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About The Author
Dr. Vieira has a Ph.D. in Biomedical Sciences from
the University Of Florida College Of Medicine. She has
worked in hospitals and clinics conducting clinical
research with patients, as well as in biotechnology
laboratories, researching the biochemistry and molecular
biology of the body at a cellular level. Later, she worked
in the food industry with the largest food company in
America. There she conducted nutrition research
focused on discovering and confirming the health
benefits of vitamins, minerals, fruits, vegetables, herbs,
amino acids, plant extracts and other natural
compounds. Her projects there included discovering
novel ingredients for improving bone strength, preventing/treating diabetes and
more. She has extensively studied natural medicines and therapies, leading to
her discoveries of existing research on dietary and lifestyle changes that prevent,
cure or improve most health conditions.
Website:
Facebook:
Twitter:
http://KarenVieira.com
http://facebook.com/DrKarenVieira
http://twitter.com/DrKarenV
© Dr. Karen Vieira 2011
Page 2
Table of Contents
(Click to go directly to a section)
About The Author ............................................................................................ 2
Introduction ...................................................................................................... 4
What Are Your Results Telling You? ............................................................... 5
How to Use This Guide .................................................................................... 6
The Different Blood Tests and What They Measure ........................................ 8
Decoding Your Results .................................................................................. 17
Potential Causes of Abnormal Results .......................................................... 23
What’s Next? ................................................................................................. 36
This e-book is copyrighted with all rights reserved. The author does not assume liability for
the misuse of any information contained within. The information contained within this e-book is
offered to provide you with beneficial concepts regarding your health and well-being. The author
is a Ph.D. medical researcher, not a physician. Please consult your primary care physician before
beginning any new program of nutrition, dietary supplementation, exercise or lifestyle changes.
By consulting your primary care physician, you will have a better opportunity to understand and
address your particular symptoms and situation in the most effective ways possible.
While every attempt has been made to provide information that is both accurate and proven
effective, the author and, by extension, the e-book, makes no guarantees that the information
presented herein will help everyone in every situation. As the symptoms and conditions for each
person are unique to individual histories, genetics and environment, successes will vary.
© Dr. Karen Vieira 2011
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Introduction
Blood tests are one of the most powerful tools doctors have for diagnosing
illnesses. If the results are used correctly, a blood test can also provide
information that can help prevent disease and help you live a longer, healthier
life.
You don't have to have a medical degree in order to make sense of your
blood test results. In fact, by the time you finish reading this guide you will not
only be able to read and understand your current blood test results, but you will
also be able to use them to choose the right diet and lifestyle choices to optimize
your health.
Before we get started, though, you should know that the information included
in this guide is for educational purposes only. You should not use it in place of an
evaluation or advice from a qualified, licensed healthcare professional. If you
have any questions or concerns about your blood test results, talk to your family
doctor, specialist or other qualified healthcare practitioner.
© Dr. Karen Vieira 2011
Page 4
What Are Your Results Telling You?
Your blood test results can give you and your doctor a lot of information about
what was going on in your body at the exact moment your blood was drawn. In
this way blood tests are kind of like taking a photo of the inner workings of your
body. They tell you what is actually going on in there at that moment. In
comparison, urine tests tell you what's left over from yesterday or last week.
Blood tests may help your doctor diagnose a specific disease or may help
prevent a chronic disease from developing when combined with changes to your
diet and lifestyle.
Although some blood tests may give you a definite yes or no answer, like a
pregnancy test, most blood tests give you a number instead. These numbers are
listed on the blood test report you'll get from your doctor or the testing lab.
Usually there are a lot of different numbers listed on this report, and each one
gives you a little piece of the entire puzzle. For example, one test your doctor
may run is for cholesterol. Most people over the age of 40 put a lot of emphasis
on this number, especially if heart disease runs in their family. But cholesterol is
only one marker of heart disease and not a very accurate one actually. In order
to get the entire picture of how healthy or unhealthy your heart actually is, you
also have to take into account other cardiovascular-related markers, like Creactive protein and homocysteine. This is why your doctor should order an
entire heart panel, rather than just a cholesterol check.
Although the thought of wading through all of the numbers listed on your
blood test report may be a little overwhelming right now, you definitely don't need
a medical degree to understand the basics of what they are trying to tell you. And
in the end, knowing how to read your own blood test results will give you the
power and the knowledge to understand your own body and take control of your
health. For example, even if your test results are within the normal ranges, this
doesn't always mean you are truly healthy. By being able to understand what
your blood tests are telling you, you can start a conversation with your doctor
about optimizing your health instead of blindly guessing at what diet, vitamins,
minerals and other supplements could help prevent potential disease and help
you feel better, more energetic and more like the you that you always knew you
should be.
© Dr. Karen Vieira 2011
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How to Use This Guide
This guide was designed to help you learn how to make sense of your blood
test results. It's not going to turn you into a doctor, but it will help you become a
more informed patient.
Before you can begin, you need a copy of your most recent blood test results
handy. You can get a copy of the report from your doctor or directly from the lab
that tested your blood, if you know which one it was. If you haven't had a blood
test recently, talk to your doctor about ordering one. You can use the information
in the next section to help you and your healthcare provider decide which panel
or panels would give you the most beneficial information about your health.
Once you have your results, the rest of this guide will walk you through the
four easy steps you need to follow to understand them and use them to improve
your health.
STEP 1: Use the tables included in this guide to figure out whether your
results are within the normal and/or optimal range.
Oftentimes the lab will do this for you, highlighting any results that fall outside
the normal reference range. However, many of the "normal" levels used by labs
are calculated from a sample group of people who may or may not be completely
healthy. As a result, you should also check to see if your results are in the
optimal range. While results within the normal range mean you are not sick,
results within the optimal range show real health and wellness.
STEP 2: Figure out why your results (if any) are not within the normal range.
Abnormal results can be caused by deficiencies, illnesses, infections or other
types of health conditions. Without knowing the exact cause, you and your health
care provider can only blindly guess at how to improve your health.
STEP 3: Design a plan to improve your results.
Just like trying to lose weight, you can't expect your blood test results to
improve instantly. Instead you and your doctor need to set achievable goals and
work your way into the normal range. This will take time, but it will help move you
out of the "disease zone" and reduce your risk of developing more conditions in
the future. Once you are out of the danger zone, you and your doctor can start
thinking about moving your levels all the way into the optimal range. These goals
can often be reached by changing your diet or using specific supplements.
STEP 4: Check and re-check your results.
© Dr. Karen Vieira 2011
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Even after you start a lifestyle or supplementation program to improve your
health, you need to make sure it’s actually making a difference. Even if you think
the program is helping improve your energy levels or the way you feel, you can
only be 100% sure if you have evidence of the changes inside your body.
Therefore you need to continue to have regular blood tests and check your
results. With each new blood test, you'll start this process all over again, making
adjustments in your program to ensure you are moving your numbers in the right
direction – toward overall good health and true wellness.
© Dr. Karen Vieira 2011
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The Different Blood Tests and What They Measure
There are all sorts of blood tests available, and each one focuses on one
specific thing, like cholesterol or the amount of iron in your blood. While each of
these numbers tells you and your doctor something important about your health
and the way your body is functioning, it doesn't give a very complete picture.
Therefore, if you want to check on something like the health of your heart or liver,
you will need to have a number of different tests run on your blood. This is known
as a blood panel.
Blood panels can also be used to get a broad picture of your general health.
One of the quickest, simplest and cheapest ways to start looking at your overall
health is with a Complete Blood Panel.
Complete Blood Panel
The foundation of the Complete Blood Panel is the typical, standard group of
blood tests run by your family doctor. Because the tests are so general, they act
like nets with large holes – they can catch the big fish, but the smallest fish swim
right through.
Still, the Complete Blood Panel is the best place to start when you have
concerns about your health. This is because from a doctor's point of view, you
need to make sure that there's no infection, anemia or other huge underlying
issue that is causing problems. These are the "big fish" that are caught very
easily with a complete blood panel.
So what tests actually make up this panel? And why are they important? Well,
the primary test that makes up this panel is the complete blood count. This test
is basically exactly what it sounds like. The lab is going to count your blood cells.
