Lab Results

c CBC; Hemogram; CBC with differential

Complete Blood Count
Blood smear; Hemoglobin; Hematocrit; Red blood cell (RBC) count; White
blood cell (WBC) count; White blood cell differential count; Platelet count
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he hemoglobin test is an integral part of your health evaluation.

he test is used to:
J measure the severity of anemia or polycythemia,

J monitor the response to treatment of anemia or polycythemia, and
J help make decisions about blood transfusions if the anemia is severe.
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he hemoglobin test is normally ordered as a part of the complete blood count (CBC) , which is
ordered for many different reasons, including for a general health screen.
he test is also
repeated in patients who have ongoing bleeding problems or chronic anemias or polycythemia.
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Normal values in an adult are 12 to 18 grams per deciliter (100 milliliters) of blood. Above-
normal hemoglobin levels may be the result of:
J dehydration,
J excess production of red blood cells in the bone marrow,
J severe lung disease, or
J several other conditions.
Below-normal hemoglobin levels may lead to anemia that can be the result of:
J iron deficiency or other deficiencies, such as B12 and folate,

J inherited hemoglobin defects, such as sickle cell anemia or thalassemias,
J other inherited conditions, such as enzyme defects,
J cirrhosis of the liver,
J excessive bleeding,
J excessive destruction of red blood cells,
J kidney disease,
J other chronic illnesses,
J bone marrow failure or aplastic anemia, or
J cancers that affect the bone marrow.

Hemoglobin decreases slightly during normal pregnancy.
Hemoglobin levels peak around 8 a.m. and are lowest around 8 p.m. each day.
Heavy smokers have higher hemoglobin levels than nonsmokers.
Living in high altitudes increases hemoglobin values due to an increase in the number of red
blood cells. Your body produces more red blood cells in response to the decreased oxygen
available at these heights.
Hemoglobin levels are slightly lower in older men and women and in children.
Hematocrit
÷
his test is used to evaluate:
J anemia,
J polycythemia,
J response to treatment of anemia or polycythemias,
J dehydration,
J blood transfusion decisions for severe symptomatic anemias, and
J the effectiveness of those transfusions.
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èecreased hematocrit indicates anemia, such as that caused by iron deficiency or other
deficiencies. Further testing may be necessary to determine the exact cause of the anemia.
Other conditions that can result in a low hematocrit include vitamin or mineral deficiencies,
recent bleeding, cirrhosis of the liver, and malignancies.
he most common cause of increased hematocrit is dehydration, and with adequate fluid intake,
the hematocrit returns to normal. However, it may reflect a condition called R
D
that is, when a person has more than the normal number of red blood cells.
his can be due to a
problem with the bone marrow or, more commonly, as compensation for inadequate lung
function (the bone marrow manufactures more red blood cells in order to carry enough oxygen
throughout your body). Anytime a hematocrit is persistently high, the cause should be
determined in consultation with a doctor.
With regard to transfusions, this is normally not considered for otherwise healthy persons as long
as the hemoglobin level is above 8 grams per deciliter or the hematocrit is above 24%.

Pregnancy usually causes slightly decreased hematocrit values due to extra fluid in the blood.
Living at high altitudes causes increased hematocrit valuesDthis is your body¶s response to the
decreased oxygen available at these heights.

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A decreased number of RBCs results from either acute or chronic blood loss. Acute blood loss is
a rapid depletion of blood volume. Chronic blood loss stems from various conditions that often
results in some form of an anemia. Chronic anemias are due to loss of small amounts of blood
over a long period of time (bleeding), mechanical destruction of the RBCs, or some physiologic
problem such as decreased RBC production. Increased number of RBCs can result from a
number of conditions that include dehydration, congenital heart disease, pulmonary diseases, and
situations involving tissue hypoxia.
he list below includes some of these conditions.
è

J
rauma
J Burns
J Pregnancy
J Hemolytic anemia
J Hemorrhagic infections
J Gastrointestinal (GI) or other vascular bleed
J Iron deficiency anemia
J Vitamin B12 or folate deficiency
J bone marrow damage
J Metabolic disorders
J Chronic inflammation

J èehydration
J Pulmonary disease
J Congenital heart disease
J

J Renal problems
J Over-transfusion of whole blood
J
issue hypoxia

Alteration of the number of RBCs is often transient and can be easily corrected and/or return to
normal levels by eliminating the causative agent. èecreases in red blood cells are normally seen
during pregnancy as a result of body fluid increases that dilute them.
Living at high altitudes causes an increase in RBC counts; this is your body's response to the
decreased oxygen available at these heights.
èrugs that may increase RBC levels include gentamicin and methyldopa.

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he results indicate the percentage of each type of white blood cell that is present.
Ô R
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. èecreased neutrophil levels may be the result of severe infection or
other conditions, such as responses to various medications, particularly chemotherapy.
R
can increase in response to allergic disorders, inflammation of the skin, and parasitic
infections.
hey can also increase in response to some infections or to various bone marrow
disorders. èecreased levels of eosinophils can occur as a result of infection.
R
can increase in cases of leukemia, chronic inflammation, the presence of a
hypersensitivity reaction to food, or radiation therapy.
R
can increase in cases of viral infection, leukemia, cancer of the bone marrow, or
radiation therapy. èecreased lymphocyte levels can indicate diseases that affect the immune
system, such as lupus, and the later stages of HIV infection.

