u/Ok_Organization_7350

I am an adult female on no medication. Last fall a blood test at another specialist flagged results of hypogammaglobulinemia. His follow-up tests showed low total bound & unbound light chains, but normal free light chains. At the same time that fall, my bones started hurting me. So I had bone labs, and they were all normal. At a doctor appointment in January, I asked for blood tests because of the hypogammaglobulinemia & bone pain. The comment on the lab report said Large Granular Lymphocytes. My doctor said it's because of an infection. I said I don't have an infection. It was a small clinic, so I also wonder if it was just easier for them to call anything abnormal an LGL as a generic term, but maybe they didn't really know what they were looking at.

So I went to another doctor 2 months later in March to double check it. This time their lab report said 14% Atypical Lymphocytes, compared to a maximum normal range of 5%. Also that lab report said hypersegmented neutrophils (I'm not B12 deficient), elevated myeloid lineage, burr cells, elliptocytes, and polychromasia. A doctor said it was an infection reaction. I said I do not have an infection. Also note that in the autumn that other specialist ran extra detailed reports for inflammation and auto-immune. It was all negative.

I went to a big fancy hematologist oncologist in May. He asked if I had bruises. I said yes, big ones and little ones (petechiae), and I showed them to him. He said they don't count. He asked if I had fevers, and I said no but I often feel sick and go to bed in the afternoons. And after that he lost interest in me. He said my blood result was probably from an infection. He was kind of gruff and rushed, and said come back when your CBC is worse, because my RBC & WBC counts were normal. And he didn't run any other tests besides the automatic CBC & Chemistry.

Next I went back to a PCP in June but a different one, and showed him all my labs. I told my him that my inside front rib bones hurt all the time & my inside upper arm bones hurt so badly at night they feel like they want to rip open. He seemed nicer and more concerned than the hematologist. He ordered a follow-up blood test. This time the Atypical Lymphocytes went up to 20% (43% increase in 2 months, since the previous result of 14%), the abnormally shaped RBCs were marked again, and it said smudge cells. But the prior March lab report said no smudge cells.

So I have had three test results of Atypical Lymphocytes over 5 months now, with each lab report worse than the previous. If it is from an infection, then I want tested for this mysterious infection that gives me no infection symptoms, and I would appreciate any virus or parasite testing recommendations. Also I have had continuing mild thrombocytosis for a year, but previously it used to be normal. And I had a weird patchy scab on my head that went away. And a weird little 1-cm peach colored rubbery bubble sore on the top of my leg which also went away,

I am scheduling a return appointment with the nice PCP who ordered these recent tests, for him to go over them with me. Which lab test should he order next to follow-up? Since my hematologist was absent from my care, this PCP is kind of doing the work of a hematologist, which is considerate of him, but he shouldn't have to do that.

I am a patient. I have been going to a doctor for blood and bone problems. My doctor wrote me a lab order for a "CBC with differential AND PERIPHERAL BLOOD SMEAR". I first had this test several months ago. The hospital lab technician expertly drew my blood, did a finger prick, and put it on a slide right in front of me. Then later I received three lab reports: a CBC, a Manual Differential with a lot of detail, and a Blood Smear Pathologist report. Everything went smoothly.

I was given a new lab order of the same ("CBC with differential AND PERIPHERAL BLOOD SMEAR"), to check on my blood, since the smear pathology review last time had bad results and I am getting sicker. I went to a mega academic medical center hospital in a giant city, who is an NCI Comprehensive Cancer Center, and who has a special team of Hematopathologists who offer second opinion pathology reviews for patients across the country. So you would think they could handle a blood smear, right?

But no, the phlebotomy technician looked directly at the lab order for CBC with Differential and Blood Smear. And she chose to key it in instead as Automatic CBC & Differential. Nothing else, no manual differential, no blood smear. So the lab report I got is useless junk, and it about gave me a heart attack out of disappoinmtent. My doctor and I did not get the tests he ordered. I had to call the hospital Patient Relations and submit a complaint. They are looking into the quality control issue which went wrong and are trying to help me reschedule to do a re-draw and start from scratch, but I don't know if this will take place.

