Friday, March 28, 2008

Maddi's Blood Tests 10-23-2008

I have just received the results from many lab tests:

  1. Hep A, AB, hep BsAg, Hep BsAb, Hep Bc IgC, Hep C Ab (These were all Non-Reactive...no Hepatitis!)
  2. Antimitochondrial Ab- AMA (Mine are In Range) (To test for PBC - Primary Biliary Cirrhosis PBC , Lupus, and Hemochromatosis {see Below Hemochromotosis}) Other Related tests: Autoantibodies, Alkaline phosphatase (ALP), Alanine aminotransferase {ALT}, Liver Panel) (Negative)
  3. ANA (Also, to test for PBC and other autoimmune diseases) (Negative)
  4. Anti Liver-Kidney Ab_Live-Kidney microsomal Ab (In Range = no Hepatitis diseases)
  5. Anti Smooth muscle Ab- ASMA (Another test for PBC...to help distinguish PBC from another disease such as Lupus, Rheumatoid Arthritis or thyroiditis) (In Range = No Viral Hepatitis)
  6. Alpha-1 Anti Trypsin phenotype-A1AT (Alpha-1 antitrypsin {AAT} is a protein that is produced in the liver and released into the bloodstream. AAT helps to inactivate several enzymes but primarily works to protect the lungs from elastase. Elastase is an enzyme produced by neutrophils and it is part of the body’s normal response to injury and inflammation. Elastase breaks down proteins so that they can be removed and recycled by the body but, if its action is not regulated by AAT, elastase will also begin to break down and damage lung tissue. (My A1A Phenotype = PI*MM. 90% of Patients have MM Phenotype, with normal quantative ATT levels)
    • AAT is produced at the direction of two copies of a protease inhibitor (Pi)
      gene. This gene is co-dominant, which means that each Pi gene copy is
      responsible for producing half of the body’s AAT. If there is a change or
      mutation in one or both of the gene copies, then less AAT and/or dysfunctional
      AAT is produced. If the resulting AAT production drops down to 30% of normal or
      less, then the affected patient will experience a disorder called alpha-1
      antitrypsin deficiency. Patients with this disorder are at a considerable risk
      of developing emphysema (a progressive lung disease) in early adulthood. If they
      smoke, or are exposed to occupational dust or fumes, the lung damage tends to
      occur sooner and be more severe.
    • If the AAT produced is dysfunctional it
      tends to accumulate in the liver cells that produce it. As it builds up in these
      cells, the AAT forms abnormal protein chains, and begins to destroy the cells
      and damage the liver. About 10% of those affected with AAT deficiency will be
      jaundiced as a newborn. Many improve on their own but in severe cases these
      infants may require a liver transplant to survive. AAT deficiency is currently
      the most common reason for a liver transplant in the pediatric population.
    • The amount and function of the AAT created depends on the mutation inherited. While there are more than 70 different alleles (variations) in the Pi gene, only a few
      are common. Most people in the U.S., about 90%, have two copies of the normal M
      gene (MM). The most common of the abnormal forms are S and Z. Those people
      with:
        • One copy of M and one of S or Z (MS or MZ) will produce reduced amounts of AAT but should have enough to protect themselves. They will be carriers of the condition, however, and can pass it on to their children.
        • Two copies of S (SS) may be asymptomatic or moderately affected (they produce about 60% of the required AAT)
        • One copy of S and one of Z (SZ) are at an increased risk of developing emphysema (they produce about 40% of normal AAT)
        • Two copies of Z (ZZ) are the most severely affected (they only produce about 10% of the required AAT) along with those who have one or two copies of rare forms of the Pi gene which are “null” (they do not produce any AAT).
    • Types of AAT tests. Different AAT tests can be used to measure the amount of AAT, determine which types and concentrations of AAT protein are present, and determine which Pi gene alleles a patient has. Alpha-1 Antitrypsin, this test measures the concentration of AAT present
      • Alpha-1 Antitrypsin Phenotype, separates out the different variants of
        alpha-1 protein being produced and compares them to known patterns. It also
        allows an estimation of the amount of each type present. Since AAT is an alpha1 globulin type of protein a regular protein electrophoresis test can beused to screen for a severe AAT deficiency {this is the one my doctor used for me}
      • Alpha-1 Antitrypsin DNA testing, genetic testing can be done to identify which protease inhibitor gene mutations (Pi gene alleles) are present. Only the most common mutations are usually
        evaluated (M, S, Z). This test can be used to help evaluate affected patients and their family members.
  7. Alpha Fetoprotrin- AFP (AFP is used to detect tumors that mark cancers of the liver, testes, and ovaries. Patients with chronic liver diseases such as cirrhosis or chronic hepatitis B must be monitored at regular intervals because they have a lifetime risk of developing liver cancer. A doctor may order an AFP test, along with imaging studies, to try to detect liver cancer when it is in its earliest, and most treatable, stages. Increased AFP levels can mean liver cancer, cancer of the ovary, germ cell tumor of the testes, cirrhosis, hepatitis, or other cancers (stomach, colon, lung, breast, lymphoma). {I think this is a very good test for me.}) (In Range)
  8. Serum Ferritin, Iron Sat., TIBC, transferring () retic count
    • (Serum Ferritin: To determine whether your blood iron level is normal. The serum
      iron test measures the amount of iron in serum, the liquid portion of blood.
      Iron is an essential trace element. It is necessary for the production of
      healthy red blood cells, which carry oxygen through your body, and some enzymes,
      which perform tasks in your body. ) (In Range)
    • (Total Iron Binding Capacity
      {TIBC} - measures the amount of iron that can be carried through blood by
      transferrin. Transferrin is the protein that transports iron from the gut to the
      cells that use it. Your body makes transferrin in relationship to your need for
      iron; when iron stores are low, transferrin levels increase and vice versa. In
      healthy people, about one-third of the binding sites on transferrin are used to
      transport iron. This number is called the transferrin saturation.) (Low)
    • (TIBC transferring: Transferrin is the plasma protein that binds to iron and
      transports it through the circulation. TIBC measures the total amount of iron
      that transferrin can bind. While the two tests are different and are reported in
      different units {g/L for transferrin and umol/L for TIBC}, they measure
      essentially the same thing.
  9. Serum Ceruloplasmin, copper (Ceruloplasmin is primarily ordered along with blood and/or urine copper tests to help diagnose Wilson’s disease, an inherited disorder associated with decreased levels of ceruloplasmin and excess storage of copper in the liver, brain, and other organs. Rarely, it may be ordered to help diagnose or differentiate between conditions associated with copper deficiencies. It is ordered along with copper tests when someone has signs and symptoms that the doctor suspects may be due to Wilson’s disease such as: anemia, nausea, abdominal pain, jaundice fatigue, behavioral changes, tremors, difficulty walking and/or swallowing, dystonia. Rarely, ceruloplasmin may also be ordered along with copper tests when your doctor suspects that you have a copper deficiency and periodically if monitoring is recommended.) (In Range)
  10. TSH, Free T4 (Thyroid) (High)
  11. Liver Function Tests:
    • Alb (In Range),
    • T Bili (In Range),
    • D Bili (In Range),
    • AST (In Range),
    • ALT (In Range),
    • Alk Phos (High 155 - normal is 33-130), (Alkaline phosphatase is an
      enzyme, a protein that helps cells work. You find alkaline phosphatase in high
      concentrations in the cells that make bone and in the liver. In the liver, it is
      found on the edges of cells that join to form bile ducts (tiny tubes that drain
      bile from the liver to the bowels where it is needed to help digest fat in the
      diet). Smaller amounts of ALP are found in the placenta (afterbirth) of women
      who are pregnant, and in the bowel. Each of these body parts makes different
      forms of ALP. The different forms are called isoenzymes. High ALP usually means
      that the bone or liver has been damaged. If other liver tests such as bilirubin,
      aspartate aminotransferase (AST), or Alanine aminotransferase (ALT) are
      also high, usually the ALP is coming from the liver. If calcium and phosphate
      measurements are abnormal, usually the ALP is coming from bone. In some forms of
      liver disease, such as hepatitis, ALP is usually much less elevated than AST and
      ALT. When the bile ducts are blocked (usually by gallstones, scars from previous
      gallstones or surgery, or by cancers), ALP and bilirubin may be increased much
      more than AST or ALT. In a few liver diseases, ALP may be the only test that is
      high. In some bone diseases, such as a disorder called Paget’s disease (where
      bones become enlarged and deformed), or in certain cancers that spread to bone,
      ALP may be the only test result that is high. Sometimes doctors don’t know why
      ALP is high, and they need to order other tests to determine the exact cause. In
      such cases, your doctor may order another enzyme, GGT, that is made by the liver
      in the same places as is ALP, but which is not made by bone. )