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. èecreased 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.

rating, physical activity, and stress may alter white blood cell differential values.
Long-term use of steroids or long-term exposure to toxic chemicals (such as lye or insecticides)
can increase the risk of an abnormal differential.

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If platelet levels fall below 20,000 per microliter, spontaneous bleeding may occur and is
considered a life-threatening risk. Patients who have a bone marrow disease, such as leukemia or
another cancer in the bone marrow, often experience excessive bleeding due to a significantly
decreased number of platelets (thrombocytopenia). As the number of cancer cells increases in the
bone marrow, normal bone marrow cells are crowded out, resulting in fewer platelet-producing
cells.
Low number of platelets may be seen in some patients with long-term bleeding problems (e.g.,
chronic bleeding stomach ulcers), thus reducing the supply of platelets. èecreased platelet counts
may also be seen in patients with Gram-negative sepsis.
Individuals with an autoimmune disorder (such as lupus or idiopathic thrombocytopenia purpura

(I
P), where the body¶s immune system creates antibodies that attack its own organs) can cause
the destruction of platelets.
Certain drugs, such as acetaminophen, quinidine, sulfa drugs, digoxin, vancomycin, valium, and
nitroglycerine, are just a few that have been associated with drug-induced decreased platelet
counts. Patients undergoing chemotherapy or radiation therapy may also have a decreased
platelet count. Up to 5% of pregnant women may experience thrombocytopenia at term.
Platelet consumption may be observed in renal diseases.

hrombocytopenic purpura (
P) and
hemolytic uremic syndrome (HUS) are seen in renal failure and can result in fewer circulating
platelets in the blood. Similarly, a condition known as splenic sequestration, where platelets pool
within the spleen, can also cause a platelet decrease.
More commonly (up to 1% of the population), easy bruising or bleeding may be due to an
inherited disease called von Willebrand¶s disease. While the platelets may be normal in number,
their ability to stick together is impaired due to a decrease in von Willebrand¶s factor, a protein
needed to initiate the clotting process. Many cases may go undiagnosed due to the mild nature of
the disease. Many cases are discovered when a patient has to have surgery or a tooth extraction
or when delivering a baby. However, some cases are more severe and can be aggravated by use
of certain drugs, resulting in a life-threatening situation.
Increased platelet counts (thrombocytosis) may be seen in individuals who show no significant
medical problems, while others may have a more significant blood problem called
myeloproliferative disorder. Some, although they have an increased number of platelets, may
have a tendency to bleed due to the lack of stickiness of the platelets; in others, the platelets
retain their stickiness but, because they are increased in number, tend to stick to each other,
forming clumps that can block a blood vessel and cause damage, including death
(thromboembolism).

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èecreased levels may be seen in women before menstruation.
Other inherited disorders caused by defective platelets or decreased/absent proteins that activate
the platelets include Glanzmann¶s
hrombasthenia, Bernard-Soulier disease, Chediak-Higashi
syndrome, Wiskott-Aldrich syndrome, May-Hegglin syndrome, and èown syndrome.
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occurrence of these genetic abnormalities, however, is relatively rare.

