Cholesterol: Group of fats vital to cell membranes, nerve fibers and bile salts, and a necessary precursor for the sex hormones. High levels indicate diet high in carbohydrates/sugars. Low levels indicate low fat diet, malabsorption, or carbohydrate sensitivity.
HDL/LDL: LDL is the "bad cholesterol", which carries cholesterol for cell building needs, but leaves behind any excess on artery walls and in tissues. HDL is the "good cholesterol" which helps to prevent narrowing of the artery walls by removing the excess cholesterol and transporting it to the liver for excretion. A low HDL percentage frequently indicates diets high in refined carbohydrates and/or carbohydrate sensitivity.
CO2: The CO2 level is related to the respiratory exchange of carbon dioxide in the lungs and is part of the bodies buffering system. Generally, when used with the other electrolytes, carbon dioxide levels indicate pH or acid/alkaline balance in the tissues. This is one of the most important tests that we measure. Most people have too much acid in their body. If you garden you will know that it is very difficult to grow plants in soil where the pH is incorrect. Our blood is similar to soil in many respects and it will be difficult to be healthy if our body's pH is not well balanced.
WBC: White blood count measures the total number of white blood cells in a given volume of blood. Since WBCs kill bacteria, this count is a measure of the body's response to infection.
Hemoglobin: Hemoglobin provides the main transport of oxygen and carbon in the blood. It is composed of "globin", a group of amino acids that form a protein and "heme", which contains iron. It is an important determinant of anemia (decreased hemoglobin) or poor diet/nutrition or malabsorption.
Hematocrit: Hematocrit is the measurement of the percentage of red blood cells in whole blood. It is an important determinant of anemia (decreased), dehydration (elevated) or possible overhydration (decreased).
MCV: Thismeasures the average size of the red blood cells and their volume. These components together can indicate iron deficiency anemia (decreased), B12/folate deficiency anemia (increased), or rheumatoid arthritis (decreased).
These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.
Grouped Together Platelets [posted 11/11/98]
Question: The results of my blood test have just come back. They say everything seems O.K but that my "platelets are grouped together". The Doctor says this is nothing to worry about but I have been feeling very tired now for a few months - could this be linked?
Answer: Not unless your serum protein levels are high, probably no relationship.
White Blood Count Concerns [posted 11/11/98]
Question: I just found out that I have a low WBC count. What is this a sign of?
Answer: Depends on how low and if it is sustained. Many things can cause this and it will need to be evaluated if persistently below 3000 or so. Certainly below 1000.
White Blood Count Concerns [posted 11/6/98]
Question: I am a 41 year old female in excellant health, low blood pressure and weigh 118 lbs. at 5'6". Three days ago I experienced abdominal pain, mostly lower right side, had no appetite and felt weak. Had a tempurature of 99 up to 101. My normal temperature is 97.8. I also had back lower back pain on both sides. Went to my gyn. on the third day, he did an ultrasound and ordered a blood work-up. He found two cysts on my right ovary but thought there was something else wrong because of my symptoms. He called me on the 4th day to tell me my white count was through the roof and sent me for an ultrasound of my appendix and consult with a surgeon. Nothing out of the ordinary with the ultrasound but the surgeon informed me my blood count was over 18,000. I do feel somewhat better, have an appetite and no more fever. What should be my next move? I asked the doctor to prescribe another blood test to see what mt count is today, now that I know I no longer have a fever and feel better, he said it wasn't a bad idea, but my husband thinks it's not nessecary. Any suggestions on what it could be?
Answer: An elevated white blood count only shows some type of inflammation. It will not give the answer. Serial exams with the md would be my recommendation.
Low White Blood Count Concerns [posted 11/5/98]
Question: My boyfriend is 24 and just had his blood taken and they told him that his WBC coount is low. Is this something that he should be concerned with or not worry about? He is going back in to get his blood taken again. He is in good health. He takes multi-vitamin and antioxidants. I am not sure but I do not hink this is something that runs in the family. Thank you for your time.
Answer: Depends on how low and if it persists. Usually counts excede 4000, occasional patients will be down to 2000. It also depends on the differential;that is, what is low of the white cells. I need some more information.
Red Blood Count [posted 10/19/98]
Question: My son has had a blood test taken as part of his college physical. The doctor said he had a high red blood cell count and has asked him to take another blood test. He is a football player and weight lifter but has not taken steriods. He has tried androsteine but that was over a year ago. What could a high red cell mean and how can it be treated. We are continuing to see the doctor, but I'd like to do a little investigating on my own.
Answer: Would depend on how high. If over 50 is very bothersome. Young men often get to the high 40s due to their level of testerone-but, shouldn't be over 50. A red cell mass should be done in nuclear medicine to see his actual red cell mass-this is the first step in diagnosing his problem. One would be suspicious of someone who has taken steroids that they are taking they again and causing the problem.
High Red Blood Count [posted 8/14/98]
Question: I recently had some blood tests done and the results came in saying I have high rbc. What does this mean? I know rbc means Red Blood Count, but what does it mean if it is high?
Answer: Probably nothing unless your count is a hematocrit much above 48 or so. High counts can cause strokes, etc., and can be a marker for polycythemia vera. However, this is always above a Hct of 50. What is your Hct?
