Good Lab Levels for us?
I just posted a bunch of references on the B12 thing over on the B12 question.
If you email me privately at [email protected] I can send you MY list.
The ranges change over time and vary from lab to lab. Some have stayed steady most of my post-op life, for example, iron at appx 35-170, so when I target 80-90, it's based on that steady level. (I'm at 97, so WOOHOO!)
Vit D was only discovered in the 20's and only measured since the 70's, so that whole thing is still newish. Levels were 20-57, and still are insome labs. Newer levels are 32-100 (like at my lab), so I shoot for 70-100 (got 98). Bt studies I've read even more recently are showing toxic at 500, so I'm not worried about potentially topping over 100 any more, but I'm also not trying to go over.
One thing to remember, tho, is that this is ALL I do. As in read, study, take classes and all that, so I'm probably more likely to run into this stuff than the average person. And I only retain what pertains to malabsorption, not much on normies.
Today was reading all kinds of cool stuff on surgical procedures. This works, this doesn't, these kinds of problems here, pros and cons there. But I won't retain it for long, cuz, well, I'm not asking and I don't think anyone will be inviting me to perform any surgeries any time soon! LOL I feel honored to have watched a handful.
Michelle
RNY, distal, 10/5/94
P.S. My year + long absence has NOTHING to do with my WLS, or my type of WLS. See my profile.
BLOOD TESTS In a CBC, various types of hematic (blood) cells are analyzed, using six different tests on whole blood:
Red blood cell count (RBC) RBC's are counted with a machine that gives you an actual number, usually in the millions per uL (uL is a millionth of a liter). For adult males this would be 4.7 to 6.1 million/uL, and for adult females 4.2 to 5.4 million red cells per microliter (uL) of blood.
Hematocrit: a percent of the red blood cells in the serum and usually ranges between 40% - 54% in males and 37% - 47% in females. A low hematocrit may indicate various types of anemia, blood loss, bone marrow failure, hemolysis related to transfusion reaction, leukemia. malnutrition or specific nutritional deficiency, over hydration, and rheumatoid arthritis. High hematocrit may indicate dehydration, burns, diarrhea, eclampsia, erythrocytosis, polycythemia vera, and shock.
White blood cell count (WBC) The total number of WBC's are noted, giving the doctor an overall indication if a problem might exist and is closely tied to the immune system. A high WBC is termed leukocytosis. Inflammation, infection, leukemia, or other cancers can cause an elevated WBC count. A low WBC count is called leucopenia. A virus, an immunosuppressive disease, or a problem with the bone marrow can cause it.
The white blood cell count is done by counting the number of white blood cells in a sample of blood. A normal WBC is in the range of 4.8 to 10.8 thousand cells per microliter (uL) of blood.
Differential blood count (Diff) After the total WBC is determined, the WBC's are broken down into their different types. This is called a differential blood count or Diff.
There are five different types of white blood cells: Neutrophils; Lymphocytes; Monocytes; Eosinophils; Basophils These different types all have unique functions in the normal processes of the body. Changes in the amounts of these different types, whether or not the WBC count is normal, high, or low, also gives the doctor important information.
A high neutrophil count can indicate infection, certain types of cancer, arthritis, or physical stress to the body, such as surgery, trauma or a heart attack. Low lymphocyte count can be a symptom of AIDS. High monocyte count can indicate infection, often by bacteria. High eosinophil count can indicate allergies, certain skin diseases, or parasitic infection. Immature white blood cells of any type can indicate bacterial infection or leukemia.
Platelet count may also be performed if a patient is about to undergo surgery. In addition to the red and white blood cells the blood also contains platelets. Platelets are the cell fragments essential for the process of blood clotting. A normal platelet count is 150 to 450 thousand platelets per microliter of blood. A low platelet count is called thrombocytopenia, which may occur as a result of cancer treatment, certain leukemias, certain other types of cancer, or immune thrombocytopenic purpura. Immune thrombocytopenic purpura is a disorder of the blood in which platelet counts are abnormally low.