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he blood glucose test is ordered to measure the amount of glucose in the blood right at the time
of sample collection. It is used to detect both hyperglycemia and hypoglycemia, to help diagnose
diabetes, and to monitor glucose levels in persons with diabetes. Blood glucose may be measured
on a fasting basis (collected after an 8 to 10 hour fast), randomly (anytime), post prandial (after a
meal), and/or as part of an oral glucose tolerance test (OG
/ G
). An OG
is a series of
blood glucose tests. A fasting glucose is collected; then the patient drinks a standard amount of a
glucose solution to "challenge" their system.
his is followed by one or more additional glucose
tests performed at specific intervals to track glucose levels over time.
he OG
may be ordered
to help diagnose diabetes and as a follow-up test to an elevated blood glucose.
he American èiabetes Association recommends either the fasting glucose or the OG
to
diagnose diabetes but says that testing should be done twice, at different times, in order to
confirm a diagnosis of diabetes.
Most pregnant women are screened for gestational diabetes, a temporary form of hyperglycemia,
between their 24th and 28th week of pregnancy using a version of the OG
, a 1-hour glucose
challenge. If either fasting glucose or a random glucose is above the values used to diagnose
diabetes in those who are not pregnant, the woman is considered to have gestational diabetes and
neither the screening nor the glucose tolerance test is needed. If the 1-hour level is higher than
the defined value, a longer OG
is performed to clarify the patient's status.
èiabetics must monitor their own blood glucose levels, often several times a day, to determine
how far above or below normal their glucose is and to determine what oral medications or
insulin(s) they may need.
his is usually done by placing a drop of blood from a skin prick onto
a glucose strip and then inserting the strip into a glucose meter, a small machine that provides a
digital readout of the blood glucose level.
In those with suspected hypoglycemia, glucose levels are used as part of the "Whipple triad" to
confirm a diagnosis. (See "Is there anything else I should know?" section).
he urine glucose is seldom ordered by itself. At one time, it was used to monitor diabetics, but
it has been largely replaced by the more sensitive and ³real time´ blood glucose.
he urine
glucose is, however, one of the substances measured when a urinalysis is performed. A urinalysis
may be done routinely as part of a physical or prenatal checkup, when a doctor suspects that a
patient may have a urinary tract infection, or for a variety of other reasons.
he doctor may
follow an elevated urine glucose test with blood glucose testing.
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Blood glucose testing can be used to screen healthy, asymptomatic individuals for diabetes and
pre-diabetes because diabetes is a common disease that begins with few symptoms. Screening for
glucose may occur during public health fairs or as part of workplace health programs. It may also
be ordered when a patient has a routine physical exam. Screening is especially important for
people at high risk of developing diabetes, such as those with a family history of diabetes, those
who are overweight, and those who are more than 40 to 45 years old.
he glucose test may also be ordered to help diagnose diabetes when someone has symptoms of
hyperglycemia, such as:
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Blood glucose testing is also done in emergency settings to determine if low or high glucose is
contributing to symptoms such as fainting and unconsciousness. If a patient has pre-diabetes
(characterized by fasting or OG
levels that are higher than normal but lower than those
defined as diabetic), the doctor will order a glucose test at regular intervals to monitor the
patient¶s status. With known diabetics, doctors will order glucose levels in conjunction with
other tests such as hemoglobin A1c to monitor glucose control over a period of time.
Occasionally, a blood glucose level may be ordered along with insulin and C-peptide to monitor
insulin production.
èiabetics may be required to self-check their glucose, once or several times a day, to monitor
glucose levels and to determine treatment options as prescribed by their doctor.
Pregnant women are usually screened for gestational diabetes late in their pregnancies, unless
they have early symptoms or previously have had gestational diabetes. When a woman has
gestational diabetes, her doctor will usually order glucose levels throughout the rest of her
pregnancy and after delivery to monitor her condition.
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High levels of glucose most frequently indicate diabetes, but many other diseases and conditions
can also cause elevated glucose.
he following information summarizes the meaning of the test
results.
hese are based on the clinical practice recommendations of the American èiabetes
Association.

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Some of the other diseases and conditions that can result in elevated glucose levels include:
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Low to non-detectible urine glucose results are considered normal. Anything that raises blood
glucose levels also has the potential to elevate urine glucose levels. Increased urine glucose
levels may be seen with medications, such as estrogens and chloral hydrate, and with some forms
of renal disease.
Moderately increased blood levels may be seen with pre-diabetes.
his condition, if left un-
addressed, often leads to type 2 diabetes.
Low blood glucose levels (hypoglycemia) are also seen with:
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Hypoglycemia is characterized by a drop in blood glucose to a level where first it causes nervous
system symptoms (sweating, palpitations, hunger, trembling, and anxiety), then begins to affect
the brain (causing confusion, hallucinations, blurred vision, and sometimes even coma and
death). An actual diagnosis of hypoglycemia requires satisfying the "Whipple triad."
hese three
criteria include:
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Primary hypoglycemia is rare and often diagnosed in infancy. People may have symptoms of
hypoglycemia without really having low blood sugar. In such cases, dietary changes such as
eating frequent small meals and several snacks a day and choosing complex carbohydrates over
simple sugars may be enough to ease symptoms.
hose with fasting hypoglycemia may require
IV glucose if dietary measures are insufficient.
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BUN is often ordered with creatinine when kidney problems are suspected. Some signs and
symptoms of kidney dysfunction include:
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BUN also may be ordered:
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BUN concentrations may be elevated when there is excessive protein breakdown (catabolism),
significantly increased protein in the diet, or gastrointestinal bleeding (because of the proteins
present in the blood).
Low BUN levels are not common and are not usually a cause for concern.
hey may be seen in
severe liver disease, malnutrition, and sometimes when a patient is overhydrated (too much fluid
volume), but the BUN test is not usually used to diagnose or monitor these conditions.
Both decreased and increased BUN concentrations may be seen during a normal pregnancy.
If one kidney is fully functional, BUN concentrations may be normal even when significant
dysfunction is present in the other kidney.
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he result of your BUN test is measured by your doctor against a reference range for the
test to determine whether the result is ³normal´ (it is within the range of numbers), high (it is
above the high end of the range), or low (it is below the low end of the range). Because there can
be many variables that affect the determination of the reference range, the reference range for
this test is specific to the lab where your test sample is analyzed. For this reason, the lab is
required to report your results with an accompanying reference range.
ypically, your doctor will
have sufficient familiarity with the lab and your medical history to interpret the results
appropriately.
While there is no such thing as a ³standard´ reference range for BUN, most labs will report a
similar, though maybe not exactly the same, set of numbers as that included in medical textbooks
or found elsewhere online. For this reason, we recommend that you talk with your doctor about
your lab results. For general guidance only, we are providing the reference range for this test
from the classic medical text,
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extbook of Clinical Chemistry and Molecular èiagnostics.
For more information on reference ranges, please read Reference Ranges and What
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A combination of blood and urine creatinine levels may be used to calculate a creatinine
clearance.
his test measures how effectively your kidneys are filtering small molecules like
creatinine out of your blood.
Urine creatinine may also be used with a variety of other urine tests as a correction factor. Since
it is produced and removed at a relatively constant rate, the amount of urine creatinine can be
compared to the amount of another substance being measured. rxamples of this are when
creatinine is measured with protein to calculate a urine protein/creatinine ratio (UP/CR) and
when it is measured with microalbumin to calculate microalbumin/creatinine ratio (also known
as albumin/creatinine ratio, ACR).
hese tests are used to evaluate kidney function as well as to
detect other urinary tract disorders.
Serum creatinine measurements (along with your age, weight, and gender) also are used to
calculate the estimated glomerular filtration rate (eGFR), which is used as a screening test to
look for evidence of kidney damage.
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he creatinine blood test may be ordered, along with BUN test and microalbumin, at regular
intervals when you have a known kidney disorder or have a disease that may affect kidney
function or be exacerbated by dysfunction. Both BUN and creatinine may be ordered when a C
scan is planned, prior to and during certain drug therapies, and before and after dialysis to
monitor the effectiveness of treatments.
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Creatinine blood levels can also increase temporarily as a result of muscle injury and are
generally slightly lower during pregnancy.
Low blood levels of creatinine are not common and are not usually a cause for concern.
hey can
be seen with conditions that result in decreased muscle mass.
Levels of 24-hour urine creatinine are evaluated with blood levels as part of a creatinine
clearance test.
Random urine creatinine levels have no standard reference ranges.