Since your blood is made up for two different groups of cells: red and white blood
cells, you are going to have a red blood cell (RBC) count on your report as well
as a white blood cell (WBC) count.
The lab is also going to calculate how much of your whole blood is made up
of red blood cells. This test is called hematocrit. The results not only depend on
how many red blood cells you have, but also how big they are.
It is also important to measure your hemoglobin levels. Hemoglobin is a
protein found in your red blood cells that carries oxygen from your lungs to your
tissues and organs and then shuttles toxic carbon dioxide from your tissues and
organs back to your lungs. This iron-containing protein is also what makes your
blood red.
© Dr. Karen Vieira 2011
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The lab will also take a closer look at your white blood cells by doing a test
called a differential. This basically means separating and counting the specific
types of white blood cells:
Neutrophils – the most common type of white blood cell in the
bloodstream. Their main job is to kill and break down invading bacteria in
the body.
Lymphocytes – small white blood cells that help protect the body from
infections. There are two main types: T cells and B cells. B cells make
antibodies that attack bacteria and toxins, while T cells attack and destroy
body cells that have been invaded by viruses or have turned cancerous.
Monocytes – the largest type of white blood cell. They surround,
gobble up and digest any disease-causing invaders that might enter the
body. They also act like trash compactors, devouring any cells in your
body that may have died and cleaning up any other unneeded cellular
material.
Eosinophils – another type of disease-fighting white blood cell. Their
main role in the body hasn't been completely figured out yet, but they are
known to contribute to allergic reactions.
Basophils – the least common type of white blood cell. They are
involved in the beginning stages of inflammation, which is the body's
reaction to injury or irritation.
Immature granulocytes – white blood cells that are not fully
developed. These could be immature neutrophils, eosinophils or
basophils.
The lab will also count the number of platelets in your blood sample. These
disc-shaped cells are your body's main clotting factor. When you do something
like cut yourself, your platelets clump together to help form a blood clot that will
plug the wound and stop the bleeding.
Three other common tests included in this panel are:
Mean Corpuscular Volume (MCV) – measures the average size of
your red blood cells.
Mean Corpuscular Hemoglobin (MCH) – figures out the average
amount of hemoglobin inside each of your red blood cells.
Red Blood Cell Distribution Width (RDW) – calculates how much
difference there is in size between your red blood cells.
© Dr. Karen Vieira 2011
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Blood Type – tells you what your blood type is (A, B, AB or O).
Liver Panel
Your liver performs an estimated 500 different functions in your body, from
processing nutrients from the food you eat and making bile to removing toxins
from your body and building proteins. Therefore a healthy liver is absolutely
essential for a healthy life. To find out how well your liver is functioning, you will
need to look at:
Bilirubin – a yellowish pigment in bile that is formed from the
breakdown of hemoglobin. Direct bilirubin is a subset of total bilirubin
that is joined to another molecule in the blood.
Alkaline phosphatase – an enzyme made in the liver that is usually
found in high concentrations in bile.
Aspartate aminotransferase (AST) – a liver enzyme that helps
promote a specific chemical reaction.
Alanine aminotransferase (ALT) – another important liver enzyme
involved in metabolism.
Gamma glutamyl transpeptidase (GGT) – an enzyme involved in
amino acid transport and glutathione metabolism.
Heart Panel
Heart disease is the leading cause of death for both men and women living in
the United States. Around the world, an estimated 17 million people die from
heart attacks, strokes and other cardiovascular conditions every year. However,
a very large portion of these deaths could be prevented if we took the time to
measure our risk and modify our lifestyles and diets to reduce this risk.
The road to prevention starts with a simple blood panel. There are two
different sets of markers that your doctor will want to check: lipids and
inflammation.
Lipids are a group of fatty substances that are stored in the body and can be
measured in the blood. Tests for lipids include:
Total cholesterol – Cholesterol is a waxy substance made by your
body and taken in through your diet that is needed to produce hormones,
vitamin D and bile, as well as protect nerve cells and provide structure to
© Dr. Karen Vieira 2011
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your cells. There are two different types of cholesterol, so total cholesterol
is a measure of both of them together.
Low-density lipoprotein (LDL) – considered the "bad" cholesterol
because it can slowly build up on the inner walls of your blood vessels and
block blood flow. It can also combine with other substances to harden your
arteries, making it much harder for blood to move through them.
High-density lipoprotein (HDL) – considered the "good" cholesterol
because it carries other types of bad cholesterol away from the arteries
and back to the liver where they are released from the body.
Triglycerides – a form of fat made in the body.
Inflammation is the immune process that causes tissues to swell, become
painful and red. You are probably most used to this happening when you do
something like cut your hand. However, inflammation can occur inside your body
as well and may get out of control. While this is a beneficial process in the short
term, in the long term it can damage healthy tissue and cause a number of
different health conditions including heart disease. Tests for inflammation that is
linked to heart disease are:
C-reactive protein – a protein produced by the liver that increases
during whole-body inflammation.
Homocysteine – an amino acid that is thought to damage the cells
that line your arteries.
Sedimentation rate – how quickly red blood cells settle to the bottom
of a test tube. When there is more inflammation in the body, red blood
cells have a tendency to stick together and fall to the bottom of the test
tube more quickly than usual.
Kidney Panel
Your kidneys work to filter your blood, removing wastes and ensuring that the
body’s fluids are balanced, not too concentrated or dilute. As a person's kidney
function declines, so does their overall health. Therefore, it is sometimes
important to test just how well your kidneys are working. To do this, your blood
will be tested for:
Glomerular filtration rate (eGFR) – measures how well your kidneys
are working by estimating how much blood passes through the tiny filters
in the kidneys (called glomeruli) every minute.
© Dr. Karen Vieira 2011
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Blood Urea Nitrogen (BUN) – measures the amount of nitrogen in
your blood that comes from the waste product called urea. Urea is usually
removed from your blood by your kidneys and then passed out of your
body in your urine.
Creatinine – chemical waste product that is produced by your
muscles. It is usually filtered out of your blood by your kidneys and then
passed out of your body in your urine.
Electrolytes (sodium, potassium, chloride, magnesium) – dissolved
salts found in your blood.
Bicarbonate – dissolved carbon dioxide (CO2) in the blood is found in
this form.
Total protein – measures the amount of all proteins in your blood.
Albumin – the main protein in human blood. It helps carry substances
through the blood and helps maintain blood volume and blood pressure.
Globulin – the other main protein found in the blood. It helps with the
functioning of your immune system.
Thyroid Panel
Your thyroid is a small butterfly-shaped gland located below the skin and
muscles at the front of your neck, right around the spot where a bow tie would sit.
Despite its small size, the thyroid has an extremely important role in the body. It
makes the hormones that help control metabolism (how fast your body turns food
into energy) and growth. Unfortunately some of the most common hormone
disorders are linked to the thyroid. In fact, at least 13 million Americans have
some type of thyroid disorder. However, many of them have no idea about their
condition. To test for a thyroid dysfunction, your doctor will look at your levels of:
Triiodothyronine (T3) and Thyroxine (T4) – two of the hormones
made by the thyroid gland. They help control your body's metabolism and
are needed for normal brain growth.
Thyroid stimulating hormone (TSH) – a hormone produced by your
pituitary gland in your brain that tells your thyroid gland to make and
release T3 and T4.
© Dr. Karen Vieira 2011
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Hormone Panel
Hormones are chemical messengers that are released into your bloodstream
by one part of your body to deliver a message to the cells and tissues in another
part of your body. The hormones that most of us are most familiar with are "sex
hormones," which help regulate our sexual development and our reproductive
cycle. Other important hormones are involved in our body's response to stress.
While hormone levels and function are different in men and women, there are
a number of hormones that are important for both sexes:
Estradiol – the most important form of estrogen in the body. It is made
and released by the ovaries, adrenal gland and placenta (in pregnant
women). Men also produce estradiol but not as much as women.
Luteinizing Hormone (LH) – a hormone produced by the pituitary
gland. In women, LH helps regulate their menstrual cycle and egg
production (ovulation). In men, LH stimulates the production of
testosterone.
