Hematology Profile

The Heme Profile or CBC (Complete Blood Count) is a long-standing platform test of the clinical laboratory. The test consists of two parts: The Machine Panel: A battery of physical/chemical measurements conducted by a single instrument that measures the size and important characteristics of each circulating blood cell. Modern instruments are able to provide estimations of: WBC, RBC, Hemoglobin, Hematocrit, MCV, MCH, MCHC, Polys & Stabs, Lymphocytes, Monocytes, Basophils, Morphology, Platelets. The Blood Smear: A thin smear of blood is applied on a glass slide, stained, and examined under a microscope to record the appearance and nature of the cellular components. This part is not required in all cases. Usually, the numerical parameters from the Machine panel can be used to determine whether a smear should be done. This is the basic test for all hematology investigations. It is also used for monitoring hematological abnormalities or hematological responses to disease. A brief description of each of the measured parameters: WBC White Blood Count: A total count of the number of white cells per liter of blood. Increased in inflammation and infection and in dyscrasias (such as leukemia). Decreased: In various infections, bone marrow defects, drugs, etc. An examination of the features described below will indicate which of the white cell types is causing the general lowering. RBC Red Cell Count: A total count of the number of red cells per liter of blood. Increased in overproduction states of the marrow (polycythemia, chronic oxygen deprivation). Decreased in anemia. An examination of the red cell indices usually reveals the nature of the abnormality. Hemoglobin: The total amount of hemoglobin in the blood (irrespective of the number of cells containing the hemoglobin). Hematocrit: The total volume of the red cells in the blood. MCV Mean Corpuscular Volume is an indication of the size of the red cells. MCH Mean Corpuscular Hemoglobin is a measure of the amount of hemoglobin per red blood cell MCHC Mean Corpuscular Hemoglobin Concentration is the amount of hemoglobin per liter of fluid in each cell.

Polys & Stabs The polymorphonuclear leukocyte white cell line. Usually responds quickly to stress and infection. Lymphocytes The lymphocytes are the circulating immune response cells Monocytes Phagocytic (engulfing) white cells Basophils Phagocytic white cells Platelets The small cells which are intimately involved in coagulation and clot formation. Morphology This is performed using a microscope. The various types of cells are examined and the nature of any abnormality is described. If significant, it will be reviewed by a hematologist who will add possible causes of the abnormalities. Cholesterol
The lipid or fat content of the blood is known to be correlated with the risk of developing cardiovascular disease. The main lipid of concern is cholesterol, which can be found in the blood in several different forms. This is because cholesterol does not dissolve in the water of which blood is composed. In order for it to be transported through the blood stream the body attaches cholesterol molecules to protein and constructs a tiny particle. The combination of cholesterol and protein is called a lipoprotein (literally a lipid protein). These tiny particles come in various densities: some are very dense and will eventually sink to the bottom of a tube of blood, others are lighter and will float to the top of a tube of blood (very much like cream floats to the surface of milk). Thus, we have high, low, and very-low density lipoproteins and each of these has a different influence on the body. When we measure the Total Cholesterol in the blood we are actually measuring the combination of high, low, and very-low density lipoprotein. Because each of these fractions means something different, it is important to know what the amount of each. The LDL-Cholesterol (Low Density Lipoprotein Cholesterol) (LDL-C) constitutes the largest fraction of cholesterol in the blood. This is the bad cholesterol and the higher its value, the greater is the risk of developing heart disease. This is the cholesterol that travels from the liver (where the lipoprotein is assembled) to the tissues where it has an important metabolic role. However, along the way, it can become trapped in the walls of blood vessels where it causes a tiny lesion (called a plaque) and contributes to the process of narrowing the blood vessels, like rust in a water pipe. The HDL-Cholesterol (High Density Lipoprotein Cholesterol) (HDL-C) is a smaller fraction and represents the good cholesterol. This is the cholesterol that travels out of tissues. Opposite to LDL-C, the higher the value of HDL-C the lower the risk of cardiovascular disease.

