BASOPHILS

 

Typical Ref. Range: 0-3% of WBC

 

Optimal Range: 0-1% of WBC

 

Causes of Increased

 

• Chronic Hemolytic anemia

• Chronic Hypersensitivity reactions (foods, drugs, inhalants)

• Myeloproliferative Disorders (polycythemia vera, CGL, basophilic leukemia)

• Urticaria Pigmentosa

• Ulcerative Colitis

• Parasites (with elevated eosinophils)

• Chickenpox

• Myxedema (Severe hypothyroidism)

• Systemic inflammatory conditions

 

Discussion

 

Basophils are involved in: (1) Lysosomes that contain enzymes needed for relief of histamines; (2) Allergic responses with release of histamine, kinins, and slow-reacting substance of anaphylaxis; (3) Release of heparin to prevent blood clotting. Basophils contain hyaluronic acid, a protective ingredient to insure a normal inflammatory process.

 

BUN (BLOOD UREA NITROGEN)

 

Typical Ref. Range: 5-25 mg/DL

 

Optimal Range: 12-20 mg/DL

 

Causes of Increased (“Azotemia”)

 

Renal dysfunction (creatinine increases proportionately)

 

Pre-renal Azotemia (less proportional creatinine elevation)

• Diabetes mellitus, uncontrolled

• Starvation/dehydration/diarrhea

• Congestive heart failure (decreased renal circulation)

• GI hemorrhage and obstruction

• Shock/Tissue necrosis/ Third degree burns

• Renal Artery Stenosis (with hypertension)

 

Post-Renal

• Renal vein thrombosis

• Urinary tract obstruction

 

Non-Renal

• Gout

• Increased protein catabolism (Tetracycline, Addison’s, excess glucocorticoids)

• High protein diet

 

Causes of Decreased

 

• Syndrome of Inappropriate ADH secretion (SIADH)

• Liver/biliary dysfunction (severe)

• Malnutrition (inadequate protein digestion or intake)

• Celiac Sprue

• Advanced stages of acidosis

• Zinc deficiency

• Posterior pituitary hypofunction

• Anabolic hormones

• May be seen during normal pregnancy

 

Discussion

 

Urea is a by-product of nitrogen (protein) utilization and is converted to ammonia when combined H2O.

 

CALCIUM, Total Serum

 

Typical Ref. Range: 8.5-10.8 mg%

 

Optimal Range: 9.5-10.2 mg%

 

Causes of Increased

 

Increased Parathyroid Hormone (PTH)

• Primary Hyperparathyroidism (tumor, hyperplasia)

• Secondary Hyperparathyroidism (after Vitamin D deficiency, after renal transplant)

• Tertiary Hyperparathyroidism (Chronic Renal Failure)

• Aluminum induced bone disease

• Familial (low urine calcium)

• Drugs: lithium, theophylline

• Pheochromocytoma

 

Normal or Decreased Parathyroid Hormone

• Malignancy (esp lung, myeloma, breast, squamous cell)

• Endocrine (Anterior pituitary dysfunction, thyrotoxicosis or hypothyroidism, acute adrenal cortical hypofunction, ovarian hyperfunction)

• Hypophosphatasia

• Toxic effects of non-medicinal metals (Cadmium)

• Granulomatous Disease (Sarcoidosis)

• Milk-alkali Syndrome

• Medications: Thiazide diuretics, Tamoxifen and other anti-estrogens, TPN

• Epilepsy

• Paget’s Disease

• Immobilization from any cause

• Excess ingestion of Vitamin D or A

• Pregnancy and lactation

 

Causes of Decreased

 

Low parathyroid hormone (PTH)

• Hypoparathyroidism (surgical, autoimmune, radiation)

• Magnesium deficiency (end organ resistance)

 

Normal or increased parathyroid hormone (PTH)

• Ovarian hypofunction

• Vitamin D insufficiency

• Anticonvulsants

• Rapid bone deposition

• Protein malnutrition

• Digestive dysfunction (Hypochlorhydria)

• Renal dysfunction

• Pancreas dysfunction

• Pregnancy

• Metabolic acidosis

 

Discussion

 

Serum calcium is not at all reflective of total body stores of calcium but rather reflects the metabolic and hormonal state of the individual. Ionic or free calcium is not only the biologically active form of calcium but reflects the amount of albumin and the blood pH. In acidemia, calcium becomes ionized and liberated from serum proteins. In alkalemia, more calcium is bound to proteins as well as precipitating out of solution. This may lead to extra-osseous deposition or kidney stones. The Calcium/Phosphorus ratio is an index of great value in detecting more subtle hormonal imbalances.