DHEA-Sulfate (DHEA-S) – a weak masculine hormone that is
produced by the adrenal gland in both men and women.
Cortisol – a stress hormone produced by the adrenal glands. It
reduces inflammation and weakens your immune system.
For men, a hormone panel will also measure your levels of:
Testosterone – a male hormone produced by the testes and adrenal
glands. It is responsible for the development of male sexual characteristics
during puberty, like a deepening voice and hair growth. Testosterone also
affects the brain, bone and muscle mass, fat distribution, the blood
vessels, energy levels and sexual function.
Dihydrotestosterone (DHT) – the most active male sex hormone. It is
produced from testosterone in the prostate gland, testes, hair follicles and
adrenal glands and does many of the same things as testosterone in the
body.
Prostate Specific Antigen (PSA) – protein produced by certain cells
in the prostate gland that keeps semen watery. Most PSA is carried out of
the body in semen, but a very small amount slips into the bloodstream.
© Dr. Karen Vieira 2011
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Hormone panels for women should include tests for:
Progesterone – a female hormone produced by the ovaries when they
release a mature egg during ovulation. It helps prepare the lining of the
uterus in case the egg is fertilized. Very high levels of progesterone are
also produced by the placenta during pregnancy.
Follicle Stimulating Hormone (FSH) – a hormone released by the
anterior pituitary gland that stimulates the production of eggs. It also
stimulates the production of estradiol during the first half of a woman's
menstrual cycle.
Testosterone – a male hormone that is also produced in lesser
amounts in the adrenal glands and ovaries of women. As with men,
testosterone affects the brain, bone and muscle mass, fat distribution, the
blood vessels, energy levels and sexual function.
Glucose Panel
Diabetes is one of the fastest growing lifelong diseases in the United States,
currently affecting nearly 8% of the population. However, nearly 6 million
Americans don't know they have the disease, and another 57 million may be
unaware they are at risk of developing it in the future. Because of the serious
health consequences linked to uncontrolled diabetes, it is important to figure out
if you are one of them. To do this, your doctor will order a Glucose Panel, which
includes testing:
Glucose – the main type of sugar in your blood. Your body uses
glucose as its main source of energy.
Insulin – a hormone produced by the pancreas that lowers the amount
of glucose in your blood. It helps your body cells absorb glucose from your
bloodstream.
Hemoglobin A1c – testing for this substance shows your average
blood sugar levels over the past 2 to 3 months.
Nutrient Panel
Nutrients like vitamins and minerals help your body work properly. They can
boost your immune system, ensure normal growth and development and help
your cells, tissues and organs do their jobs. Although you get some vitamins and
minerals for the foods you eat, many of us do not get enough of these essential
nutrients in our diets, putting our health and wellbeing at risk.
© Dr. Karen Vieira 2011
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A complete Nutrient Panel will test your blood for important nutrients like:
Folic acid (folate) – a form of a water-soluble B vitamin that your body
needs to make and repair DNA and produce healthy red blood cells. Your
brain also needs folic acid to function properly, and it plays an important
role in maintaining your mental and emotional health.
Iron – a mineral found in every cell in your body. You also need iron to
make oxygen-carrying proteins like the hemoglobin found in your red
blood cells.
Vitamin B12 – one of the B-complex vitamins. Your body needs
vitamin B12 to build proteins and make red blood cells. It also helps your
brain, spinal cord and nerves work properly.
Vitamin C – a vitamin that helps boost the immune system, combats
potentially damaging free radicals, promotes the production of collagen
(an essential part of connective tissue, which is literally the framework that
holds our bodies together), and encourages healthy blood flow through
your blood vessels.
Vitamin D3, 25-Hydroxy – a vitamin produced when the sun hits your
bare skin. It helps your body keep the right amount of calcium and
phosphorus in your blood, as well as performing a number of other
important functions.
Calcium – a mineral that helps build strong bones and teeth. Calcium
also plays a role in blood clotting, transmitting signals between nerves and
contracting/relaxing muscles. It is also needed to keep a normal heartbeat.
Zinc – this mineral is a common component of many enzymes, which
makes it essential for many biological processes. It is particularly
important to normal brain and reproductive function.
Additional Tests
Partial prothrombin time (PTT) – Prothrombin is a clotting factor in the
blood. This test indicates the amount of time required for blood to clot.
Amylase – Amylase is an enzyme that breaks down carbohydrates. Amylase
blood levels are used to diagnose and monitor problems with the pancreas.
© Dr. Karen Vieira 2011
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Creatine kinase (CK) – This is also called creatine phosphokinase or CPK.
Creatine kinase is an enzyme necessary for storage of creatine in muscles for
quick energy.
Lactate dehydrogenase (LDH) – This is an important metabolic enzyme
found in most tissues of the body.
Uric acid – This is a waste material that is carried to the kidneys and
converted to urine.
© Dr. Karen Vieira 2011
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Decoding Your Results
To understand your blood test results there are a couple of important terms
you should know:
Normal Reference Range – a span of numbers that generally means
you do not have a disease. Numbers higher or lower than this range are
considered abnormal and may mean that you have some type of illness or
condition.
Optimal Range – a span of numbers that indicates little to no risk of
disease, where aging is slowed down and you are living in a state of
optimal wellness.
Looking at your lab report, you'll probably notice that any abnormal results
(those outside the normal reference range) have been highlighted in some way.
You may notice an "H" next to a result, which means that it is higher than normal.
If you have an "L" next to a result, it generally means "low", and "WNL" means
"within normal limits". It is important to understand that different labs might have
significantly different normal ranges because of the type of equipment and
methods they are using to test your blood. The normal ranges listed in the
following tables are generally taken from either National Institute of Health or
American Medical Association general guidelines, but they should only serve as
examples. The ranges specified in your lab results should be your first point of
reference in interpreting your results. Optimal ranges haven’t been established
for all tests and may also vary according to age and sex.
