• A/G Ratio : The A/G ratio is the albumin (A) value divided by the globulin (G) value. A low ratio is found in a variety of disease states related to those of liver or kidney and to infections and inflammations.

• Albumin : Albumin is the major protein found in blood making up over 60% of the total protein. Low levels of albumin occur in malnutrition, chronic inflammation and severe acute disease and may also manifest with aging. Dehydration caused by exercise or fluid loss can cause increased serum albumin levels.

• Alkaline Phosphatase : The origin of this enzyme in the blood of normal adults is primarily from the liver and bone with a small amount from the intestine. Elevations in the blood are usually indicative of liver or bone disease. Children, because of the activity of bone growth, and pregnant women (third trimester) have significantly higher normal values.

• Bilirubin : Bilirubin is a yellow colored substance that is produced in the body from hemoglobin and is released when red blood cells disintegrate due to normal aging or damage. The liver removes the bilirubin from the blood to be excreted in the bile. A small amount of bilirubin is present in the blood of normal individuals. Increases in bilirubin are usually due to liver disease, inflammation (hepatitis), liver failure, obstruction of the bile duct, or excessive destruction of red blood cells.

• Blood Urea Nitrogen (BUN) : This waste product from protein metabolism is formed in the liver and excreted by the kidneys. High BUN values could mean that the kidneys are not working as well as they should. Low BUN values are less frequent. They could be due to low protein intake, pregnancy, or severe liver failure.

• BUN/Creatinine Ratio : This number is obtained by dividing the BUN result by the creatinine result. It has little significance when the BUN is normal but can help to determine the cause of high BUN levels.

• Calcium : Calcium is the most abundant mineral in the body with about 98% found in the skeleton. The calcium level in the blood is normally maintained within a narrow range of about 8.5 to 10.8 mg/dL which is critical for many basic processes such as function of the nervous system and muscles, blood clotting and many others necessary for life. Excessive secretion of parathyroid hormone (PTH) is one cause of high blood calcium levels. Other possible causes for elevated calcium are bone disease and excess dietary intake of calcium rich foods (milk) or medicines (antacids). Low blood levels of calcium may lead to tetany (spasms of muscles) and can be due to malfunction of the parathyroid glands, kidney disease, vitamin D deficiency and malabsorption caused by disease of the intestine. Either too high or too low a blood level of calcium can be serious and your doctor will know best how to manage them.

• Cholesterol : Cholesterol is a fatty substance necessary for the proper function of every cell in the body. In the blood, cholesterol is carried in tiny packets encased by various proteins of which the major forms are the HDL and the LDL. High levels of total cholesterol are associated with an increased risk of heart disease caused by thickening of the walls of the coronary arteries. High cholesterol levels can be reduced by nutritional supplements, altering the composition of your diet and by certain medications when diet modifications alone are not sufficient.

• HDL Cholesterol : This "good" cholesterol is thought to counteract the effects of LDL cholesterol. The higher the HDL cholesterol the better. High levels of HDL cholesterol are associated with lower risk of developing heart disease. Low levels of HDL are associated with higher risks for heart disease. There are measures that can be taken to increase HDL cholesterol, such as regular exercise and losing weight when being overweight. Your doctor will use the total cholesterol, HDL and LDL cholesterol values to determine what, if any, measures need to be taken to minimize your risk of heart disease.

• Cholesterol/HDL Ratio : This ratio is obtained by dividing the cholesterol result by the HDL result. The higher this number, the greater the risk of developing coronary heart disease (CHD). Conversely, the lower the ratio the lower the risk of developing CHD.

• LDL Cholesterol : LDL cholesterol ("bad cholesterol") is the fraction of your cholesterol tht is implicated in the deposits that thickens the walls of blood vessels. LDL cholesterol values less than 130 mg/dL are desirable. Values higher than 160 are associated with a higher risk for heart disease.

• Chloride : Chloride is one of the electrolytes present in blood. The normal concentration is maintained in a narrow range. Your doctor interprets the significance of low or elevated values, in relation to the other electrolytes.

• Creatinine : Creatinine is a waste product of muscle metabolism. The blood level is determined by your muscle mass and by the efficiency of the kidneys to excrete creatinine. High values, especially together with a high BUN, usually mean kidney disease.