    • GGT (Mine is High 108...normal = 3-70) (GGT is an enzyme found mainly in the liver; it is very sensitive to changes in liver function. It is normally present in low levels in the blood. When the liver is injured or obstructed, the GGT level rises. It is
      the most sensitive liver enzyme in detecting bile duct problems. A rise in GGT
      can occur even when there is no identifiable cause that is related to liver disease.) , total protein (In Range) (Liver function) High ALP and GGT may be indicative of liver damage or blockage of bile duct(s).
  12. PY, PTT, INR (The PT may be ordered when a patient who is not taking anti-coagulant drugs has signs or symptoms of a bleeding disorder, which can range from nosebleeds, bleeding gums, bruising, heavy menstrual periods, blood in the stool and/or urine to arthritic-type symptoms {damage from bleeding into joints}, loss of vision, and chronic anemia.) (PT High 12.5) (INR High 1.2) (APTT In Range) If you are not taking anti-coagulant drugs and your PT is prolonged, additional testing may be necessary to determine the cause. A prolonged, or increased, PT means that your blood is taking too long to form a clot. This may be caused by conditions such as liver disease, vitamin K deficiency or a coagulation factor deficiency. Result of the PT is often interpreted with that of the PTT in determining what condition may be present.
  13. CBC with diff (White blood cell) (WBC) count is a count of the actual number of white blood
    cells per volume of blood. Both increases and decreases can be significant.
    White blood cell differential looks at the types of white blood cells present.
    There are five different types of white blood cells, each with its own function
    in protecting us from infection. The differential classifies a person's white
    blood cells into each type: neutrophils (also known as segs, PMNs, granulocytes,
    grans), lymphocytes, monocytes, eosinophils, and basophils. Red blood cell (RBC) count is a count of the actual number of red blood cells per volume of blood. Both increases and decreases can point to abnormal conditions.
    • (Red Blood Count = Low 3.57) (Red Blood Cells (RBCs) RBCs are pale red in
      color and shaped like a donut with a thinner section in the middle instead of a
      hole. They have hemoglobin inside them, a protein that transports oxygen
      throughout the body.
      The CBC determines whether there are sufficient RBCs present and whether the population of RBCs appears to be normal. RBCs are normally all the same size and shape; however, variations can occur with vitamin B12 and folate deficiencies, iron deficiency, and with a variety of other conditions. If there are
      insufficient normal RBCs present, the patient is said to have anemia and may
      have symptoms such as fatigue and weakness. Much less frequently, there may be too many RBCs in the blood (erythrocytosis or polycythemia). In extreme cases, this can interfere with the flow of blood through the veins and arteries.)
    • Hemoglobin measures the amount of oxygen-carrying protein in the blood.
      (Hemoglobin = Low 10.8)
      (This test measures the amount of hemoglobin, a protein found in red blood cells, in a blood sample, which is a good indication of the blood’s ability to deliver oxygen to tissues and organs and to transport the waste product carbon dioxide to the lungs, where it is exhaled. If your hemoglobin levels are low, you may have anemia, a condition in which your body is not getting enough oxygen, causing fatigue and weakness. The hemoglobin rises when the number of red blood cells increases. The hemoglobin falls to less than normal, indicating anemia, when your body decreases its production of red blood cells, increases its destruction of red blood cells, or if blood is lost due to bleeding.) Hematocrit measures the percentage of red blood cells in a given volume of whole blood.
    • (Hematocrit = Low 32.5) (Hematocrit is a measurement of the proportion of blood that is made up of red blood cells. The value is expressed as a percentage or fraction of cells in blood. For example, a hematocrit value of 40% means that there are 40 milliliters of red blood cells in 100 milliliters of blood. The hematocrit rises when the number of red blood cells increases or when the plasma volume is reduced, as in dehydration. The hematocrit falls to less than normal, indicating anemia, when your body decreases its production of red blood cells or increases its destruction of red blood cells or if blood is lost due to bleeding. The hematocrit reflects both the number of red cells and their volume (mean corpuscular volume or MCV). If the size of the red cell decreases, so will the hematocrit and vice versa.) The platelet count is the number of platelets in a given volume of blood. Both increases and decreases can point to abnormal conditions of excess bleeding or clotting.
      1. Mean platelet volume (MPV) is a machine-calculated measurement of the average size of your platelets. New platelets are larger, and an increased
        MPV occurs when increased numbers of platelets are being produced. MPV gives your doctor information about platelet production in your bone marrow.
      2. Mean corpuscular volume (MCV) is a measurement of the average size of your RBCs. The MCV is elevated when your RBCs are larger than normal
        (macrocytic), for example in anemia caused by vitamin B12 deficiency. When the MCV is decreased, your RBCs are smaller than normal(microcytic) as is seen in iron deficiency anemia or thalassemias.
      3. Mean corpuscular hemoglobin (MCH) is a calculation of the average amount of oxygen-carrying hemoglobin inside a red blood cell. Macrocytic RBCs are large so tend to have a higher MCH, while microcytic red cells would have a lower value.
      4. Mean corpuscular hemoglobin concentration (MCHC) is a calculation of the average concentration of hemoglobin inside a red cell. DecreasedMCHC values (hypochromia) are seen in conditions where the hemoglobin is abnormally diluted inside the red cells, such as in iron deficiency anemia and in thalassemia. Increased MCHC values (hyperchromia) are seen in conditions where the hemoglobin is abnormally concentrated inside the red cells, such as in burn patients and hereditary spherocytosis, a relatively rare congenital disorder.
        (My MCV = In Range) (MCH = In Range) (MCHC = In Range)
  • Red cell distribution width(RDW) is a calculation of the variation in the size of your RBCs. In some anemias, such as pernicious anemia, the amount of variation (anisocytosis) in RBC size (along with variation in shape – poikilocytosis) causes an increase in the RDW (RDW = High).
  • White Blood Count (WBC) is a count of the actual number of white blood cells per volume of blood. Both increases and decreases can be significant. (White Blood count = In Range) White blood cell differential looks at the types of white blood cells present. There are five different types of white blood cells, each with its own function in protecting us from infection.
    The differential classifies a person's white blood cells into each type: neutrophils (also known as segs, PMNs, granulocytes, grans), lymphocytes, monocytes, eosinophils, and basophils. The white blood cell (WBC) count numerates the number of white blood cells in a sample of blood. An abnormal high or low
    count may suggest the presence of illness. White blood cells are made in the bone marrow and protect the body against infection and aid in the immune response. If there is an infection, white blood cells will attack and destroy the bacteria, fungus, or virus causing the infection. An elevated number of white blood cells is called leukocytosis. This can result from bacterial infections, inflammation, leukemia, trauma, intense exercise, or stress. A decreased WBC
    count is called leukopenia. It can result from many different situations, such as chemotherapy, radiation therapy, or diseases of the immune system. Counts that continue to rise or fall to abnormal levels indicate that the condition is getting worse. Counts that return to normal indicate improvement. The results indicate the percentage of each type of white blood cell that is present.
    • Neutrophils can increase in response to bacterial infection or inflammatory disease. Severe elevations in neutrophils may be caused by various bone marrow disorders, such as chronic myelogenous leukemia. Decrease neutrophil levels may be the result of severe infection or other conditions, such as responses to various medications, particularly chemotherapy.
    • Eosinophils can increase in response to allergic disorders, inflammation of the skin, and parasitic infections. They can also increase in response to some infections or to various bone marrow disorders. Decreased levels of eosinophils can occur as a result of infection.
    • Basophils can increase in cases of leukemia, chronic inflammation, the presence of a hypersensitivity reaction to food, or radiation therapy.
    • Lymphocytes can increase in cases of viral infection, leukemia, cancer of the bone marrow, or radiation therapy. Decreased lymphocyte levels can indicate diseases that affect the immune system, such as lupus, and the later stages of HIV infection.
    • Monocyte levels can increase in response to infection of all kinds as well as to inflammatory disorders. Monocyte counts are also increased in certain malignant disorders, including leukemia. Decreased monocyte levels can indicate bone marrow injury or failure and some forms of leukemia
  • Since percentages might be misleading in some patients, absolute values of the various types of WBCs can also be reported, such as the absolute neutrophil count (ANC), also known as the absolute granulocyte count or AGC. Absolute values are calculated by multiplying the number of WBCs by the percentage of each type of white cell and can aid in diagnosing illness and monitoring therapy.