White Blood Cell Count [posted 8/11/98]
Question: My white blood cell count came back at about 21.5, and normal is around 11. Does this imply anything besides leukemia? Is 21.5 possibly a spike, fighting off flu, or because it is high, if repeated in another test, should that mean go to a bone marrow test automatically? Will a blood test indicate if it's chronic or quick?
Answer: Possibly an infection, but pretty high for a simple infection. Re-check it in 3 weeks, but I'd keep a close eye on this. Are the white cells lymphocytes, neutrophils, etc. Are there any immature forms or blasts? These are all important questions.
Low White Blood Cell Count [posted 8/5/98]
Question: What are the reason for a below normal white blood cell count in a 14 year old male? Can it be caused by a virus such as the flu? Are there any life treating illnesses indicated by this?
Answer: Viral syndromes are notorious for causing low white blood cell counts. Simply repeat the test about 10 days later. There are numerous causes of low counts. 5% of individuals are low by definition (the counts are based on 95% of the population). I'd simply recheck it before getting too concerned.
White Blood Cell Count
Question: Please tell me what it means if one's white blood cell count is slightly high?
Answer: It can mean several things depending on the height of the blood count and the type of cells that are elevated. Many inflammatory conditions can elevate one's blood count and this is normal under certain stresses. Infections of virus, bacteria etc., are the most common and these pass after a couple of weeks. Disorders of blood production can produce elevated white counts. These are usually accompanied by unusual cells(blasts, etc.) In the blood count. First of all recheck the count 4 weeks or so after the first count (or after any infection clears). If the count is above 15 thousand this is very unusual. It is common to have counts to 15,000 and it is usually not even elevated until 10,000.
White blood cell count
Question: My white blood cell count has been consistently below normal range. The most recent reading was 3.6. Last year, at this time, it was 4.1. I have two aunts that apparently have the same condition. They also have consistently low to below normal white blood cell counts. However, they cannot remember the name of the syndrome. What is the name of this syndrome and should I be concerned?
Answer: There are several syndromes that can produce low white cell counts. However, if it runs in your family I would not be to concerned. A more critical question is the differential count. That is, are all the white cells represented or is one type absent or decreased. This is the key to the problem.
Blood Amount
Question: How many gallons of Blood does the body have?
Answer: 60% of body mass is fluid. About 20% is extracellular. So, for a 150 lb. adult, about 9 lbs are blood. One pound = one pint.
My father has had a CEA blood test after surgery for a colon cancer. The doctor is very pleased as the level is below 1. He says that my father is now cured. Why are they testing his blood and does this really mean that he is cured?The initials CEA stand for carcinoembryonic antigen. Over thirty years ago it was discovered that levels of this protein were raised in the blood of some patients with bowel cancer. There was hope that measuring the CEA level might become a way of testing for the presence of bowel cancer.
Further research showed that the level could be raised in the presence of some other cancers, such as ovarian cancer or cancer of the pancreas, and also in some non-cancerous bowel diseases. Also it was discovered that some people with bowel cancer did not have a raised CEA level.
Having realised it was not a reliable test to make the initial diagnosis of bowel cancer doctors then wondered if it could be used to monitor people who had had surgery for bowel cancer, to check whether the condition was cured. Some careful clinical trials showed that although a rising level of CEA in the blood might help to detect the return of the cancer in some patients this did not influence the outcome of treatment and did not benefit the patient. Other trials have suggested a possible survival advantage from measuring CE
There is thus conflicting evidence and this is an area where there are international differences of opinion. Current national guidelines in the UK for the management of large bowel cancer do not recommend routine monitoring of CEA levels after surgery, but in the United States at least one set of authoritative guidelines feels that CEA measurement may be of value and has recommended that it be checked every three months after surgery.
This difference of opinion clearly shows that there is still some uncertainty regarding the usefulness of CEA monitoring. Consequently some doctors still like to do CEA checks as they feel that at least a normal level gives them, and their patients, some reassurance that the cancer has not returned.
Unfortunately, however, a normal CEA level is not a guarantee that the cancer has not come back, nor does it prove that the cancer will not come back. This means that a normal CEA level cannot be used to say that a cancer is cured.
Glucose: this is the main source of energy for all living organisms. A glucose level greater than 120 in a person, who has fasted (hasn't eaten anything) for 12 hours, may suggest a diabetic tendency. This is a very useful test that can predict diabetes years before a person may develop the actual disease.
Sodium: sodium plays an important role in salt and water balance in your body. A low level of sodium in the blood can be caused by too much water intake, heart failure, or kidney failure.
Creatinine: Creatinine is a product in the blood that occurs from protein breaking down. The level of creatinine in the body is an indicator of the body's muscle mass. Low levels may be due to low protein intake, liver disease, kidney damage or pregnancy. Elevated levels are generally due to kidney damage and need to be monitored carefully.
Iron: iron is important for red blood cell production in the body. The body needs iron to make hemoglobin. Hemoglobin helps transfer oxygen from the lungs to your muscles and tissues. If the body does not have enough iron, all the cells in the body do not function well. If you have low iron, you may need a Ferritin test, especially if you are female and are still menstruating.
Cholesterol: cholesterols are a group of fats that are vital to the body. High levels, however, indicate a diet that is too high in carbohydrates, particularly sugars. High levels of cholesterol over time can lead to heart disease.