In the meantime I gave up on them and took the order to the first hospital I went to who did it correctly the first time. There was a new person this time who didn't seem as sharp as the first lady. I told her "Please remember that since a peripheral smear is ordered, that you need to key in the Differential as Manual. If you don't, then they will accidentally just do an automatic differential which is the wrong test." She just kept looking at me with a blank look and empty eyes, and said she didn't understand. So this is the second order which is botched too.

** Just out of curiosity, when you receive blood smear slides - who was able to prepare them? I would just like to know, so I can go to those types of places instead. I think the hospital labs at the giant hospitals in my area apparently "don't like doing slides", so they keep changing and downgrading the order.

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EDIT UPDATE: Thanks everyone for all your helpful comments. I have learned some new things. (1) It was probably not the phlebotomist's choice or fault which changed my doctor's order. (2) Instead, it was the lab administration (not the medical technologist's fault) using facetious algorithms to change the lab order, because they do not want to do the manual differential and smear, because they are more work.

Fyi, for all the people trying to defend automatic differentials being used on everyone universally - they are NOT equal to a manual differential and NOT as good, like you think they are. I have had an automatic and differentials done at the same time for comparison. The automatic shows low white blood cells. The manual shows high white blood cells plus a note of high mutant white blood cells. The reason is the machines do not recognize my type of mutant white blood cells as WBCs at all - so they don't include them in the WBC count! Also the automatic differentials don't include the misshapen RBCs which my doctor was also watching.

I used to be a vegan. During that time, my guts always hurt and were sore. And food would not digest. I imagined that I had some terrible type of unique IBS disease. But after I escaped and started eating meat, my intestines magically healed themselves immediately. Then after following this board, I keep seeing other people mention the same thing sometimes.

Now this famous person in the news, Bryan Johnson, who is a vegan, was announced as being diagnosed with Auto-Immune Gastritis. And I see a lot of other vegan people say that they have pernicious anemia, "not from diet! but from an auto-immune condition".

I finally found someone in the news who explained this phenomenon.

"Plants contain hundreds of NPAAs (Non-proteinogenic amino acids), what would also be called pseudo-amino acids, which trick the body into incorporating them into peptide chains. However, they do not fold into the correct shapes, and hence are deemed foreign bodies by the immune system which then attacks them."

So veganism DOES create gastritis, including even auto-immune gastritis, and it can create actual auto-immune pernicious anemia. So sometimes a vegan can be deficient in B12 or have B12 deficiency sickness symptoms, not necessarily from not getting enough B12, but sometimes instead just from not being able to absorb B12 anymore from the damaged stomach lining from veganism itself. Fascinating but sad.

I am a research and laboratory professional myself. But this time I am submitting a post about CBC lab results processing. I am not seeking any opinions about diagnoses.

My doctors have been ordering CBC & Differential blood tests for me for hematology issues for a while. When the test is outsourced to Quest or done at one hospital laboratory in my town, then my WBC count is normal, and my lymphocytes % is normal. However, when this same test is done at the other hospital lab in my town, then the WBC count is high and out of range, the lymphocytes % is low and out of range, and there is a field added for out of range high % of atypical lymphocytes.

So it appears that the latter hospital lab is using a different & better type of hematology analyzer, which can see the atypical lymphocytes and includes them in the total WBC count, this increasing the number, and it subtracts them from the lymphocyte % since they are not normal lymphocytes. But the Quest lab and the other hospital lab in my town use a hematology analyzer which cannot see the atypical lymphocytes, so it doesn't include them in the WBC count which produces a lower number.

Is that correct and is this what it looks like to me? If so, what brand do you think the hospital uses who produces more specific and more accurate results, since it could see the atypical lymphocytes? It seems like more doctors should be aware of this situation and how the machine type can really alter the patient results.