Hemochromotosis: In people who have two copies of the abnormal gene, too much iron is absorbed, and excess iron is deposited in many different organs, where it can cause damage and organ failure. The HFE gene test uses a sample of blood drawn from your arm to see if you have the mutations that cause the disease {the most cHemochromatosis HFE mutation: C282Y, H63D (HFE gene test - Hemochromatosis is a common genetic disease that causes your body to absorb too much iron. It is usually due to an inherited abnormality in a specific gene, called the HFE gene, that regulates the amount of iron absorbed from the gutommon is called C282Y}. Too much iron can lead to damage to a number of organs, including the heart, liver, pancreas {where insulin is made}, and joints. The most common cause of iron excess is an inherited disease called hemochromatosis. In this disease, the body absorbs more iron than it needs from the gut, and the excess iron gradually accumulates, causing organ damage over many years. The disease is inherited, usually when you get one copy of an abnormal HFE gene from each of your parents. People with only one abnormal HFE gene show no evidence of the disease. One good point...I have never had heart problems or disease! {Maybe I do not have the HFE gene. However, I do have the pancreatitis and liver problems. I have the same fingers, hands, knees and shoulders arthritis, I have the fatigue and many other of the symptoms. We shall see! }Many people who have hemochromatosis will have no symptoms for their whole life, while others start to develop symptoms such as joint pain, abdominal pain, and weakness in their 20’s or 30’s. Heavy alcohol use seems to increase the amount of iron absorbed, while women are somewhat protected because they lose iron every month with their menstrual period. There is now a test to detect the abnormal form of the gene; this can be used if you have unexplained high iron levels or if you have a family history of hemochromatosis.) Some Clinical Manifestations of Hemochromatosis {the symptoms in bold are ones I have}: Hemochromatosis HFE mutation: C282Y, H63D (HFE gene test - Hemochromatosis is a common genetic disease that causes your body to absorb too much iron. It is usually due to an inherited abnormality in a specific gene, called the HFE gene, that regulates the amount of iron absorbed from the gut. In people who have two copies of the abnormal gene, too much iron is absorbed, and excess iron is deposited in many different organs, where it can cause damage and organ failure. The HFE gene test uses a sample of blood drawn from your arm to see if you have the mutations that cause the disease {the most common is called C282Y}. Too much iron can lead to damage to a number of organs, including the heart, liver, pancreas {where insulin is made}, and joints. The most common cause of iron excess is an inherited disease called hemochromatosis. In this disease, the body absorbs more iron than it needs from the gut, and the excess iron gradually accumulates, causing organ damage over many years. The disease is inherited, usually when you get one copy of an abnormal HFE gene from each of your parents. People with only one abnormal HFE gene show no evidence of the disease. One good point...I have never had heart problems or disease! {Maybe I do not have the HFE gene. However, I do have the pancreatitis and liver problems. I have the same fingers, hands, knees and shoulders arthritis, I have the fatigue and many other of the symptoms. We shall see! }Many people who have hemochromatosis will have no symptoms for their whole life, while others start to develop symptoms such as joint pain, abdominal pain, and weakness in their 20’s or 30’s. Heavy alcohol use seems to increase the amount of iron absorbed, while women are somewhat protected because they lose iron every month with their menstrual period. There is now a test to detect the abnormal form of the gene; this can be used if you have unexplained high iron levels or if you have a family history of hemochromatosis.)

  • Malaise;
  • Liver cirrhosis (with an increased risk of hepatocellular carcinoma.) Liver disease is always preceded by evidence of liver dysfunction including elevated serum enzymes specific to the liver;
  • Insulin resistance (often patients have already been diagnosed with diabetes mellitus type 2) due to pancreatic damage from iron deposition;
  • Erectile dysfunction and hypogonadism;
  • Decreased libido secondary to the above;
  • Congestive heart failure, arrhythmias or pericarditis;
  • Arthritis of the fingers (especially the first and second joints), hands (especially the first and second MCP joints), but also the knee and shoulder joints;
  • Adrenal gland (leading to adrenal insufficiency)

    Disease
    Iron
    TIBC
    UIBC
    Ferritin
    Iron deficiency
    Low
    High
    High
    Low
    Chronic Illness
    Low
    Low
    Low-normal
    Normal-high
    Hemochromatosis
    High
    Low
    Low
    High
    Iron Poisoning
    High
    Normal
    Low
    Normal

    Fig. 1

    Interpretation of PT and PTT in patients with a bleeding syndrome

    PT Result.........PTT Result .....Possible Condition Present

    Prolonged ........Normal ..........Liver disease, decreased

    ......................................vitamin K, decreased

    ......................................decreased or defective

    ......................................factor VII ...me???

    Normal ............Prolonged ......Decreased or defective

    .......................................factor VIII, IX or XI

    .......................................or lupus anticoagulant present

    Prolonged .......Prolonged ........Decreased or defective

    ........................................factor I, II, V or X,

    ........................................Von Willebrand disease,

    ........................................liver disease, disseminated

    ........................................intravascular coagulation (DIC)

    Normal ............Normal ..........Decreased platelet

    ........................................function, thrombocytopenia,

    .........................................factor XIII deficiency, mild

    .........................................deficiencies in other factors, mild

    .........................................form of Von Willebrand’s disease

    We are awaiting November 19th for a Gastric Emptying
    study to check my Gastroparesis.

      Tuesday, September 25, 2007

      Complete Blood Count (CBC)

      http://www.webmd.com/a-to-z-guides/Complete-Blood-Count-CBC?page=1
      Complete Blood Count (CBC)
      A complete blood count (CBC) gives important information about the kinds and numbers of cells in the blood, especially red blood cells, white blood cells, and platelets. A CBC helps your health professional check any symptoms, such as weakness, fatigue, or bruising, you may have. A CBC also helps him or her diagnose conditions, such as anemia, infection, and many other disorders.