Basic Blood Panel
Test Name
Normal Reference Range
Optimal Range
4.5-10103/μL or 4.510109/L
5-6106/μL or 5-61012/L
5.5-10103/μL or 5.510109/L
same as normal range
same as normal range
Hematocrit, male
4-5106/μL or 4-51012/L
14.0-17.5 g/dL or 140-175
g/L
12.3-15.3 g/dL or 123-153
g/L
40.7-50.3% or 0.407-0.503
Hematocrit, female
36.1-44.3% or 0.361-0.443
same as normal range
MCV
80-100 fL or 8-1010-14 L
27.0-31.0 pg or
2.7-3.110-11 g
same as normal range
WBC
RBC, male
RBC, female
Hemoglobin, male
Hemoglobin, female
MCH
© Dr. Karen Vieira 2011
same as normal range
same as normal range
same as normal range
same as normal range
Page 17
MCHC
32-36 g/dL or 320-360 g/L
same as normal range
RDW
11.0-15.0% or 0.11-0.15
150-450103/μL or 150450109/L
2.5-7.0103/μL or 2.57.0109/L
1.0-4.8103/μL or 1.04.8109/L
0.2-0.6103/μL or 0.20.6109/L
0.1-0.4103/μL or 0.10.4109/L
0.04-0.1103/μL or 0.040.1109/L
0.0-0.1×103/μL or 0.00.1×109/L
same as normal range
240-400×103/μL or 240400109/L
3.0-6.5×103/μL or 3.06.5×109/L
3.0-6.5×103/μL or 3.06.5×109/L
Platelets
Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils
Immature
Granulocytes
same as normal range
0.1-0.3×103/μL or 0.10.3×109/L
same as normal range
same as normal range
Liver Panel
Test Name
Normal Reference Range
0.3-1.9 mg/dL or 5.1332.49 μmol/L
0-0.3 mg/dL or 0-5.13
μmol/L
Total bilirubin
Direct bilirubin
Alkaline
phosphatase
AST
Optimal Range
same as normal range
same as normal range
44-147 IU/L
65-85 IU/L
10-34 IU/L
same as normal range
ALT
0-40 IU/L
same as normal range
GGT, male
0-50 IU/L
same as normal range
GGT, female
0-30 IU/L
same as normal range
Normal Reference Range
Optimal Range
Heart Panel
Test Name
Total Cholesterol (TC)
Triglycerides (TG)
130-199 mg/dL or 3.375.15 mmol/L
(Borderline: 200-240
mg/dL or 5.18-6.216
mmol/L)
30-149 mg/dL or 0.34-1.68
mmol/L
© Dr. Karen Vieira 2011
165-199 mg/dL or 4.275.15 mmol/L
<50 mg/dL or <0.57
mmol/dL
Page 18
TC/HDL Ratio
(Borderline: 150-199
mg/dL or 1.69-2.25
mmol/L)
40-150 mg/dL or 1.03-3.39
mmol/L
0-129 mg/dL or 0-3.34
mmol/L
(Borderline: 130-160
mg/dL or 3.37-4.14
mmol/L)
3.9-5.7
TG/HDL Ratio
none
less than 2.0
LDL/HDL Ratio
Sedimentation
Rate, male
Sedimentation
Rate, female
0.5-3.0
less than 2.0
0-20 mm/hr
0-10
0-30 mm/hr
0-10
Cardiac CRP
0-0.3 mg/dL or 0-3 mg/L
HDL
LDL
Homocysteine
0-2 mg/L or 0-14.8 μmol/L
>60 mg/dL or 1.55 mmol/L
40-99 mg/dL or 1.04-2.56
mmol/L
less than 2.5
less than 0.1 mg/dL or 1.0
mg/L
0-0.85 mg/L or 0-6.3
μmol/L
Kidney Panel
Test Name
Normal Reference Range
Optimal Range
eGFR
Blood Urea Nitrogen
(BUN) or Urea
Nitrogen
greater than 59
greater than 90
7-20 mg/dL or 2.5-7.14
mmol/L
15-20 mg/dL or 5.36-7.14
mmol/L
Creatinine
0.8-1.4 mg/dL or 70.7123.8 μmol/L
less than 1.1 mg/dL or
97.2 μmol/L
BUN/Creatinine Ratio
or Urea/Creatinine
Ratio
10-20 or 35-60
same as normal range
Sodium
Potassium
Chloride
Magnesium
Bicarbonate (CO2)
135-145 mEq/L or 135145 mmol/L
3.7-5.2 mEq/L or 3.7-5.2
mmol/L
96-106 mEq/L or 96-106
mmol/L
1.7-2.2 mg/dL or 0.7-0.9
mmol/L
20-29 mEq/L or 20-29
© Dr. Karen Vieira 2011
same as normal range
same as normal range
same as normal range
same as normal range
same as normal range
Page 19
mmol/L
Total Protein
6.0-8.3 g/dL or 60-83 g/L
7.0-8.3 g/dL or 70-83 g/L
Albumin
3.4-5.4 g/dL or 34-54 g/L
4.4-5.4 g/dL or 44-54 g/L
Globulin
2.0-3.5 g/dL or 20-35 g/L
same as normal range
1.1-2.5
1.7-2.2
Test Name
Normal Reference Range
Optimal Range
TSH
0.4-4.0 mIU/L
4.5-11.2 μg/dL or 58-144
nmol/L
0.8-1.8 ng/dL or 10.3-23.2
pmol/L
100-200 ng/dL or 1.543.08 nmol/L
2.30-4.80 pg/mL, 230-480
pg/dL or 3.5-7.4 pmol/L
24-37% or 0.24-0.37
90-350 pg/mL, 9-35 ng/dL
or 139-539 pmol/L, 1.395.39 nmol/L
0.4-2.0 mIU/L
7.5-8.1 μg/dL or 95-105
nmol/L
1.2-1.4 ng/dL or 15.4-18
pmol/L
120-180 ng/dLor 1.85-2.77
nmol/L
2.80-3.20 pg/mL, 280-320
pg/dL or 4.3-4.9 pmol/L
same as normal range
Albumin/Globulin Ratio
Thyroid Panel
T4, total
T4, free
T3, total
T3, free
T3, uptake
T3, reverse
same as normal range
Hormone Panel (Male)
Test Name
Estradiol (E2)
LH
Testosterone
Free
Testosterone
DHT
DHEA-S
Cortisol
Normal Reference Range
Optimal Range
10-50 pg/mL or 36.7-183.6
pmol/L
1-10 mIU/mL or 1-10 IU/L
300-1200 ng/dL or 10.4-41.6
nmol/L
4.7-26.5 pg/mL or 16-92
pmol/L
less than 40 pg/mL or 147
pmol/L
same as normal range
650-1200 ng/dL or 20.841.6 nmol/L
10-25 pg/mL or 34.7-86.6
pmol/L
55-85 ng/dL or 1.9-2.9
nmol/L
30-85 ng/dL or 1-2.9 nmol/L
age 20-29: 280-640 μg/dL or
7.6-17.3 μmol/L, then drops
steadily
above age 65: 28-175 μg/dL
or 0.76-4.7 μmol/L
6-23 μg/dL or 165.6-634.8
© Dr. Karen Vieira 2011
500-640 μg/dL or 13.517.3 μmol/L at age 20-29
5-10 μg/dL or 138-276
Page 20
PSA
nmol/L
nmol/L
Age below 50: 0-2.5 ng/mL
or 0-2.5μg/L, increasing to
ng/mL or 0-6.5 μg/Lfor men
over 50
Within relevant range
Hormone Panel (Female)
Test Name
Estradiol (E2)
Normal Reference Range
premenopause: 30-400 pg/mL
or 110-1486 pmol/L
postmenopause: 0-30 pg/mL or
0-110 pmol/L
HRT: 50-100 pg/mL or 184-367
pmol/L
Optimal Range
within relevant range
Progesterone
premenopause: 0.1-20 ng/mL
depending on menstrual phase
postmenopause: <1 ng/mL
women under 50:
within relevant range
women over 50:
1.5-4.5 ng/mL
LH
premenopause: 1-20 mIU/mL or 120 IU/L
postmenopause: 15-60 mIU/mL or
15-60 IU/L
within relevant range
FSH
premenopause: 4.7-21.5 mIU/mL
or 4.7-21.5 IU/L
postmenopause: 25.8-134.8
mIU/mL or 25.8-134.8 IU/L
Testosterone
30-95 ng/dL or 1.0-3.3 nmol/L
DHEA-S
Age 20–29: 65-380 g/dL or 1.810.3
,
then drops steadily with age
above age 65: 17-90 μg/dL or
0.45-2.4
250-380 μg/dL or 6.810.3 μmol/L
Cortisol
6-23 μg/dL or 165.6-634.8 nmol/L
5-10 μg/dL or 138-276
nmol/L
Test Name
Normal Reference Range
Optimal Range
Glucose
<100 mg/dL or <5.55 mmol/L
75-85 mg/dL or 4.15-
women under 50:
within relevant range
women over 50:
25-100 mIU/mL or 25100 IU/L
35-65 ng/dL or 1.2-2.3
nmol/L
Glucose Panel
© Dr. Karen Vieira 2011
Page 21
4.7 mmol/L
Hemoglobin A1c
6% or 0.06 or less
Insulin
0.0-25 μIU/mL or 0-173.6 pmol/L
4.8-5.1% or 0.0480.51
2.0-10.0 μIU/mL or
13.9-69.5 pmol/L
Nutrient Panel
Test Name
Folic acid (Folate)
Iron
Vitamin A
Vitamin B12
Vitamin C
Vitamin D, 25-Hydroxy
Calcium
Zinc
Normal Reference Range
2.7-17ng/mL or 6.1-38.5
nmol/L
60-170 μg/dL or 10.7-30.4
μmol/L
30-65 μg/dL or 1-2.3
μmol/L
130-950 ng/L, 130-950
pg/ml or 95.9-701 pmol/L
0.4-1.5 mg/dL or 22.7-85.1
μmol/L
14-80 ng/mL or 34.9-199.7
nmol/L
8.5-10.2 mg/dL or 2.1-2.55
mmol/L
75-120 μg/dL or 11.5-18.4
μmol/L
Optimal Range
>3 ng/mL or >6.8 nmol/L
55-125 μg/dL or 9.8-22.4
μmol/L
same as normal range
>600 ng/L, >600 pg/ml or
>442.8 pmol/L
>1 mg/dL or >56.8
μmol/L
>70 ng/mL or >174.7
nmol/L
9-10.2 mg/dL or 2.252.55 mmol/L
same as normal range
Other Tests
Test Name
Normal Reference Range
Optimal Range
Prothrombin (PTT)
25-41 sec
same as normal range
Amylase
23-140 IU/L
same as normal range
Creatine Kinase (CK)
Lactate Dehydrogenase
(LDH)
40-150 U/L
same as normal range
105-333 IU/L
same as normal range
4-8 mg/dL or 238-476
μmol/L
same as normal range
Uric Acid
There may be some tests you were looking for that are not outlined here. This
list is a comprehensive view of the more common tests, but not of every possible
test. If you want to see information on a test not included, feel free to ask. Also,
to get more information about additional tests, see the bonus report called The
Other Tests.
