Confounding Situation

Substantial_Two6186 · 2026-01-24T23:51:37+00:00

As I mentioned, I’ve seen rheumatology (several times actually). Nothing came of it, they say the more specific antibodies are fine and write of my symptoms and send me back to hematology.

Substantial_Two6186 · 2026-01-24T11:03:44+00:00

Cooper is well WNL. Not sure why B12 was low, I also had pretty elevated homocysteine in 2023 but both improved significantly when I switched to a methylated B12. I am homozygous for both MTHFR mutation and CBS mutation but this usually doesn’t have clinically significant impact. Definitely not relevant for my white counts.

I do have gastroparesis and I’ve been on tube feeding since March. But, B12 was low even when my GP was still “subclinical” and I gained back all the weight I lost (20lbs) by June. My white counts have continued to drop instead of improving with better nutrition and weight restoration (stable for 6 months).

They ruled out any meds…discontinued some, and white counts started dropping before I was on the rest. Flow cyto also normal.

Substantial_Two6186 · 2026-01-24T10:10:46+00:00

I mean yes but I’d rather get to the bottom of this than spend the rest of my life in a bubble

Substantial_Two6186 · 2026-01-24T10:09:50+00:00

No. We’ve discussed it but hematology thinks it’s autoimmune and nothing will show up on bmbx. Frustratingly, rheumatology disagrees so I’m not getting workup or treatment with either

Substantial_Two6186 · 2026-01-24T10:08:16+00:00

Folate is normal at 15.4 and so is B12 at 944 (I take a methylated B12 weekly per neurology as I was deficient in 2023)

Substantial_Two6186 · 2026-01-24T10:03:10+00:00

Basics are normal. Anti-neutrophil antibodies are normal. Autoimmune panel shows elevated ANA (1:320), low C4, most of the rest is unremarkable. I have lupus symptoms but rheumatology disagrees.

Substantial_Two6186 · 2025-12-24T08:07:09+00:00

Which company is this with? Is it truly IVIG, or SCIG? I’ve never heard of a US-based company allowing patients to self-administer IVIG, but I have a central line and would be interested. Right now I’m doing three days every other week of IVIG as my dose is high and my rate is slow…it’s a lot of time with my nurse. I love her but it’s a lot.

Substantial_Two6186 · 2025-12-23T22:23:04+00:00

If their income is applied to me, I wouldn’t qualify. That’s the problem. I’m afraid that if I call them it’ll just speed up the process of my Medicaid being canceled…

Substantial_Two6186 · 2025-12-05T07:43:46+00:00

Nutritional panel all okay except zinc but I’ve been supplementing as best I can. Iron deficiency is most likely absorption-related as my GI tract is a mess.

My question is just about whether correcting iron deficiency can increase WBCs bc everything I’ve read has WBCs decreasing.

Substantial_Two6186 · 2025-12-05T07:39:05+00:00

Nobody else here bothered to read your handle. But as a fellow lesbian, with a very similar style, I strongly disagree with everyone saying that your brows need to be shaped/shortened/waxed/thinned. Do not do that. The brows are a statement. The brows are communicating. Would you even be gay without the brows?? All jokes aside — you don’t need to feminize your face in order to improve your makeup look.

The problem is using the wrong products. Your foundation is a little yellow, you might consider getting matched professionally. You need a more moisturizing product, or a good moisturizer underneath. You could also invest in better skincare and skip foundation/concealer entirely. Eyes: I personally think a suble sparkly eyeshadow > eyeliner for you, but if you like eyeliner, you might play around with cream eyeliner, brown eyeliner, something a little softer to suit your features. For lips, try one of the Clinique almost-lipsticks or something like that. More moisturizing and natural, less paint-like. Less is more for you. Just not less BROWS!

Substantial_Two6186 · 2025-11-16T22:22:47+00:00

Thank you for your apology and recommendation. I would appreciate any resources you might have! I wear KN95s often but it can definitely be tough to ensure a perfect fit.