      A CBC test usually includes:

      White blood cell (WBC, leukocyte) count. White blood cells protect the body against infection. If an infection develops, white blood cells attack and destroy the bacteria, virus, or other organism causing it. White blood cells are bigger than red blood cells but fewer in number. When a person has a bacterial infection, the number of white cells rises very quickly. The number of white blood cells is sometimes used to find an infection or to see how the body is dealing with cancer treatment.

      White blood cell types (WBC differential). The major types of white blood cells are neutrophils, lymphocytes, monocytes, eosinophils, and basophils. Immature neutrophils, called band neutrophils, are also part of this test. Each type of cell plays a different role in protecting the body. The numbers of each one of these types of white blood cells give important information about the immune system. Too many or too few of the different types of white blood cells can help find an infection, an allergic or toxic reaction to medicines or chemicals, and many conditions, such as leukemia.

      Red blood cell (RBC) count. Red blood cells carry oxygen from the lungs to the rest of the body. They also carry carbon dioxide back to the lungs so it can be exhaled. If the RBC count is low (anemia), the body may not be getting the oxygen it needs. If the count is too high (a condition called polycythemia), there is a chance that the red blood cells will clump together and block tiny blood vessels (capillaries). This also makes it hard for your red blood cells to carry oxygen.

      Hematocrit (HCT, packed cell volume, PCV). This test measures the amount of space (volume) red blood cells take up in the blood. The value is given as a percentage of red blood cells in a volume of blood. For example, a hematocrit of 38 means that 38% of the blood's volume is made of red blood cells. Hematocrit and hemoglobin values are the two major tests that show if anemia or polycythemia is present.

      Hemoglobin (Hgb). The hemoglobin molecule fills up the red blood cells. It carries oxygen and gives the blood cell its red color. The hemoglobin test measures the amount of hemoglobin in blood and is a good measure of the blood's ability to carry oxygen throughout the body.

      Red blood cell indices. There are three red blood cell indices: mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC). They are measured by a machine and their values come from other measurements in a CBC. The MCV shows the size of the red blood cells. The MCH value is the amount of hemoglobin in an average red blood cell. The MCHC measures the concentration of hemoglobin in an average red blood cell. These numbers help in the diagnosis of different types of anemia. Red cell distribution width (RDW) can also be measured which shows if the cells are all the same or different sizes or shapes.

      Platelet (thrombocyte) count. Platelets (thrombocytes) are the smallest type of blood cell. They are important in blood clotting. When bleeding occurs, the platelets swell, clump together, and form a sticky plug that helps stop the bleeding. If there are too few platelets, uncontrolled bleeding may be a problem. If there are too many platelets, there is a chance of a blood clot forming in a blood vessel. Also, platelets may be involved in hardening of the arteries (atherosclerosis).

      Your doctor may order a blood smear test to be done at the same time as a CBC but it is not part of the regular CBC test. In this test, a drop of blood is spread (smeared) on a slide and stained with a special dye. The slide is looked at under a microscope. The number, size, and shape of red blood cells, white blood cells, and platelets are recorded. Blood cells with different shapes or sizes can help diagnose many blood diseases, such as leukemia, malaria, or sickle cell anemia.

      http://www.webmd.com/a-to-z-guides/Complete-Blood-Count-CBC?page=2
      Complete Blood Count (CBC) (continued)

      Why It Is Done
      A complete blood count may be done to:
      • Find the cause of symptoms such as fatigue, weakness, fever, bruising, or weight loss.
      • Find anemia.
      • See how much blood has been lost if there is bleeding.
      • Diagnose polycythemia.
      • Find an infection.
      • Diagnose diseases of the blood, such as leukemia.
      • Check how the body is dealing with some types of drug or radiation treatment.
      • Check how abnormal bleeding is affecting the blood cells and counts.
      • Screen for high and low values before a surgery.
      • See if there are too many or too few of certain types of cells. This may help find other conditions, such as too many eosinophils may mean an allergy or asthma is present.
      A complete blood count may be done as part of a regular physical examination. A blood count can give valuable information about the general state of your health.

      How To Prepare
      You do not need to do anything before having this test.

      How It Is Done
      Your health professional drawing blood will:
      • Wrap an elastic band around your upper arm to stop the flow of blood. This makes the veins below the band larger so it is easier to put a needle into the vein.
      • Clean the needle site with alcohol.
      • Put the needle into the vein. More than one needle stick may be needed.
      • Attach a tube to the needle to fill it with blood.
      • Remove the band from your arm when enough blood is collected.
      • Put a gauze pad or cotton ball over the needle site as the needle is removed.
      • Put pressure to the site and then a bandage.
      If this blood test is done on a baby, a heel stick will be done instead of a blood draw from a vein.

      How It Feels
      The blood sample is taken from a vein in your arm. An elastic band is wrapped around your upper arm. It may feel tight. You may feel nothing at all from the needle, or you may feel a quick sting or pinch.

      Risks
      There is very little chance of a problem from having a blood sample taken from a vein.
      • You may get a small bruise at the site. You can lower the chance of bruising by keeping pressure on the site for several minutes.
      • In rare cases, the vein may become swollen after the blood sample is taken. This problem is called phlebitis. A warm compress can be used several times a day to treat this.
      • Ongoing bleeding can be a problem for people with bleeding disorders. Aspirin, warfarin (Coumadin), and other blood-thinning medicines can make bleeding more likely. If you have bleeding or clotting problems, or if you take blood-thinning medicine, tell your doctor before your blood sample is taken.
      http://www.webmd.com/a-to-z-guides/Complete-Blood-Count-CBC?page=3
      Complete Blood Count (CBC) (continued)
      Results
      A complete blood count (CBC) gives important information about the kinds and numbers of cells in the blood, especially red blood cells, white blood cells, and platelets. A CBC helps your health professional check any symptoms, such as weakness, fatigue, or bruising, you may have. A CBC also helps him or her diagnose conditions, such as anemia, infection, and many other disorders.

      Normal
      Normal values can vary from lab to lab.

      Normal values for the complete blood count (CBC) tests depend on age, sex, how high above sea level you live, and the type of blood sample. Your health professional may use all the CBC values to check for a condition. For example, the red blood cell (RBC) count, hemoglobin (Hgb), and hematocrit (HCT) are the most important values needed to tell whether a person has anemia, but the red blood cell indices and the blood smear also help with the diagnosis and may show a possible cause for the anemia.

      To see if the white blood cell (WBC, leukocyte) count is good and how the cells look on the smear, your health professional will look at both the number (WBC count) and the WBC differential. To see whether there are too many or too few of a certain type of cell, your health professional will look at the total count and the percentage of that particular cell. There are normal values for the total number of each type of white cell.

      Pregnancy can change these blood values. Your doctor will talk with you about normal values during each trimester of your pregnancy.