hey are usually used with
other tests to reference levels of other substances measured in the urine. Some examples include
the microalbumin test and urine protein test.
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he result of your blood creatinine test is measured by your doctor against a reference
range for the test to determine whether the result is ³normal´ (it is within the range of numbers),
high (it is above the high end of the range), or low (it is below the low end of the range). Because
there can be many variables that affect the determination of the reference range, the reference
range for this test is specific to the lab where your test sample is analyzed. For this reason, the
lab is required to report your results with an accompanying reference range.
ypically, your
doctor will have sufficient familiarity with the lab and your medical history to interpret the
results appropriately.
While there is no such thing as a ³standard´ reference range for blood creatinine, most labs will
report a similar, though maybe not exactly the same, set of numbers as that included in medical
textbooks or found elsewhere online. For this reason, we recommend that you talk with your
doctor about your lab results. For general guidance only, we are providing the reference range
for this test from the classic medical text,
ietz
extbook of Clinical Chemistry and Molecular
èiagnostics.
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Increased creatinine clearance rates may occasionally be seen during pregnancy, exercise, and
with diets high in meat.
Patients with one dysfunctional and one normal kidney will usually have normal creatinine
clearance rates as the functional kidney will increase its rate of filtration in compensation.

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Certain drugs, such as aminoglycosides, cimetidine, cisplatin, and cephalosporins, can decrease
the creatinine clearance measurement. èiuretics can increase the result.

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A total calcium level is often measured as part of health screening. It is included in the
Comprehensive Metabolic Panel (CMP) and the Basic Metabolic Panel (BMP) ± groups of tests
that are performed together to diagnose or monitor a variety of conditions. When an abnormal
total calcium result is obtained, it is viewed as an indicator or some kind of underlying problem.
o help diagnose the underlying problem, additional tests are often done to measure ionized
calcium, urine calcium, phosphorous, magnesium, vitamin è, and parathyroid hormone (P
H).
P
H and vitamin è are responsible for maintaining calcium concentrations in the blood within a
narrow range of values.
Measuring calcium and P

H together can help determine whether the parathyroid gland is
functioning normally. Measuring urine calcium can help determine whether the kidneys are
excreting the proper amount of calcium, and testing for vitamin è, phosphorus, and/or
magnesium can help determine whether other deficiencies or excesses exist. Frequently the
balance among these different substances, and the changes in them, are just as important as the
concentrations.
Calcium can be used as a diagnostic test if you go to your doctor with symptoms that suggest:
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he total calcium test is the test most frequently ordered to evaluate calcium status. In most
cases, it is a good reflection of the amount of free calcium involved in metabolism since the
balance between free and bound is usually stable and predictable. However, in some patients, the
balance between bound and free calcium is disturbed and total calcium is not a good reflection of
calcium status. In those circumstances, measurement of ionized calcium is necessary. Some
conditions where ionized calcium should be the test of choice include: critically ill patients who
are receiving transfusions or IV fluids, patients undergoing major surgery, and patients with
blood protein abnormalities like low albumin.
Large fluctuations in ionized calcium can cause the heart to slow down or to beat too rapidly, can
cause muscles to go into spasm (tetany), and can cause confusion or even coma. In critically ill
patients, it is extremely important to know the ionized calcium level to be able to intervene and
prevent serious complications.
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Your doctor also may order a calcium test when you have:
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Your doctor may order an ionized calcium test when you have numbness around the mouth and
in the hands and feet and muscle spasms in the same areas.
hese can be symptoms of low levels
of ionized calcium. However, when calcium levels fall slowly, many people have no symptoms
at all.
You may need calcium monitoring when you have certain kinds of cancer (particularly breast,
lung, head and neck, kidney, and multiple myeloma), have kidney disease, or have had a kidney
transplant. Monitoring may also be necessary when you are being treated for abnormal calcium
levels to evaluate the effectiveness of treatments such as calcium or vitamin è supplements.
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In most cases, total calcium is measured because the test is more easily performed than the
ionized calcium test and requires no special handling of the blood sample.
otal calcium is
usually a good reflection of free calcium since the free and bound forms are typically each about
half of the total. However, because about half the calcium in blood is bound to protein, total
calcium test results can be affected by high or low levels of protein. In such cases, it is more
useful to measure free calcium directly using an ionized calcium test.
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A normal total or ionized calcium result together with other normal lab results generally means
that your calcium metabolism is normal and blood levels are being appropriately regulated.