Most foods contain carbohydrates (carbohydrates include sugars, fibers, and starches.) Carbohydrates come from a wide variety of foods--including beans, milk, popcorn, bread, potatoes, cookies, spaghetti, and cherry pie--but these foods don't all contain the same type of carbohydrate. Carbohydrates are a necessary part of a healthy diet because they provide the body with the energy it needs for physical activity and to keep organs functioning properly. When there are too many carbohydrates in your body, more energy than you can use from your food, they settle into the body as higher levels of fats.
Low levels of cholesterol indicate a low-fat diet, or malabsorption of fat. Amount of blood drawn = 4 milliliters (equals 1 and 1/3 teaspoons)
HDL/LDL: HDL is a “good” cholesterol that helps to remove excess cholesterol from the body. LDL is a “bad” cholesterol that carries cholesterol to the cell, but leaves behind excess cholesterol on the artery walls and tissues. High LDL and low HDL levels indicate diets high in refined carbohydrates. Amount of blood drawn: 4 milliliters (equals 1 and 1/3 teaspoons)
White blood cells (WBC): white blood count measures the total number of white blood cells in a given volume of blood. Because white blood cells kill bacteria, this count is a measure of the body's response to infection.
Hemoglobin: hemoglobin transports oxygen and carbon in the blood. Low hemoglobin levels indicate the presence of anemia or poor diet and nutrition.
Lipid Profile: a group of tests that are often ordered together to determine risk of coronary heart disease. They usually measure triglycerides, cholesterols and glucose. Triglycerides are the principal form of fats, circulating in your blood stream. Most of your body fat comes in this form. Triglycerides are derived from two sources: 1) from the foods you eat, mainly sugar, animal products and saturated fats and, 2) from the liver itself. Cholesterols are also fats, mostly produced by your liver and from foods eaten. Glucose (sugar) levels in your blood are also usually measured in a Lipid Profile.
A key element to taking control over your health is learning to monitor your immune system. The bulk of immune monitoring is done through a variety of blood tests. Learning to read and understand your laboratory tests can be quite frustrating. This article will provide the basic information to help with this process. Because different labs report results a little differently, it may be wise to ask your primary health care provider to help you read your results as well.
There are some basic rules which hold true for nearly all laboratory tests:
1. Different laboratories can get different results on the same sample of blood. Make sure you ask your primary health care provide which lab was used if it is not noted on the report.
2. Laboratories can make mistakes. if your results have changed dramatically form your previous test, have it run again.
3. Most lab values need to be interpreted along with other clinical and laboratory data in order to develop a meaningful diagnosis. Very seldom will only one value give all of the answers.
4. Laboratory values differ according to age, sex, current medications, etc. Therefore, the interpretation of these values needs to be done with these other parameters in mind.
5. The "normal" range is the value that is normal for a person who does not have HIV. For example, a low cholesterol value in an HIV infected individual in not uncommon
CBC - The Complete Blood Count (CBC) is one of the most common tests ordered by a provider. It is a routine test used to evaluate the blood and general health. Asymptomatic, HIV positive individuals should have this test done twice a year. Symptomatic individuals should have their CBC done at least every three months. Additionally, if you are on antivirals or other medications you might need to have this test done more often. A CBC measures all the following parameters: red blood cell count (RBC), white blood cell count (WBC), hemoglobin, hematocrit, three red cell indices, and the white cell differential. Platelet counts are sometimes included in a CBC.
RBC Count - The RBC count is the number of RBCs in a cubic millimeter of blood. The RBCs are the cells produced in the bone marrow that carry oxygen to your tissues. The normal range is 4.5- 5.9 million/mm3 for men and 4.0-5.3 million/mm3 for women. a slight decreased value is not cause for alarm as many individuals with HIV infection have values below the normal range. However, a markedly decreased value should be thoroughly investigated. A person with a significantly low RBC count can have symptoms of fatigue, shortness of breath, and appear pale in color. A low RBC count can be due to progressive HIV illness or to certain medications or both. AZT, for example, can suppress the production of RBCs in some individuals. A decrease in the RBC count usually causes a decrease in the hemoglobin and hematocrit values.
WBC Count - The WBC count is the number of WBCs in a cubic millimeter of blood. The primary function of these cells is to prevent and fight infections. There are many different types of white blood cells that play specific roles in fight infections. These specific types of WBCs can be measured in the white cell differential. Normal WBC count is from 4,500 to 1,000. The WBC count can be decreased for a variety of reasons: certain medications decease the production of WBCs in the bone marrow, minor viral infections which you may not even be aware of, stress, and opportunistic infections. Values markedly decreased should be cause for concern, since during this situation one is more susceptible to other infections.
Hemoglobin - Oxygen is carried to the tissues via hemoglobin in the RBC. A normal hemoglobin level is 14.0-18.0 g/dl for men and 12.0-16.0 g/dl for women. A slow, progressive decline in hemoglobin is often seen in people with AIDS. This is usually due to a decline in the number of RBCs produced in the bone marrow. Any drug which causes a suppression of the bone marrow, will decrease the hemoglobin level. In most cases it's a matter of balancing the effects of the drug with its potential side effects. When the side effects become too great, either the drug must be removed or the dose reduced to a tolerable level. A drug which mimics the action of the hormone erythropoietin (AKA Procrit, EPO and other names), has its effect on the bone marrow causing the production of new RBCs. It has provided great relief to thousands of individuals with HIV infection and kidney dialysis patients. Erythropoietin has enabled many people to stay on bone marrow suppressive drugs without the need for transfusions.
