What Your Lab Tests Mean This is a guide to your lab tests and will help you to understand better the meaning of the tests that we have performed during our evaluation of your health. On your lab sheet will be a list of the test(s) run (usually at the lefthand side of the page) followed by the numerical result. This result will appear in the next column. If your result falls outside the expected “normal” range, it will be marked in some way. The “normal” value range for each test usually appears at the right side of the page. A value for a test that is outside the normal range may indicate a problem, but does not necessarily mean anything is wrong. LIPID PANEL The primary purpose of these tests is to assess the risk of heart disease, specifically, “atherosclerosis, “ or coronary artery disease, the leading cause of heart attacks and the leading cause of death and illness for adult men and women. COMPREHENSIVE METABOLIC PANEL This panel of tests looks at the general state of the body with special attention to the function of the liver and kidneys. VITAMINS CBC (COMPLETE BLOOD COUNT) WITH DIFFERENTIAL This is a summary of the “cellular” components of the blood, white cells, red cells and platelets HORMONE FUNCTION RHEUMATOID PROFILE This panel of tests looks for evidence of inflammatory processes in the body such as certain types of arthritis, connective tissue and auto-immune disease.

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What Your Lab Tests Mean  LIPID PANEL  The primary purpose of these tests is to assess the risk of heart disease, specifically, “atherosclerosis, “ or coronary artery disease, the leading cause of heart attacks and the leading cause of death and illness for adult men and women. Cholesterol, total – high levels outside the normal range have long been associated with increased risk of heart disease, depending on the breakdown of “good” and “bad” cholesterol HDL cholesterol – “good” cholesterol – high levels of this are actually protective of the coronary arteries – this type of cholesterol is actually dense packets of cholesterol that remove “bad” cholesterol from the blood – exercise and balanced diet improve HDL levels – smoking, saturated fats, and excess carbohydrates in the diet lower HDL LDL cholesterol – “bad” cholesterol – high levels of this are associated with increased risk of coronary artery disease – levels below 100 are desirable in all persons – in patients with other risk factors for heart disease, levels below 80 are the goal of treatment Triglycerides – a measure of the “fat” in the bloodstream. This is the fat created by the body that circulates in the blood prior to being stored in the fat cells themselves. Usually associated with excess carbohydrate (starch/sugar) intake and higher insulin levels, this is often found leading up to and accompanying Type II Diabetes. High levels promote increased levels of bad LDL cholesterol and the formation of arterial plaques. CHOL/HDL ratio – an indicator or risk for atherosclerosis - low ratio is good (high HDL relative to total)

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What Your Lab Tests Mean Non-HDL cholesterol – thought by many to be one of the most important numbers in estimating risk of vascular disease. As the name suggests, it is the sum of all the “bad cholesterol” components apart from “protective” HDL.

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What Your Lab Tests Mean  COMPREHENSIVE METABOLIC PANEL  This panel of tests looks at the general state of the body with special attention to the function of the liver and kidneys. Glucose – blood sugar – high levels (above 140 or so in the fasting state) are usually indicative of diabetes – low levels are sometimes indicative of “hypoglycemia” Urea nitrogen (BUN) – high levels are often associated with decreased kidney function or dehydration – low levels are usually normal Creatinine – a by-product of muscle function, this protein is filtered from the blood by the kidneys – high levels are the best early indicator that the kidneys aren’t working properly BUN/Creatinine ratio – when BUN is elevated, this ratio helps to determine if BUN elevation is due to dehydration or if it’s due to kidney problems (a low ratio means creatinine is elevated relative to BUN) Sodium, chloride, and potassium – the main salts in the bloodstream – important indicators of kidney function – can be thrown out of balance (especially potassium) by diuretics (“water pills”) Carbon dioxide – another indicator of kidney function, especially as it relates to the maintenance of the proper pH of the blood (balance between acidity and alkalinity in the body) – low levels are often associated with extreme stress on the body or abnormal kidney function

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What Your Lab Tests Mean Calcium – most calcium is in the bones – this test does not measure that – this is calcium in the bloodstream, important for proper function of the muscles – abnormal calcium levels are usually associated with malfunction of the parathyroid glands, or with severe illness – often calcium levels will be slightly outside normal ranges associated with either high or low total protein levels – this is because calcium is attached to proteins in the blood – in this case, calcium is probably normal Protein, total – proteins are the “building blocks” of the body and an indicator of body metabolism and general health of the liver and immune system – this number is the sum of the body’s albumin and globulin levels Albumin – protein produced by the liver – low levels are associated with liver disease Globulin – produced by the immune system (cells from the bone marrow) – there are many types of globulin that can be measured separately to determine what type of disease is going on if the globulin levels are abnormal Albumin/globulin ratio – helps to discern if there is a problem with either globulin or albumin when the total protein is abnormal Bilirubin, total – a by-product of the breakdown of hemoglobin, the red pigment that carries oxygen in red blood cells, this protein is processed by the liver and excreted in the digestive tract through the gallbladder in bile – elevated levels usually indicate a problem with the liver’s ability to process bilirubin either through increased breakdown of red cells, or, more often, liver disease such as hepatitis – greatly elevated bilirubin levels cause jaundice

