Declining serum Albumin levels anyone?

[MAT51]

I've just noticed that my latest Cellcept blood monitoring levels are just below range for Albumin. They used to be around 40-45 (normal lab range 35-50) but have slowly lowered and now at 34 - just under range. My CRP is invariably above range too but this isn't new.

Is this low Albumin a Sjogren's thing or other? My diet is very wholesome - but I have unpleasant GI slow transit problems. I've checked my FBC results over the past six years and it's never been under range previously although it has got steadily lower. Hoping just a one off but vaguely concerned by this trend.

[irish]

Are you having any malabsorption problems. Also, some meds can affect this. Ask your doctor next time. Irish

[MAT51]

Thanks Irish I will ask when I speak to my GP on phone a week today.

I had been travelling the previous two weeks prior to blood test and hadn't been able to take my most powerful laxatives or stick to my usual gf diet. However I've been tested for Ceoliacs several times and don't have it. I don't know of other types of malabsorption really but will definitely ask. I see a dietician in December and have been referred to gastroenterology to assess whether my GI issues are neurogenic or IBS. The Sjögren's specialist said a mix of lack of mucosa and autonomic 50/50 is common in her SS patients.  So perhaps this would cause malabsorption although I try my hardest to eat a very wholesome range of foods and suppliment B12 and AdCal D3.

[MAT51]

Are you having any malabsorption problems. Also, some meds can affect this. Ask your doctor next time. Irish

PS also had a thought - I'm drinking huge amounts of water just for purposes ofbasic swallowing of food these days as throat and tract so troublesome. So perhaps I'm overhydrated / saturated and all this fluid retention it's impacting on my kidneys somehow?

[irish]

Generally if one is over hydrating it will show up in other blood work.

Also, question whether you are having decreased pancreatic enzymes as this can affect absorption of food. But, with this problem one usually has large stools, weird stools, fatty stools, or diarrhea. Still best bet to ask the doc. Irish

[MAT51]

Thanks Irish. My stools have been strange for ages because of the slow transit issues relating to a mixture of dryness and neurogenic issues I'm told. I'm due to see a gastroenterologist at some stage next year. But my amylase was normal when last checked a few months ago and I had stool check last year for pancreatic involvement - it was fine. My blood results are good too apart from this recent trend of lowered Albumin and persistently elevated CRP and high sed rate/ plasma viscosity. I'm told these relate to Sjogren's though.

[anita]

Anyone with slow GI transit can have malabsorption issues.  Your most important absorption takes place in the small intestine, not stomach...and small intestine can easily be effected by gastroparesis/slow transit.

Is your iron low (or lower than normal?  What about other vitamins/nutrients?  Typically, if malabsorption is a problem, then it effect ALL nutrients, not just a few.  But some are more easily effected than others, so you can still have normal absorption of some things.

[MAT51]

Thanks Anita. Well my haemaglobin level was 135 and is invariably 140 (lab range 120 160) so definitely a bit lower than my usual. Hardly anaemia though! I've been feeling very dizzy/ light headed on standing (carefully I might add) despite no drop in blood pressure when I've checked.

As I've posted separately I've also discovered that the ongoing numbness and tingle plus twitching and burning lips might well be related to a cavity at the base of a very old root canal in a molar sitting directly across my trigeminal nerve - so my dentist thinks. He's concerned that I might get an abscess if this part of my jaw isn't cleaned up. Apart from anything else this further convinces me that sensory issues are never functional for me.

And I'm convinced that my ongoing GI issues aren't functional as the gastroenterologist I'm to see at some stage has suggested - decided on the basis of my bloods apparently. I do think this marginally low Albumin is related to my ongoing slow transit issues. Thanks!

[irish]

My blood work is normal for the pancreatic enzymes, but I have one test that is just on the border of low. With all the symptoms I have had these past years my doc said that I should use the pancreatic enzymes because people with Sjogrens have problems with this. The enzymes have made a difference. irish

I have had anemia for quite a few years too so will see how this is affected.

[anita]

Your hemoglobin is NOT the same as iron level.  You don't have to be completely anemic to have lower iron levels.  You have to be tested for ferritin to get iron levels.  What about other minerals/nutrients...like vit D, B, etc?

Your posts aren't easy to read as this site has issues with copy/paste function.  What were you saying about the Gi 'function'?  Is the doctor saying it is NOT functional...and what does she mean by that?  What bloods is she basing a dx on?

[MAT51]

They don't take my ferritin, folate or vitamin levels, blood glucose, thyroid or Cholesterol more than once every few years Anita. They do check other things in the hospital clinics every four months  but not these. I had it all checked by endocrinologist last year and had fasting glucose tests too - all fine. I take prescription Adcal D3, over the counter B12 and my potassium, sodium and other electrolytes are all okay. The only other thing I'm aware of is a consistently raised RBC level but it's at the top of range or just slightly over rather than properly elevated mostly. Many of my symptoms would corrrspond with Polycythemia Vera, apart from red skinned, so I keep a close eye on my full blood count and ask for print outs after the primary care nurse has taken my blood each month. The GP never calls to warn me if things are off kilter so they clearly aren't concerned about any of my blood results.