Normal
The Chemistry Panel A typical blood chemistry panel might include the following tests:
General Metabolism |
Kidney Function |
Electrolytes |
Liver Function |
Thyroid |
Pancreas |
GLU (Glucose) LDH (Lactate dehydrogenase) CPK (Creatine phosphokinase) |
BUN (Blood Urea Nitrogen) CREAT (Creatinine) |
Na (Sodium) K (Potassium) Cl (Chloride) CA (Calcium) PHOS (Phosphorus) |
ALP (Alkaline phosphatase) ALT (Alanyl amino transferase) ALB (Albumin) GGT (Gamma-glutamyl transpeptidase) SGPT (Serum glutamate pyruvate transaminase) TP (Total Protein) CHOL (Cholesterol) GLOB (Globulin) TBILI (Total Bilirubin) |
T3 (Triiodothyronine) T4 (Thyroxine) |
AMY (Amylase) LIP (Lipase) |
In preparing patients for an operation the following blood test determine whether
the patient is fit to stand the effects of general anesthesia and surgery:
Electrolytes
SODIUM Sodium is the most abundant cation in the blood and its chief base. It functions in the body to maintain osmotic pressure, acid-base balance, and to transmit nerve impulses.
Panels: Electrolyte
POTASSIUM
Potassium is the major intracellular cation in the blood.It, along with sodium, helps to maintain osmotic balance and is also involved in acid-base balance. It is needed forproper nerve and muscle action.
Normal
Panels: Electrolyte
Panels: Electrolyte
CO2 (Carbon Dioxide)
The CO2 level is related to the respiratory exchange of carbon dioxide in the lungs and is part of the body's buffering system. Generally when used with the other electrolytes, it is a good indicator of acidity and alkalinity.
Panels: Electrolyte
CALCIUM
The most abundant mineral in the body, it is involved in bone metabolism, protein absorption, fat transfer muscular contraction, transmission of nerve impulses, blood clotting, and cardiac function. It is highly sensitive to elements such as magnesium, iron, and phosphorus as well as hormonal activity, vitamin D levels, alkalinity and acidity, and many drugs.
Panels: Electrolyte, Kidney Function
PHOSPHORUS
Phosphorus is an abundant element found in most tissues and cells. It is closely related to the calcium level with an inverse relationship. When calcium is increased, phosphorus tends to decrease and vice versa. Careful following of blood draw procedures are necessary because improper handling may cause falsely elevated values. Phosphorus is needed for its buffering action, calcium transport, and osmotic pressure.
Panels: Electrolyte, Kidney Function
Liver Enzymes
ALKALINE PHOSPHATASE
Produced in the cells of the bone and liver with some activity in the kidney, intestine, and placenta. Used extensively as a tumor marker it is also present in bone injury, pregnancy, or skeletal growth (elevated values). Growing children have normally higher levels of this enzyme also. Low levels are sometimes found in hypoadrenia, protein deficiency, malnutrition, and a number of vitamin deficiencies.
Normal
Adult
Range : 20 - 125 IU/L
Optimal Adult Value: 72.5 IU/L
Normal
Child
Range : 40 - 400 IU/L
Optimal Child Value: 220 IU/L
ALT (ALT Alanine Aminotransferase - sGPT)
ALT (Alanine Aminotransferase) or sGPT (serum Glutamic Pyruvic Transaminase) is an enzyme found primarily in the liver but also to a lesser degree, in the heart and other tissues. It is useful in diagnosing liver function more so than sGOT levels. Decreased sGPT in combination with increased cholesterol levels is seen in cases of a congested liver. Increased levels are also seen in mononucleosis, alcoholism, liver damage, kidney infection, chemical pollutants, or myocardial infarction.
