward but what about the Neutrophils ?
Well our Neutrophils are so very important because and here is the key bit….. unlike the rest of our other White Blood Cells, they are NOT LIMITED to a specific area of circulation. Our Neutrophils move freely through the walls of our veins and into tissues of our bodies to attack antigens (harmful stuff) quickly. Our Neutrophils are our key response team if you like, they can go anywhere, intact they can do what other White Blood Cells can only dream of doing. It’s the unlimited, free movement that distinguishes the Neutrophils from the rest of the White Blood Cells you see, so they are absolutely the top white cell dogs.
Right then what happens if your Neutrophil count is low and why might that be ?
A low Neutrophil level is called NEUTROPENIA and it can be caused by a suppressed immune system (for example long use of steroids, or Rituximab treatment), some other drugs like chemotherapy, aplastic anaemia, bone marrow failure, HIV, some autoimmune illnesses like rheumatoid arthritis, leukaemia, and some congenital disorders like Kostmann Syndrome and Cyclic Neutropenia. Low levels of Neutrophils can be dangerous as it means we will be much more vulnerable to infections, bacteria, viruses, illnesses in general. If our levels fall below 1500 (1.5) Neutrophils per micrometer of blood the this could be life threatening if we are then exposed to infection etc as our systems would struggle to fight it off.
So can you have a Neutrophil level which is too high ?
Oh yes indeed you can and such a condition is known as NEUTROPHILIA. I have been one of those people with a higher that normal Neutrophil count. I alluded to it earlier and it happened to me back in the Summer of 2016. The reason why my Neutrophil levels were a bit too high was a direct response to my taking Prednisolone ( which I had been doing yet again from February 2016 to June 2016) . So in my case there was an obvious and acceptable reason why my Neutrophil levels had increased. My specialist also knew that once my Prednisolone dosage was reduced we would see a corresponding fall in my Neutrophil level. And we did ! Three cheers all round and cup of tea for everyone !
A higher than normal Neutrophil level can be caused by infections (usually bacterial), non infectious inflammation, surgery, smoking, high stress levels, over exercising, heart attack, chronic myeloid leukaemia and as already stated, steroids including Prednisolone.
So our specialists want to keep a close eye on our Neutrophil levels and will investigate further if our results show anything which strays too far from the normal range, especially if there is no obvious explanation why it might have happened.
Right so we’ve now looked at Red Blood Cells, White Blood Cells and the key White Blood Cell Neutrophils, what else is in the blood test that might be useful to our specialist ? Well next up is something called Creatinine.
- CREAT 97
CREAT is an abbreviation of CREATININE which is actually the waste product that our bodies produce from the normal breakdown of our muscle tissue. It is a break down product of Creatinine Phosphate in muscle and it is produced at a fairly constant rate by our bodies. This substance Creatinine is filtered through our kidneys and excreted in our urine. So it will probably come as no surprise then that the testing of our Creatinine levels is something which acts as an indicator of the efficiency of our kidneys and renal system.
What should our Creatinine level be then ?
Normal levels of Creatinine in our blood are between 0.6 and 1.2 milligrams of Creatinine per deciliter of blood for an adult male (expressed as between 60 and 120) and 0.5 to 1.1 in an adult female(expressed as 50 and 110). Figures for children depend on age. So when our Creatinine levels are tested our specialist is looking at the efficiency or otherwise of our kidneys and renal system to rid our bodies of this substance. If we have too much of it in our blood sample then it indicates that we are possibly having kidney or renal system issues in expelling it from our bodies. If we have too little of it then it could indicate that we may have an underlying reason for not producing enough of the Creatinine in the first place. Clear ? Well just to explain a bit more then….
A higher than normal Creatinine level might mean what exactly ?
It could signify a problem with the kidney function or kidney disease /damage. In the event that our kidney function is hampered for any reason the Creatinine levels in our blood will rise due to poor clearance of it by our kidneys. So we keep more of it than is normal on board so to speak.
Now our specialists will want to keep an eye on this because yet again like many other aspects of our system, any treatments we have had for our ITP might produce a reaction in our kidneys and renal system. In most cases it will not and as my recent result of a Creatinine level of 97, everything is in order despite me having had Prednisolone 5 times in 11 ITP years, Rituximab twice and now Mychophenolate Mofetil for over a year. But it is important to monitor these things.
High levels of Creatinine might be due to kidney or renal system damage or disease but also they could be the result of infection, major shock, low blood flow to kidneys, urinary tract blockage, heart problems, cancer and to round things off here’s another of our old friends DEHYDRATION (we need to drink 2 litres of water per day in case you’d forgotten).