© Dr. Karen Vieira 2011
Page 22
Potential Causes of Abnormal Results
When you receive the results of the blood test panels, you may be happy to
find that for the most part, your results fall within the optimal or normal range.
However, you may also find that one or more tests fall outside the optimal range,
and are either higher or lower than normal.
It is important to remember these tests are only a snapshot of your
metabolism at the time the test was taken, and do not necessarily mean that
something is seriously wrong with your health. For example, a high glucose result
could mean that you have diabetes, but could also mean that you ate something
just before the test! There are a wide variety of possible reasons for “abnormal”
results.
The following descriptions aim to give you an idea of what a high or low
reading could indicate. A better picture of your overall health can be gained by
looking at the overall pattern of panel results. It is also important to remember
that further testing is usually needed to either confirm or rule out that you have a
particular medical condition.
Complete Blood Panel
Many of the following results are usually interpreted together with other
results of the blood panel. For example, red blood cell, hematocrit and
hemoglobin counts are usually compared with each other, and can give a better
idea of, for example, the type of anemia someone is suffering from.
Red Blood Cell (RBC) – a high red blood cell count, or polycythemia, could
indicate a variety of conditions, including dehydration, lack of oxygen in your
tissues, lung disease (such as pulmonary fibrosis), congenital heart disease or a
bone marrow disorder.
On the other hand, a low RBC count, indicating anemia, can be the result of
blood loss that is acute (trauma, burns, pregnancy, or infection), or chronic
(anemia, internal bleeding such as from ulcers, iron/vitamin B12/B6/folate
deficiency, bone marrow cancer or chronic inflammation). Anemia can also result
from:




Poor nutrition
Excess or chronic alcohol consumption
Pregnancy (excessive water weight gain can dilute the blood causing
low levels of red blood cells and hemoglobin)
Kidney disease (your kidneys release a hormone that helps bone
marrow produce red blood cells. When the kidneys are not functioning
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Page 23

properly, these hormone levels and therefore red blood cell production
drop)
Some medications, e.g., chemotherapy drugs, interfere with red blood
cell production
Hemoglobin (Hgb) – As with the RBC count, a low hemoglobin count can
indicate anemia, whereas a high hemoglobin count can indicate polycythemia
due to dehydration, hypoxia, lung, heart, or bone marrow disease. Hgb can be
used to get an idea of how severe the condition is.
Hematocrit (Hct) – Hct measures the ratio of RBCs to blood volume,
therefore a low or high Hct percentage usually indicates the same conditions as
low or high RBC and hemoglobin counts. Low Hct may indicate anemia, and a
high Hct can be seen if you live at a high altitude, or are a chronic smoker.
Mean Corpuscular Volume (MCV) – This measurement can be used to shed
light on the cause of an abnormal RBC count. A high MCV value indicates that
your red blood cells are enlarged (macrocytic) and you may have anemia caused
by a vitamin B12 and/or folic acid deficiency. A low MCV value indicates that your
red blood cells are smaller in size than average (microcytic), which may be due
to iron deficiency anemia.
Mean Corpuscular Hemoglobin (MCH) – This value, like MCV, can also be
used to shed light on the cause of an abnormal RBC count. A high MCH value
indicates that your red blood cells have a high amount of hemoglobin (and are
therefore also likely to be larger than normal), whereas a low MCH value
indicates that your red blood cells carry a lower amount of hemoglobin than
average.
Mean Corpuscular Hemoglobin Concentration (MCHC) – Similar to the
MCH, which indicates the amount of hemoglobin per red blood cell, the MCHC
indicates the amount of hemoglobin in red blood cells but also takes into account
the size of the cells (Hct value). Like MCV and MCH, high MCHC may be related
to vitamin B12/folic acid deficiency, and low MCHC may reflect anemia caused
by iron deficiency.
Red Cell Distribution Width (RDW) – Like with MCV and MCH, RDW also
gives an indication of the physical state of your red blood cells. In this case,
variation in size is what is measured, and so a low RDW is a good sign, whereas
an increased RDW indicates that your red blood cells vary quite a bit in size and
shape – a possible indication of pernicious anemia.
Platelets – As platelets help the blood clot, the number of platelets per mL of
blood can be affected by a number of different diseases. Therefore, this measure
is often used to monitor or diagnose conditions. If platelet number is below
normal (thrombocytopenia) the following conditions may be present:
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










Disseminated intravascular coagulation – a bleeding disorder that can
be caused by infection, cancer, pregnancy complications, sepsis or a
reaction to a blood transfusion
Hemolytic anemia – a condition in which red blood cells are
prematurely destroyed due to infection, medication side effects or
abnormal immune responses
Hypersplenism – a disorder where the spleen destroys healthy red
blood cells
Thrombocytopenic purpura – the appearance of reddish/purple marks
on the skin associated with the body’s destruction of platelets; it can be
caused by a rare blood coagulation disorder (thrombotic), or when the
body produces antibodies that destroy platelets, usually due to longterm infection, with no clear trigger (idiopathic) or in response to a
blood transfusion.
Leukemia
Systemic viral or bacterial infection
Liver failure
Systemic lupus erythematosus
Dengue fever
HIV-associated thrombocytopenia
Medication-induced thrombocytopenia – chemotherapy drugs, heparin,
valium, digoxin, and antibody-binding drugs are common
thrombocytopenia-inducing drugs.
Increased platelet levels (thrombocytosis) can be observed without any
underlying medical condition. Thrombocytosis can also be an indicator of
anemia, some types of cancer, or occur in response to inflammation such as
infection, rheumatoid arthritis, and inflammatory bowel disease.
White Cell Distribution (WBC) – A WBC count at the upper end of the
normal range means that your immune system is producing enough white blood
cells to fight infection. However, if the levels are too high (leukocytosis) this could
mean that you have a bacterial, viral, fungal or parasitic infection, or tissue
inflammation such as rheumatoid arthritis. A high WBC count can also be caused
by leukemia or a chronic condition, such as fatigue or stress. On the other hand,
if WBC levels are too low (leucopenia), this could indicate an immune deficiency,
including HIV infection, or a liver or spleen disorder. The cause of an abnormal
WBC count can be determined by measuring the different types of WBCs in your
body (neutrophils, lymphocytes, etc.)
Neutrophils – A higher proportion of neutrophils in your blood (neutrophilia)
is commonly due to an acute bacterial infection. Fewer neutrophils in your blood
than usual (neutropenia) may indicate a viral infection, or that you are recovering
from a bout of radiotherapy or chemotherapy.
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Lymphocytes – A high lymphocyte count (lymphocytosis) could be an
indicator of acute infections such as measles, mumps or mononucleosis and
some forms of leukemia. A low lymphocyte count (lymphocytopenia) can be due
to chemotherapy or treatment with immune-suppressing drugs like
corticosteroids, recent infection, particularly HIV infection, and some other forms
of cancer. In the event of an abnormal lymphocyte count, additional tests can
count each subtype of lymphocytes to determine the cause.
Monocytes – A high number of monocytes in your blood (monocytosis) may
indicate chronic inflammation, immune disorders or infection. Low levels
(monocytopenia) are found after glucocorticoid treatment, or could indicate an
acute infection, stress, or certain types of leukemia.