      White blood cell (WBC, leukocyte) count
      Men:.............5,000–10,000/microliter (mcL)3
      .......................or 5–10 x 109/Liter (SI units)
      Nonpregnant -
      women:.........4,500–11,000/mcL3 or 4.5–11.0 x 109/Liter
      .........................(SI units)
      Pregnant women:
      ........................1st trimester: 6,600–14,100/mcL
      ..............................or 6.6–14.1 x 109/L
      ........................2nd trimester: 6,900–17,100/mcL
      ..............................or 6.9–17.1 x 109/L
      ........................3rd trimester: 5,900–14,700/mcL
      ..............................or 5.9–14.7 x 109/L
      .......................Postpartum: 9,700–25,700/mcL
      ..............................or 9.7–25.7 x 109/L

      White blood cell types (WBC differential)
      Neutrophils:..........55%–70%
      Band neutrophils:...0%–3%
      Lymphocytes:........20%–40%
      Monocytes:............2%–8%
      Eosinophils:...........1%–4%
      Basophils:..............0.5%–1%
      Red blood cell (RBC) count
      Men:............4.7–6.1 million RBCs per microliter (mcL)
      .......................or 4.7–6.1 x 1012/Liter (SI units)
      Women:.....4.2–5.4 million RBCs per mcL or 4.2–5.4 x 1012/L
      Children:...4.0–5.5 million RBCs per mcL or 4.6–4.8 x 1012/L
      Newborn:...4.8–7.1 million RBCs per mcL or 4.8–7.1 x 1012/L

      Hematocrit (HCT)
      Men:.............42%–52% or 0.42–0.52 volume fraction (SI units)
      Women:........37%–47% or 0.37–0.47 volume fraction
      Pregnant women
      ........................1st trimester: 35%–46%
      ........................2nd trimester: 30%–42%
      ........................3rd trimester: 34%–44%
      Postpartum:....30%–44%
      Children:........32%–44%
      Newborns:......44%–64%

      Hemoglobin (Hgb)
      Men:.............14–18 grams per deciliter (g/dL)
      ..........................or 8.7–11.2 millimoles per liter (mmol/L) (SI units)
      Women:........12–16 g/dL
      ..........................or 7.4–9.9 mmol/L

      Pregnant women:
      ........................1st trimester: 11.4–15.0 g/dL
      ..............................or 7.1–9.3 mmol/L
      ........................2nd trimester: 10.0–14.3 g/dL
      ..............................or 6.2–8.9 mmol/L
      ........................3rd trimester: 10.2–14.4 g/dL
      ..............................or 6.3–8.9 mmol/L
      Postpartum:....10.4–18.0 g/dL or 6.4–9.3 mmol/L
      Children:..........9.5–15.5 g/dL
      Newborn: 14–24 g/dL

      In general, a normal hemoglobin level is about one-third the value of the hematocrit.

      Red blood cell indices
      Mean corpuscular volume (MCV): 80–95 femtoliters (fL)
      Mean corpuscular hemoglobin (MCH): 27–31 picograms (pg)
      Mean corpuscular hemoglobin concentration (MCHC): 32–36
      Red cell distribution width (RDW)
      Normal: 11%–14.5%

      Platelet (thrombocyte) count
      Normal:
      ...Children and adults 150,000–400,000 platelets per mm3
      .......................or 150–400 x 109/Liter (SI units)
      ...Baby 200,000–475,000 mm3
      ...Newborn 150,000–300,000 mm3

      Blood smear
      Normal:
      Blood cells are normal in shape, size, color, and number.

      High values
      Red blood cell (RBC)
      Conditions that cause high RBC values include smoking, exposure to carbon monoxide, long-term lung disease, kidney disease, some cancers, certain forms of heart disease, alcoholism, liver disease, a rare disorder of the bone marrow (polycythemia vera), or a rare disorder of hemoglobin that binds oxygen tightly.

      Conditions that affect the body's water content can also cause high RBC values. These conditions include dehydration, diarrhea or vomiting, excessive sweating, severe burns, and the use of diuretics. The lack of fluid in the body makes the RBC volume look high; this is sometimes called spurious polycythemia.

      White blood cell (WBC, leukocyte)
      Conditions that cause high WBC values include infection, inflammation, damage to body tissues (such as a heart attack), severe physical or emotional stress (such as a fever, injury, or surgery), burns, kidney failure, lupus, tuberculosis (TB), rheumatoid arthritis, malnutrition, leukemia, and diseases such as cancer.

      The use of corticosteroids, underactive adrenal glands, thyroid gland problems, certain medicines, or removal of the spleen can also cause high WBC values.

      Platelets
      High platelet values may be seen with bleeding, iron deficiency, some diseases like cancer, or problems with the bone marrow.

      Low values
      Red blood cell (RBC)
      Anemia lowers RBC values. Anemia can be caused by heavy menstrual bleeding, stomach ulcers, colon cancer, inflammatory bowel disease, tumors, Addison's disease, thalassemia, lead poisoning, sickle cell disease, or reactions to some chemicals and medicines. A low RBC value may also be seen if the spleen has been taken out.

      A lack of folic acid or vitamin B12 can also cause anemia, such as pernicious anemia, which is a problem with absorbing vitamin B12.

      The RBC indices value and a blood smear may help find the cause of a low RBC value.

      White blood cell (WBC, leukocyte)
      Conditions that can lower WBC values include chemotherapy and reactions to other medicines, aplastic anemia, viral infections, malaria, alcoholism, AIDS, lupus, or Cushing's syndrome.
      A large spleen can lower the WBC count.
      Platelets
      Low platelet values can occur in pregnancy or idiopathic thrombocytopenic purpura and other conditions that affect how platelets are made or that destroy platelets.
      A large spleen can lower the platelet count.
      Complete Blood Count (CBC)(continued)
      What Affects the Test
      Reasons you may not be able to have the test or why the results may not be helpful include:
      • If the band was on your arm a long time while the blood sample was taken. Taking medicines that can cause low platelet levels. Some examples of the many medicines that cause this include steroids, some antibiotics, thiazide diuretics, chemotherapy medicines, quinidine, and meprobamate (Equanil, Miltown, Meprospan).
      • A very high white blood cell count or high levels of a type of fat (triglycerides). These can cause falsely high hemoglobin values.
      • Having an enlarged spleen, which may cause a low platelet count (thrombocytopenia) or a low white blood cell count. An enlarged spleen may be caused by certain types of cancer.
      • Pregnancy, which normally causes a low RBC value and less often a high WBC value.
      • Clumping of platelets in the test tube. This can cause a falsely low platelet count and occurs because of the substance used in the test tub
        What To Think About
        The white blood count can change by as much as 2,000 WBCs per microliter (mcL) from exercise, stress, or smoking. Children normally have higher WBC (leukocyte) counts than adults.
        Other red blood cell tests that may be done include: Erythrocyte sedimentation rate (ESR). An ESR test measures how quickly red blood cells (erythrocytes) settle in a test tube. When inflammation in the body is present (such as from an infection or cancer), red blood cells may settle more slowly than normal. An ESR may help find certain inflammatory diseases when CBC results are normal. For more information, see the medical test Sedimentation Rate.
        Reticulocyte count. This test counts the number of immature red blood cells (reticulocytes) in a blood sample. Generally, only a few reticulocytes are present in the blood in relation to mature red blood cells. However, recent bleeding or mature red blood cells being destroyed can cause a lot of new reticulocytes made. This test can help find some types of anemia and check how well treatment is working. For more information, see the medical test Reticulocyte Count. Hematocrit measurements can be very different depending on the method and type of machine used to do the test.
          Other Works Consulted
          Chernecky CC, Berger BJ, eds. (2004). Laboratory Tests and Diagnostic Procedures, 4th ed. Philadelphia: Saunders.
          Fischbach FT, Dunning MB III, eds. (2004). Manual of Laboratory and Diagnostic Tests, 7th ed. Philadelphia: Lippincott Williams and Wilkins.
          Pagana KD, Pagana TJ (2006). Mosby’s Manual of Diagnostic and Laboratory Tests, 3rd ed. St. Louis: Mosby.

          Author Jan Nissl, RN, BS Editor Susan Van Houten, RN, BSN, MBA Associate Editor Tracy Landauer Primary Medical Reviewer Patrice Burgess, MD- Family Medicine Specialist Medical Reviewer Joseph O'Donnell, MD- Hematology Last Updated December 4, 2006 <>

          WebMD Medical Reference from Healthwise
          Last Updated: December 04, 2006
          This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
          @ 1995-2007, Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.