• Globulin : This is the name of a group of proteins, which comprise the remainder of the total protein not present as albumin. It is determined by subtracting albumin from total protein. Low globulin values are found in certain kidney problems, in hematological disorders, diseases of the intestine and in other special uncommon conditions. High globulin is found in many types of inflammation, certain infections and in chronic liver disease.

• Glucose : In healthy people the blood level of glucose fluctuates in response to food intake and fasting within the fairly narrow range of about 65 to 140 mg/dL. It is therefore important to know whether you had eaten before your blood was drawn or whether you were fasting for at least 8-12 hours. The main uses of glucose testing are in the diagnosis of diabetes mellitus and in the monitoring of treatment and compliance for this condition. If blood glucose levels fall below the lower normal limit, the patient may experience symptoms such as weakness, dizziness, fainting and collapse. This condition is called hypoglycemia. It may occur in diabetic patients whose food intake and insulin dosage are not properly balanced and often in otherwise healthy persons.

• Iron : Iron is a critical part of the hemoglobin molecule found in red blood cells. When the body iron is low, the person may eventually suffer from decreased hemoglobin. This is called iron deficiency anemia. Excess iron can be stored in the liver and in other body organs. A rare, but clinically important, disease of excess iron storage is called hemochromatosis. Thus, decreased iron in the blood or increased iron in the blood may be a signal to your doctor for further diagnostic studies.

• Lactate Dehydrogenase (LDH) : LDH is an enzyme present in almost all tissues of the body. Any damaged tissue may leak LDH into the blood and increases above normal will be observed. These tissues include heart, liver, muscle, kidney, bone marrow and a variety of tumors. Slight elevations, when other enzymes are normal, are usually of no clinical significance. Strenuous exercise including jogging long distances may result in mild increases in blood LDH.

• Phosphorus : Phosphorus, like calcium, is abundant throughout the body with about 85% in the bones. The level in blood varies over a somewhat wide range as food intake can significantly alter blood levels. There are many possible causes for low or high values. The relationship to calcium levels must be considered in determining the significance of an abnormal phosphorus level.

• Potassium : The potassium level inside the cells of the body is about 25 times higher than the level in blood. The maintenance of this balance is important for many life functions. Low blood values can occur after prolonged vomiting and diarrhea, in renal disease and in individuals taking diuretics. Elevated blood potassium levels may indicate renal disease. Both low and high values are of clinical significance since potassium is important in the functioning of the neuromuscular system and especially the muscles of the heart.

• Sodium : This element, present in body fluids, is the major one of the four "electrolytes" along with potassium, chloride and bicarbonate. Sodium plays a key role in salt and water balance. Low sodium values can be found in a variety of conditions that cause more loss of sodium than water. Some of these conditions are diarrhea, kidney disease and medication with diuretics. High sodium values can occur in conditions resulting in excessive loss of water, e.g. profuse sweating. Your doctor may also evaluate blood sodium levels as they relate to the other electrolytes.

• Total Proteins : The plasma proteins serve a number of important functions including maintenance of normal blood volume and water content in the tissues, and maintaining normal acid-base balance in the blood. Values below or above the normal range need further investigation by your doctor to determine which specific proteins are involved.

• Transaminase SGOT (AST) : This enzyme has its highest concentrations in heart, liver and muscles. Increased levels in blood are seen shortly after a heart attack, in liver disease and diseases involving muscle damage.

• Transaminase SGPT (ALT) : This enzyme is present in higher concentration in liver than in muscle. Consequently an elevation is more specific for liver disease. Both SGOT and SGPT become elevated whenever liver cells are damaged as, for instance, in viral hepatitis.

• Triglycerides : Triglycerides are the major form of fat found in nature and are the storage form of fat in the body. Their primary function is to provide energy. The level in blood varies widely depending upon the intake of fat and rate of removal by the tissues of the body. Therefore it is very important to fast for 12-14 hours to obtain a meaningful measure of the triglyceride concentration in the blood. High fasting triglyceride levels are associated with higher risk for coronary heart disease.

• Uric Acid : Uric acid is a very important antioxidant. It is actually a waste product of the metabolism of the cells in our bodies. Uric acid is a very important antioxidant in mammalians, and, together with BUN and creatinine, is excreted by the kidney. Certain foods such as meat (especially organ meats) may raise uric acid blood levels. Elevated levels of uric acid in blood are much more common than are decreased levels. Increased values are caused by numerous diseases such as gout, kidney failure, diabetes, and the use of diuretics. Low levels of uric acid may indicate a certain nutritional deficiency that should be corrected.