Previously for scheduled chemistry/ glucose serum lab testing, the patient was told to fast the night before.

And when chemistry/ glucose labs were taken, they were either marked as fasting or non-fasting. And then the glucose lab normal range on the results report would respectively show either the fasting or non-fasting lab range.

But now the fasting requirement has been removed and patients are not told to fast anymore before chemistry tests. But of the fasting or non-fasting lab range, the labs are all using the fasting range by default for all patients.

I am not a doctor but I work in another medical profession (clinical research) where I review patient labs, so this has affected me with my job. This has caused a new situation where all patient glucose lab results are always flagged in red as out of range. But the doctors know they weren't fasting. So they will say to ignore it because it probably wasn't fasting.

* So now doctors are either being subconsciously trained to not recognize or acknowledge glucose lab results which defeats the purpose of the test. This happens more in the specialists offices who do not treat glucose but order it as a formality.

* And for doctors who do use these pseudo glucose lab results such as primary care, this could result in patients falsely being classified as diabetic and put on diabetes medicine unnecessarily, which is dangerous if they don't really have diabetes. From my experience working with this, I have seen that this is indeed happening.

If all chemistry/ glucose testing is now non-fasting, then the labs should be using the non-fasting lab range. That would be more accurate science. I do not understand why they are shifting on purpose to this imprecise situation.

EDIT: For the people saying "but our office only uses one range in the first place" - that one range they are using is actually the fasting range specifically, if you look up the current standard fasting & non-fasting glucose lab normal ranges, which was my point.

And when I review medical records, I see the messages going out to patients and the ICD diagnoses. Yes, patients are being messaged about "high" glucose lab results, and basically reprimanded and chided about "improving their lifestyle and nutrition", even after just one of these false tests, and sometimes told they could be diabetic now. And doctors are using the ICD diagnosis for diabetes on the billing side sometimes, even for just one of these false tests, which can negatively mark patients with their insurance company. Also A1c is not a requirement for diabetes diagnosis. It can be diagnosed by several glucose test results alone without high A1c which is done sometimes.

Women’s Regular Cancer Screenings: Cervical Cancer Vs Other Cancers

Below are incidences of yearly deaths for some cancers in women in the US for 2025:

• Cervical Cancer: 4,320
• Uterine Cancer: 13,860
• Ovarian Cancer: 12,730
• Endometrial Cancer: 14,000
• Kidney & Urinary System: 10,300
• Blood Cancers: 24,290
• Lung/ Respiratory System Cancer: 61,860

References, including for other cancers:

https://acsjournals.onlinelibrary.wiley.com/doi/10.3322/caac.21871

https://ocrahope.org/for-patients/gynecologic-cancers/ovarian-cancer/ovarian-cancer-statistics/

https://pmc.ncbi.nlm.nih.gov/articles/PMC12221196/

The only type of cancer in this list for which doctors care to screen is cervical cancer with a pap smear.  This is done by mychart reminders, phone calls, letters in the mail, nagging, coercion, by force, by blackmail from withholding other medications, by lying and telling patients it is mandatory, sometimes by lying and tricking patients into it without their consent or even actually against their consent. But cervical cancer has the lowest incidence in this list. It is NOT the most common cancer for women.

Now look at all the other more dangerous and more common cancers in women in this list. What regular screenings are done for these? None. Do screening tests exist for these? Yes. But doctors don’t care and won’t use them.