Hematocrit - The hematocrit is the percent of the cellular components in your blood to the fluid or blood plasma. This test is one of the truest markers of anemia. Normal values for men are 40- 54% and for women 37-47%. A decrease in hematocrit is always seen with a decrease in the hemoglobin. These two values are linked to one another.
MCV - The mean cell volume or MCV is the most important of the RBC indices. It is a measure of the average size of the RBC. For those individuals taking AZT, the MCV will always be normally elevated, i.e. greater than 100. Vitamin B12 and Folic Acid deficiencies also cause increases in MCV. Normal MCV levels are 80-96.
The other 2 indices are not so important. They are the MCH and the MCHC and are used to help diagnose various anemias and leukemias.
Platelets - Platelets are cellular fragments which are necessary for the blood to clot. When activated by "trauma," platelets migrate to the site of injury where they become "sticky," adhering to the injured site and subsequently used in the developing fibrin clot (scab). Normal platelet values are 150,000-350,000. In some individuals, HIV infection itself causes a decrease in the number of platelets. Otherwise, drugs can also cause low platelet counts. Even though counts are considered low below 150,000, most people can survive without the threat of internal bleeding with counts above 50,000. On very rare occasions, the number of platelets present are adequate, but for unknown reasons they don't function correctly. Any malady involving ones platelets can be a potentially serious condition.
White Cell Differential - The white cell differential counts 100 white cells and differentiates them by type. This gives a percent of the different kinds of white cells in relation to one another. The three main types are: polymorphonuclear cells (or PMNs), lymphocytes, and monocytes. PMNs are increased during bacterial infections while lymphocytes are decreased with viral infections. Increased monocytes are sometimes seen in chronic infections. normal percent of PMNs is 55-80%. 25-33% is the normal number of lymphocytes, and 3-7% is normal for monocytes.
There are a wide range of blood chemistry tests which are done on individuals either routinely or for a specific reason. Some of the ones pertaining to HIV infection are mentioned below.
Cholesterol - Cholesterol levels, as mentioned earlier, are routinely decreased in HIV positive individuals. It's not understood why this occurs, but is thought to be related to altered metabolism. normal cholesterol levels are 150-250 mg/dl.
Amylase - amylase is an enzyme that is secreted in the mouth by the salivary glands and also in the pancreas. It can be an early warning sign of acute Pancreatitis when elevated. ddI can cause problems with the pancreas in a small number of patients taking the drug. Normal amylase levels are 25-125 milliunits/ml.
CPK - CPK or CK is an enzyme that's found in the brain and the muscles of the body. Strenuous exercise as well as a heart attack can cause increases in CPK. This makes clear the point of evaluating an abnormal test result in the context of other factors. Myopathy, dysfunction/distress with the muscles, can sometimes be confirmed with an elevated CPK. Myopathy is usually caused by HIV but can also be due to AZT, especially at higher dosages. Normal levels of this enzyme are 12-80 milliunits/ml (30 degrees) or 55-170 milliunits/ml (37 degrees). Values will be slightly lower for women.
Liver function Tests - Liver Function Tests include 5-6 individual tests which collectively can help determine the status of ones liver. elevated liver enzymes are most often caused by certain medications. The HIV infected population also has a high prevalence of hepatitis. at least 4 different viruses are known to cause hepatitis, all leading to increased liver function tests. Therefore compound factors can be at work. If liver enzymes are only moderately elevated, most providers will take a "wait and see" attitude, monitoring them over a period of a few weeks to a few months. However, if the elevation is quite high, the underlying factor must be found. this might very well be one of the medications that you're currently taking. The names of these liver function tests include SGOT, SGPT, alkaline phosphate, total bilirubin and LDH.
Kidney Functions - Two tests which measure kidney function are the BUN and Creatinine. The usefulness of these tests in an HIV infected individual usually relates to medications possibly toxic to the kidneys. Hence kidney function is monitored in this way. Foscarnet is an example of a drug which can cause renal toxicity. Normal BUN levels are 10-20 mg/dl. Normal levels of creatinine are 0.6-1.2 mg/dl.
Lymphocyte subsets - The category of lymphocyte subsets includes absolute counts and percentages of CD4 and CD8 cells as well as other parameters. Usually the number and percent of B cells is included and the number and percent of all lymphocytes (except those called "natural killer" or NK cells). Lymphocytes are broken down mainly into T and B cells. T cells are further divided into CD4(+) cells and CD8(+) cells. It is well known that HIV infection causes a slow, progressive decline in the number and percent of CD4(+) cells in most individuals. There are exceptions. Some individuals progress in their disease very rapidly and others don't seem to progress much at all after more than 12 or 13 years of infection. Normal CD4 counts are 400-1500. The role of CD8 cells is less clearly understood. Early on in the epidemic, high CD8 cell counts caused inversion of the CD4:CD8 ratio and was thought to adversely affect illness. Now it is generally believed that elevated CD8 cell counts are advantageous in the HIV positive individual as it's thought to indicate the body's ability to keep HIV somewhat constrained. Normal CD8 cell counts in an HIV negative individual are 275-780. How CD8 cells are beneficial is still being investigated.
