A/G RATIO (Albumin/Globulin Ratio) the A/G ratio is the albumin value divided by the globulin value. A low ratio is found in a variety of disease states related to those of liver or kidney and to infections. A high level is not considered clinically significant.
Range: 0.8 - 2.0
ALBUMIN is the major protein found in blood. It is manufactured by the liver from the amino acids taken through the diet. Low levels of albumin occur in malnutrition, diarrhea, fever, infection, liver disease, inadequate iron intake.
Range: 3.2 - 5.0 g/dl
ALKALINE PHOSPHATASE The origin of this enzyme is primarily from the liver and bone. Elevations in the blood are usually indicative of liver or bone disease. It is used extensively as a tumor marker. Low levels are sometimes found in protein deficiency, malnutrition and a number of vitamin deficiencies.
Range: 20 - 125 U/L
BILIRUBIN is produced in the body from hemoglobin and is released when red blood cells disintegrate due to aging or damage. The liver removes the bilirubin from the blood. A small amount of bilirubin is present in the blood of normal individuals. Bilirubin is a good indication of the liver's function. 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. Decreased levels are seen in people with an inefficient liver.
Range 0 - 1.3 mg/dl
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. Increases can be caused by excessive protein intake, kidney damage, certain drugs, low fluid intake, intestinal bleeding. Decreased levels may be due to a poor diet, malabsorption, liver damage.
Range: 7 - 25 mg/dl
CO2 (Carbon Dioxide) the CO2 level is related to the respiratory exchange of carbon dioxide in the lungs. Generally when used with the other electrolytes, it is a good indicator of acidosis and alkalinity.
Range: 22-32 mEq/L
CALCIUM is the most abundant mineral in the body. The calcium level in blood is normally maintained within a narrow range, and 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 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 spasms of muscles and can be due to malfunction of the parathyroid glands, kidney disease, and vitamin D deficiency.
Range: 8.5-10.3 mEq/dl
CHOLESTEROL is a critical fatty substance necessary for the proper function of every cell in the body. Mostly synthesized in the liver, some is absorbed through the diet. In the blood, cholesterol is carried 'in 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. Elevated cholesterol has been seen in arteriosclerosis, diabetes, and hypothyroidism. Low levels are seen in depression, malnutrition, liver insufficiency, and anemia.
Range: 120 - 240 mg/dl
CHLORIDE is one of the electrolytes present in blood. Its significance relates to its maintenance of cellular integrity. Elevated levels are related to acidosis as well as too much water crossing the cell membrane. Decreased levels with decreased serum albumin may indicate water retention.
Range: 95-112 mEq/L
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. Low levels are seen in kidney or liver disease.
Range: .7 - 1.4 mg/dl
FERRITIN is an iron-containing protein found in many cells and in the circulating blood. Blood levels fairly accurately reflect the status of iron stores in the body. The higher the serum ferritin the greater the iron stores and vice versa. High ferritin levels are seen in a variety of conditions ranging from inflammation and infections to liver disease, and hemochromatosis.
GGT (Gamma-Glutamyl Transpeptidase) involved in the transport of amino acids and peptides into cells as well as glutithione metabolism, GGT 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, drug abuse.
Range: 0 - 65 U/L
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, immune compromised patients and in other uncommon conditions. High globulin is found in many types of chronic infections, liver disease, rheumatoid arthritis, and lupus.
Normal Range: 2.2 - 4.2 g/dl
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 elevated in diabetes, liver disease, pancreatitis, and diet. Low levels may be indicative of liver disease, overproduction of insulin, hypothyroidism.
Range: 60 - 115 mg/dl
HDL (High-Density Lipoprotein) HDL 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 HDL inhibits cellular uptake of LDL and serves as a carrier that removes cholesterol from the peripheral tissues and transports it back to the liver for catabolism and excretion.
Range: 35 - 135 mg/dl
HEMATOCRIT (HCT) is the measurement of the percentage of red blood cells in whole blood. Red cells make up about 45% of whole blood. If the number of red cells is low, the hematocrit decreases. It is an important determinant of anemia (decreased), if the high value is an indication of dehydration.Range 37 - 54%
HEMOGLOBIN (HGB) Hemoglobin makes up one third of the mass of each red cell. It is composed of globin a group of amino acids that form a protein and heme which contains iron atoms and the red pigment Hemoglobin carries oxygen from the lung to the tissues of the body. 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.
Range: 14 - 18%
IRON 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 hemochromitosis, liver damage, pernicious anemia and hemolytic anemia.
Range: 30 - 170 mcg/dl
LAH (Lactic Acid Dehydrogenase) Lactic acid 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).
Normal Range: 0 - 250 U/L
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, is used. It is Total Cholesterol - HDL Cholesterol - Triglycerides/5. When triglyceride levels are greater than 400, this method is not accurate.
Range: 62 - 130 mg/dl
LDH LACTATE DEHYDROGENASE 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.