Okay sorry to explain in a bitty way about the gastrointestinal stuff Anita. It's complicated because here in UK we can't easily gain access to our blood results or clinical letters, referral letters etc. However I did manage to gain access to all very recently, because I made a stink about it! I discovered that, for the second time in a year, the hospital had changed their computer system and my data had all gone astray. So my primary care practice were cross for me too and their practice manager gave me all referral letters and my blood tests in printed copy form.

This meant I was privy to information normally not disclosed to NHS patients!

And, as I always request copies of my blood results I could use these to check against older ones - which is how I came to see the trend of consistently raised CRP, always high but fluctuating PV (like sed rate but much more accurate), raised total protein and this first under range Albumin result.

Regarding the functional comment - I was referred to gastroenterology at my last Connective Tissue Disease clinic appointment by the Vascular Doctor who specialises in nailfold cappiliiaries and Scleroderma - which he tells me I don't have so far. I explained that the GI tract issues at both ends are very dominating and my GPs are treating me for IBS-c but I would like clarity because my rheumatologist (his colleague) thinks it's low transit dysmotility - and I feel it is important that I'm treated for the right thing. He agreed so referred me internally.

In his referral letter to his gastro colleague he explains my situation and says that a CT and colonoscopy done last year show nothing sinister or particularly untoward apart from large haemorrhoids. My IgG is always elevated as is my IgA - and I have tested negative for Ceoliacs several times. But he would like me to be seen nonetheless. The gastro doctor replies to say okay he will see me in due course out of respect for his colleague. But goes on to say that as my bloods don't suggest an inflammatory bowel disease he thinks this is probably just functional ie IBS-c.

This has made me study my bloods more closely. Also the Sjögren's specialist I saw recently down in England at my own expense - has written that her Sjögren's patients often suffer from GI problems and usually this is due to a mix of dryness and autonomic dysfunction. I don't think this is quite the same as functional/ IBS is it? She also commented that my consistently raised CRP is unusual for a Sjögren's sufferer although my high PV/ ESR is to be expected.

So what is causing my CRP to be always fairly raised - between 12 and 21 (normal 0-5)? Another thing - my new GP has written on her referral letter to respiratory (ongoing sleep problems to be checked for apnea) that I have Sjögren's and Fibromyalgia - which I most certainly don't! Hence I'm feeling a bit paranoid about my medical team's propensity to relegate my symptoms to "functional". Hope this explains more clearly why I'm feeling less than sure about my ongoing chronic constipation- which is the bain of my life really along with Trigeminal issues and the hopelessness of NHS Hospitals in taking a multidisciplinary approach!!

[irish]

I have low ferritin level and am getting IV iron now. I have the malabsorption stools which I won't go into here but they are not fun to have and can disrupt life. One important blood level was on the very low end of normal.

I do not remember the blood work she did and my portal is not working now so can't go refresh my memory. There are some things in life that are not cut in stone and can take place in spite of "evidence". A person with seronegative sjogrens is an example.

I have a low B12 also. My doctor is one of the best GI docs I have seen and I trust her judgment. Especially since my GI symptoms are much less since the introduction of the pancreatic enzymes. I am just telling my experiences and didn't know there was a right or wrong way to do it. Irish

[MAT51]

You are so right about things occurring  against the odds. The trouble is that it takes a special kimd of detective-doctor to identify the zebra. And, in an era where the NHS and other health systems are under huge pressure, these kind of great detective Doctors are very thin on the ground!

[anita]

I understand more now.

If there is any question of malabsorption, then they would need to repeat those other labs more frequently then every few years.   They can also test the stool for malabsorption.

Are they at least treating the IBS-C?  Do you take anything for the constipation?  Is it helping?

[MAT51]

Hi Anita. I had a stool test early last year when the constipation first started out of the blue - and it was normal. I will ask my GP about other blood tests when I speak to her on Tuesday. Most of my prevailing or worsening issues seem to be neurological if anything. The Sjögren's expert thought it was probably a mix of mucosal dryness and autonomic dysfunction as common to Sjögren's.

Re treatment - yes absolutely. I've been on a mix of osmotic, stimulant laxative and fibre. But it turned out the fibre and osmotic were causing awful abdominal pain and more bloating so I've switched recently to a syrup of Senna and Laxido powders. I'm always still struggling to get the balance between severe pain and nothing happening at all right. I have a stand by laxative called Bisocodyl for if things are getting too sluggish. The problem is that I get feocal incontinence if I can't stick rigidly to a routine - and my life is far from routine often eg lots of car travel.