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What Your Lab Tests Mean Alkaline phosphatase – an enzyme found in the cells that line the ducts of the liver and also in bone – high levels of this can be an indicator of blockage in the liver, or damage to bone (a further test can be run to tell the difference between bone or liver alk phos) AST (SGOT), ALT (SGPT) – two enzymes found within the cells of the liver – elevations of these enzymes can indicate stress on the liver (as can be caused by some medications or alcohol) or actual damage to liver cells (as in hepatitis, cirrhosis, or other liver disease) GGT – another liver enzyme frequently included in the “liver panel” – this is a most sensitive indicator of liver stress or damage (even in the past) and is often elevated in patients who have had liver disease in the past or who are presently on a medication, drinking excess alcohol, or exposed to something that is putting stress on the liver TSH (Thyroid Stimulating Hormone) – this is a hormone from the pituitary gland in the brain that tells the thyroid gland to produce thyroid hormone – thyroid hormone is essential for almost every function in the body – if the thyroid is not producing enough thyroid hormone, the pituitary will produce more TSH – therefore, high TSH is the easiest way to diagnose inadequate thyroid function

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What Your Lab Tests Mean  VITAMINS  Vitamin D – this is important for bone and tissue health as well as for protection from chronic diseases. It is made in the skin with exposure to adequate natural sunlight. Low levels are common. Vitamin B 12 – an important vitamin for brain and neurological health as well as for general energy levels. Found in greatest supplies in red meats and organ meats, low levels can cause memory, emotional, and thought-processing issues as well as loss of equilibrium.

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What Your Lab Tests Mean  CBC (COMPLETE BLOOD COUNT) WITH DIFFERENTIAL  This is a summary of the “cellular” components of the blood, white cells, red cells, and platelets White blood cell count – also called “leukocytes,” these are the cells that fight infection and protect the body by identifying and getting rid of invading organisms, viruses, dead or abnormal cells, or foreign bodies in the blood or tissues. Abnormally low levels can indicate immune system problems. High white cell count can mean the body is stressed or fighting infection. Extremely high counts can indicate severe infection or leukemia. Red blood cell count – red cells carry oxygen to the body. Reduced numbers of these cells is referred to generally as “anemia”. Anemia can be caused by irondeficiency and a host of other things. The count refers to the absolute number of red cells in a given volume of blood Hemoglobin – this refers to the amount of this oxygen-carrying molecule in a given volume of blood. Low hemoglobin usually means low iron. Iron is what makes blood red. Hematocrit – another way to measure the quantity of red blood cells, this number is the percent of red cells by volume in a given amount of blood MCV – “Mean Corpuscular Volume” – the average size of the red cells – this can be altered in many disease states, either larger or smaller depending on what the problem is MCH, MCHC – Mean Corpuscular Hemoglobin, and Mean Corpuscular Hemoglobin Concentration – measures of the amount of hemoglobin in the red cells

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What Your Lab Tests Mean RDW (Red cell Distribution of Width) – refers to percent variation in size of red cells. In times of disease or damage to red blood cells, this variation will be high, and indicates often that the body is making a lot of new cells. Platelet count – these are the cells that make blood clot. Extremely low platelet counts are associated with some bleeding problems – excessively high counts can also cause problems Neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils – these are all specialized types of white blood cells – they are expressed on the lab sheet both as an absolute count and as a percent of the total white count – minor variations of these counts from the “normal” range are common and of no concern – abnormal counts or percentages of these sub-types are usually only meaningful when the total white count is grossly abnormal and one of these types of white cells predominates.

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What Your Lab Tests Mean  HORMONE FUNCTION  TSH (Thyroid Stimulating Hormone) – this is a hormone from the pituitary gland in the brain that tells the thyroid gland to produce thyroid hormone – thyroid hormone is essential for almost every function in the body – if the thyroid is not producing enough thyroid hormone, the pituitary will produce more TSH – therefore, high TSH is the easiest way to diagnose inadequate thyroid function FSH (Follicle Stimulating Hormone) – this is a hormone from the pituitary gland in the brain that tells the ovaries (ovarian follicles) to produce the female hormone estrogen – if the ovaries are not working (as happens at menopause), the FSH levels will go very high as the pituitary tries to get the ovaries to work – therefore, a high FSH is a good laboratory indicator of ovarian failure just as a high TSH indicates low thyroid function

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What Your Lab Tests Mean  RHEUMATOID PROFILE  This panel of tests looks for evidence of inflammatory processes in the body such as certain types of arthritis, connective tissue, and auto-immune disease. Uric acid – levels of this are elevated in gout Sed Rate (Westergren) – this is a non-specific marker or indicator of inflammation Anti-streptolysin O – this is an antibody to the bacteria Streptococcus that is often present in individuals who have joint pains due to the presence of high level of this bacteria in their system Antinuclear antibodies (ANA) – these are immune proteins that the body makes – when these are at very high levels, they can be indicators of “autoimmune” diseases such as lupus, scleroderma, polymyositis, and mixed connective tissue disease – ANA levels are frequently elevated to some degree in normal patients, therefore these tests must be interpreted with caution Rheumatoid factor – this is a non-specific marker in the blood that is often, but not always, elevated in patients who have rheumatoid arthritis C-reactive protein – another non-specific inflammatory marker

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