Uterine Cancer, Ovarian Cancer, and Endometrial Cancer, which accounted for 40,590 deaths in US women last year, cannot be detected by a pap smear or pelvic exam. They are in another separate body cavity which cannot be viewed through the pelvic exam. The screening test for these is outer pelvic ultrasound (not transvaginal ultrasound, because that is indecent and sadistic to women), and the simple easy blood test for some ovarian/ uterine/ endometrial cancers is CA-125. Another screening test for endometrial cancer is the endometrial biopsy which should only be done when there are symptoms. But I just cannot remember my doctor sending me a mychart message saying “Dear patient, Remember that ovarian/ uterine/ endometrial cancers are the most common gynecology cancers with the most deaths in women! We care about your health! Please call us back to schedule your yearly outer pelvic ultrasound and CA-125 blood test!”….. Did I miss this message from my doctors? Where did it go? Or did they not really care about me when they did the same thing for pap smears? And did they have other motives besides my health, such as billing, and metrics for their yearly bonus??

Some of the kidney and urinary system cancers would be detected by a Chemistry labs or Urinalysis labs, which used to be standard yearly health screenings. But the Urinalysis has been removed from almost all doctor’s offices for yearly screening, and many primary care doctors have also discontinued running yearly Chemistry labs like they used to.

Blood cancers also accounted for 6 times more deaths in US women last year, than cervical cancer. The screening tests for these would be a CBC, patient symptoms, then a Peripheral Blood Smear. But many primary care doctors removed the yearly CBC and never do it at all. If a patient feels sick and begs for a CBC lab to be done, and it shows abnormal results, then the doctors still sometimes do not care and say to ignore the results. And some blood cancers can have normal counts on the CBC, but only show up instead on the Peripheral Blood Smear which should be done for patient symptoms but never is. Again – where is the “love and concern” for patients for these cancers, which doctors exhibited for patients when demanding pap smears?

And the last cancer on the list which is the worse one: Lung/ Respiratory Cancer killed 61,860 women in 2025. These numbers are higher than all the gynecology and blood cancers put together. This is serious. Apparently, women should have a yearly chest x-ray for lung cancer screening. But they don’t. And even when women do have symptoms and say they feel sick and their chest hurts, doctors usually will not believe them, and they often will not let them have any tests for it. Instead those women end up in the ER as a last recourse when it finally progresses more by then.

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I am very disturbed and disappointed by what I see above. There is much phoniness in this industry, and hateful disregard & neglect for women’s health in more pressing areas where they genuinely need it.  

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EDIT: For anyone wanting the 2025 incidence rate in addition to the death rate, this is shown below, also from the same references above.

Cervical Cancer had both the lowest cancer death rate in 2025 on this list, and also the lowest incidence rate too. The pap smear screening is not what was making the death rate lower. Rather, cervical cancer is simply just an uncommon cancer in the first place, compared to others.

• Cervical Cancer: 13,360
• Uterine Cancer: 69,120
• Ovarian Cancer: 20,890
• Endometrial Cancer: 67,880
• Kidney & Urinary System: 50,150
• Blood Cancers: 83,340
• Lung/ Respiratory Cancer: 121,000

 

I have a question for Hematology physicians.

- Gamma Globulin is frequently low in Multiple Myeloma (MM).

- And Gamma Globulin levels are sometimes used as a marker to partially assess or gauge progression or health status in current Multiple Myeloma patients.

- Sometimes patients with low Gamma Globulin (Hypogammaglobulinemia), including both those with Multiple Myeloma and other patients without MM who have Hypogammaglobulinemia for other reasons, are administered Immunoglobulin infusions to treat this.

- And sometimes low Gamma Globulin can cause doctors to check for Multiple Myeloma in a patient who was not known to have it.

Many medical centers use Quest Diagnostics for their patient labs. A couple months ago, Quest Diagnostics changed their Gamma Globulin lab normal range. Previously, the lower limit of normal was 0.8 g/dL. Now all the sudden Quest dropped the Gamma Globulin lower limit of normal to 0.6 g/dL instead. Someone who had a Gamma Globulin lab level of 0.6 or 0.7 g/dL might previously have a diagnosis of Hypogammaglobulinemia from their doctor in their medical records.

** So now will doctors suddenly remove that diagnosis of Hypogammaglobulinemia for those patients who still have continuing levels of 0.6 or 0.7, or stop treatment of it, because of the new Quest lab range?