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Pathology/How abnormal is abnormal!

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Dear Dr Dahiya

I am a 38yr old female with an identical twin sister. We have both had a difficult life with constant upper respiratory infections and viral infections during childhood and as we became adults general ill health including severe muscle weakness and constant infections.  In 2008 we were diagnosed with CVID by a hematologist.  We are both now treated with monthly IVIg which has been had amazing results reducing infections and fatigue. However we still are having a few problems such as weight loss and severe asthenia/weakness and loss of axillary hair etc. We have some problems including hashimotos thyroiditis which the blood test results are clear about. We both also have very low DHEAS and low testosterone levels with no ambiguity in test results.Contrary to the low DHEAS we both have high prolactin which seems to rule out hypopituatism.  However there are a few other results which seem to be borderline.

I have recently been told I have premature ovarian failure due to low AMH (9.8) however FSH on day 2 is only 20 rather than the required 40 for official diagnosis.

My question is specifically: How low is abnormal and how high is abnormal.

For example we both have some kind of bleeding disorder and I have hemorrhaged 3 times during surgery (nearly dying each time)and many other times however these events weren't as severe. However the only platelet function test which looks unusual is the ristocetin which is right on the bottom number for normal. So technically the test looks 'normal' but the reality is not normal.  DDAVP has been used with good effect. My sister has the exact same results and has hemorrhaged twice.

Also my 8am ACTH came back at less than 5 however the cortisol was 220 which was low normal but I was told it was 'close enough' to normal. My sister has similar results.

Calcium is 'low normal' being on the very bottom of normal. My sister is also the same.

Oral glucose tolerance test came back as just over the upper limit for me and just below the upper limit for my sister.

So long as all results are borderline, either over or under, does the discount these tests as being of significance?

Even our immunoglobulin levels fluctuate, some months they look all normal except for IGA (being barely below normal) and other months being mostly all just below normal however we are lucky our Hematologist has looked at the overall clinical picture rather than just the numbers.

In one way I'm glad nothing 'jumps' out but on the other hand I wish I had a firm answer/treatment.

Thanks in advance for your opinion.

Anne

Answer
Hello Anne:
Thanks for the detailed history. I apologize for the delay in responding to your query.

The various functions of the body which produce these hormones in the body and the function they serve are dynamic. The values change every time you get tested. That is why you have a range and not affixed number.

Most ranges are set after averaging values of normal,healthy people. Having said that, there are people who fall outside the range. It the values are borderline or even slightly above or below normal range but there are no symptoms which can be attributed to them there is nothing to worry about. However if any of these continue to rise or fall on subsequent follow ups. The you may need further evaluation.

In your case you have more reason to believe that these values are the Norma for you as your twin sister has similar results. You are each other's control.

Have regular follow ups and do not worry unless there is a dramatic rise or fall in any of the tests.

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Neha Dahiya MD

Expertise

Help patients understand the medical terminology of their lab results and / or tissue biopsy reports.

Experience

I am a pathologist and director of clinical laboratory services. I have been a practicing pathologist for last 9 years in a 350 bed multi specialty hospital laboratory in India.

Organizations
Indian association of pathologists and microbiologists.
International Academy of Cytology
International association of Pathologists - Indian division
Indian association of Cytology

Education/Credentials
MD (pathology) MBA

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