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          Sunday, August 26, 2007

          Comprehensive Metabolic Panel (CMP)

          Comprehensive Metabolic Panel (CMP)
          http://www.labtestsonline.org/

          The Comprehensive Metabolic Panel (CMP) is typically a group of 14 specific tests that have been approved, named, and assigned a CPT code (a Current Procedural Terminology number) as a panel by Medicare (although labs may adjust the number of tests up or down). Since the majority of insurance companies also use these names and CPT codes in their claim processing, this grouping of tests has become standardized throughout the United States. The CMP is a frequently ordered panel that gives your doctor important information about the current status of your kidneys, liver, and electrolyte and acid/base balance as well as of your blood sugar and blood proteins. Abnormal results, and especially combinations of abnormal results, can indicate a problem that needs to be addressed.

          The CMP is used as a broad screening tool to evaluate organ function and check for conditions such as diabetes, liver disease, and kidney disease. The CMP may also be ordered to monitor known conditions, such as hypertension, and to monitor patients taking specific medications for any kidney- or liver-related side effects. If your doctor is interested in following two or more individual CMP components, he may order the entire CMP because it offers more information.
          The CMP is routinely ordered as part of a blood work-up for a medical exam or yearly physical and is collected by inserting a needle into a vein in your arm. Although it may be performed on a random basis, the CMP sample is usually collected after a 10 to 12 hour fast (no food or liquids other than water). While the individual tests are sensitive, they do not usually tell your doctor specifically what is wrong. Abnormal test results or groups of test results are usually followed-up with other specific tests to confirm or rule out a suspected diagnosis.

          The CMP includes:

          • Glucose
          • Calcium
            Both increased and decreased levels can be significant.
          • Proteins
            • Albumin
            • Total Protein
              Albumina, a small protein produced in the liver, is the major protein in
              serum. Total protein measures albumin as well as all other proteins in
              serum. Both increases and decreases in these test results can be
              significant.
          • Electrolytes
            • Sodium
            • Potassium
            • CO2 (carbon dioxide, bicarbonate)
            • Chloride
              The concentrations of sodium and potassium are tightly regulated by the body as is the balance between the four tests. Electrolyte (and acid-base)imbalances can be present with a wide variety of acute and chronic illnesses. Chloride and CO2 tests are rarely ordered by themselves.
          • Kidney Tests
            • BUN (blood urea nitrogen)
            • Creatinine
              BUN and Creatinine are waste products filtered out of the blood by the kidneys. Increased concentrations in the blood may indicate a temporary or chronic decrease in kidney function. When not ordered as part of the CMP, they are still usually ordered together.

          Sources

          1. S1Thomas, Clayton L., Editor (1997). Taber’s Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition].
          2. S2Pagana, Kathleen D. & Pagana, Timothy J. (2001). Mosby’s Diagnostic and Laboratory Test Reference 5th Edition: Mosby, Inc., Saint Louis, MO.
          3. S3American Medical Association (2002). Current Procedural Terminology, cpt 2002, Standard Edition.

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          Digestive Diseases Library


          Saturday, April 28, 2007

          Tumor Markers

          Tumor Markers

          What are they?
          Tumor markers are substances, usually proteins, that are produced by the body in response to cancer growth or by the cancer tissue itself. Some tumor markers are specific, while others are seen in several cancer types. Many of the well-known markers are also seen in non-cancerous conditions. Consequently, these tumor markers are not diagnostic for cancer. There are only a handful of well-established tumor markers that are being routinely used by physicians. Many other potential markers are still being researched. Some marker tests cause great excitement when they are first discovered but, upon further investigation, prove to be no more useful than markers already in use. The goal is to be able to screen for and diagnose cancer early, when it is the most treatable and before it has had a chance to grow and spread. So far, the only tumor marker to gain wide acceptance as a general screen is the Prostate Specific Antigen (PSA) for men. Other markers are either not specific enough (too many false positives, leading to expensive and unnecessary follow-up testing) or they are not elevated early enough in the disease process. Some people are at a higher risk for particular cancers because they have inherited a genetic mutation. While not considered tumor makers, there are tests that look for these mutations in order to estimate the risk of developing a particular type of cancer. BRCA1 and BRCA2 are examples of gene mutations related to an inherited risk of breast cancer and ovarian cancer. For more information, see our overview on genetic testing.

          Why are they done?
          Tumor markers are not diagnostic in themselves. A definitive diagnosis of cancer is made by looking at biopsy specimens (e.g., of tissue) under a microscope. However, tumor markers provide information that can be used to:







          • Screen. Most markers are not suited for general screening, but some may be used in those with a strong family history of a particular cancer. In the case of genetic markers, they may be used to help predict risk in family members. PSA testing for prostate cancer is an example.

          • Help diagnose. In a patient that has symptoms, tumor markers may be used to help identify the source of the cancer, such as CA-125 for ovarian cancer, and to help differentiate it from other conditions. Remember that tumor markers cannot diagnose cancer themselves but aid in this process.

          • Stage. If a patient does have cancer, tumor marker elevations can be used to help determine how far the cancer has spread into other tissues and organs.

          • Determine prognosis. Some tumor markers can be used to help doctors determine how aggressive a cancer is likely to be.

          • Guide Treatment. Some tumor markers, such as Her2/neu, will give doctors information about what treatments their patients may respond to (for instance, breast cancer patients who are Her2/neu positive are more likely to respond to Herceptin treatment).

          • Monitor Treatment. Tumor markers can be used to monitor the effectiveness of treatment, especially in advanced cancers. If the marker level drops, the treatment is working; if it stays elevated, adjustments are needed. The information must be used with care, however. CEA, for instance, is used to monitor colorectal cancer, but not every colorectal cancer patient will have elevated levels of CEA.

          • Determine recurrence. Currently, one of the biggest uses for tumor markers is to monitor for cancer recurrence. If a tumor marker is elevated before treatment, low after treatment, and then begins to rise over time, then it is likely that the cancer is returning. (If it remains elevated after surgery, then chances are that not all of the cancer was removed.)

          Common Tumor Markers Currently in Use

          Tumor Markers.........Cancers..............What else?.............When/How Used.....Usual
          .................................................................................................................Sample
          ________________________________________________________________
          AFP (Alpha-feto protein)..Liver, germ cell...Also elevated........Help diagnose,.......Blood
          ................................
          cancer of ovaries..during pregna.....monitor treatment,
          ................................or
          testes...........................................or determine
          .........................................................................................recurrence


          B2M........................
          Multiple myeloma..Present in many....Determine............ Blood
          ...............................and
          lymphomas ...other conditions,....prognosis
          ...........................................................including Crohn's
          ............................................................disease and
          ............................................................hepititis; often
          ............................................................used to deter-
          ............................................................mine cause of
          ............................................................renal failure.