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he result of your total calcium test is measured by your doctor against a reference range
for the test to determine whether the result is ³normal´ (it is within the range of numbers), high
(it is above the high end of the range), or low (it is below the low end of the range). Because
ypically, your
While there is no such thing as a ³standard´ reference range for total calcium, most labs will
report a similar, though maybe not exactly the same, set of numbers as that included in medical
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Blood and urine calcium measurements cannot tell how much calcium is in the bones. A test
similar to an X-ray, called a bone density or "èexa" scan, is used for this purpose.
aking thiazide diuretic drugs is the most common drug-induced reason for a high calcium level.

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It is not uncommon to see high bilirubin levels in newborns, typically 1 to 3 days old.
his is
sometimes called physiologic jaundice of the newborn. Within the first 24 hours of life, up to
50% of full-term newborns, and an even greater percentage of pre-term babies, may have a high
bilirubin level. After birth, newborns begin breaking down the excess red blood cells (RBCs)
they are born with and, since the newborn¶s liver is not fully mature, it is unable to process the
extra bilirubin, causing the infant's bilirubin levels to rise in the blood and other body tissues.
his situation usually resolves itself within a few days. In other instances, newborns¶ red blood
cells may be being destroyed because of blood incompatibilities between the baby and her
mother, called hemolytic disease of the newborn.
In adults or older children, bilirubin is measured to diagnose and/or monitor liver diseases, such
as cirrhosis, hepatitis, or gallstones. Patients with sickle cell disease or other causes of hemolytic
anemia may have episodes where excessive RBC destruction takes place, increasing bilirubin
levels.
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Other symptoms that may be present include:
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Adults and children: Bilirubin levels can be used to identify liver damage/disease or to monitor
the progression of jaundice. Increased total or unconjugated bilirubin may be a result of
hemolytic, sickle cell or pernicious anemias or a transfusion reaction. If conjugated bilirubin is
elevated, there may be some kind of blockage of the liver or bile ducts, hepatitis, trauma to the
liver, cirrhosis, a drug reaction, or long-term alcohol abuse.
Inherited disorders that cause abnormal bilirubin metabolism (Gilbert¶s, Rotor¶s, èubin-Johnson,
Crigler-Najjar syndromes) may also cause increased levels.
Low levels of bilirubin are not generally a concern and are not monitored.

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Bilirubin is not normally present in the urine. However, conjugated bilirubin is water-soluble and
therefore may be excreted from the body in the urine when levels increase in the body. Its
presence in the urine usually indicates blockage of liver or bile ducts, hepatitis or some other
liver damage.
he most common method for detecting urine bilirubin is using the dipstick test
that is part of a urinalysis.
Bilirubin levels tend to be slightly higher in males than females, while African Americans show
lower values. Strenuous exercise may also increase bilirubin levels.

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levels are also often compared with levels of other liver enzymes, alkaline phosphatase
(ALP), and alanine aminotransferase (AL
), to determine which form of liver disease is present.
rven though AS
is found in heart and other muscles, another enzyme, creatine kinase (CK), is
present in much higher amounts and is usually used to detect heart or muscle injury.
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Persons who have mild symptoms, such as fatigue, may be tested for AL
to make sure they do
not have chronic liver disease. AL
is often measured to monitor treatment of persons with liver
disease, and may be ordered either by itself or along with other tests.
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Children have higher ALP levels because their bones are growing, and ALP is often very high
during the growth spurt, which occurs at different ages in males and females.
Some drugs may increase ALP levels, especially some of the drugs used to treat psychiatric
problems, but this is rare.
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In persons with mild symptoms, such as fatigue or loss of energy, AL

may be tested to make
sure they do not have chronic liver disease. AL
is often used to monitor the treatment of
persons who have liver disease, to see if the treatment is working, and may be ordered either by
itself or along with other tests.
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AL
levels are usually not as high in chronic hepatitis, often less than 4 times the highest normal
level: in this case, AL
levels often vary between normal and slightly increased, so doctors
typically will order the test frequently to see if there is a pattern. In some liver diseases,
especially when the bile ducts are blocked, when a person has cirrhosis, and when other types of
liver cancer are present, AL
may be close to normal levels.