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HDL/LDL: LDL is the "bad cholesterol", which carries cholesterol for cell building needs, but leaves behind any excess on artery walls and in tissues. HDL is the "good cholesterol" which helps to prevent narrowing of the artery walls by removing the excess cholesterol and transporting it to the liver for excretion. A low HDL percentage frequently indicates diets high in refined carbohydrates and/or carbohydrate sensitivity.
CO2: The CO2 level is related to the respiratory exchange of carbon dioxide in the lungs and is part of the bodies buffering system. Generally, when used with the other electrolytes, carbon dioxide levels indicate pH or acid/alkaline balance in the tissues. This is one of the most important tests that we measure. Most people have too much acid in their body. If you garden you will know that it is very difficult to grow plants in soil where the pH is incorrect. Our blood is similar to soil in many respects and it will be difficult to be healthy if our body's pH is not well balanced.
WBC: White blood count measures the total number of white blood cells in a given volume of blood. Since WBCs kill bacteria, this count is a measure of the body's response to infection.
Hemoglobin: Hemoglobin provides the main transport of oxygen and carbon in the blood. It is composed of "globin", a group of amino acids that form a protein and "heme", which contains iron. It is an important determinant of anemia (decreased hemoglobin) or poor diet/nutrition or malabsorption.
Hematocrit: Hematocrit is the measurement of the percentage of red blood cells in whole blood. It is an important determinant of anemia (decreased), dehydration (elevated) or possible overhydration (decreased).
MCV: Thismeasures the average size of the red blood cells and their volume. These components together can indicate iron deficiency anemia (decreased), B12/folate deficiency anemia (increased), or rheumatoid arthritis (decreased).
These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.
Grouped Together Platelets [posted 11/11/98]
Question: The results of my blood test have just come back. They say everything seems O.K but that my "platelets are grouped together". The Doctor says this is nothing to worry about but I have been feeling very tired now for a few months - could this be linked?
Answer: Not unless your serum protein levels are high, probably no relationship.
White Blood Count Concerns [posted 11/11/98]
Question: I just found out that I have a low WBC count. What is this a sign of?
Answer: Depends on how low and if it is sustained. Many things can cause this and it will need to be evaluated if persistently below 3000 or so. Certainly below 1000.
White Blood Count Concerns [posted 11/6/98]
Question: I am a 41 year old female in excellant health, low blood pressure and weigh 118 lbs. at 5'6". Three days ago I experienced abdominal pain, mostly lower right side, had no appetite and felt weak. Had a tempurature of 99 up to 101. My normal temperature is 97.8. I also had back lower back pain on both sides. Went to my gyn. on the third day, he did an ultrasound and ordered a blood work-up. He found two cysts on my right ovary but thought there was something else wrong because of my symptoms. He called me on the 4th day to tell me my white count was through the roof and sent me for an ultrasound of my appendix and consult with a surgeon. Nothing out of the ordinary with the ultrasound but the surgeon informed me my blood count was over 18,000. I do feel somewhat better, have an appetite and no more fever. What should be my next move? I asked the doctor to prescribe another blood test to see what mt count is today, now that I know I no longer have a fever and feel better, he said it wasn't a bad idea, but my husband thinks it's not nessecary. Any suggestions on what it could be?
Answer: An elevated white blood count only shows some type of inflammation. It will not give the answer. Serial exams with the md would be my recommendation.
Low White Blood Count Concerns [posted 11/5/98]
Question: My boyfriend is 24 and just had his blood taken and they told him that his WBC coount is low. Is this something that he should be concerned with or not worry about? He is going back in to get his blood taken again. He is in good health. He takes multi-vitamin and antioxidants. I am not sure but I do not hink this is something that runs in the family. Thank you for your time.
Answer: Depends on how low and if it persists. Usually counts excede 4000, occasional patients will be down to 2000. It also depends on the differential;that is, what is low of the white cells. I need some more information.
Red Blood Count [posted 10/19/98]
Question: My son has had a blood test taken as part of his college physical. The doctor said he had a high red blood cell count and has asked him to take another blood test. He is a football player and weight lifter but has not taken steriods. He has tried androsteine but that was over a year ago. What could a high red cell mean and how can it be treated. We are continuing to see the doctor, but I'd like to do a little investigating on my own.
Answer: Would depend on how high. If over 50 is very bothersome. Young men often get to the high 40s due to their level of testerone-but, shouldn't be over 50. A red cell mass should be done in nuclear medicine to see his actual red cell mass-this is the first step in diagnosing his problem. One would be suspicious of someone who has taken steroids that they are taking they again and causing the problem.
High Red Blood Count [posted 8/14/98]
Question: I recently had some blood tests done and the results came in saying I have high rbc. What does this mean? I know rbc means Red Blood Count, but what does it mean if it is high?
Answer: Probably nothing unless your count is a hematocrit much above 48 or so. High counts can cause strokes, etc., and can be a marker for polycythemia vera. However, this is always above a Hct of 50. What is your Hct?
White Blood Cell Count [posted 8/11/98]
Question: My white blood cell count came back at about 21.5, and normal is around 11. Does this imply anything besides leukemia? Is 21.5 possibly a spike, fighting off flu, or because it is high, if repeated in another test, should that mean go to a bone marrow test automatically? Will a blood test indicate if it's chronic or quick?