          BTA (Bladder tumor......Bladder.................Gaining acceptance...Help diagnose.........Urine
          antigen...........................................................................and determine
          .......................................................................................recurrence

          CA 15-3 (Cancer.....Breast and other...Also Elevated.......Stage disease...........Blood
          antigen 15-3..........including lung,......in benign breast....monitor
          .............................ovarian..................conditions;..........treatment
          .............................Doctor can use...................................determine
          .............................CA 27-29 (two differ-.............................recurrence
          .............................ent assays for same
          .............................marker

          CA 19-9 (Cancer....Pancreatic,............Also Elevated.......Stage disease..........Blood
          antigen 19-9..........sometimes............in pancreatitis and...monitor
          .............................
          colorectal..............inflammatory........treatment
          .............................and bile ducts........bowel disease........and determine
          ........................................................................................recurrence

          CA 72-4 (Cancer....
          Ovarian................No evidence that.......help...................Blood
          antigen 72-4).................................... it is better than..........diagnose
          ..........................................................
          CA-125 but may be
          ..........................................................useful when
          ..........................................................combined with it

          CA-125 (Cancer......Ovarian ..............Also elevated with.....Help..................Blood
          antigen 125)......................................endo-metriosis,.........diagnose
          .........................................................some other diseases...monitor -
          .........................................................and benign condi;.......treatment
          .........................................................tions not recom-........and determine
          .........................................................mended as a general...recurrence
          .........................................................screen

          Calcitonin...........Thyroid.................Also elevate in............help diagnose....Blood
          ...........................medullary..............pernicious anemia.....monitor
          ...........................carcinoma.............and tyroiditis.............treatment and
          ...........................................................................................determine
          ...........................................................................................recurrence

          CEA (Carcino-.....Colorectal, lung,....Elevated in other........monitor.............Blood
          ...........................
          breast, thyroid,.....conditions such as......treatment and
          ...........................
          pancreatic, liver,...hepatitis, COPD,.........determine
          ...........................
          cervix, and............colitis, pancreatitis....recurrence
          ...........................bladder..................and smokers

          EGFR (Her-1)...... solid tumors,.........Not Available in........Guide treat-........Tissue
          ...........................such as of the.........every lab..................ment and
          ...........................lung (non small.......................................determine
          ...........................cell), head and.........................................prognosis
          ...........................neck, colon,
          ...........................pancreas, or breast

          Estrogen receptors....Breast.................. Increased in...............Determine...........Tissue
          .......................................................hormone- dependent..prognosis and
          .......................................................cancer........................guide treatment

          hCG (Human.......Testicular and.......Elevated in preg-........Help diagnose,.....Blood
          chorionic............trophoblastic........nancy, testicular........monitor...............urine
          gonadotropin)..................................failure........................treatment,
          ..........................................................................................determine
          ..........................................................................................recurrence

          Her-2/neu..........
          Breast ...................Oncogene that is........Determine...........Tissue
          ........................................................present in multiple....prognosis and
          ........................................................copies in 20-30%.......guide treatment
          ........................................................of invasive breast
          ........................................................cancer

          Monoclonal......
          Multiple myeloma....Overproduction......Help diagnose,.......Blood
          ........................and Waldenstrom’s....of an immuno-.........monitor treatment,...Urine
          ........................macroglobulinemia....globulin or...............and determine
          ........................................................antibody, usually.....recurrence
          .......................................................detected by protein
          .......................................................electrophoresis

          NSE (Neuron-..Neuroblastoma,......may be better than....Monitor.................Blood
          specific............small cell lung........CEA for following.......treatment
          enolase)...........cancer...................this particular kind
          .....................................................of lung cancer

          NMP22........... Bladder................. Not widely used........Help diagnose and...Urine
          .....................................................................................determine
          .....................................................................................recurrence

          Progesterone receptors
          ......................Breast ...................Increased in...............Determine...............Tissue
          ....................................................hormone-..................prognosis and
          ....................................................dependent cancer.....guide treatment

          PSA...............Prostate ................Elevated in benign.....Screen for and help...Blood
          (Prostate.....................................Prostatic hypertrophy...diagnose, monitor
          specific........................................prostatitis with age....treatment, and
          antigen),.......................................................................determine recurrence
          total and free

          Prostate-.......Prostate................Not widely used...........Help diagnose..........Blood
          specific.......................................levels increase
          membrane..................................with age
          antigen (PSMA)

          Prostatic......Metatastic prostate...Not widely used...........Help diagnose..........Blood
          acid.............cancer, myeloma,..anymore, elevated in
          phosphatase....lung cancer............prostatitis and other
          (PAP)........................................conditions

          S-100...........Metastatic.............Not widely used..........Help diagnose...........Blood
          ....................melanoma

          TA-90..........Metastatic.............Not widely used..........Help diagnose...........Blood
          ....................melanoma.............being studied

          Thyroidglobin....Thyroid...............Used after thyroid is...Determine................Blood
          .................................................removed to evaluate...recurrence
          .................................................treatment

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          Urinalysis

          Urinalysis
          Also known as: Urine test
          Formal name: Urinalysis
          Related tests: Urine culture, Urine protein
          At A Glance:

          Why get tested?
          To screen for metabolic and kidney disorders and for urinary tract infections.

          When to get tested?
          During a routine physical or when you have symptoms of a urinary tract infection, such as abdominal pain, back pain, frequent or painful urination, or blood in the urine; as part of a pregnancy checkup, a hospital admission, or a pre-surgical work-up.

          Sample required?
          One to two ounces of urine; first morning sample is most valuable


          The Test Sample

          What is being tested?A urinalysis is a group of tests that detect and semi-quantitatively measure various compounds that are eliminated in the urine, including the byproducts of normal and abnormal metabolism as well as cells, including bacteria, and cellular fragments. Urine is produced by the kidneys, located on either side of the spine at the bottom of the ribcage. The kidneys filter wastes and metabolic byproducts out of the blood, help regulate the amount of water in the body, and conserve proteins, electrolytes, and other compounds that the body can reuse. Anything that is not needed is excreted in the urine and travels from the kidneys to the bladder, through the urethra, and out of the body. Urine is generally yellow and relatively clear, but every time someone urinates, the color, quantity, concentration, and content of the urine will be slightly different because of varying constituents.
          Many disorders can be diagnosed in their early stages by detecting abnormalities in the urine. These include increased concentrations of constituents that are not usually found in significant quantities in the urine, such as:

          • glucose,
          • protein,
          • bilirubin,
          • red blood cells,
          • white blood cells,
          • crystals, and
          • bacteria.
          They may be present

          • because there are elevated concentrations of the substance in the blood and the body is trying to decrease blood levels by “dumping” them in the urine,
          • because kidney disease has made the kidneys less effective at filtering,
          • or in the case of bacteria, due to an infection.
          A complete urinalysis consists of three distinct testing phases:

          1. physical examination, which evaluates the urine's color, clarity, and concentration;
          2. chemical examination, which tests chemically for 9 substances that provide valuable information about health and disease; and
          3. microscopic examination, which identifies and counts the type of cells, casts, crystals, and other components (bacteria, mucous ) that can be present in urine. Usually, a routine urinalysis consists of the physical and the chemical examinations. These two phases can be completed in just a few minutes in the laboratory or doctor’s office. A microscopic examination is then performed if there is an abnormal finding on the physical or chemical examination, or if the doctor specifically orders it.
          How is the sample collected for testing?
          Urine for a urinalysis can be collected at any time. The first morning sample is the most valuable because it is more concentrated and more likely to yield abnormal results. Because of the potential to contaminate urine with bacteria and cells from the surrounding skin during collection (particularly in women), it is important to first clean the genitalia. Women should spread the labia of the vagina and clean from front to back; men should wipe the tip of the penis. As you start to urinate, let some urine fall into the toilet, then collect one to two ounces of urine in the container provided, then void the rest into the toilet. This type of collection is called a midstream collection or a clean catch.

          A urine sample will only be useful for a urinalysis if it is collected as a clean catch and taken to the doctor’s office or laboratory for processing within a short period of time. If it will be longer than an hour between collection and transport time, then the urine should be refrigerated.

          Is any test preparation needed to ensure the quality of the sample?
          No test preparation is needed.

          How is it used?
          The urinalysis is used as a screening and/or diagnostic tool because it can help detect substances or cellular material in the urine associated with different metabolic and kidney disorders. It is ordered widely and routinely to detect any abnormalities that should be followed up on. Often, substances such as protein or glucose will begin to appear in the urine before patients are aware that they may have a problem. It is used to detect urinary tract infections (UTI) and other disorders of the urinary tract. In patients with acute or chronic conditions, such as kidney disease, the urinalysis may be ordered at intervals as a rapid method to help monitor organ function, status, and response to treatment.