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Many drugs may raise AL

levels by causing liver damage in a very small percentage of patients
taking the drug.
his is true of both prescription drugs and some ³natural´ health products. If
your doctor finds that you have a high AL
, tell him or her about all the drugs and health
products you are taking.

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Urine sodium levels are typically tested in patients who have abnormal blood sodium levels to
help determine whether an imbalance is from, for example, taking in too much sodium or losing
too much sodium. Urine sodium testing is also used to see if a person with high blood pressure is
eating too much salt. It is often used in persons with abnormal kidney tests to help the doctor
determine the cause of kidney damage, which can help guide treatment.
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A blood sodium test may be ordered when a patient has symptoms of hyponatremia, such as
weakness, confusion, and lethargy, or symptoms of hypernatremia such as thirst, decreased
urinary output, muscle twitching, and/or agitation.
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Hyponatremia is rarely due to decreased sodium intake (deficient dietary intake or deficient
sodium in IV fluids). Most commonly, it is due to sodium loss (Addison¶s disease, diarrhea,
excessive sweating, diuretic administration, or kidney disease). In some cases, it is due to
increased water (drinking too much water, heart failure, cirrhosis, kidney diseases that cause
protein loss [nephrotic syndrome]). In a number of diseases (particularly those involving the
brain and the lungs, many kinds of cancer, and with some drugs), your body makes too much
anti-diuretic hormone, causing you to keep too much water in your body.
A high blood sodium level means you have hypernatremia and is almost always due to
dehydration without enough water intake. Symptoms include dry mucous membranes, thirst,
agitation, restlessness, acting irrationally, and coma or convulsions if levels rise extremely high.
In rare cases, hypernatremia may be due to increased salt intake without enough water, Cushing
syndrome, or a condition caused by too little anti-diuretic hormone (AèH), called diabetes
insipidus.
Sodium urine concentrations must be evaluated in association with blood levels. Concentrations
may mirror blood levels or be the opposite.
he body normally excretes excess sodium, so the
concentration in the urine may be elevated because it is elevated in the blood. It may also be
elevated in the urine when the body is losing too much sodium. In this case, the blood level
would be normal to low. If blood sodium levels are low due to insufficient intake, then urine
concentrations will also be low.
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Sodium levels are often evaluated in relation to other electrolytes and can be used to calculate
anion gap in order to identify the cause of acidosis.
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he result of your sodium test is measured by your doctor against a reference range for
the test to determine whether the result is ³normal´ (it is within the range of numbers), high (it is
appropriately.
While there is no such thing as a ³standard´ reference range for sodium, most labs will report a
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Potassium concentrations may be ordered at regular intervals to monitor drugs that can cause
your kidneys to lose potassium, particularly diuretics, resulting in hypokalemia. Monitoring may
also be done if you have a condition or disease, such as acute or chronic kidney failure, that can
be associated with abnormal potassium levels.
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Certain drugs can also cause hyperkalemia in a small percent of patients. Among them are non-
steroidal anti-inflammatory drugs (such as Advil, Motrin, and Nuprin); beta blockers (such as
propanolol and atenolol), angiotensin-converting enzyme inhibitors (such as captopril, enalapril,
and lisinopril), and potassium-sparing diuretics (such as triamterene, amiloride, and
spironolactone).
èecreased levels of potassium indicate hypokalemia. èecreased levels may occur in a number of
conditions, particularly:
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In diabetes, your potassium may fall after you take insulin, particularly if your diabetes had been
out of control for a while. Low potassium is commonly due to ³water pills´ (diuretics); if you are
taking these, your doctor will check your potassium level regularly.
Additionally, certain drugs such as corticosteroids, beta-adrenergic agonists such as

isoproterenol, alpha-adrenergic antagonists such as clonidine, antibiotics such as gentamicin and
carbenicillin, and the antifungal agent amphotericin B can cause loss of potassium.
NO
r:
he result of your potassium test is measured by your doctor against a reference range
for the test to determine whether the result is ³normal´ (it is within the range of numbers), high
(it is above the high end of the range), or low (it is below the low end of the range). Because
ypically, your
While there is no such thing as a ³standard´ reference range for potassium, most labs will report
a similar, though maybe not exactly the same, set of numbers as that included in medical
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If there are any questions as to how your blood was collected, your doctor may request that the
test be repeated to verify results.
Chloride
Also known as: Cl
Formal name: Chloride

