- Hep A, AB, hep BsAg, Hep BsAb, Hep Bc IgC, Hep C Ab (These were all Non-Reactive...no Hepatitis!)
- 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)
- ANA (Also, to test for PBC and other autoimmune diseases) (Negative)
- Anti Liver-Kidney Ab_Live-Kidney microsomal Ab (In Range = no Hepatitis diseases)
- 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)
- 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. - 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)
- 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. - 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)
- TSH, Free T4 (Thyroid) (High)
- 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). - 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.
- 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.
- 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. - 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. - 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.
- 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 Emptyingstudy to check my Gastroparesis.