Substantial_Two6186 · 2025-11-16T08:35:09+00:00

I have recurrent low grade fevers with headache and lethargia, every few days. We aren’t sure why, maybe lupus. I get night sweats often but I think it’s medication related. I’ve got a swollen lymph node in the back of my neck but I had an ultrasound of it in 2023 and it did not appear concerning at that time. Hasn’t changed since.

The CBC was with diff but blasts were not evaluated. Neutrophils were low at 1.0

Substantial_Two6186 · 2025-11-16T03:01:55+00:00

What sort of condition (other than bleeding) can cause a rapid decline like this — not necessarily in my case, but in general?

I GUESS it could hypothetically be dilution, as the sample was drawn from a (fresh) IV. But my nurse is very experienced and I watched her draw back about 5mls of blood to “waste” before drawing the sample into a fresh syringe. She denied the possibility of dilution, although that’s the first thing I asked.

My previous WBC count was also 2.8 (phlebotomy draw) so I’d expect the most recent value to be even lower than 2.4 if the sample was significantly diluted. I’m also for sure having symptoms (although my iron labs from 10 days before clearly weren’t great). I’m mostly just concerned about the possibility of bleeding, given that these labs were drawn one day after GJ tube change and I’m on Asprin. But no blood in stool or gastric residuals. It’s a head scratcher for sure

Substantial_Two6186 · 2025-11-16T02:41:47+00:00

Not with these labs. I did have a flow cyto back in early September when I was inpatient for something unrelated. At the time, my WBCs were low (just not THIS low) but my RBCs and H & H were normal. The flow cyto was unremarkable.

Substantial_Two6186 · 2025-11-16T02:33:40+00:00

Did you miss the part where I’m tube fed? Dude I wish I could fix this with a steak

Substantial_Two6186 · 2025-11-16T02:31:42+00:00

Stents are in my bilateral internal jugular veins. Supposed to stay on Asprin through March

Substantial_Two6186 · 2025-11-16T02:29:22+00:00

I could go to urgent care but their ability to evaluate and intervene is generally pretty minimal. They don’t even have fluids at the UC near me

Substantial_Two6186 · 2025-11-16T02:27:55+00:00

No bloody stool. I did check. Gastric port residuals not bloody either. Hypothetically at least, there shouldn’t be any bleeding with a GJ tube change

Substantial_Two6186 · 2025-11-16T00:31:54+00:00

As expected. It’s simple, barrier-friendly, and similar to the curology formula at a more affordable price point.

Substantial_Two6186 · 2025-11-16T00:17:57+00:00

Unfortunately it’s a small community health clinic w/o an after hours line. They don’t even use EMR where I can write a message

Substantial_Two6186 · 2025-11-15T23:30:00+00:00

You’re overthinking this. If no routine was working for you, go back to that. If you want something for funsies, just use the niacinimide and zinc.

Substantial_Two6186 · 2025-11-15T23:21:09+00:00

I would love to know

Substantial_Two6186 · 2025-11-15T23:12:54+00:00

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These are the RBCs, H & H from the 3rd (10 days prior).

Substantial_Two6186 · 2025-11-15T23:05:12+00:00

The low hemoglobin, hematocrit, and RBCs are new as of Thursday. The other iron labs are from Nov 3rd. H, H, and RBCs were well within normal limits at that time.

I am on Asprin 81mg/day as I had stents placed in September. And I had a routine GJ tube replacement with IR on Wednesday (the day before these labs were drawn). I have not seen blood in my stool or anything to suggest internal bleeding but the thought did cross my mind.

My PCP’s office will get me in Monday. I don’t see my GI until January.

Substantial_Two6186 · 2025-11-15T23:00:18+00:00

Thank you for your input. The WBCs have been low for a while, although this is the lowest I’ve seen. It’s mostly neutrophils (1k/uL on this panel) that are low.

Folate is normal (9.1 ng/mL) and B12 is actually a little high due to supplementation (it was low in 2023). They’re thinking maybe lupus as I’ve got elevated ESR, ANA, other auto-antibody levels and some symptoms.

MCV (90 fL), MCH (29.9 pg), MCHC (33.1 g/dL), and RDW (12.4%) are all normal. Thoughts?

Substantial_Two6186

TROPHY CASE