Now low levels of Creatinine may also occur and indicate lower muscle mass caused by Muscular Dystrophy or simply by ageing. (Basically as we get older we just have less muscle left). Pregnancy can also cause low Creatinine levels and low levels might also indicate some types of liver disease or a diet especially low in protein .
The mention of the liver leads me nicely into the next part of my recent blood test.
The letters LFT stand for Liver Function Tests and they are a group of tests designed to give information to our specialist or doctor about the general health of our Liver.
There are six Liver Function Tests which are usually conducted via the blood test, and they are … 1) Alanine Transaminase (ALT), 2) Aspartate Aminotransferase (AST), 3) Alkaline Phosphatase (ALP), 4) Albumin, 5) Total Protein, 6) Bilirubin.
Most Liver diseases cause only mild symptoms initially but diseases must be detected early. Our Liver is incredibly resilient and is the biggest internal organ in our bodies. The biggest organ incidentally is our skin. Our Liver is vital in detoxifying our bodies (getting rid of the substances and chemicals we do not need ) and storing the chemicals and vitamins that we do need to maintain a healthy body).
Our specialist will be keen to keep an eye on our overall Liver health as again if we have any treatments for our ITP it could impact on the efficiency and health of our Liver. In fact the Liver has a key role in the normal blood clotting process and if the Liver is damaged the blood becomes thin and takes longer to clot. A symptom of this is ….. DRUM ROLL …… a tendency to bruise easily.
So you see for us ITP folk our specialist will keep a close eye on our Liver function because although in most ITP cases it is the Spleen where our Platelets are destroyed, the same can happen as a result of Liver damage. The substance called Thrombopoietin is produced by the Liver and this is what regulates the production pf our Platelets. So any damage to the Liver may impact on the Platelets circulating in our blood if it hampers the production of Thrombopoietin.
This all brings us nicely to PLT, the sixth part of my Blood Test results. You may well have guessed that this is Platelets. For us with ITP this is of course the heart of the matter. So here goes !
- PLT - 205
So relief all round my Platelet count was 205, and this is confirmation that the Mychophenolate Mofetil that I have been taking since April 2016 is clearly working. The dosage I have been prescribed has been reduced gradually since I started taking 600 grams, twice per day at the beginning. I am now on just 500 grams once per day and my specialist is hoping that we can reduce it to just 250 grams per day at my next discussion with him at the end of October.
No doubt we shall see soon enough but I can’t say that I am not just a little sceptical that reducing the dosage too much might lead to the old purple ghoul returning. It’s a tricky balance, a choice that Hobson himself would think long and hard about. Nobody wants to take any drug unless they really have to take it but on the other hand the spectre of the old ITP looming large in the background is enough to get me rushing to the pharmacy.
We all know that Platelets are the heart of the ITP conundrum, so I won’t rake over familiar, old ground here except to say that the following links will provide most of the interesting and important information on the one thing we purple folk are often short of.
There are a a number of other things that your specialist or doctor may request be tested when you have a blood sample taken and the following four are the most common. None of these are tests that I have had done but my specialist drew them to my attention as things that some people may encounter routinely.
- Calcium Profile.
A Blood Calcium Test is often used to diagnose/screen for conditions relating to the bones, nerves, heart , teeth and kidneys.
- Urea and Electrolytes.
Used to check kidney function.
- Blood Film Examination.
Shows information and detail about number and shape of red and white blood cells.
- Lactate Dehydrogenase Level - LDH Test.
This is used to check kidney and liver function. LDH is an enzyme the body uses during the process of turning sugar into energy for our cells to use. LDH is found in many of the body’s tissues and organs, like the liver, kidneys, heart , muscles, pancreas, brain and blood cells. High levels of LDH may indicate tissue damage. Often our LDH levels are elevated after strenuous exercise.
So I hope that this brief tour of my recent blood test has given a little insight into what our specialists may be looking at when they analyse our blood test results and more importantly why they are looking at those things in the first place. I have to say that until 2006, I cannot remember ever having had a blood test at all in the first 46 years of my life. Since then of course, like all of us purple folk, I have become as familiar with blood as that character from the Bram Stoker novel. I’ve seen more blood (all my own I might add) than an extra in the Michael Jackson Thriller video.
Oh well here’s to the next sample of claret that I’m due to provide in two weeks time. Be sure that I’ll be ready with my sleeve rolled up, prepared as ever for just a sharp scratch and hoping for the results to come back with the right numbers on them.
LIVER FUNCTION TESTS…
ITP and PLATELETS….
BLOOD CALCIUM TEST…
UREA and ELECTROLYTES TEST…
BLOOD FILM EXAMINATION…
LACTATE DEHYDROGENASE LEVEL...
WHITE BLOOD CELL COUNT…
NEXT TIME - GETTING AWAY FROM IT ALL - The Benefits of a little R n R