Worrisome lab tests results

One of my endos requested it on my behalf because I was convinced my a1c was inaccurate. There seems to be a lot of trust in a1c but the more I learn about the dynamics, the more I’d want to do a fructosamine test along side to ensure it was broadly accurate.

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My A1c has been 5.3 and under for almost 15 yrs except once or twice and I have been in the 4’s before, so my 4.8 isn’t shocking.

4.1 is ridiculous though.

So no number for immature Reticulocyte Fraction for you?

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No fraction info. I can request this next time. What will it tell me? How concerned should I be with my 160k+ readout?

Jon, I am sorry, but this is all new to me. I am going to make an appointment with a hematologist.

Are your blood counts low at all? My WBC is always low and my RBC is just a tiny bit low. If my RBC was lower I would be more worried about my Immature Reticulocyte Fraction number because that would mean that red blood cells were in trouble. Since my other Reticulocyte numbers are fine, my GP isn’t worried.

So the doctor who knew enough to order this test for you, doesn’t understand it well enough to explain it to you? I seem to be having that problem too. I guess that is why there are hematologists.

Please keep me informed and in a few weeks I will let you know what I find out from the hematologist. My GP said that he will recommend one.


The fractionated reticulocyte test is new. Some doctors have not really seen it yet.

It’s not really been around enough to get a good read on its implication.

Simply stated, your body makes red blood cells, they come out immature, those are reticulocytes, the yquickly mature into usable red cells.
It is normal to have a half percent retics at any time.

The fractionated test tells you how immature they are.

There are 3 types. Late( expected) delayed( middle ) and immature.

The test you get is actually the last 2 groups together.
So the number is a fraction of the total number of reticulocytes.

That makes the number look way more alarming than it is.

Like if I have a dollar and I give you 10 percent of it. You have 10 cents.
And you spend 9 cents. It appears you spent 90 percent of your income.
But really it’s only 9. Because you are taking a fraction of a fraction.

I hope that makes sense.

As far as iron goes , doctors think anemia in women means throw iron at them, which is correct most of the time.
However your blood results don’t point to iron shortages.
Iron supplements won’t hurt you though.

A hematologist will really know this stuff. Go for a younger doctor if you can. They have been educated more recently and know cutting edge testing better


Thank you so very much Timothy. I really appreciate your input.


My sister looked up high immature Reticulocyte fraction and type 1 diabetes and found this conversation.

I guess I have been very naive when it comes to posting my picture and name.

There is probably not a whole lot of people talking about it so it makes sense.

Why be sorry to be known for bringing a useful topic up for discussion as I greatly benefited from reading this as I have been struggling with the same issue since 2002.

I had been upset that my GP would not let me see a hematologist for many years as he had said being 7% below range is not to be concerned about and hematologists are busy helping people really having low cell counts after receiving treatments like chemotherapy.

So yes I had fatigue and had been looking for all the reasons as I also had high réticulocytes when they did test me at the beginning after I had that problem with neuropathy. My situation is not due to low HbA1c. So I had considered whether it was due to macrocytosis and so I have been taking B12 for years and that is no longer an issue.
In April 2016 I finally did see an hematologist as my endo agreed to refer me to one.

She did my blood tests in her hospital lab only 2 hours before I saw her and when she got the results she said I was fine, but as she saw me late by about an hour and I had waited so long and have a problem of not recognizing a low BS when it comes on I was not able to ask any questions and when I got out and took my test it was too low for me to really be able to have responded.

Anyway I gave it a lot of thought after as I have researched this issue inside and out and it is known that blood results get worse the longer from being taken out of the body they are analyzed. So wow, if I am ok if they look at the blood right away, then why should I be worried if it is worse by 7% a few days later when analyzed too late? There is indeed no point so my GP had been right What is more important is how it is inside the body and that is precisely why the specialist gets very fast analysis done. to see how it is when it was recently in the body.

Now I am not saying this is your case, as ALL I am doing is explaining my case in a similar situation of blood test results.

So if you are tired maybe the issue is due to something else and I have an idea but won’t mention it in this thread of discussion as it is a different issue.

Thank you for sharing your experience Janina. I am glad that you are doing well.

The other issue I wanted to mention is what you have already mentioned elsewhere about the thyroid and feeling cold. That is a topic I have studied in depth since 2014. There was a woman who was more often a part of this group of tudiabetes called Gerri who told me about reverse T3 in 2011, but I did not act on it to get it tested right away until 2014, so I wonder have you had reverse T3 tested when TSH, FT4 and FT3 are tested?

Because what I found in June 2014 was that it was reverse T3 that was my only issue, then with all the reading I found the supplements needed and tried many experiments over the next two years that cost me a lot to do, given that T3 is so expensive. So that is why I have stopped that until I get to be over 65 when I might have a chance of having T3 covered to only occasionnally use it as that is KEY, to not use it constantly. However during those experiments my TSH went super low and my GP got really upset and I fully understood why, as it is a way to lose the ability to produce the hormone if you do it long enough just like almost all people eventually lose their ability to produce insulin just by taking insulin, like I have, so I understood the problem. That is why I was determined not to have done to my thyroid the same as has been done to my pancreas.