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In persons with too much base, urine chloride measurements can tell the doctor whether the
cause is loss of salt (in cases of dehydration, vomiting, or use of diuretics, where urine chloride
would be very low) or an excess of certain hormones such as cortisol or aldosterone (where urine
chloride would be high). Urine tests for chloride are also used, along with sodium, to monitor
persons put on a low-salt diet. If sodium and chloride levels are high, the doctor knows that the
patient is not following the diet.
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Some of these tests may be ordered at regular intervals when a patient has a disease or condition
or is taking a medication that can cause an electrolyte imbalance. rlectrolyte panels or basic
metabolic panels are commonly used to monitor treatment of certain problems, including high
blood pressure (hypertension), heart failure, and liver and kidney disease.
A urine chloride test may be performed along with a blood or urine sodium when evaluating the
cause of low or high blood chloride levels.
he doctor will look at whether the chloride
measurement changes mirror those of the sodium.
his helps the doctor determine if there is also
an acid-base imbalance and helps to guide treatment.
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èecreased levels of blood chloride (called hypochloremia) occur with any disorder that causes
low blood sodium. Hypochloremia also occurs with prolonged vomiting or gastric suction,
emphysema or other chronic lung diseases (causing respiratory acidosis), and with loss of acid
from the body (called metabolic alkalosis).
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r:
he result of your chloride test is measured by your doctor against a reference range for
the test to determine whether the result is ³normal´ (it is within the range of numbers), high (it is
appropriately.
While there is no such thing as a ³standard´ reference range for chloride, most labs will report a
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When an acid-base imbalance is identified, bicarbonate (as part of the electrolyte panel) and
blood gases may be ordered to evaluate the severity of the imbalance, determine whether it is
primarily respiratory (due to an imbalance between the amount of oxygen coming in and CO2
being released) or metabolic (due to increased or decreased amounts of bicarbonate in the blood)
in nature, and monitor its treatment until the acid-base balance is restored.
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Some of the causes of a low bicarbonate level include:
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he result of your CO2 test is measured by your doctor against a reference range for the
test to determine whether the result is ³normal´ (it is within the range of numbers), high (it is
appropriately.
While there is no such thing as a ³standard´ reference range for CO2, most labs will report a
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èrugs that may decrease bicarbonate levels include methicillin, nitrofurantoin, tetracycline,
thiazide diuretics, and triamterene.
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Increased levels of magnesium are rarely due to dietary sources but are usually the result of an
excretion problem or excessive supplementation. Increased levels are seen in:
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Since magnesium is an electrolyte, it may be ordered along with other electrolytes such as
sodium, potassium, chloride, bicarbonate (or total CO2), calcium, and phosphorus to evaluate a
patient¶s electrolyte balance. If magnesium is low, it is not unusual for potassium also to be low.
Magnesium blood levels may be low normally in the second and third trimesters of pregnancy.
Cardiac rnzymes
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LèH levels may also occasionally be ordered to monitor damage caused by muscle trauma or
injury and to help identify hemolytic anemia. Hemolytic anemia is caused by the breakage of red
blood cells ± either because they are unusually fragile or because something is mechanically
breaking them, such as an artificial heart valve.
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With some chronic and progressive conditions, and some drugs, moderately elevated LèH levels
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Sometimes, a test for myoglobin is used to detect elevated levels in the urine of patients that have
had extensive damage to their skeletal muscles. Myoglobin is toxic to the kidneys. If severe
muscle injury occurs, blood levels of myoglobin may rise very quickly and the kidneys, which
clear myoglobin from the blood and excrete it in the urine, may be damaged by the increased
amounts.
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Urine myoglobin may be ordered when there has been extensive traumatic injury to muscle, and
damage to the kidneys is suspected.
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Since this blood test is used to detect increased levels in people with chest pain, a low or normal
level of myoglobin means that either a heart attack has not occurred or myoglobin has already
cleared the bloodstream. A test for troponin or other cardiac markers may be used as follow-up
to a low or normal result.
Myoglobin levels are normally very low or not detectable in the urine. High levels of urine
myoglobin indicate an increased risk for kidney damage and failure. Additional tests, such as
BUN, creatinine, and urinalysis, are done to monitor kidney function in these patients.

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A urine dipstick test for hemoglobin can also be positive in the presence of myoglobin. If the
urine dipstick test is positive and myoglobin is suspected to be the cause, it can be followed-up
with more specific testing for myoglobin.

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he troponin test is used to help diagnose a heart attack, to detect and evaluate mild to severe
heart injury, and to distinguish chest pain that may be due to other causes. In patients who
experience heart-related chest pain, discomfort, or other symptoms and do not seek medical
attention for a day or more, the troponin test will still be positive if the symptoms are due to heart
damage.
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In patients with stable angina, a troponin test may be ordered if the patient¶s symptoms get
worse, occur when the patient is at rest, and/or no longer ease with treatment.
hese are all signs
that the angina is becoming unstable, which increases the risk of a heart attack or other serious
heart problem in the near future.
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roponin values can remain high for 1±2 weeks after a heart attack.
he test is not affected by
damage to other muscles, so injections, accidents, and drugs that can damage muscle do not
affect troponin levels.
roponin may rise following strenuous exercise, although in the absence
of signs and symptoms of heart disease, it is usually of no medical significance.

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CRP may be used to screen apparently healthy people for the following conditions. However, in
these cases, the more sensitive test hs-CRP will be ordered:
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While the CRP test is not specific enough to diagnose a particular disease, it does serve as a
general marker for infection and inflammation, thus alerting medical professionals that further
testing and treatment may be necessary.
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CRP also is used to monitor wound healing and to monitor patients who have surgical cuts
(incisions), organ transplants, or burns as an early detection system for possible infections.
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If the CRP level in your blood drops, it means that you are getting better and inflammation is
being reduced.