Panels: Liver Function
AST (Aspartate Aminotransferase - sGOT)
AST (Aspartate Aminotransferase) or sGOT (serum Glutamic-Oxaloacetic Transaminase) is an enzyme found primarily in the liver, heart, kidney, pancreas, and muscles. Seen in tissue damage, especially heart and liver, this enzyme is normally elevated. Vitamin B deficiency and pregnancy are two instances where the enzyme may be decreased.
Normal
Panels: Cardiac Marker, Liver Function
Panels: Liver Function
GGT (Gamma-Glutamyltransferase or Gamma-Glutamyl Transpeptidase)
Believed to be involved in the transport of amino acids and peptides into cells as well as glutathione metabolism, Gamma-Glutamyl Transferase is mainly found in liver cells and as such is extremely sensitive to alcohol use. Elevated levels may be found in liver disease, alcoholism, bile-duct obstruction, cholangitis, drug abuse, and in some cases excessive magnesium ingestion. Decreased levels can be found in hypothyroidism, hypothalamic malfunction, and low levels of magnesium.
Normal
Panels: Liver Function
LD (Lactic Dehydrogenase - LDH)
Lactic dehydrogenase is an intracellular enzyme from particularly in the kidney, heart, skeletal muscle, brain, liver, and lungs. Increases are usually found in cellular death and/or leakage from the cell or, in some cases, it can be useful in confirming myocardial or pulmonary infarction (only in relation to other tests). Decreased levels of the enzyme may be seen in cases of malnutrition, hypoglycemia, adrenal exhaustion, or low tissue or organ activity.
Panels: Cardiac Marker, Kidney Function, Liver Function
BILIRUBIN, TOTAL
A byproduct of the breakdown of hemoglobin from red blood cells in the liver, bilirubin is a good indication of the liver's function. Excreted into the bile, bilirubin gives the bile its pigmentation. Elevated in liver disease, mononucleosis, hemolytic anemia, low levels of exposure to the sun, and toxic effects to some drugs, decreased levels are seen in people with an inefficient liver, excessive fat digestion, and possibly a diet low in nitrogen bearing foods.
Panels: Liver Function
Nitrogen Elements
B.U.N. (Blood Urea Nitrogen)
The nitrogen component of urea, B.U.N. is the end product of protein metabolism and its concentration is influenced by the rate of excretion. Increases can be caused by excessive protein intake, kidney damage, certain drugs, low fluid intake, intestinal bleeding, exercise, or heart failure. Decreased levels may be due to a poor diet, malabsorption, liver damage, or low nitrogen intake.
Panels: Kidney Function, Nitrogen
CREATININE
Creatinine is the waste product of muscle metabolism. Its level is a reflection of the body's muscle mass. Low levels are sometimes seen in kidney damage, protein starvation, liver disease, or pregnancy. Elevated levels are sometimes seen in kidney disease due to the kidneys job of excreting creatinine, muscle degeneration, and some drugs involved in impairment of kidney function.
Panels: Kidney Function, Nitrogen
URIC ACID
Uric acid is the end product of purine metabolism and is normally excreted through the urine. High levels are noted in gout, infections, kidney disease, alcoholism, high protein diets, and with toxemia in pregnancy. Low levels may be indicative of malabsorption, a diet low in purines, liver damage, or an overly acid kidney.
Panels: Kidney Function, Nitrogen
Protein
PROTEIN, TOTAL
Proteins are the most abundant compound in serum. The protein makeup of the individual is of important diagnostic significance because of protein's involvement in enzymes, hormones, and antibodies as well as osmotic pressure balance, maintaining acid-base balance, and as a reserve source of nutrition for the body's tissues and muscles. The major serum proteins measured are Albumin and Globulin (alpha1, alpha2, beta, and gamma). Decreased levels may be due to poor nutrition, liver disease, malabsorption, diarrhea, or severe burns. Increased levels are seen in lupus, liver disease, chronic infections, alcoholism, leukemia, tuberculosis amongst many others. Careful review of the individuals albumin, globulin, and A/G ratio are recommended.