Answer: Possibly an infection, but pretty high for a simple infection. Re-check it in 3 weeks, but I'd keep a close eye on this. Are the white cells lymphocytes, neutrophils, etc. Are there any immature forms or blasts? These are all important questions.
Low White Blood Cell Count [posted 8/5/98]
Question: What are the reason for a below normal white blood cell count in a 14 year old male? Can it be caused by a virus such as the flu? Are there any life treating illnesses indicated by this?
Answer: Viral syndromes are notorious for causing low white blood cell counts. Simply repeat the test about 10 days later. There are numerous causes of low counts. 5% of individuals are low by definition (the counts are based on 95% of the population). I'd simply recheck it before getting too concerned.
White Blood Cell Count
Question: Please tell me what it means if one's white blood cell count is slightly high?
Answer: It can mean several things depending on the height of the blood count and the type of cells that are elevated. Many inflammatory conditions can elevate one's blood count and this is normal under certain stresses. Infections of virus, bacteria etc., are the most common and these pass after a couple of weeks. Disorders of blood production can produce elevated white counts. These are usually accompanied by unusual cells(blasts, etc.) In the blood count. First of all recheck the count 4 weeks or so after the first count (or after any infection clears). If the count is above 15 thousand this is very unusual. It is common to have counts to 15,000 and it is usually not even elevated until 10,000.
White blood cell count
Question: My white blood cell count has been consistently below normal range. The most recent reading was 3.6. Last year, at this time, it was 4.1. I have two aunts that apparently have the same condition. They also have consistently low to below normal white blood cell counts. However, they cannot remember the name of the syndrome. What is the name of this syndrome and should I be concerned?
Answer: There are several syndromes that can produce low white cell counts. However, if it runs in your family I would not be to concerned. A more critical question is the differential count. That is, are all the white cells represented or is one type absent or decreased. This is the key to the problem.
Blood Amount
Question: How many gallons of Blood does the body have?
Answer: 60% of body mass is fluid. About 20% is extracellular. So, for a 150 lb. adult, about 9 lbs are blood. One pound = one pint.
My father has had a CEA blood test after surgery for a colon cancer. The doctor is very pleased as the level is below 1. He says that my father is now cured. Why are they testing his blood and does this really mean that he is cured?The initials CEA stand for carcinoembryonic antigen. Over thirty years ago it was discovered that levels of this protein were raised in the blood of some patients with bowel cancer. There was hope that measuring the CEA level might become a way of testing for the presence of bowel cancer.
Further research showed that the level could be raised in the presence of some other cancers, such as ovarian cancer or cancer of the pancreas, and also in some non-cancerous bowel diseases. Also it was discovered that some people with bowel cancer did not have a raised CEA level.
Having realised it was not a reliable test to make the initial diagnosis of bowel cancer doctors then wondered if it could be used to monitor people who had had surgery for bowel cancer, to check whether the condition was cured. Some careful clinical trials showed that although a rising level of CEA in the blood might help to detect the return of the cancer in some patients this did not influence the outcome of treatment and did not benefit the patient. Other trials have suggested a possible survival advantage from measuring CE
There is thus conflicting evidence and this is an area where there are international differences of opinion. Current national guidelines in the UK for the management of large bowel cancer do not recommend routine monitoring of CEA levels after surgery, but in the United States at least one set of authoritative guidelines feels that CEA measurement may be of value and has recommended that it be checked every three months after surgery.
This difference of opinion clearly shows that there is still some uncertainty regarding the usefulness of CEA monitoring. Consequently some doctors still like to do CEA checks as they feel that at least a normal level gives them, and their patients, some reassurance that the cancer has not returned.
Unfortunately, however, a normal CEA level is not a guarantee that the cancer has not come back, nor does it prove that the cancer will not come back. This means that a normal CEA level cannot be used to say that a cancer is cured.
Glucose: this is the main source of energy for all living organisms. A glucose level greater than 120 in a person, who has fasted (hasn't eaten anything) for 12 hours, may suggest a diabetic tendency. This is a very useful test that can predict diabetes years before a person may develop the actual disease.
Sodium: sodium plays an important role in salt and water balance in your body. A low level of sodium in the blood can be caused by too much water intake, heart failure, or kidney failure.
Creatinine: Creatinine is a product in the blood that occurs from protein breaking down. The level of creatinine in the body is an indicator of the body's muscle mass. Low levels may be due to low protein intake, liver disease, kidney damage or pregnancy. Elevated levels are generally due to kidney damage and need to be monitored carefully.
Iron: iron is important for red blood cell production in the body. The body needs iron to make hemoglobin. Hemoglobin helps transfer oxygen from the lungs to your muscles and tissues. If the body does not have enough iron, all the cells in the body do not function well. If you have low iron, you may need a Ferritin test, especially if you are female and are still menstruating.
Cholesterol: cholesterols are a group of fats that are vital to the body. High levels, however, indicate a diet that is too high in carbohydrates, particularly sugars. High levels of cholesterol over time can lead to heart disease.