LYMPHOCYTES are involved in protection of the body from viral infections such as measles, rubella, chickenpox, or infectious mononucleosis. Elevated levels may indicate an active viral infection and a depressed level may indicate an exhausted immune system or if the neutrophils are elevated an active infection.
Range: 18 - 48 %
MCHC (Mean Corpuscular Hemoglobin Concentration) This measures the average concentration of hemoglobin in red blood cells. It is valuable in evaluating therapy for anemia because Hemoglobin and Hematocrit are used, not R.B.C. in the calculation. Low MCHC means that a unit of packed R.B.C.'s contain less hemoglobin than normal and a high MCHC means that there is more hemoglobin in a unit of R.B.C.'s. Increased MCHC is seen in spherocytosis, and not seen in pernicious anemia whereas decreased levels may indicate iron deficiency, blood loss, and B6 deficiency of thalassemia.
Range: 32 - 36 %
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.Range: 27 - 33 pg
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 help in characterizing an anemia.
Range: 80 - 100 fl
MONOCYTES cells are helpful in fighting severe infections and are considered the body's second line of defense against infection and are the largest cells in the blood stream. Elevated levels are seen in tissue breakdown or chronic infections, carcinomas, leukemia (monocytic) or lymphomas. Low levels are indicative of a state of health.
Normal Range: 0 - 9 %
PHOSPHORUS, like calcium, is abundant in most tissues and cells. 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 abnormal phosphorus. . Phosphorus is needed for its buffering action, and calcium transport.
Range: 2.5 - 4.5 mEq/dl
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. 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.
Range: 3.5 - 5.5 mEq/L
PLATELETS Blood platelets are even smaller than red cells. The same small droplet of blood that contains 5 million red cells also is containing between 140,000 and 450,000 platelets. They are vital to coagulation of the blood to prevent excessive bleeding from injured l blood vessels by sticking together and forming plugs. Decreased levels may indicate an immune system failure; A variety of disease conditions can cause low numbers of platelets. Increased platelets are noted serious conditions such as diseases of the bone marrow.
Range: 130 - 400 thous
PROTEIN The protein makeup of the individual is of important diagnostic significance because of protein involvement in enzymes, hormones and antibodies as well as maintaining acid-base balance and as a source of nutrition for tissues and muscles. The major serum proteins measured are Albumin and Globulin Decreased levels may be due to poor nutrition, liver disease, malabsorption, Increased levels are seen in lupus, liver disease, chronic infections, leukemia, and in many others diseases.
Range: 6.0 -8.5 g/dl
RED BLOOD CELL COUNT (RBC) Red blood cells are the major component of your blood. They cause the red color of blood. A tine droplet the size of a pinhead, normally contains about 5 million cells! Red cells are made in the bone marrow and release into the circulating blood. Red blood cells main function is to carry oxygen to the tissues and to transfer carbon dioxide to the lungs.
Range: 4.2 - 5.6 mill/mcl
RETICULOCYTE COUNTReticulocytes are red blood cells that are only a few days old. The percentage of these "fresh" red blood cells may increase in certain blood diseases or other conditions.
SODIUM This element, present in body fluids, is the major one of the four "electrolytes." Sodium plays a key role in salt and water balance. And in transmitting nerve impulses. Low sodium values can be found in a variety of conditions such as diarrhea, kidney disease. High sodium values can occur in conditions resulting in excessive loss of water. Normal Range: 135-146 mEq/L
TRANSAMINASE SGOT (AST) Serum Glutamic Oxalocetic Transaminase or AST is an enzyme found primarily in the heart, liver and muscles. Increased levels in blood are seen shortly after a heart attack, in liver disease and diseases involving muscle damage. Range: 0 - 42 U/L
TRANSAMINASE SGPT (ALT) Serum Glutamic Pyruvic Transaminase or ALT is an enzyme 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 mononucleosis. Chemical pollutants. Normal Adult Range: 0 - 48 U/L
TRIGLYCERIDESTriglycerides 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. Triglycerides, stored in adipose tissues as glycerol, fatty acids and monoglyceroids, are reconverted as Triglycerides by the liver. The level in blood varies widely depending upon the intake of fat and rate of removal by the tissues of the body High 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. Range: 0 - 200 mg/dl
URIC ACID Uric acid is a waste product of the metabolism of the cells in our bodies. The kidney excretes uric acid, together with BUN and creatinine. 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. Numerous diseases such as gout, kidney failure, diabetes, and the use of diuretics cause increased values. Low levels may be indicative of kidney disease, malabsorption, poor diet, liver damage or an overly acid kidney.