Panels: Kidney Function, Liver Function, Protein
ALBUMIN
Albumin is the major constituent of serum protein (usually over 50%). It is manufactured by the liver from the amino acids taken from the diet. It helps in osmotic pressure regulation, nutrient transport, and waste removal. High levels are rarely seen and are primarily due to dehydration. Low levels are seen in poor diets, diarrhea, fever, infection, liver disease, inadequate iron intake, third-degree burns and edemas, and hypocalcemia.
Panels: Kidney Function, Liver Function, Protein
Panels: Kidney Function, Liver Function, Protein
GLOBULIN
Globulin, a larger protein than albumin, is important for its immunologic responses, especially its gamma component (IgA, IgG, IgM, and IgE). Globulins have many diverse functions such as, the carrier of some hormones, lipids, metals, and antibodies. When chronic infections, liver disease, rheumatoid arthritis, myelomas, and lupus are present, elevated levels are seen. Lower levels may be found in immune compromised patients, poor dietary habits, malabsorption, and liver or kidney disease.
Panels: Kidney Function, Liver Function, Protein
A/G RATIO (Albumin/Globulin Ratio)
A/G ratio is an important indicator of disease states although a high level is not considered clinically significant.
Panels: Kidney Function, Liver Function, Protein
Lipids
CHOLESTEROL
Cholesterol is a critical fat that is a structural component of cell membrane and plasma lipoproteins, and is important in the synthesis of steroid hormones, glucocorticoids, and bile acids. Mostly synthesized in the liver, some is absorbed through the diet, especially one high in saturated fats. High density lipoproteins (HDL) is desired as opposed to the low density lipoproteins (LDL), two types of cholesterol. Elevated cholesterol has been seen in artherosclerosis, diabetes, hypothyroidism, and pregnancy. Low levels are seen in depression, malnutrition, liver insufficiency, malignancies, anemia, and infection.
Panels: Cardiac Marker, Kidney Function, Lipids, Liver Function
TRIGLYCERIDES
Triglycerides, stored in adipose tissues as glycerol, fatty acids, and monoglycerides, are reconverted as triglycerides by the liver. Ninety percent of the dietary intake and 95% of the fat stored in tissues are triglycerides. Increased levels may be present in artherosclerosis, hypothyroidism, liver disease, pancreatitis, myocardial infarction, metabolic disorders, toxemia, and nephrotic syndrome. Decreased levels may be present in chronic obstructive pulmonary disease, brain infarction, hyperthyroidism, malnutrition, and malabsorption.
Panels: Cardiac Marker, Lipids
LDL (Low Density Lipoprotein)
LDL is the cholesterol rich remnants of the lipid transport vehicle VLDL (very-low density lipoproteins) there have been many studies to correlate the association between high levels of LDL and arterial artherosclerosis. Due to the expense of direct measurement of LDL a calculation, known as the Friedewald formula is used. It is Total Cholesterol - HDL Cholesterol - (Triglycerides/5). When triglyceride levels are greater than 400 mg/dL, this calculation is not accurate.
Panels: Cardiac Marker, Lipids
HDL (High Density Lipoprotein)
HDL or High-density lipoprotein is the cholesterol carried by the alpha lipoproteins. A high level of HDL is an indication of a healthy metabolic system if there is no sign of liver disease or intoxication. The two mechanisms that explain how HDL offers protection against chronic heart disease are that 1. HDL inhibits cellular uptake of LDL and 2. serves as a carrier that removes cholesterol from the peripheral tissues and transports it back to the liver for catabolism and excretion.
Normal
Panels: Cardiac Marker, Lipids
CHOLESTEROL/LDL RATIO
The ratio of total cholesterol and LDL (low density lipoprotein). Normal
Panels: Cardiac Marker, Ratios
Ratios
ANION GAP (Sodium + Potassium - CO2 - Chloride)
The anion gap is used to measure the concentration of cations (sodium and potassium) and the anions (chloride and CO2) in the extracellular fluid of the blood. There are numerous clinical implications that can be gathered from the Anion Gap. An increased measurement is associated with metabolic acidosis due to the overproduction of acids (a state of alkalinity is in effect). Decreased levels may indicate metabolic alkalosis due to the overproduction of alkaloids (a state of acidosis is in effect).