Eosinophils – High eosinophil levels commonly indicate the presence of
allergies, but could also be an indicator of a parasitic infection (worms) or
eczema, asthma or an autoimmune disease. It is important to note that an
eosinophil reading in the normal range does not necessarily mean that you don’t
have any allergies; it just means that if you do have allergies, they are more likely
to be food-related or related to a specific allergen. A low eosinophil count may
indicate alcohol intoxication or excess cortisol production in your body.
Basophils – High and low levels of basophils (basophilia and basopenia) are
fairly rare. Basopenia is difficult to identify because the normal basophil range is
so low, but is related to the appearance of hives. Basophilia is found in some
types of leukemia.
Immature Granulocytes – Immature granulocyte count (granulocytopenia)
indicates how your body produces neutrophils, eosinophils and basophils, which
give you resistance to infection. Normally absent in peripheral blood, the
presence of immature granulocytes may be an indicator of a genetic disorder,
bone marrow damage, or leukemia. A higher than normal number of immature
granulocytes in the blood could be the result of infection or due to taking some
medications.
Liver Panel
Total Bilirubin –Too much total bilirubin (a product of hemoglobin breakdown) may indicate various forms of anemia (hemolytic, sickle cell, and
pernicious), transfusion reaction, and liver pathology. Many drugs including
chemotherapy and hormones can also cause increases in bilirubin. Extremely
high levels can cause jaundice (yellowing of the skin). Low levels of bilirubin are
not considered a problem.
Direct bilirubin – Direct bilirubin is a good indicator of blockage in the liver’s
bile ducts, which are necessary for transporting waste to the intestines. In
© Dr. Karen Vieira 2011
Page 26
addition to bile duct blockage, elevated direct bilirubin may indicate underlying
causes of hepatitis, cirrhosis, and other pathological changes including those
from alcoholism.
Alkaline phosphatase – Abnormally high blood levels of alkaline
phosphatase may indicate bone fractures, liver disease including hepatitis and
cirrhosis, bile duct obstruction, gall bladder inflammation, or certain cancers,
particularly of the bone and liver. The enzyme is often elevated in individuals with
chronic myelogenous leukemia. Levels are also normally increased during
pregnancy. Abnormally low levels of alkaline phosphatase can be caused by
malnutrition or the genetic condition hypophosphatasia, which causes bone
deformities.
Aspartate aminotransferase (AST) – Any disease or injury that affects liver
cells tends to cause AST levels to increase. Therefore, elevated AST may
indicate liver disease as well as damage to other organs, including kidney failure,
heart attack, or trauma, or taking any medications that have toxic effects on the
liver.
Alanine aminotransferase (ALT) – A high level of ALT in the blood is a more
specific indicator of liver problems than AST, and may indicate drug or alcohol
damage (anything toxic to the liver), decreased blood flow to the liver, blockage
of bile ducts, hepatitis, or cancer. A higher than normal AST:ALT ratio can be
used to distinguish alcohol-related hepatitis and cirrhosis from viral hepatitis.
Gamma glutamyltransferase (GGT) – A high level of GGT indicates liver
disease, hepatitis, bile obstruction, alcoholism, inflammation of the pancreas,
prostate cancer or occur in patients taking certain medications, such as
phenytoin or phenobarbital. It is not possible to have levels that are too low.
Heart Panel
Total cholesterol (TC) – As you may already know, low levels (ideally under
200 mg/dL) of total cholesterol in your blood are considered by some doctors to
be beneficial, and that you are less likely than someone with high TC to have
coronary heart disease. By that scale, between 200 and 239 mg/dL, you are at
borderline risk, and above 240, you are at high risk of developing heart disease.
Total cholesterol/High-density lipoprotein ratio (TC/HDL) – TC is also
measured as a ratio with HDL (see below). A high TC/HDL ratio means that your
total cholesterol is balanced by good cholesterol, so a high TC alone does not
necessarily tell the whole story.
Triglycerides (TG) – Elevated triglycerides (fat) can be due to being
overweight or obese, sedentary, smoking cigarettes, drinking alcohol, and having
© Dr. Karen Vieira 2011
Page 27
a diet that is very high in carbohydrates (carbs are 60 percent of total calories or
more). A high TG level is often seen together with a high TC count. Below 150
mg/dL is ideal, a borderline case lies between 150 and 199 mg/dL, and a count
above 200 mg/dL usually indicates that you should change your diet and lifestyle
to reduce your risk for type 2 diabetes and heart disease. Extremely high TG
counts may indicate underlying metabolic syndrome, which if left untreated may
give rise to type 2 diabetes and heart disease.
Triglycerides/High-density lipoprotein ratio (TG/HDL) – A high TG/HDL
ratio may indicate high levels of insulin, and be a marker for insulin resistance (a
sign of diabetes). If your ratio is less than 2, you are healthier than if your ratio is
greater than 4. The higher your TG/HGL ratio, the more likely you are to have a
heart attack.
Low-density lipoprotein (LDL) – Most doctors believe that the lower your
LDL count is (ideally below 100 mg/dL), the lower your risk of heart disease
(heart attacks and stroke). A borderline (130 to 159 mg/dL) to high (above 160
mg/dL) LDL count is a sign that you may need to improve diet and lifestyle
factors to improve your overall health.
High-density lipoprotein (HDL) – A high level (over 60 mg/dL) of this “good”
cholesterol means that you are healthier than if you have a low HDL level (under
40 mg/dL). A lower-than-normal HDL count means that you are at a higher risk of
heart disease. A low HDL count can also be due to steroid intake and hormonal
fluctuations.
Low-density lipoprotein/High-density lipoprotein ratio (LDL/HDL) – A
high LDL/HDL ratio is to be avoided typically. Ideally, this ratio should be kept
above 0.4 in order to reduce your chances of developing heart disease.
Sedimentation rate – A high RBC sedimentation rate (also known as ESR)
indicates the presence of inflammation, which may be caused by infection, an
autoimmune disorder, thyroid disease or cancer. However, if no other indication
of sickness is present, a high sedimentation rate on its own is not necessarily a
sign of pathology. A very low sedimentation rate may be seen in several
disorders, including congestive heart failure and some red blood cell disorders.
C-reactive protein (CRP) – Elevated CRP levels (above 3.0 mg/L) may
indicate whole-body acute inflammation (such as from an infection or following
surgery) or cancer, and can accurately predict the development of heart disease.
CRP is also elevated during pregnancy or hormone replacement therapy. Ideally,
your CRP level should be under 1 mg/L.
Homocysteine – This test is usually performed to determine overall health,
and to help identify vitamin B12/folic acid deficiency or an inherited condition
known as homocystinuria. High levels of homocysteine (above 2.3 mg/L) may
© Dr. Karen Vieira 2011
Page 28
indicate aging via free-radical oxidation, higher risk of stroke, vitamin deficiency,
artery disease, kidney disease, high alcohol intake or cancer. Low levels (below
1 mg/L) may indicate that you are taking vitamins, and are indicative of good
overall health.
Kidney Panel
Estimated glomerular filtration rate (eGFR) – Typically healthy or strong
kidneys have an eGFR level greater than 60. An eGFR 59 or lower may be an
indication of weakened kidneys, which may or may not be due to diseases such
as diabetes and hypertension. A low eGFR level can also be a sign of kidney
disease or decreased kidney functioning that may occur with age. eGFR levels
can also be affected by certain medications, such as gentamicin and cisplatin.
Blood urea nitrogen (BUN) – The BUN test is used to determine whether a
patient has kidney dysfunction, disease or failure. An increased BUN value may
indicate kidney problems, or a range of other problems such as heart attack,
shock, stress, reduced blood or urine flow, or dehydration. Many drugs can also
increase BUN levels. Conversely, high BUN levels may indicate overhydration or
liver disease, but are not usually a problem.
Creatinine – This test also monitors kidney function, with a higher level
indicating kidney damage, infection, urinary tract obstruction, or diseases that
cause reduced blood flow to the kidneys (see BUN above). As with BUN, very
low creatinine levels are rare, and are not usually problematic.
