PAP Tests, Low Blood Counts, Autoimmune Disease

Year 2, Month 1:

Just over two years ago it was determined through a routine PAP test that my cells were a little abnormal, but nothing to worry about. The abnormal cells were what is known as ASCUS cells: Atypical Squamous Cells of Uncertain Significance. In other words:

“cells that cover most of the external part of the cervix (squamous cells-ASCUS) or in the cells that cover the lining of the uterus opening and canal (glandular cells-AGCUS) for which the cause is undetermined.” (Lab Tests Online)

They told me to come back in a year for another exam.  I didn’t worry about it. In fact, I forgot about it.

A year later, I was in a new town with a new medical clinic. I was retested for the PAP as previouly suggested, and when it came up abnormal (again), I was immediately retested. This time, not only were my cells abnormal, but they were changing. They had upgraded themselves from ASCUS to LGSIL (Low-Grade Squamous Intraepithelial Lesions, "lesions" meaning "abnormal cells") – not necessarily cancerous, but scary nonetheless.


Time to Backtrack.....


What is a PAP test anyway? It is an examination of the cells collected from the cervix to detect cancer or abnormal cells that could possibly lead to cancer. This type of cancer (cervical) is usually slow-growing and may not have any symptoms at all.  The PAP test can also identify noncancerous conditions, such as infections and inflammation (National Cancer Institute, 2010).

What do my results mean? There are many types of cells and results. Without getting too technical, let me just briefly explain the most common cell types and results. For more detailed information, please visit the National Cancer Institute website or Google other reputable sources.

For most people, the results will either be “normal” or “abnormal” such as mine was two years ago. I was told not to worry because “abnormal” does not necessarily mean cancerous, and in fact, “abnormal” rarely becomes cancerous (National Cancer Institute).

Abnormal (Squamous) Cell Types:

ASC, ASC-US:  Initially, my “abnormal” cells were ASC (atypical squamous cells), and more specifically, ASC-US (atypical squamous cells of undetermined significance, as mentioned above).  These types of abnormal cells are fairly common, and can be related to HPV infection (Human Papilloma Virus).

LSIL, LGSIL: Climbing up the worry ladder, the next step is LSIL (LGSIL): Low-Grade Squamous Intraepithelial Lesions. This is what appeared in my test results the following year and indicated changes in the size and shape of the cells. It usually means “mild abnormalities caused by HPV infection” (National Cancer Institute) which carries the potential to become cancer.

HSIL, HGSIL: Next up is HSIL (HGSIL): High-Grade Squamous Intraepithelial Lesions. At this stage, there are more obvious changes in the size and shape of the (precancerous) cells and they don’t even resemble normal cells anymore.

SQUAMOUS CELL CARCINOMA: Following HSIL cells is simply Squamous Cell Carcinoma: it becomes cancer.


Back to the Story...

In 2011, I was referred to a specialist who performed a colposcopy and biopsy. At the same time, blood tests were run by my regular medical provider, and it was found that my blood count was low. My red blood cells were low, and my white blood cells were even lower. Ruling everything else out, I was given three likely causes: Cancer, HIV, or Lupus (or some other autoimmune response).

"Autoimmune response?"  Haven't I been barking up this tree for long enough yet?  I have had numerous symptoms pointing to an autoimmune problem for over two years now, and we still can't figure this out?

What was going on with my body? First it was thought to be Celiac Disease, and then a gluten intolerance. What was happening to me? My system was so down that now my blood count was low and my last four PAP tests were all abnormal, each one progressively worse.

The only good news seemed to be that results of the colposcopy and biopsy indicated that the cells "appeared" to be on the mend. They were trying to get better. I was told to report back in six months for another PAP test….

This time I took it seriously.

But what about the low blood count? More blood tests were done, HIV ruled out, and lupus not likely. I was sent to a hematologist at the local cancer clinic. Talk about scary. A cancer clinic? Really? If it wasn't HIV or lupus, was it cancer?

More blood tests were done by the hematologist, and suddenly, I was in the clear. Somehow, my blood cells also appeared to be on the mend. They were finally increasing. I was told to take iron pills to keep the red blood cells at optimal levels.

Fast forward to 2012… I got a phone call from the clinic after my most recent PAP and was told to come in for blood tests again.  I knew they were checking for infection of some kind, and since I had not yet heard the results of my PAP, I figured it probably was not good news. Sure enough, it was “abnormal” again.  It was my fifth "abnormal" PAP in a row.

…and... the CBC revealed low blood counts.  Back to square one.


PAP Tests and Autoimmune Disorders.....

So what does all this have to do with Celiac Disease or gluten intolerance?

Is there a connection between abnormal PAP results and Celiac? Well, actually… Yes, not just Celiac, but autoimmune disorders in general. That means your immune system sometimes attacks the wrong cells in the body, causing inflammation and other problems.

In fact, just last year, the National Institute of Health posted a study about the “Association of Pap smear abnormalities with autoimmune disorders” (Pak j Biol Sci 2011 May).

This study suggested that “there might be an association between immunological disorders and cervical premalignant and malignant abnormalities” (Esmaeili H, Ghahremanzadeh K.; NIH). Though most of their focus was on lupus (SLE) and rheumatoid arthritis (RA), they found that “Frequency of abnormal Pap smear testing was significantly higher” (boldface added) among those women affected with an autoimmune disorder, yet not statistically different between the autoimmune disorders. (Full Text here)

Lupus is probably one of the most well known and studied autoimmune diseases, although Celiac Disease occurs in 1 in every 133 people.  According to Johns Hopkins Hospital, “studies have shown an elevated risk of cervical cancer and abnormal PAP tests in women with lupus”  and I can see the logic.  When your immune system is compromised, it makes it harder for us to fight off viruses including HPV, which can lead to cervical cancer.

It seems obvious that something is happening between autoimmune disorders and cervical cancer and/or abnormal PAP results.


Blood Counts.....

And what about the low blood counts? Is there a connection with Celiac or gluten intolerance?

It just so happens that just the other day, I ran across an article "The Connection Between Gluten Intolerance and Low Platelets" which states that:

when "gluten is ingested, the immune system goes to work fighting off what it believes to be a harmful invader. In those with an undiagnosed intolerance to this protein, the immune system is continually in 'fight' mode, which begins to cause a host of autoimmune problems." (I Told You I Was Sick) 

This article also goes on to say:

"Though many conventional doctors do not agree with the gluten/low platelet connection, studies show that those with celiac disease or gluten intolerance are more likely to have decreased platelet counts."

Though we know very little about the author and she does not cite her sources, she uses Leaky Gut Syndrome as a compelling example, in that "the lining of the gut is more porous than it’s supposed to be, allowing undigested particles of food to leak into the blood stream, causing body-wide inflammation and allergic response" (I Told You I Was Sick).

This is definitely something I will be looking into further, and will post my findings here. 

In the meantime, I don't know what 2012 will bring me as far as my health goes.  I have high hopes that it will continue to be another year of recovery.  The year marks my 2nd year of research and new discoveries... of taking my health into my own hands, and finding a path that will give me answers.

For the most part, I remain gluten-free because the medical community has not been able to provide any solid answers for me -- as to why I became so sick in the first place; why my heart began to fail; why my body has been wracked with one immune problem after the other... it has been a slow process, but a learning process.

One step at a time...