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Another test to monitor inflammation is called the erythrocyte sedimentation rate (rSR). Both
tests are elevated in the presence of inflammation; however, CRP appears and then disappears
sooner than changes in the rSR.
hus, your CRP level may fall to normal if you have been
treated successfully, such as for a flare-up of arthritis, but your rSR may still be abnormal for a
while longer.
LiPid Panel

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Cholesterol is tested at more frequent intervals (often several times per year) in patients who
have been prescribed diet and/or drugs to lower their cholesterol.
he test is used to track how
well these measures are succeeding in lowering cholesterol to desired levels and in turn lowering
the risk of developing heart disease.
Cholesterol testing may be ordered more frequently for those who have one or more risk factors
for heart disease. Major risk factors include:
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For those under 20 years of age and at low risk, cholesterol testing is usually not ordered
routinely. However, screening for high cholesterol as part of a lipid profile is recommended for
children and youths who are at an increased risk of developing heart disease as adults. Some of
the risk factors are similar to those in adults and include:
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High-risk children should have their first cholesterol test between 2 and 10 years old, according
to the American Academy of Pediatrics. Children younger than 2 years old are too young to be
tested. If the initial results are not worrisome, the fasting test should be done again in three to
five years.
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he risk categories for children and adolescents are different than adults.
alk to your child¶s
pediatrician about your child¶s results.
In a treatment setting, testing is used to see how much cholesterol is decreasing as a result of
treatment.
he goal for the amount of change or the final (target) value will be set by your
doctor.
he target value is usually based on LèL-C.

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here is some debate about whether very low cholesterol is bad. Low cholesterol (less than 100
mg/dL (2.59 mmol/L)) is often seen when there is an existing problem like malnutrition, liver
disease, or cancer. However there is no evidence that low cholesterol causes any of these
problems.
Cholesterol is high during pregnancy. Women should wait at least six weeks after the baby is
born to have cholesterol measured.
Some drugs that are known to increase cholesterol levels include anabolic steroids, beta blockers,
epinephrine, oral contraceptives, and vitamin è.
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Your HèL-C level may also be monitored by your doctor on a regular basis if previous test
results have shown you to have an increased risk for heart disease or if you have had a heart
attack or if you are undergoing treatment for high cholesterol levels.
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HèL-C, as part of the lipid profile, may be ordered more frequently for those who have one or
more risk factors for heart disease. Major risk factors include:
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For children and adolescents at low risk, lipid testing is usually not ordered routinely. However,
screening with a lipid profile is recommended for children and youths who are at an increased
risk of developing heart disease as adults. Some of the risk factors are similar to those in adults
and include a family history of heart disease or health problems such as diabetes, high blood
pressure, or being overweight. High-risk children should have their first lipid profile (including
HèL-C) between 2 and 10 years old, according to the American Academy of Pediatrics.
Children younger than 2 years old are too young to be tested.
HèL-C levels may also be ordered at regular intervals to evaluate the success of lifestyle
changes such as diet and exercise or smoking cessation aimed at increasing your level of HèL-C.
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he risk categories for children and adolescents are different than adults.
alk to your child¶s
pediatrician about your child¶s results.
Some laboratories report a ratio of total cholesterol to HèL cholesterol.

he ratio is obtained by
dividing the total cholesterol by the HèL cholesterol. For example, if a person has a total
cholesterol result of 200 mg/dL and an HèL cholesterol level of 50 mg/dL, the ratio would be
stated as 4 (or 4:1). A desirable ratio is below 5 (5:1); the optimum ratio is 3.5 (3.5:1).
he
American Heart Association recommends that the absolute numbers for total blood cholesterol
and HèL cholesterol levels be used because they are more useful than the ratio in determining
appropriate treatment for patients.
HèL should be interpreted in the context of the overall findings from the lipid profile and in
consultation with your doctor.
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HèL cholesterol should be measured when a person is not ill. Cholesterol is temporarily low
during acute illness, immediately following a heart attack, or during stress (like from surgery or
an accident). You should wait at least six weeks after any illness to have cholesterol measured.
In women, HèL cholesterol may change during pregnancy. You should wait at least six weeks
after your baby is born to have your HèL cholesterol measured.

Lab Results

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Lab Results

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c  CBC; Hemogram; CBC with differential

he hemoglobin test is an integral part of your health evaluation.

J measure the severity of anemia or polycythemia,

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J iron deficiency or other deficiencies, such as B12 and folate,

Heavy smokers have higher hemoglobin levels than nonsmokers.

his test is used to evaluate:

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he list below includes some of these conditions.

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Individuals with an autoimmune disorder (such as lupus or idiopathic thrombocytopenia purpura

Platelet consumption may be observed in renal diseases.

èecreased levels may be seen in women before menstruation.

he American èiabetes Association recommends either the fasting glucose or the OG

is performed to clarify the patient's status.

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Low blood glucose levels (hypoglycemia) are also seen with:

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BUN also may be ordered:

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Random urine creatinine levels have no standard reference ranges.

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) 'c

c% c% 4

J $

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