The VLDL-Cholesterol (Very Low Density Lipoprotein Cholesterol) (VLDL-C) is cholesterol that is wrapped up with the triglyceride fats in the blood stream. Triglycerides (TG) are oils consisting of three fatty acid chains attached to a glycerol molecule. Triglycerides are greatly elevated in diabetes when out of control, in liver disease, and in certain inherited disorders. Triglycerides rise after meals, which is why a fasting period is required before measuring lipids. Cholesterol found in VLDL is neutral in terms of atherosclerosis and is another reason why the measurement of Total Cholesterol may be misleading. How do you interpret the results? There are various ways to interpret the results of these tests. You may read about cholesterol in magazine or newspaper articles and be confused by the fact that the values are so much different from what you have obtained in the lab. This is because much of the material you read is from the USA and is expressed in conventional units rather than the SI units that most of the world employs. To convert American units (mg/dL) into Canadian units (mmol/L) you must multiply the American value by 0.026 . The following links describe the interpretation of lipid results based on the most recent (2006) Canadian clinical guidelines. verview Over 2 million Canadians have diabetes. There are three main forms of this condition. Type I: This occurs when the body fails to produce insulin. As insulin is required to control (lower) the blood glucose by making it available for metabolism, a lack of insulin allows the glucose to rise to uncontrolled levels. Ironically, though the blood has too much glucose, the tissues do not have enough and they begin to metabolize fat in order to get energy. This results in the production of ketones that may cause metabolic crises and even death. Insulin injections are required for treatment. Type II: Most people with diabetes have this form. This is the variety developed later in life that was formerly called adult onset diabetes. In Type II the body can still produce insulin but it either does not produce enough or the insulin it does produce is not used effectively. The result is ineffective utilization of glucose that rises to elevated levels in the blood stream. It can often be treated by diet and weight loss to reduce the demand for insulin, but treatment with insulin may be required. The third type of diabetes is a temporary situation that occurs in pregnancy known as gestational diabetes. It is found in 2-4% of all pregnancies and poses a risk to the well being of the fetus. It is standard practice to screen for the presence of this condition in all pregnancies during the first or second trimesters.

The symptoms of diabetes vary. Some persons with Type II or gestational diabetes have no symptoms at all but are still at risk from the long-term complications of the disorder. When the symptoms become overt, the patient feels unwell, is very thirsty, excretes abnormally large volumes of urine, experiences unexplained weight loss, and may suffer serious metabolic disturbances. Diagnosis The diagnosis of diabetes is confirmed with laboratory tests. Screening for diabetes is recommended (at a minimum) every three years in individuals 40 years of age. A patient with metabolic decompensation and unequivocal hyperglycemia may be diagnosed as diabetic with a single glucose measurement. All other patients must have two venous plasma glucose measurements. The diagnosis of diabetes can be made if one of the following sets of criteria are met: 1. 2. 3. Symptoms of diabetes plus a random plasma glucose 11.1 mmol/L Fasting plasma glucose 7.0 mmol/L Plasma glucose 11.1 mmol/L in the 2-hour sample of the 75g oral glucose tolerance test

Refer to page S15 of the 2008 Canadian Diabetes Guidelines for more information on the diagnosis of diabetes as well as the related conditions impaired fasting glucose and impaired glucose. To diagnose gestational diabetes, all pregnant women should undergo a Gestational Diabetes Screening Test between 24 and 28 weeks gestation unless they have multiple risk factors, in which case the Screening Test should be performed during the first trimester. In the Screening Test, the pregnant woman consumes a 50-gram glucose drink and the blood glucose level is measured after one hour. The test may be performed at any time of the day and fasting is not required. If the glucose level exceeds 7.7 mmol/L, then a Glucose Tolerance Test should be carried out: however, a level greater than 10.3 mmol/L is diagnostic of gestational diabetes and further testing is not required. Unless specified otherwise by the physician, this Tolerance Test requires the patient to be fasting and consists of measurements of blood glucose before and then 1h, 2h and 3h following a 100-gram glucose drink. If two or more levels exceed their designated targets, a diagnosis of Gestational Diabetes is made. A physician may elect to treat a patient as a diabetic if the values get close to these limits. Refer to page S168 of the 2008 Canadian Diabetes Guidelines for more information on the diagnosis of gestational diabetes. Note that since the Glucose Tolerance Test is a 100-gram / 3h procedure as per consensus of BC laboratory physicians (rather than 75-gram / 2h, as suggested by the Canadian Diabetes Association), different target values apply: these may be found here.