          When is it ordered?
          A routine urinalysis may be done when you are admitted to the hospital. It may also be part of a wellness exam, a new pregnancy evaluation, or a work-up for a planned surgery. A urinalysis will most likely be performed if you see your health care provider complaining of abdominal pain, back pain, painful or frequent urination, or blood in the urine, symptoms of a UTI. This test can also be useful in monitoring whether a condition is getting better or worse.

          What does the test result mean?
          NOTE: A standard reference range is not available for this test. Because reference values are dependent on many factors, including patient age, gender, sample population, and test method, numeric test results have different meanings in different labs. Your lab report should include the specific reference range for your test. Lab Tests Online strongly recommends that you discuss your test results with your doctor. For more information on reference ranges, please read Reference Ranges and What They Mean.

          Urinalysis results can have many interpretations. They are a red flag, a warning that something may be wrong and should be evaluated further. Generally, the greater the concentration of the abnormal substance (such as greatly increased amounts of glucose, protein, or red blood cells), the more likely it will be that there is a problem that needs to be addressed. But the results do not tell the doctor exactly what the cause of the finding is or whether it is a temporary or chronic condition. A normal urinalysis also does not guarantee that there is no illness. Some people will not release elevated amounts of a substance early in a disease process and some will release them sporadically during the day (which means they may be missed by a single urine sample). In very dilute urine, small quantities of chemicals may be undetectable.

          Is there anything else I should know?
          The urinalysis is a set of screening tests that can provide a general overview of a person’s health. Your doctor must correlate the urinalysis results with your health complaints and clinical findings and search for the causes of abnormal findings with other targeted tests (such as a comprehensive metabolic panel (CMP), complete blood count (CBC), or urine culture (to look for a urinary tract infection).

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          Urine Culture


          Urine Culture
          Related tests: Urinalysis, Blood cultures, Susceptibility testing

          The Test Sample

          What is being tested?
          The urine culture test detects and identifies bacteria and yeast in the urine. Urine is produced by the kidneys, located on either side of the spine at the base of the ribcage. The kidneys filter waste out of the blood and produce urine, a yellow fluid, to carry the wastes out of the body. Urine travels through tubes called ureters from the kidneys to the bladder, where it is stored temporarily, and then through the urethra as it is voided. Urine is generally sterile, but sometimes bacteria (or, more rarely, yeast) can move from the skin outside the urethra and migrate back up the urinary tract to cause a urinary tract infection (UTI).

          With a urine culture, a small sample of urine is placed on one or more agar plates (a thin layer of a nutrient gel) and incubated at body temperature. Any microorganisms that are present in the urine sample grow over the next 24 to 48 hours as small circular colonies. The size, shape, and color of these colonies give clues as to which bacteria are present, and the number of colonies indicates the quantity of bacteria originally present in the urine sample. A laboratorian observes the colonies on the agar plate, counting the total number and determining how many types have grown. Ideally, if a good clean sample was collected for the test (see below), then the only bacteria present should be due to an infection. Usually, this will be a single type of bacteria that will be present in relatively large numbers. Sometimes, more than one type of bacteria will be present. This may be due to an infection that involves more than one pathogen (disease-causing microorganism); however, it is more likely to be due to contamination from the skin picked up during the urine collection.

          The laboratorian will take a colony from each type of bacteria present that appears significant in number or type, smear it on a slide, dry it, and stain it with dyes (called a gram stain). The laboratorian then examines the microorganisms under the microscope. Different types of bacteria will have different colors and shapes that can differentiate different types of bacteria present. For instance, the bacterium Eschericia coli, which causes the majority of urinary tract infections, will appear as gram-negative rods (pink rods) under the microscope and Lactobacillus, which is a common vaginal contaminant in women’s urine samples, will appear as gram-positive bacilli (thin purple rods). Some of these bacteria, such as Lactobacillus, are easy for an experienced laboratorian to identify and are nonpathogenic (do not cause an infection) and do not require any further investigation. Others, such as gram-negative rods, represent groups of similar bacteria and will require additional testing to determine exactly which type of bacteria is present.

          Based upon the information obtained, the laboratorian gives the doctor an initial report of the quantities and types of bacteria (or yeast) present in the urine. Examples would be: “no growth in 24 hours” (nothing grew on the agar), “less than 10,000 organisms/ml” (a small amount of bacteria was present) or “greater than 100,000 organisms per ml of gram negative rods, ID and susceptibility to follow” (the patient probably has an infection caused by a gram negative bacteria that needs to be further identified).

          If there is no or little growth on the agar after 24 to 48 hours of incubation, the urine culture is considered negative for pathogens and the culture is complete. If there is one or more pathogen present, further testing is performed. Biochemical tests are used to identify which bacteria are present and susceptibility testing evaluates the ability of the bacteria to grow in the presence of a specific selection of antimicrobial drugs to help determine which drug treatments are likely to be effective in resolving the infection.

          How is the sample collected for testing?
          Urine for a culture can be collected at any time. Because of the potential to contaminate urine with bacteria and cells from the surrounding skin during collection (particularly in women), it is important to first clean the genitalia. Women should spread the labia of the vagina and clean from front to back; men should wipe the tip of the penis. As you start to urinate, let some urine fall into the toilet, then collect one to two ounces of urine in the sterile container provided, then void the rest into the toilet. This type of collection is called a mid-stream clean catch urine.

          Is any test preparation needed to ensure the quality of the sample?
          No test preparation is needed.

          How is it used?
          The test is used to diagnose a urinary tract infection (UTI).

          When is it ordered?
          A urine culture may be ordered when symptoms indicate the possibility of a urinary tract infection, such as pain and burning when urinating and frequent urge to urinate. Antibiotic therapy may be prescribed without requiring a urine culture for symptomatic young women, who have an uncomplicated lower urinary tract infection. If there is suspicion of a complicated infection, or symptoms do not respond to initial therapy, then a culture of the urine is recommended. Pregnant women without any symptoms may be screened for bacteria in their urine, which could affect the health and development of the fetus.

          What does the test result mean?
          The presence of a single type of bacteria growing at high colony counts (greater than 10,000 colony forming units (CFU)/ml) is considered a positive urine culture. A culture that is reported as no growth in 24 or 48 hours or less than 10,000 CFU/ml usually indicates that there is no infection. If the symptoms persist, however, the culture may be repeated to look for the presence of bacteria at lower colony counts (less than 10,000 CFU/ml) or other microorganisms that may cause these symptoms. The presence of white blood cells and low numbers of microorganisms in a symptomatic patient is a condition known as acute urethral syndrome.

          If a culture shows growth of several different types of bacteria, then it is likely that the growth is due to contamination. This is especially true if the organisms present include Lactobacillus and common nonpathogenic vaginal bacteria in women. If the symptoms persist, the doctor may request a repeat culture on a sample that is more carefully collected.

          The presence of a significant amount of a single type of bacteria usually indicates an infection. Susceptibility testing is performed to guide antimicrobial treatment. Any bacterial infection may be serious and can spread to other areas of the body if not treated. Since pain is often the first indicator of an infection, prompt treatment, usually with antibiotics, will help to alleviate the pain.

          Is there anything else I should know?
          Females get UTIs more often than males. Even school-age females may have frequent UTIs. For males with a culture-proven UTI, the doctor may order further tests to rule out the presence of a kidney stone or structural abnormality that could cause the infection.

          If you have recurrent urinary tract infections, culture and susceptibility testing may be performed with each episode. For patients who have frequent UTIs, their bacteria may become resistant to antibiotics over time, making careful selection of antibiotic (and the full course of treatment) essential. Those with kidney disease and/or with diseases that affect the kidneys, such as diabetes and those with compromised immune systems, may be more prone to recurring UTIs.

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