I have found websites concerning bodybuilding that have suggested people use insulin to build muscles but they also strongly worded it to NOT do that taking of extra insulin long term for there is a risk of becoming diabetic. So when I saw that I said thank God some people understand. The whole problem is the medical field in my opinion is largely run by the drug companies and they love it when people become diabetic or come down with anything whereby they will be able to sell drugs to them for the rest of their life…

So the main problem in our case is the medical field is taught about drugs and not even schooled in how to make people better as that is against the business model of the drug companies. So that is why my approach to solving neuropathy has met with such lack of caring because they would prefer to keep people sick. I know because even though my doctor asked me to help people about it over the years since I managed to get myself better, he told me in 2011 if he said publicly that vitamins could cure neuropathy he said he might soon be sued. That is also another reason why now there are bots that monitor comments on facebook and youtube to remove that which is stating anything about a cure, as it is the drug companies who do not want there to be any cure, probably for anything.

So that is why my endo still asks me about neuropathy signs and i asked why he does that after so many years and he said because he was obliged to do so, and that makes me think it is because again the drug companies want it that way. He also regularly asks if I want to go on statins, as if he would get browning points if he got me on them, but I know how to deal with that and he has seen my excellent cholesterol numbers when I am taking a lot of antioxidants.

So the full reality is if a person does want to be cured from any issue they themselves have to do all the research as doctors rarely have the time to help and so the person who is sick needs to take their own case in hand.

So that is why currently there is so much anger from the drug companies about the plain fact that Ivermectin is so well and usefully used off label for the pandemic and so they are now trying to take that down wherever doctors are talking about it and it angers doctors, and rightfully so.

So for all these years when I had the repeatedly low blood results numbers and even once a warning about thrombocytopenia, I knew it was up to me to figure it out as my GP said my low numbers were OK and he would only send me to a hematologist if I got to 20% below. So that is why this topic was so much of interest to me as I have struggled with it since 2002 when I had that neuropathy problem. My GP even agreed with me years ago that maybe my bone marrow took a hit. But I have also wondered if it is a diabetes issue or a parasite issue, as I have done so much looking around for answers to my fatigue and the low red blood cells seemed a likely reason.

So recently I asked him if I could take Ivermectin as an experiment to see if it also could improve my red blood cell counts and he immediately said YES and wrote me the prescription for Ivermectin and said both myself and my BF should both take it as he said he and his staff are taking it for the protection from the pandemic.

So I have had now had three doses and in several more months I will do blood tests and see if my blood results are better, but I am planning to take a total of 11 doses over about 5 months.

I have had thyroid problems for at least two decades. My mom took thyroid and so does my husband, son and so did our dog. I am well balanced and don’t have to deal with cold feet or fatigue due to unbalances. I don’t mind taking T3 and T4.

Like you, I have also spent a lot of time studying thyroid. I have read a couple of books about thyroid and have discussed what I read with one of the authors. I have asked many, many questions over a period of years and have argued with physicians who wanted to keep me under medicated. Life is hardly worth living if one is extremely tired all of the time.

Yes, I do get my reverse T3 tested and have for many years. I agree that it is important to get all of the numbers. Because I have spent years trying to get my thyroid numbers balanced, I now give it little thought. In the past two years I have stopped taking Armour Thyroid and Naturethroid because i have been advised that the formulas have been changed and that they do not work nearly as well as they once did.

I have been taking Levothyroxine and Liothyronine for close to two years and am quite pleased with my thyroid levels now. I do keep close watch on them. I hope that you will soon be able to take T3 if you so desire.

Eventually I will if I can get it covered and then will not be spending money on the tests as the lab has increased the reverse T3 test cost from $35 to about $65 or $75 the last time and I was shocked. I will not do the test then unless that is also covered, as I do remember my strategy is to use T3 on a periodic basis and not continually, as the sole reason is to get the reverse T3 down and not to be making my body depend on the drug.

So selenium is what helps get the T4 translated into T3 and shen I had forgotten to take that for a few days, I believe that is why my temperatures had gone down. And now it is 97.8 so it is also going down again, but I take my supplements when I eat and do that only once a day…later. I had to have a snack of pumpkin seeds (zinc) and walnuts and a few raisins given I awoke with a low of 3.6 mmol…and what I had was very few just to get the number a little higher. At that time my ketones were at a trace level.

So now that I have a slight headache and I test again I see my ketones have increased to large and is at a level of 8, so that accounts for the headache and whether that comes from the 1.5 walnuts and the seeds or my own fat is not possible to tell, so now is the time for my next test and some insulin. So was 6.3 mmol and took 1u4u and will later take more when I eat my one meal of the day as I am trying to lose weight.

I saw a hematologist this afternoon and he said that I can take a little prescription iron, but other than that not to worry about my labs.

He said that the lower counts have nothing to do with my diet, and that they should look more normal with iron.

He also said that my 4.8 Alc was accurate and not affected by the immature Reticulocyte Fraction.

I just have to assume that he is correct.


Even if your retics are altering your a1c. It doesn’t matter. Your numbers are so low. You are looking really good.


Hi Marilyn,
I am new to this forum and your post caught my attention as I have experienced the same results in my blood work for the past 5 years. I’ve had T1D 46 years. My endo says not to be concerned. But the numbers keep going a little further out of range every six months. A hematologist told me she considers 5 factors and if 3 or more are out of range she does a bone marrow biopsy, which she suggested I do. I have not followed through with that at this point. I feel very healthy, full of energy, sleep well and keep my A1C at about 6.8. I appreciate everyone’s comments and look forward to understanding and treating whatever this issue is.
Blessings to you, Suzan

Hello Suzan1 welcome! I find it interesting that your labs were somewhat off too. I will soon get mine retested and will find out if the iron was helpful. I had read about maybe needing a bone marrow test, but the hematologist didn’t even mention one. I can understand why you are putting getting one off since you feel very good. I too feel good and have had more energy since starting iron.

I will post my results here. Thanks so much for commenting Suzan.