 

Serum calcium can not be properly interpreted without serum albumin level. Use the formula Adjusted Calcium = Serum calcium – serum albumin + 4. By far the most common causes of hypercalcemia are primary hyperparathyroidism, malignancy, and drug-induced. A PTH, calcium, albumin and phosphorus level drawn simultaneously helps classify the etiology into main groups. Watch for signs of calcium deposition and kidney stones.

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CHLORIDE

 

Optimal Range: 101-103 mEq/L

 

Causes of Increased

 

• Metabolic acidosis (primary CO2 deficit)

• Renal dysfunction (Polycystic, obstruction, tubular acidosis, pyelonephritis)

• Excess sodium chloride intake (IV solutions)

• Adrenal cortical hyperfunction

• Severe dehydration (diabetes)

• Diabetes insipidus

• Hyperparathyroidism

• Anterior pituitary hypofunction

 

Signs, Causes & Symptoms Decreased

 

Renal chloride loss

• Loop diuretics (furosemide)

• Bartter’s Syndrome

• Salt-losing nephropathies

 

GI chloride loss

• Zollinger-Ellison Syndrome

• Secretory diarrhea

 

Other

• Metabolic alkalosis (primary CO2 excess)

• Chronic compensated respiratory acidosis

• Congestive Heart Failure

• Overhydration

• Syndrome of Inappropriate ADH (SIADH)

• Burns

• Diabetes

• Adrenal cortical hypofunction (Addison’s)

• Hypoparathyroidism

• Perspiration (Cystic Fibrosis)

 

Discussion

 

Chloride contributes to the body’s acid/base balance. Along with Sodium, Potassium and Carbon Dioxide, it is important in evaluating acid/base relationships, state of hydration, adrenal and renal functions. Its level varies inversely with Carbon Dioxide. Chloride elevation indicates acidosis, decrease indicate alkalosis.

 

CHOLESTEROL

 

Optimal Range: 185-200 mg/dl

 

Causes of Increased

 

• Hypothyroidism

• Hepatobiliary dysfunction

• Pancreatic dysfunction

• Renal dysfunction (Nephrotic Syndrome, chronic insufficiency)

• Familial hyperlipoproteinemias II, III and V

• Pregnancy

• Insulin (resistance, treatment)

• Anabolic/anaerobic metabolic states (glucocorticosteroids)

• Acute Intermittent Porphyria

• Diet high in refined carbohydrates

 

Causes of Decreased

 

• Herpes Zoster

• Various free radical pathologies (Autoimmunity, acute/active infection, catabolic metabolism)

• Hyperthyroidism

• Depression

• Malignancies

• Anemia

• Abetalipoproteinemias (lack of microsomal triglyceride transfer protein)

• Tangier’s Disease (defective HDL synthesis)

• Malabsorption/malnutrition

• Cardiac dysfunction

• Liver/biliary disease (hepatitis, mononucleosis)

 

Discussion

 

Cholesterol is an important part of our diet. It is essential to the proper function and structure of cell membranes. Bile acids are derived from cholesterol. The liver, adrenals, sex glands, intestines, and even the placenta, manufacture cholesterol. Cholesterol is best used as an indicator of other metabolic dysfunction. Should not be considered a disease by itself unless extreme, which indicates familial cause. Check triglycerides and HDL/LDL. Cholesterol is increased with endocrine hypofunction. Low levels are not necessarily desirable as it is associated with increased incidence of malignancy and mental illness.

 

CO2 BICARBONATE

 

Typical Ref. Range: Serum pH: 7.35-40; PaCO2: 35-45 mm/HG; PaO2: 80-100 mm/HG; HCO3: 22-32 mEq/L

 

Optimal Range: 24-28mEq/L

 

Causes of Increased

 

Metabolic Alkalosis

• Excess bicarbonate intake (calcium antacids)

• Adrenal cortical hyperfunction

• Compensated Respiratory acidosis

• Hyperventilation

• Renal dysfunction

• Long-term diuretic therapy

• PVC’s with hypokalemia

• Milk-alkali Syndrome

 

Causes of Decreased

 

Metabolic Acidosis

• Asthma

• Chronic renal dysfunction (uremia)

• Fever

• High Anion Gap acidosis (see AG list)

 

Discussion

 

As a compensatory reaction to metabolic acidosis, the lungs eliminate CO2 + and as s result HCO3 – will be retained. As a compensatory reaction to metabolic alkalosis, the lungs decrease ventilation to increase the blood CO2 + and the kidneys conserve H+ to excrete HCO3 –.