Most foods contain carbohydrates (carbohydrates include sugars, fibers, and starches.) Carbohydrates come from a wide variety of foods--including beans, milk, popcorn, bread, potatoes, cookies, spaghetti, and cherry pie--but these foods don't all contain the same type of carbohydrate. Carbohydrates are a necessary part of a healthy diet because they provide the body with the energy it needs for physical activity and to keep organs functioning properly. When there are too many carbohydrates in your body, more energy than you can use from your food, they settle into the body as higher levels of fats.
Low levels of cholesterol indicate a low-fat diet, or malabsorption of fat. Amount of blood drawn = 4 milliliters (equals 1 and 1/3 teaspoons)
HDL/LDL: HDL is a “good” cholesterol that helps to remove excess cholesterol from the body. LDL is a “bad” cholesterol that carries cholesterol to the cell, but leaves behind excess cholesterol on the artery walls and tissues. High LDL and low HDL levels indicate diets high in refined carbohydrates. Amount of blood drawn: 4 milliliters (equals 1 and 1/3 teaspoons)
White blood cells (WBC): white blood count measures the total number of white blood cells in a given volume of blood. Because white blood cells kill bacteria, this count is a measure of the body's response to infection.
Hemoglobin: hemoglobin transports oxygen and carbon in the blood. Low hemoglobin levels indicate the presence of anemia or poor diet and nutrition.
Lipid Profile: a group of tests that are often ordered together to determine risk of coronary heart disease. They usually measure triglycerides, cholesterols and glucose. Triglycerides are the principal form of fats, circulating in your blood stream. Most of your body fat comes in this form. Triglycerides are derived from two sources: 1) from the foods you eat, mainly sugar, animal products and saturated fats and, 2) from the liver itself. Cholesterols are also fats, mostly produced by your liver and from foods eaten. Glucose (sugar) levels in your blood are also usually measured in a Lipid Profile.
A key element to taking control over your health is learning to monitor your immune system. The bulk of immune monitoring is done through a variety of blood tests. Learning to read and understand your laboratory tests can be quite frustrating. This article will provide the basic information to help with this process. Because different labs report results a little differently, it may be wise to ask your primary health care provider to help you read your results as well.
There are some basic rules which hold true for nearly all laboratory tests:
1. Different laboratories can get different results on the same sample of blood. Make sure you ask your primary health care provide which lab was used if it is not noted on the report.
2. Laboratories can make mistakes. if your results have changed dramatically form your previous test, have it run again.
3. Most lab values need to be interpreted along with other clinical and laboratory data in order to develop a meaningful diagnosis. Very seldom will only one value give all of the answers.
4. Laboratory values differ according to age, sex, current medications, etc. Therefore, the interpretation of these values needs to be done with these other parameters in mind.
5. The "normal" range is the value that is normal for a person who does not have HIV. For example, a low cholesterol value in an HIV infected individual in not uncommon
CBC - The Complete Blood Count (CBC) is one of the most common tests ordered by a provider. It is a routine test used to evaluate the blood and general health. Asymptomatic, HIV positive individuals should have this test done twice a year. Symptomatic individuals should have their CBC done at least every three months. Additionally, if you are on antivirals or other medications you might need to have this test done more often. A CBC measures all the following parameters: red blood cell count (RBC), white blood cell count (WBC), hemoglobin, hematocrit, three red cell indices, and the white cell differential. Platelet counts are sometimes included in a CBC.
RBC Count - The RBC count is the number of RBCs in a cubic millimeter of blood. The RBCs are the cells produced in the bone marrow that carry oxygen to your tissues. The normal range is 4.5- 5.9 million/mm3 for men and 4.0-5.3 million/mm3 for women. a slight decreased value is not cause for alarm as many individuals with HIV infection have values below the normal range. However, a markedly decreased value should be thoroughly investigated. A person with a significantly low RBC count can have symptoms of fatigue, shortness of breath, and appear pale in color. A low RBC count can be due to progressive HIV illness or to certain medications or both. AZT, for example, can suppress the production of RBCs in some individuals. A decrease in the RBC count usually causes a decrease in the hemoglobin and hematocrit values.
WBC Count - The WBC count is the number of WBCs in a cubic millimeter of blood. The primary function of these cells is to prevent and fight infections. There are many different types of white blood cells that play specific roles in fight infections. These specific types of WBCs can be measured in the white cell differential. Normal WBC count is from 4,500 to 1,000. The WBC count can be decreased for a variety of reasons: certain medications decease the production of WBCs in the bone marrow, minor viral infections which you may not even be aware of, stress, and opportunistic infections. Values markedly decreased should be cause for concern, since during this situation one is more susceptible to other infections.
Hemoglobin - Oxygen is carried to the tissues via hemoglobin in the RBC. A normal hemoglobin level is 14.0-18.0 g/dl for men and 12.0-16.0 g/dl for women. A slow, progressive decline in hemoglobin is often seen in people with AIDS. This is usually due to a decline in the number of RBCs produced in the bone marrow. Any drug which causes a suppression of the bone marrow, will decrease the hemoglobin level. In most cases it's a matter of balancing the effects of the drug with its potential side effects. When the side effects become too great, either the drug must be removed or the dose reduced to a tolerable level. A drug which mimics the action of the hormone erythropoietin (AKA Procrit, EPO and other names), has its effect on the bone marrow causing the production of new RBCs. It has provided great relief to thousands of individuals with HIV infection and kidney dialysis patients. Erythropoietin has enabled many people to stay on bone marrow suppressive drugs without the need for transfusions.