BUN/Creatinine ratio – This ratio is a good indication of dehydration, kidney
damage and gastrointestinal bleeding in cases where the ratio is high. However,
a high ratio can also be seen in individuals with a diet high in protein, and in
individuals with muscle wasting, such as older individuals or patients undergoing
chemotherapy. A low ratio can be seen in people with a low-protein diet,
cirrhoses of the liver, or severe muscle injury.
Electrolytes (sodium, potassium, chloride, magnesium) – High levels of
these dissolved salts in your blood can be an indication of a diet high in these
electrolytes, dehydration (e.g., due to heavy sweating, diarrhea or vomiting),
decreased urine output, or certain diseases such as kidney disease (high sodium
or potassium). Low levels of electrolytes may be due to overhydration (too much
water in your system), burn damage, hormone regulation disorders
(hypoparathyroidism, hypoaldosteronism), or diseases of the liver, heart or
kidney. The specific pattern of abnormalities will help to refine a diagnosis. Many
factors such as recent trauma or surgery, consumption of fluid or salt, and
medications including diuretics can also affect electrolyte levels. Types of muscle
and nerve disease are also associated with electrolyte abnormalities.
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Bicarbonate (CO2 content) – Blood CO2 levels reflect kidney and lung
function. Low levels are seen in diarrhea, kidney disease, and acidosis
(ketoacidosis, lactic acidosis, metabolic acidosis), in which the body fluids
contain abnormally high levels of acid.
Total protein – The total serum protein test includes separate values for total
protein, albumin, and globulin, and the albumin/globulin ratio. The total protein
measure is indicative of overall health, and the state of your liver and kidneys.
High levels of total protein suggest chronic inflammation or bone marrow
disorders. Low levels may indicate a liver or kidney disorder, malnutrition, or
gastrointestinal problems that affect nutrient absorption.
Albumin – High albumin levels may be due to severe dehydration. Albumin
levels tend to decline with age and also with a number of health conditions (such
as Crohn’s disease, liver cirrhosis, hepatitis, and Hodgkin’s lymphoma) and
diseases of the kidneys and the liver. Low albumin levels may also be indicative
of a poor diet or diabetes.
Globulin – High globulin levels may be caused by anemia, lymphoma,
leukemia or other cancers, autoimmune diseases (such as arthritis and lupus),
tuberculosis, and kidney or liver disease. Low globulin levels are not usually a
problem but may sometimes be due to liver cirrhosis or kidney disease.
Albumin/Globulin ratio – If everything is functioning normally, there is
usually slightly more albumin than globulin in the blood, or an A/G ratio greater
than 1. A ratio that is less than 1 can indicate globulin overproduction (possibly
due to myeloma or autoimmune diseases) or albumin underproduction (such as
that caused by cirrhosis or in kidney disease). A ratio that is significantly higher
than 2 may rarely indicate globulin underproduction (as seem in some genetic
disorders and forms of leukemia), but is not usually a cause for concern.
Thyroid Panel
Thyroid stimulating hormone (TSH) – The TSH measure is usually used to
determine thyroid function and screen for either hyperthyroidism (low levels of
TSH) or hypothyroidism (high levels of TSH). Hyperthyroidism is an overactive
thyroid, producing large amounts of thyroid hormone. This may be indicative of
Hashimoto’s disease, Grave’s disease, or goiter. Hypothyroidism is the
production of too little thyroid hormone, which leads to a slowing of body
functions, and may be the result of extended illness or malnutrition. Medications
that can affect TSH include dopamine, lithium, and glucocorticoids such as
prednisone.
Triiodothyronine (T3) and Thyroxine (T4) – The combination of the serum
T4 and T3 uptake is an indirect assessment of thyroid binding hormone. This test
© Dr. Karen Vieira 2011
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helps determine whether an abnormal value is due to T4 binding to globulin
molecules or to changes in thyroid hormone levels. High levels of T3 and T4
indicate hyperthyroidism, whereas low levels of T3 and T4 indicate
hypothyroidism.
T4, total vs. free – Total T4 is an older test, and the new free T4 test may
indicate the same presence or absence of hyperthyroidism, but more accurately.
In general, a high total/free T4 value may indicate an overactive thyroid gland
(hyperthyroidism), and a low total/free T4 value may indicate an underactive
thyroid gland (hypothyroidism).
T3, total vs. free – As for T4, total T3 is an older test, and the new free T3
test may indicate the same presence or absence of hyperthyroidism, but more
accurately. Greater than normal levels of T3 can be an indicator of liver disease,
pregnancy, hyperthyroidism, thyroid cancer or may just be due to the use of birth
control pills or estrogen. Lower levels may indicate hypothyroidism or may be
due to starvation.
T3, uptake – A low T3 uptake indicates increased production of the protein
TGB (or thyroxine-binding globulin) as a result of estrogen intake, pregnancy, or
hepatitis), whereas a higher-than-normal T3 uptake may indicate a decrease in
TGB (as a result of chronic liver disease or loss of protein).
T3, reverse (RT3) – In response to stress, excess T4 is converted by your
body into inactive RT3. High RT3 levels may therefore indicate a response to
surgery, acute or chronic illness (such as pneumonia) or trauma. High RT3 may
also indicate that you have Wilson’s Syndrome. A low RT3 reading may be due
to hyperparathyroidism.
Hormone Panel
Estradiol (E2) – Abnormally high levels of estradiol in women may be caused
by pregnancy, menstruation, estrogen replacement therapies, and ovarian
cancer. Low levels may be the result of menopause, ovarian failure, or low
estrogen production caused by excessive exercise, low body fat, or anorexia.
In older men (after 55), estradiol levels are slightly higher than in women of
the same age, so estradiol levels should be interpreted together with patient age.
In younger men, however, estradiol levels are generally lower. If levels are found
to be high, it may be a result of alcohol or drug consumption, some prescription
medications, or glandular cancers. Low levels of estradiol in men are not
considered a problem.
Progesterone – Because progesterone is produced naturally during the
monthly cycle and during pregnancy, a high reading for this test in a woman does
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not necessarily mean a disorder or illness. Very high levels of progesterone are
also produced in the luteal phase every month, and by the placenta during
pregnancy. High progesterone levels can also be caused by certain types of
adrenal and ovarian cancer, but are usually caused by over-supplementation.
Low progesterone may indicate low thyroid hormone levels or complications in
pregnancy.
Luteinizing hormone (LH) – Increased levels of LH are usually found in
patients with primary ovarian failure. High LH can also be caused by
chromosomal abnormalities, radiation, chemotherapy, autoimmune disease,
polycystic ovary syndrome, adrenal or thyroid disease. LH levels should be
interpreted carefully, as LH levels fluctuate during puberty and menopause.
Some drugs can cause LH to increase (such as anticonvulsants), while others
cause LH to decrease (e.g., digoxin, oral contraceptives, and hormonal
treatments). Low levels of LH in women are usually associated with secondary
ovarian failure, and may be caused by pituitary or hypothalamus malfunction.
In men, high LH levels may indicate primary testicular failure, which can be
due to developmental defects in testicular growth (such as chromosomal
abnormalities) or to testicular injury (due to viral infection, trauma, radiation,
chemotherapy, or autoimmune disease).
Follicle stimulating hormone (FSH) – Increased levels of FSH is seen in
primary ovarian failure and also during puberty and menopause. Elevated FSH
may also be due to chromosomal abnormalities, or the effects of radiation,
chemotherapy, autoimmune disease, polycystic ovary syndrome (PCOS),
adrenal or thyroid disease. Low levels of FSH in women are usually associated
with secondary ovarian failure, and may be caused by pituitary or hypothalamus
malfunction.
Testosterone – High testosterone levels in women are associated with
polycystic ovarian syndrome (PCOS) and insulin resistance. An abnormally high
level of testosterone in women may indicate cancer or PCOS.
In males, this test is usually carried out to determine the reason for delayed
puberty. An abnormally high level of testosterone in males may indicate cancer,
hyperthyroidism, or premature puberty. In males, levels of this hormone drop
naturally with age. However, in some cases, decreased levels of testosterone are
due to a disorder of the pituitary or hypothalamus, some genetic disorders,
physical injury to the testes, or alcoholism. Free testosterone is the testosterone
circulating in the blood that is not bound to any other molecules, and is therefore
considered the most able to have active effects. A newer test, free testosterone
may be a more accurate reflection of abnormalities.