Panels: Ratios
A high value in this calculation is normally indicative of too much B.U.N. being formed and a low value may show that the B.U.N. is low or that the creatinine is not being cleared effectively by the kidney. This calculation is a good measurement of kidney and liver function.
Panels: Nitrogen, Ratios
CALCIUM/PHOSPHORUS
Due to the delicate balance between calcium and phosphorus in the system, this calculation is helpful in noting subtle and acute imbalances in the relationship between the two elements.
Panels: Ratios
SODIUM/POTASSIUM
As the two major blood electrolytes, sodium as the extracellular cation and potassium as the intracellular cation, this is an important ratio to review and act upon when subtle or acute imbalances are noted.
Panels: Ratios
Thyroid
THYROXINE (T4)
Thyroxine is the thyroid hormone that contains four atoms of iodine. It is used to evaluate thyroid function. It is the direct measurement of total T4 concentration in the bloodserum. Increased levels are found in hyperthyroidism, acute thyroiditis, and hepatitis. Low levels can be found in Cretinism, hypothyroidism, cirrhosis, malnutrition, and chronic thyroiditis.
Panels: Thyroid
T-UPTAKE (T3-Uptake)
This test is an indirect measurement of unsaturated thyroxine binding globulin in the blood. Increased levels are found in hyperthyroidism, severe liver disease, metastatic malignancy, and pulmonary insufficiency. Decreased levels are found in hypothyroidism, normal pregnancy, and hyperestrogenis status.
Panels: Thyroid
FREE T4 INDEX (T7)
This index is a calculation used to correct the estimated total thyroxine for the amount of thyroxine binding globulin present. It uses the T4 value and the T-uptake ratio.
Panels: Thyroid
THYROID STIMULATING HORMONE (TSH)
TSH, produced by the anterior pituitary gland, causes the release and distribution of stored thyroid hormones. When T4 and T3 are too high, TSH secretion decreases, when T4 and T3 are low, TSH secretion increases.
Panels: Thyroid
Other
GLUCOSE (Fasting)
Glucose, formed by the digestion of carbohydrates and the conversion of glycogen by the liver, is the primary source of energy for most cells. It is regulated by insulin, glucagon, thyroid hormone, liver enzymes, and adrenal hormones. It is elevated in diabetes, liver disease, obesity, pancreatitis, due to steroid medications, or during stress. Low levels may be indicative of liver disease, overproduction of insulin, hypothyroidism, or alcoholism.
IRON, TOTAL
Iron is necessary for the formation of some proteins, hemoglobin, myoglobin, and cytochrome. Also, it is necessary for oxygen transport, cellular respiration, and peroxide deactivation. Low levels are seen in many anemias, copper deficiencies, low vitamin C intake, liver disease, chronic infections, high calcium intake, and women with heavy menstrual flows. High levels are seen in hemochromatosis, liver damage, pernicious anemia, and hemolytic anemia.
IS
FABULOUS!
It doesn't include them all, but ithas something I've never seen before and that is OPTIMAL LEVELS.
There's "WNL", within normal limits, so you can be shooting up over the top or hanging on the bottom rung and feel, bu as long as you're WNL, you're "fine". And your labs are "fine".
But you might not FEEL "fine" and in fact, there ARE optimal levels for most of us. We can't control them all, but some of them CAN be brought to "optimal" levels.
And of course, what is optimal changes periodically, esp, as I mention so often, vitamin D.
May I copy this and to whom do I give credit?
Michelle
RNY, distal, 10/5/94
P.S. My year + long absence has NOTHING to do with my WLS, or my type of WLS. See my profile.