Understanding Blood Work

The physicians at Emerald City Clinic examine all aspects of your life including what is flowing thru your body to design therapeutic plans to optimize your health.   The “normal ranges” of the lab results are based on the average American and our ranges are based on optimizing your health which may not necessarily fall within that range. Your blood is divided into two basic components:

1. Blood cells or Solids

•  Red blood cells that carry oxygen
• White blood cells which is your immune system
• Platelets that are there to help with clotting

2. Serum or Fluids:  This carries everything else we examine.The CBC or complete blood count is how we examine the solids.  We do counts of the red cells, white cells and platelets. 

1.  White blood cells are for our immune system.  They are our troops and should run between 5000-6000.   Besides the overall number, there are different types.  We should have 60% neutrophils (which are our swat team), 30% lymphocytes (which is our artillery), <10% monocytes (which fight virus), <5% eosinophils (which fight parasites and airborne allergies) and finally basophils which should be below <4% and our an inflammatory marker.
2. Red blood cells should be somewhere between  3.8 and 4.2 million cells.  They carry our oxygen and should be a certain size and shape which your physician also looks at.
3. Platelets should run around 250 and are responsible for proper clotting.

In the fluids of the blood, also called serum, we have a plethora of things we can examine.  There are entire books written on what can be found in your blood.  I will attempt to give an overview of categories:1.  Enzymes:  Every organ has its own enzymatic system.  If those enzymes are too high it usually indicates cell death in that organ.  If it is too low, it usually means the organ is under functioning and therefore has no recycling of the cell structure.  Under this category we have the following organ systems that we routinely look at:

• Kidneys:  BUN (blood urea nitrogen), Creatinine, GFR (glomular filtration rate)
• Liver:  AST, ALT
• Bones:  Alk phos

2.Individual chemicals: Items that are truly not enzymes

• Sodium/Potassium:  this is a reflection of adrenal function and neurological function since all the nerves run on sodium/potassium pumps
• Chloride/CO2:  tells us about the pH of the system and the digestive track
• Bilirubin:   fat digestion

3.  Inflammatory markers:  These are values we are looking for to rate overall inflammation in the body.

• CRP:   this is mostly cardiovascular but can be elevated due to other issues
• Uric acid:  marker for gout which is an arthritic condition
• Homocysteine:  vascular inflammation
• GTT:  liver inflammation
• Ferritin:  when high it is a general inflammatory marker
• Sed rate:  a measurement of red blood cell damage and therefore general inflammatory marker
• HgA1c:  hemoglobin A 1C:  average sugar level 24 hours/day for 3 months

4.  Cholesterol:   Many years ago we talked about “good” cholesterol (meaning HDLs) and “bad” cholesterol (meaning LDLs).  What we have found out is that there are many types of LDLs, HDLs. They are fragments that all have different roles.  The important thing about cholesterol is that an appropriate balance is needed because all our hormones, immune system,  nervous systems and skin, to name a few things are made from these building blocks.5. Hormones: There are the messengers of the body and travel from one location to another to direct our bodies.  Most hormones have a storage unit and a biological active version that is more potent and shorter acting.  Most hormones also are in a bound form when they travel around the body but most be “free” of their protein bound to influence the body.  Most often we want more of the storage version then active version so that our hormonal savings accounts are not depleted.  There are many more hormones than I will address but these are the most common we examine

• Thyroid
  • TSH (thyroid stimulating hormone) directs the thyroid to produce its hormone
  • T3:  short liver, biologically active hormone for about 6 hours
  • T4:   storage unit and is around for 12-14 hoursThe Female and Male hormones are found in both sexes and are needed in different amounts in both sexes.  One hormone is the transportation hormone for all sex hormones.  It is SHBG (sex hormone binding globulin).  If this hormone is too high then the hormone can NOT be delivered, the trucks are too sticky
• Female hormones:
  • FSH (follicle stimulating hormone) and LH (luteinizing hormones):  these direct the production of our eggs
  • Estrongens:  There are three versions of estrogens.
  • Estriol:  E3  shortest acting, biological active and most protective
  • Estradiol:  E2,  longer acting and also protective
  • Estrone:  E1, longest acting and most associated with hormone directed diseases
  • Progesterone:  highest in the second half of menstrual cycle and needs to be in balance with the estrogens
• Male hormones:
  • Testosterone:  comes in both a bound version (total testosterone) and unbound version (free testosterone)DHEA:   This hormone is a precursor to the estrogens and testosterone and support of the adrenal glands.  It too comes in bound version  (DHEA) and unbound version (DHEA –SO4).
• Vitamin D:  I am not sure whether to put this in immune system,  inflammatory marker or in hormones.  But I believe vitamin D acts like a hormone.
• Cortisol:   I leave this to last as this is the number one complaint of my clients.  I am tired.  Cortisol, also called, adrenaline is the measurement of our base energy.

I have put on our website my naturopathic normal for these values.  Remember the interpretation of labs is really an art and science and this just scratches the surface.  But the more we educate our clients the better they can manage their health and advocate for themselves.By Dr. Molly Niedermeyer