DHEA-Sulfate (DHEA-S) – Low DHEA-S is often associated with chronic
illness, and is used to measure adrenal function. High DHEA-S levels are
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associated with PCOS and insulin resistance, and may indicate cancer of the
adrenal glands or adrenal hyperplasia (growth), or that you are taking DHEA
supplements. A low DHEA-S value may indicate adrenal disease or
hypopituitarism. A drop in this hormone is normal with aging.
Cortisol – Cortisol levels fluctuate normally during the day, so measurements
must be interpreted with care. Abnormally high cortisol levels (that do not drop
later in the day) are associated with overproduction of cortisol, possibly as a
result of diet, cancer, adrenal gland malfunction (e.g., Cushing’s Syndrome),
stress or some medications. Low cortisol production in the morning may be
indicative of adrenal damage or Addison’s disease.
Male (see also, hormones above)
Dihydrotestosterone (DHT) – High DHT levels indicate high levels of
circulating testosterone, and low DHT values indicate the opposite. DHT levels
may increase naturally with aging in men.
Prostate specific antigen (PSA) – The PSA test is usually used to monitor
changes in the prostate and the effectiveness of prostate cancer treatment. A
high total PSA level relative to your age may indicate prostate cancer, especially
if levels continue to rise (in about ¼ of cases). Lower PSA levels indicate that
treatment is working, and levels should ideally be very low for total remission.
Other conditions may also be accompanied by higher PSA levels, including
infection, other prostate problems, and some drugs.
Glucose Panel
Glucose – The fasting glucose test is usually used to determine whether you
have hyperglycemia (high glucose levels) or hypoglycemia (low glucose levels).
High glucose can indicate diabetes, stress, kidney failure, Cushing syndrome,
pancreatitis and pancreatic cancer. Moderately high glucose may reflect
“prediabetes”. Low glucose levels can indicate adrenal disease, liver disease,
thyroid and pituitary disorders, and abuse of alcohol/drugs. It is important to know
that circulating levels of glucose are also affected by many day-to-day activities,
such as eating and exercising, and should therefore be interpreted with care.
Hemoglobin A1c – This test reflects more long-term abnormalities in blood
glucose. It is usually used to monitor the treatment of diabetes. The closer a
diabetic patient is to the optimal level, the better, with an increase in A1c leading
to symptoms of hyperglycemia, and a decrease of A1c leading to hypoglycemia
symptoms. It should not be used to diagnose pre-diabetes or diabetes though, as
conditions like anemia can affect levels drastically. A1c can also predict risk for
heart attack, with the lowest end of the optimal range having the lowest heart
attack risk.
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Insulin – This test can be used to diagnose the cause of hypoglycemia. High
levels of insulin may indicate insulin resistance, obesity, steroid drug ingestion,
insulinoma (an insulin-producing pancreatic tumor) or Cushing’s Syndrome. Low
levels of insulin are usually an indication of diabetes, hypopituitarism and
diseases of the pancreas.
Nutrient Panel
Folic acid (folate) – Folic acid is usually tested to determine the cause of
macrocytic anemia. Low folate levels indicate some degree of deficiency due to
anemia or dietary deficiency. A variety of drugs can decrease folate levels, such
as oral contraceptives, estrogens, alcohol and some antibiotics. Evidence
suggests that folic acid reduces the risk of heart disease, stroke and some
mental disorders. Folate is also critical for normal fetal development during
pregnancy. High levels of folate are not usually problematic and may just indicate
a vegetarian diet, but can be found together with conditions such as leukemia or
liver disease.
Iron – Low levels of iron (iron deficiency) can be mild or severe, and may be
due to inadequate diet, menstruation or breast-feeding, or more serious problems
such as chronic bleeding, infections, cancers and autoimmune disorders. High
levels of iron in the blood may indicate liver disease (due to alcoholism) or iron
poisoning, possibly from iron supplements.
Vitamin B12 – B12 can be used to help diagnose the cause of macrocytic
anemia. B12 is also important for many aspects of good health including
neurological and gastrointestinal functions. As with folic acid, drugs that can
decrease B12 include oral contraceptives, estrogens, alcohol, and antibiotics.
High levels of B12 are not usually problematic, but increased B12 can be seen in
patients with pernicious anemia and liver dysfunction.
Vitamin C – High levels of vitamin C (ascorbic acid) can interfere with the
levels of other substances tested for, such as LDL and glucose. In general,
though, high vitamin C is not cause for concern. Low vitamin C levels can
indicate malnutrition and particularly scurvy.
Vitamin D3, 25-hydroxy – Low blood levels of 25-hydroxyvitamin D may be a
result of insufficient exposure to sunlight or insufficient dietary vitamin D. It can
also be an indication of inadequate intestinal absorption. Some evidence
suggests that vitamin D is also important for the prevention of osteoporosis and
some types of cancer. Some drugs (e.g. phenytoin) can also reduce levels. High
levels of D3 usually reflect excess supplementation (for example, from vitamin
pills or other nutritional supplements).
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Calcium – This test can be used to measure the health of your metabolism.
Higher than normal levels of calcium in your blood may indicate
hyperparathyroidism, possibly due to a tumor, hyperthyroidism, metastatic bone
cancer or tuberculosis. Because much of the body’s calcium is bound to proteins,
a lower-than-normal calcium value may indicate low levels of protein in the blood,
as well as hypoparathyroidism, lack of calcium in your diet, malnutrition, and
kidney or pancreatic disease.
Zinc – Zinc deficiency may reflect poor nutrition. Vegetarians and people with
gastrointestinal problems may have weaker zinc absorption, and therefore need
to eat more foods rich in zinc to maintain optimal levels. Elevated zinc levels can
cause symptoms of toxicity (headaches, nausea, cramps) and are often caused
by over-supplementation.
Additional Tests
Partial prothrombin time (PTT) – This test indicates the amount of time
required for blood to clot. Abnormally long clotting times are seen in problems
such as hemophilia, vitamin K deficiency and liver cirrhosis.
Amylase – Amylase is an enzyme that breaks down carbohydrates.
Abnormal amylase levels in the blood indicate damage or disease in the
pancreas. Amylase is increased in pancreatitis, pancreas or bile duct obstruction,
gall bladder inflammation, obstruction of the intestines and some types of cancer.
Other forms of pancreatic cancer, pancreas damage and kidney disease can
cause decreased amylase levels.
Creatine kinase (CK) – This is also called creatine phosphokinase or CPK.
Elevation of this enzyme reflects damage to muscle tissue and is most commonly
used to diagnose heart attack and stroke. It is also increased in muscular
dystrophy.
Lactate dehydrogenase (LDH) – Like CK, LDH is elevated in cases of
muscle injury, including heart attack, vascular injury such as stroke, and
muscular dystrophy. LDH is also increased by liver disease, types of cancer and
lack of oxygen (ischemia).
Uric acid – Uric acid in the blood is used to diagnose gout, a form of arthritis.
Some cancers, kidney disease, diabetes and medications (including
chemotherapy) can also cause elevated blood uric acid. Low uric acid is usually
not cause for concern, and is observed more frequently in vegetarians.
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What’s Next?
Now you have an understanding of what your blood test results really show.
You may have one or more tests where your results were outside of the normal
or optimal ranges. Hopefully, your doctor sat with you and figured out a
personalized plan for you to get any of your abnormal or non-optimal tests into
the normal or optimal range.
If your doctor didn’t do this, you may still be feeling confused about your blood
test results right now. Since the goal of this is to have you really understand your
blood test results, the next step if you are still feeling confused is for you to see
what can be done about each of your abnormal or non-optimal blood test results.
At this point, go ahead and open up the bonus document on Abnormal Results
that came with this e-book.
Go through that document and figure out a plan for getting your blood test
levels all within the normal or optimal ranges. Talk to your doctor about it and get
his/her approval before getting started. Then stick to your plan in order to
improve your health and live your life to the fullest!
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