 

CREATININE

 

Optimal Range: 0.8-1.1

 

Causes of Increased

 

• Renal dysfunction (including obstruction)

• Congestive heart failure

• Starvation-dehydration

• Uncontrolled diabetes (can interfere with test)

• Muscle degeneration

 

Causes of Decreased

 

• Muscle atrophy

• Liver disease

• Pregnancy

 

Discussion

 

Creatinine is formed in muscles from creatine, which is formed in the liver. It is a substance that in health is easily excreted by the kidney. Because all Creatinine filtered by the kidneys is excreted into the urine, its levels at any given time interval are equivalent to the Glomerular Filtration Rate (GFR).

 

EOSINOPHILS

 

Optimal Range: 0-3% WBC

 

Causes of Increased

 

• Systemic parasitic infestation

• Systemic fungal infections (Cocci, Histo, ABPA)

• Allergic diseases (food, inhalant/environmental, asthma, eczema)

• Skin disorders (atopic dermatitis, eczema, urticaria, pemphigus, dermatitis herpetiformis)

• Pulmonary Syndromes (ABPA, Loeffler’s, PIE, Hypersensitivity pneumonitis)

• Collagen Vascular Diseases (DM, PSS, eosinophilic fasciitis, hypersensitivity vasculitis)

• Malignancy (Ovarian, epidermoid, bladder, lung, colon)

• Immunodeficiency (W-A Syndrome, Hyper-IgE, IgA Def, Nezelof’s)

• Hematologic (PCV, PA, Myelofibrosis, CML)

• Drugs (arsenic, phenothiazines, gold, iodides, nitrofurantoin, PAS, ampicillin, phenytoin, streptomycin, sulfonamides)

• Endocrine (hyperthyroidism, anterior pituitary hypofunction, adrenal cortical hypofunction)

• Inflammation (phlebitis, RA, Wegener’s Eosinophilia-Myalgia, IBD)

 

Discussion

 

Most eosinophils are found in tissues rather than blood. When there is an elevation in the blood, it implies a process is occurring in the tissues. Along with Basophils, they function as reservoirs for potent biological materials such as histamine, serotonin, and heparin. Release of these compounds alters the blood supply to tissues, thereby mobilizing the body’s defense mechanism.

 

GLUCOSE

 

Optimal Range: 85-100 mg/DL

 

Causes of Increased

 

• Diabetes mellitus and insulin resistance syndromes

• Thiamine (B1) insufficiency

• Hemochromatosis

• Ataxia telangiectasia

• Endocrine hyperfunction (adrenal cortex, pheochromocytoma, acromegaly/ACTH, hypothalamic lesions, Carcinoid, glucagonoma, somatostatinoma, thyrotoxicosis)

• Acute and chronic pancreatitis

• Drugs (anabolic and glucocorticoids, epinephrine, norepinephrine, thiazide diuretics, phenytoin)

• Stress

 

Causes of Decreased

 

• Excess insulin (insulinoma, overdosage)

• Impaired glucose tolerance (post-prandial)

• Late/large malignancies

• Endocrine hypofunction (thyroid, adrenal cortex, anterior pituitary)

• High dose salicylates

• Protein malnutrition

• Sometimes in pregnancy

• Various free radical pathologies

• Hypochlorhydria

• Liver dysfunction

• Hereditary

• After gastric surgeries (altered gastric emptying)

• Artifactual (polycythemia, failure to separate serum promptly)

 

HDL/HIGH DENSITY LIPOPROTEINS

 

Ideal Range: 55-75

 

Causes of Increased

 

• Diabetes mellitus

• Endocrine dysfunction

• Arteriosclerosis

• Liver/biliary dysfunction

• Pancreatic dysfunction

• Renal dysfunction

• Cardiac dysfunction

• Various hyperlipoproteinemias

• Pregnancy

• Systemic lupus erythematosus

• Chronic benign prostate hypertrophy

• Multiple sclerosis

 

Causes of Decreased

 

• Tobacco smoking

• Obesity

• Lack of exercise

• Beta-adrenergic blocking agents

• Hypertriglyceridemia

• Genetic

• Diabetes

• Liver dysfunction (reduced synthesis)

 

Discussion

 

HDL is comprised of phospholipids and one or two apolipoproteins. It plays a role in the metabolism of other lipoproteins, and in the transport of cholesterol to the liver. The HDL is a class of lipoproteins produced by the liver and intestines. A combination of increased triglyceride, cholesterol, and LDL with reduced HDL is indicative of atherogenic tendencies. A diet high in sugar may decrease HDL while increasing total serum cholesterol.

 

IRON

 

Optimal Range: 75-150 mg/ml

 

Causes of Increased

 

Hereditary Hemochromatosis

 

Secondary Hemochromatosis

• Ineffective erythropoiesis (thalassemias, sideroblastic)

• Intra-vascular hemolysis

• Liver disease (alcohol, portocaval shunts)

• Excessive iron intake

 

Causes of Decreased

 

• Iron deficiency (low ferritin level; nutritional, blood loss, achlorhydria, small bowel disease, increased demand)

• Chronic disease (liver dysfunction, renal dysfunction, etc.)

