Tag Archives: Hemoglobin

Opinion: Your Laboratory Tests And What They Mean

A lot of people can read the annual report of the financial health of a company. I could make a good argument that you should also be able to read your laboratory reports which report on the health of your body, just as important to you, or more so, than the health of your investments.

There are more and more laboratory tests to help doctors with your diagnosis. These laboratory tests automatically flag results that are outside the “normal range” of healthy people. There’s also a profusion of information on the Internet available these days, some of which discuss specific abnormalities of these laboratory results. People move and change doctors a lot, and the information transfer from one Dr. to another may be imperfect. For these reasons it would seem reasonable for all people except for the most confirmed technophobes to keep track of their laboratory tests.

Ask for duplicates from the doctor, and keep them in a special  3-ring binder. A side benefit of doing this is to let the doctor know that you are an Informed consumer. She may well take more time with you.

I will go over the different common laboratory tables and discuss things that you should look for, starting with the hemogram, or blood count.

  • White blood cell count— White blood cells have diverse function, usually fighting infection. The total count is often elevated with bacterial  infection and diminished with viral infection. Out of range values are flagged.
  • Red blood cell count- Red blood cells carry oxygen to your tissues, and are diminished in anemia.
  • Hemoglobin and hematocrit- The hemoglobin is the vital oxygen carrying protein. The hematocrit measures the volume of the packed red  cells. Both measure the same thing as the red cell count, but in a different way.

Comment: about a half dozen years ago, I became more and more short of breath when walking my usual exercise routine. Eventually, I could only walk about a third of the distance, and ordered some lab work. I came back very anemic, with a hemoglobin of 8.5, far below the normal range.

Iron deficiency anemia is the most common kind, and so I ordered a ferritin level, which measures iron stores. It also was very low. I started myself on oral iron, and consulted a hematologist/oncologist who takes care of blood problems, and he had me continue on the same program. I had to take two of the standard Feosol tablets, each containing 200 mg of ferrous sulfate, and 65 mg of elemental iron. After several months, my hemoglobin came back up to its normal range over about 15g/dl, and the ferritin up to 63ng/ml.

I had a endoscopy of my colon, esophagus and stomach. Nothing was found, and the presumption is a small intestinal blood leak, taking blood and iron out of my body faster than a normal diet could replace it.

  • The MCV, MCH, MCHC, and or RDW are measures of red cells that are of concern to doctors, but which are not commonly important.
  • Platelet count- platelets are essential for normal blood clotting. They are usually not a problem unless you are on chemotherapy, which reduces platelets.

The different types of white cells—neutrophils, lymphocytes, monocytes, eosinophils, Basophils, and nucleated RBC are specific types of cells important in certain special conditions. Neutrophils are commonly elevated with bacterial infection, and reduced with viral infection.

When I was going to medical school, we did our own blood cell counts manually, by looking through a microscope at the blood cells on a special slide. Now there are amazing machines that do it much more rapidly and presumably accurately.

The blood count, or hemogram is important if you are sick, and it is a good idea to know your normal values when well, which then presumably are within the normal ranges printed on the laboratory report. Each laboratory uses a little different machinery, and therefore has its different normal ranges.

Next time I will talk about the urinalysis.

—Dr. C.

IN THE LAB: TESTS FOR AND DIAGNOSING “aNEMIA”

I should have known something was wrong.

I was getting short of breath with a third of a 45-minute exercise I had done for years, but I rationalized it away. I reasoned that I hadn’t been sleeping well, I am getting old. And my heart isn’t working as well because of the Atrial Fibrillation.

Physicians have a big armamentarium of excuses they can generate, and besides it is their Karma to GIVE Medical care rather than to RECEIVE it.

The AHA moment came when I bumped my leg, and peeled back some skin. My skin is old and fragile, and I’m always tearing it in small areas.

This time, I got to see the blood run all the way down my leg like a drop of grape juice, not the thick blood I’m used to. If anything, my blood should be thicker, more viscous, since my average Hemoglobin is 16 gm., on the high side of normal.

I got my blood drawn, and ordered a CBC and a ferritin. The CBC shows the Hemoglobin level, and a number of other measurements bearing on anemia, and the ferritin gives a measure of IRON STORES.

I can’t remember the first time my ferritin was ordered, or why, but it has for years been borderline, just barely in the normal range, dipping down as low as 18, and rising as high as 35.