Monitoring Diabetes Once diabetes is diagnosed, therapy may be instituted. Most monitoring of insulin therapy is carried out by the patient with a glucose meter. There are two additional tests that are recommended for all Type I and Type II diabetics on a regular basis: glycated hemoglobin (in blood) and microalbumin (in urine). Monitoring information specific to British Columbia may be found at the BC Ministry of Health Services site. Glycated Hemoglobin The Glycated Hemoglobin test (also known as Hemoglobin A1c or Hb A1c) should be carried out every three months. In this test, blood is drawn and analyzed for the amount of glucose that has become attached to the hemoglobin molecule. Normally, not more than 6% of hemoglobin molecules have glucose attached; diabetics will have higher percentages. The percentage is related to the average blood glucose level and is therefore an indication of overall glucose control. It should be noted that the percentage is reported not as a percentage but as a decimal (e.g. 6% will be reported as 0.06). If the Glycated Hemoglobin result is too high, more stringent insulin therapy is required. The Glycated Hemoglobin test should not be used for the diagnosis of diabetes as there are no recognized standards for using it in this context. Microalbumin The other monitoring test for diabetes complications is urinary microalbumin. Despite its name, microalbumin is identical to the protein albumin present in blood: the micro prefix refers to the fact that its levels in urine are about 1000-fold lower than those in blood. The lab measures the amount of albumin in the urine sample and reports the result as a ratio to creatinine (a substance excreted at a constant amount) to correct for the variable dilution of urine. If the albumin-creatinine ratio exceeds 2.8 (females) or 2.0 (males), further testing may be carried out. The presence of abnormally high levels of urinary microalbumin indicates that diabetes is beginning to affect the kidney and therapy to prevent the rapid development of kidney problems should be initiated.

Useful information about diabetes can also be obtained from the Canadian Diabetes Association and the American Diabetes Association.

Hepatitis is a condition wherein the liver develops widespread inflammation. There are many causes of the inflammation and so we have diseases such as:

alcoholic hepatitis (caused by alcohol abuse), toxic hepatitis (caused by certain noxious materials such as carbon tetrachloride),

viral hepatitis (caused by one of several viruses that attack the liver), and autoimmune hepatitis (of unknown cause, but due to the bodys own immune system attacking the liver).

The characteristic laboratory finding in Hepatitis is an increase in the AST (Aspartate Aminotransferase) and ALT (Alanine Aminotransferase) enzyme tests. If either of these tests is increased significantly, some form of hepatitis is likely. The various forms of viral hepatitis can be identified with specific tests. It sounds like alphabet soup as there are Hepatitis A, B, C, D, and E. Hepatitis A: Hepatitis A virus spreads via sewage contamination. It causes mild to moderately severe liver infections but rarely results in permanent damage. Serious infections with Hepatitis A are caused in persons already suffering from Hepatitis C, intravenous drug users, and male homosexuals. There is now a vaccination for Hepatitis A. There are two tests for Hepatitis A. The Hepatitis A IgM antibody test indicates whether the patient has had Hepatitis A in the past few weeks to 6 months. The hepatitis A total antibody test tells whether someone has had Hepatitis A at some time in the past. When positive, these tests indicate that the patient is immune to further infection from Hepatitis A. Hepatitis B: Hepatitis B virus is transmitted by direct contact with the blood or saliva of someone infected with Hepatitis B. In the past, this condition was called serum hepatitis. Hepatitis B is usually self-limiting (cures on its own), but is a moderately severe disorder causing fever and exhaustion. It generally takes several weeks to months to recover. Up to 10% of cases are more complicated and experience a very severe acute event, develop a chronic hepatitis, or become disease carriers without actually being sick (although carriers are prone to developing late complications such as cirrhosis or liver cancer). There is an effective vaccine for Hepatitis B. There are a variety of tests for Hepatitis B that can determine infection, infectivity, and immune response. Hepatitis C: Hepatitis C has gained wide notoriety because of its transmission in tainted blood. It is a chronic and often very serious disorder. The test for Hepatitis C does not turn positive immediately and may take 6 to 8 weeks to do so.