Range: 3.5 - 7.5 mg/dl
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. Elevations of the WBC are seen in many conditions such as infections, injuries and after surgery, and in other conditions. A mild decrease in WBC frequently occurs in viral infections. WBC transport and distribute, antibodies in the immune response. Range: 3.8 - 10.8 thous/mcl
PLASMA THROMBIN TIME (THROMBIN CLOTTING TIME) Detects fibrinogen deficiency or defect. Helps confirm diagnosis of liver disease. Normal values: Thrombin times range from 10 to 15 seconds.
PLASMA AMMONIAPurpose of the test: Evaluates liver function. Helps monitor progression of severe liver disease and treatment effectiveness. Diagnoses possibility of impending or established liver failure. If plasma-ammonia levels are high, be aware of any signs indicating an impending or established hepatic coma.
TOTAL PROTEIN TEST Protein, total (TP), plasma or serum. Normal Range: 6-8 g/dL SI Range: 60-80 g/L Blood tube color: Marbled. Specfics of collection: Avoid prolonged venous stasis during collection. Physiologic Basis: The plasma protein concentration is determined by the nutritional state, hepatic function, renal function, and various disease states and hydration. The plasma protein concentration determines colloidal osmotic pressure. Increased in: Polyclonal or monoclonal gammopathies, marked dehydration. Drugs: anabolic steroids, androgens, corticosteroids, epinephrine. Decreased in: Protein-losing gastroenteropathies, acute burns, nephrotic syndrome, severe dietary protein deficiency, chronic liver disease, malabsorption syndrome, agammaglobulinemia. Comments: The serum total protein consists primarily of albumin and globulin. Hypoproteinemia usually means hypoalbuminemia, since albumin is the major serum protein. Globulin is calculated as total protein minus albumin.
Blood tests for the presence of HCV
ELISA Enzyme Linked Immunosorbent Assay. The ELISA test for hepatitis C searches the blood sample for certain biochemical sequences that correspond with the presence of antibodies to HCV. Antibodies do not show viral presence only a past exposure to HCV. There are a fair amount of false positives and negatives with this test and antibodies usually are not formed for six months from the time of exposure. This test is inexpensive and is used as the initial screening for HCV. This test is continually being improved.
RIBA (Recombinant Immunoblot Assay). The RIBA test was developed for use in hepatitis C because of the unreliability of ELISA. This test searches for two different sets of patterns that corresponds to HCV antibodies and a test for the presence of a controlled substance. Pathologists have to visually assess the positivity of the result by comparison to controls. This test is highly accurate but not 100%. It is more expensive than an ELISA, therefore it is used as confirmation tool. This test is continually being improved.
HCV-RNA BY PCR (Polymerase Chain Reaction). It is the most sensitive test available. This tests assess the presence or absence of the hepatitis C- virus itself in the blood, and other body tissue. It can detect minute traces of the HCV in any given medium; it works by taking a sample of the blood and amplifying the nucleic acid associated with the virus many millions of times. This is the chain reaction effectively a copying process. It brings the nucleic: acid up to detectable levels. The amplification effect is consistent, enabling to assess how much of the original virus is present in the sample.
This test does not rely on the forming of antibodies and may be able to detect the virus after only three days of infection.
It tends to be more sensitive to some strains or genotypes of HCV than others. This is because the nucleic acid it searches for is a closer fit in some genotypes than others; thus viral load comparisons between patients with differing genotypes may not be reliable.
There is also a problem related to the fact that HCV levels tend to fluctuate. Therefore the result may differ from time to time and be effected by anti-viral therapy in an unpredictable way.
Results are given on a logarithmic scale, which is often according to the protocols of the labs concerned. Reading and comparing the different test results are confusing.
Being PCR negative does not necessarily mean that HCV has disappeared completely; it may still be at undetectable levels in the blood, it may still be present in liver cells and in certain white blood cells. These can also be tested, although such extensive screening is rarely carried out. When it is, however, it seems that some patients judged to be clear of HCV by blood test alone actually still have traces of the virus in white blood cells.
Although PCR has these limitations it is probably the most useful single test and can be used to assess HCV.
B-DNA for HCV. B-DNA tests for the presence of the virus in the blood, but is less sensitive than the PCR test. It generates an estimate of viral loads above a certain level - PCR can detect as few or less than 1000 genomes, while B-DNA only picks up levels over 350,000. It is often used as a quick test to assess infectivity and viral load. A negative b-DNA test does not mean that you don't have HCV in your blood. Results of these tests may have caused confusion in some patients. You can be bDNA negative and PCR positive. Some clinicians use the test to assess patients suitability for interferon treatment - they assume that patients who are b-DNA negative stand a good chance of responding. This test is constantly being improved and perfected.
GENOTYPE TESTS assess which strain or strains of the virus are present. They are more difficult to assess and, are expensive and are routinely withheld. The usefulness of the test is related to the bearing of genotype on prognosis and responsiveness to treatment. This is debatable, because the importance of this test is still unclear and unknown.
Courtesy of The Hepatitis C Foundation
All contents © 1998 The Hepatitis C Foundation
Email: hepc@hepcfoundation.org
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