Since a common cause of low iron stores with a good diet is colon cancer, I had about 3 colonoscopies to rule out cancer over a period of 6 years; lucky me.

At least they were all negative, and without polyps.

This time the ferritin was 12, well into the abnormal range, and the Hemoglobin was 8.6 gm. little more than half my usual.

I had been fibrillating for 5 months, and been on 5 mg. Eliquis ( an anticoagulant/blood thinner) for the same period. Having a recent normal colonoscopy, the most likely diagnosis was AVMs (arteriovenous malformations) of the small bowel, with bleeding accelerated by the Eliquis,

Since small bowel surgery contraindicated a diagnostic videocapsule, this diagnosis would have to remain an assumption.

I reduced the Eliquis by 25%, calculated my blood loss rate and started 2 capsules of feosol alternating with 3 capsules daily. Over a period of 4 months, my Hemoglobin came back up to 15 gm., and my ferritin came up to 50. I am due another test as soon as I get enough nerve to brave the Covid and go to the lab.

This story is a good illustration of treating one illness, and thereby creating another in this world awash with medication. How much better it is to stay as healthy as possible.

However, I am becoming increasingly aware of the fact that Health is not often the top priority in most peoples lives.

As an illustration, I refer to todays’ Sunday New York Times, which reviewed 2 books on walking, one written to praise its’ health benefits. To quote the reviewer, “

The issue with ‘ in praise of walking’ is Mr. O’Mara’s assumption that how good an activity may be for us is the most essential measure of its worth”. Praising health raises an issue?

Personally, my main exercise is walking, and I do it expressly for health. That doesn’t mean that I don”t enjoy walking and have other motivations. I would not be walking as FAST, however, it it were not so healthy.

–Dr.C.

DR. C’S MEDICINE CABINET: “WHY PATIENTS TAKE ELIQUIS”

Eliquis nicely illustrates my contention in the Overview of Metabolism, that the body is a vast collection of pathways, or “supply chains”. Eliquis blocks a critical enzyme in the pathway leading to coagulation, or clotting” as the product.

Why in the world you want to block clotting? The staunching of blood flow, clotting, has saved countless hordes of early, Paleolithic humans, and continued useful through the bloody Roman and Medieval times, right through the violent 20th Century.

Recently, however, wars are becoming somewhat less popular, and eating excessively more popular, leading to a strange situation. Our evolutionarily-preserved CLOTTING mechanism is now leading to MORE problems than it is solving.

Obesity and type 2 Diabetes are leading to the production of so much fat, that it has to be stored in our arterial walls, clogging the blood flow to our Hearts and Brain, among other areas. This, and the somewhat surprising trend towards longer lives has led to an increase in a variety of age-related illnesses.

When I reached 80 years of age I developed Atrial Fibrillation, a condition leading to a tendency to form clots in my quivering atria, the upper chambers of my heart. To decrease the likelihood of clots getting into my blood stream, lodging in my brain and causing STROKE, my cardiologist started me on Eliquis, an anti-coagulant/blood thinner.

Drugs have three names. The proprietary name, Eliquis in this case, is given by the patenting company to be memorable; q,z,and x are popular letters. The second is the FDA drug name, Apixaban. The drug name often gives the doctor a clue as to its type: xaban refers to inhibiting (banning) of factor 10a (Xa). The third name is a chemical name of interest to biochemists and drug researchers.

When I started the Eliquis, at first unknown to me, I started to bleed internally, leading to a drop in my hemoglobin down to 8.6. I will go into this story when I start going through “how to read your laboratory report”.

I found that reducing my Eliquis from 5mg. to 3.75 mg. allowed me stabilize my hemoglobin by taking extra iron, which I will discuss later.

The doseage selected when the drug company markets a drug is fairly arbitrary, and usually involves round numbers. Interestingly, there is a 2.5mg. Eliquis, which is given if you meet 2 out of 3 criteria. I meet only one and am only 5 pounds shy of the second, in case you think (like my cardiologist does) that I’m taking a risk.

I believe that, whenever you are given a medication, you should be educated about the medicine, and the problem it is intended to benefit. Today’s physician often does not have the time to do this. The internet, including this website, offers a corrective.

I am trying my best to be helpful to you as a Patient Advocate. You and I both must have a doctor to rely upon. But to get the most out of our care, WE MUST BE INFORMED.

–Dr. C