Hematocrit - The hematocrit is the percent of the cellular components in your blood to the fluid or blood plasma. This test is one of the truest markers of anemia. Normal values for men are 40- 54% and for women 37-47%. A decrease in hematocrit is always seen with a decrease in the hemoglobin. These two values are linked to one another.
MCV - The mean cell volume or MCV is the most important of the RBC indices. It is a measure of the average size of the RBC. For those individuals taking AZT, the MCV will always be normally elevated, i.e. greater than 100. Vitamin B12 and Folic Acid deficiencies also cause increases in MCV. Normal MCV levels are 80-96.
The other 2 indices are not so important. They are the MCH and the MCHC and are used to help diagnose various anemias and leukemias.
Platelets - Platelets are cellular fragments which are necessary for the blood to clot. When activated by "trauma," platelets migrate to the site of injury where they become "sticky," adhering to the injured site and subsequently used in the developing fibrin clot (scab). Normal platelet values are 150,000-350,000. In some individuals, HIV infection itself causes a decrease in the number of platelets. Otherwise, drugs can also cause low platelet counts. Even though counts are considered low below 150,000, most people can survive without the threat of internal bleeding with counts above 50,000. On very rare occasions, the number of platelets present are adequate, but for unknown reasons they don't function correctly. Any malady involving ones platelets can be a potentially serious condition.
White Cell Differential - The white cell differential counts 100 white cells and differentiates them by type. This gives a percent of the different kinds of white cells in relation to one another. The three main types are: polymorphonuclear cells (or PMNs), lymphocytes, and monocytes. PMNs are increased during bacterial infections while lymphocytes are decreased with viral infections. Increased monocytes are sometimes seen in chronic infections. normal percent of PMNs is 55-80%. 25-33% is the normal number of lymphocytes, and 3-7% is normal for monocytes.
There are a wide range of blood chemistry tests which are done on individuals either routinely or for a specific reason. Some of the ones pertaining to HIV infection are mentioned below.
Cholesterol - Cholesterol levels, as mentioned earlier, are routinely decreased in HIV positive individuals. It's not understood why this occurs, but is thought to be related to altered metabolism. normal cholesterol levels are 150-250 mg/dl.
Amylase - amylase is an enzyme that is secreted in the mouth by the salivary glands and also in the pancreas. It can be an early warning sign of acute Pancreatitis when elevated. ddI can cause problems with the pancreas in a small number of patients taking the drug. Normal amylase levels are 25-125 milliunits/ml.
CPK - CPK or CK is an enzyme that's found in the brain and the muscles of the body. Strenuous exercise as well as a heart attack can cause increases in CPK. This makes clear the point of evaluating an abnormal test result in the context of other factors. Myopathy, dysfunction/distress with the muscles, can sometimes be confirmed with an elevated CPK. Myopathy is usually caused by HIV but can also be due to AZT, especially at higher dosages. Normal levels of this enzyme are 12-80 milliunits/ml (30 degrees) or 55-170 milliunits/ml (37 degrees). Values will be slightly lower for women.
Liver function Tests - Liver Function Tests include 5-6 individual tests which collectively can help determine the status of ones liver. elevated liver enzymes are most often caused by certain medications. The HIV infected population also has a high prevalence of hepatitis. at least 4 different viruses are known to cause hepatitis, all leading to increased liver function tests. Therefore compound factors can be at work. If liver enzymes are only moderately elevated, most providers will take a "wait and see" attitude, monitoring them over a period of a few weeks to a few months. However, if the elevation is quite high, the underlying factor must be found. this might very well be one of the medications that you're currently taking. The names of these liver function tests include SGOT, SGPT, alkaline phosphate, total bilirubin and LDH.
Kidney Functions - Two tests which measure kidney function are the BUN and Creatinine. The usefulness of these tests in an HIV infected individual usually relates to medications possibly toxic to the kidneys. Hence kidney function is monitored in this way. Foscarnet is an example of a drug which can cause renal toxicity. Normal BUN levels are 10-20 mg/dl. Normal levels of creatinine are 0.6-1.2 mg/dl.
Lymphocyte subsets - The category of lymphocyte subsets includes absolute counts and percentages of CD4 and CD8 cells as well as other parameters. Usually the number and percent of B cells is included and the number and percent of all lymphocytes (except those called "natural killer" or NK cells). Lymphocytes are broken down mainly into T and B cells. T cells are further divided into CD4(+) cells and CD8(+) cells. It is well known that HIV infection causes a slow, progressive decline in the number and percent of CD4(+) cells in most individuals. There are exceptions. Some individuals progress in their disease very rapidly and others don't seem to progress much at all after more than 12 or 13 years of infection. Normal CD4 counts are 400-1500. The role of CD8 cells is less clearly understood. Early on in the epidemic, high CD8 cell counts caused inversion of the CD4:CD8 ratio and was thought to adversely affect illness. Now it is generally believed that elevated CD8 cell counts are advantageous in the HIV positive individual as it's thought to indicate the body's ability to keep HIV somewhat constrained. Normal CD8 cell counts in an HIV negative individual are 275-780. How CD8 cells are beneficial is still being investigated.
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