• Test Includes: Differential count; hematocrit; hemoglobin; mean corpuscular volume (MCV); mean corpuscular hemoglobin (MCH); mean corpuscular hemoglobin concentration (MCHC); percentage and absolute counts; platelet count; red cell count; white blood cell count and all tests listed below.

• Use : Evaluate anemia, leukemia, reaction to inflammation and infections, peripheral blood cellular characteristics, state of hydration and dehydration, polycythemia, hemolytic disease of the newborn, inherited disorders of red cells, white cells, and platelets; manage chemotherapy decisions; determine qualitative and quantitative variations in white cell numbers and morphology, morphology of red cells and platelet evaluation.

Complete Blood Count (CBC)

• In the following a brief explanation is given of the nine different tests that make up a complete blood count.
• Differential White Blood Cell Count ( "Differential ") : There are five major types of white blood cells: neutrophils, lymphocytes, monocytes, eosinophils and basophils. The "differential count" gives the percentages of these five cell types. Increases or decreases of these individual percentages are characteristic for certain medical conditions. The determination of these percentages helps your doctor to arrive at a specific diagnosis.

• Hematocrit (HCT) : Red blood cells make up about 45% of the volume of whole blood. This percentage is called the hematocrit. If the number of red cells is low the hematocrit decreases. Men have somewhat higher hematocrits than do women. Low hematocrit indicates anemia.

• Hemoglobin (HGB) : Hemoglobin makes up one third of the mass of each red cell. Hemoglobin carries oxygen from the lung to the tissues of the body. Since men tend to have more red cells than do women, men also have higher hemoglobin levels. Hemoglobin contains iron. A lack of iron due to poor diet or chronic blood loss often causes anemia. In anemia less hemoglobin is available to carry oxygen to the tissues which may result in weakness and tiredness.

• Mean Corpuscular Hemoglobin Concentration (MCHC) : As stated earlier hemoglobin makes up about one third of the mass of a red cell, ranging normally from 31 to 36%. When not enough hemoglobin is produced, as for instance in iron deficiency anemia, MCHC values may fall below 25%.

• Mean Corpuscular Hemoglobin (MCH) : The weight of hemoglobin in a tiny red blood cell can be calculated. This calculation is the mean corpuscular hemoglobin (MCH). Certain conclusions are drawn from normal, low or high values in the diagnosis of anemia.

• Mean Corpuscular Volume (MCV) : Red blood cells are tiny, round disks of a certain average size. The volume of these disk-like corpuscles can be measured. In some types of anemia the MCV is abnormally small and in others abnormally large. MCV is therefore helpful in characterizing an anemia.

• Platelets : Blood platelets are even smaller than red cells. The same small droplet of blood that contains 5 million red cells also contains between 140,000 and 450,000 platelets. Their function is to stop bleeding from injured small blood vessels as in cuts or abrasions by sticking together and forming plugs. A variety of disease conditions can cause low numbers of platelets. Such patients may bleed more easily and excessively. Higher than normal platelet counts occur in pregnancy or after strenuous exercise. Increased platelets are noted in more serious conditions such as diseases of the bone marrow. Platelets do contribute to coronary heart disease and blood clot formation.

• Red Blood Cell Count (RBC) : Red blood cells are the major component of your blood. They cause the red color of blood. One cubic millimeter, a tiny droplet the size of a pinhead, normally contains about 5 million cells! Men generally have more red cells than do women. Red cells are made in the bone marrow and released into the circulating blood. If the number of red cells drops below the lower normal limit, the condition is called anemia. There are many causes of anemia. Rarely, some persons may have too many red cells in their blood, creating a condition called polycythemia. Both conditions can be treated successfully in most cases.

• White Blood Cell Count (WBC) : Blood contains a variety of white blood cells. They normally number between 4,000 and 11,000 per cubic millimeter. Their main function is defense against infections and purging of areas of injuries and inflammation. Pus consists mainly of huge numbers of white blood cells. Elevations of the WBC are seen in many conditions such as infections, injuries, after surgery, and in other conditions. A mild decrease in WBC frequently occurs in viral infections. Your doctor will advise you of the significance of any abnormality of white blood cell counts.