 

Discussion

 

Iron is known for its relationship to hemoglobin, which transports oxygen. Confirm true iron deficiency before supplementing iron. Never give Iron to someone who has an inflamed liver because this can be toxic. With B12 or Iron deficiencies, give special consideration to increased occurrence in the elderly. The most important test for iron is the serum ferritin. If this is normal then the problem is in iron metabolism rather than iron deficiency or overload.

 

LDL CHOLESTEROL

 

Optimal Range: <130

 

Causes of Increased

 

See triglycerides

 

Causes of Decreased

 

See cholesterol and triglycerides.

 

Discussion

 

Usually a calculation based on the cholesterol, HDL, and triglycerides. Thus using analysis of these measurements is more important.

 

LYMPHOCYTES

 

Optimal Range: 30-45% of WBC but depends on depends on absolute counts as well

 

Causes of Increased

 

• Infection (acute viral, chronic infections, parasites, Brucella)

• Relative neutropenia (hyperthyroidism, anterior pituitary hypofunction, adrenal cortical hypofunction)

• Stress

• Radiation

• Lead poisoning

• Food intolerances (Metabolic Rejectivity Syndrome)

 

Causes of Decreased

 

• Acute bacterial infections

• Adrenal cortical hyperfunction

• Systemic lupus erythematosis

• Immunodeficiency syndromes (HIV)

• Debilitating Diseases (TB, Hodgkin’s, SLE, terminal cancer, renal failure)

 

Discussion

 

Lymphocytes react to the toxic by-products of protein metabolism. A leukocyte with a single nucleus that is second in abundance to neutrophils in the peripheral blood. They originate from the erythroblasts of the spleen, tonsils, thymus and bone marrow. Must assess in the context of the total WBC and WBC profile.

 

MAGNESIUM, Serum

 

Optimal Range: 2-3 mg/DL

 

Causes of Increased

 

Endocrine

• Hypothyroidism

• Adrenal cortical hypofunction

• Hyperparathyroidism

 

Other

• Renal dysfunction (acute and chronic)

• Excessive magnesium intake

• Lithium use

 

Causes of Decreased

 

Excessive Urinary Losses

• Renal dysfunction (Tubular acidosis, glomerulonephritis, interstitial nephritis, etc)

• Hypercalcemia or hypophosphatemia

• Alcohol

• Hyperthyroidism

• Hyperaldosteronism

• Diuresis (diabetic ketoacidosis, hyperglycemia, acidosis, SIADH

 

Decreased Intake of magnesium

• Protein calorie malnutrition and starvation

• Chronic alcohol abuse

• Pregnancy

 

Increased Intestinal Losses

• Malabsorption syndromes

• Laxative abuse

• Severe diarrhea

• Pancreatic dysfunction

 

Altered Distribution

• Pancreatitis

• Excess catecholamines (medications, herbs, etc.)

• Alkalemia

• Hungry bone syndrome

• Digitalis, cyclosporin or diuretics may increase serum magnesium levels.

• The form of supplemental magnesium can be very important in terms of gastrointestinal absorption and systemic utilization.

 

Discussion

 

The serum magnesium is not reflective of total magnesium stores. Unfortunately there is not a good test for magnesium, but a red cell Mg level is preferable to serum magnesium. Approximately 2/3 to ¾ of magnesium in blood is not attached to protein. In other words, approximately one-third is bound to protein, the rest exists as free cations.It occurs in the serum as approximately a 5:1 ratio to total serum calcium. Low magnesium is much more common than excess. Magnesium plays a role in both carbohydrate and protein metabolism and can be lost through the gastrointestinal tract, kidneys, and in sweat.

 

MONOCYTES

 

Optimal Range: 3-8%

 

Causes of Increased

 

Infections

• Bacterial (TB, SBE, syphilis, Brucella, Listeria)

• Viral (hepatitis, mumps)

• Parasites (malaria, Kala-Azar)

• Other (Rickettsia, mycotic, protozoa)

 

Hematologic

• Preleukemia

• Leukemias (CML, AML)

• Lymphomas (Hodgkin’s and Non Hodgkin’s)

• Myeloproliferative Disorders (PCV, myelosclerosis)

• Hemolytic anemias

 

Autoimmune Disorders

• Collagen Vascular Diseases (PAN, SLE, RA)

• Ulcerative Colitis and regional Ileitis (Crohns)

• Cirrhosis

• Hand-Schuller Christian Disease

• Malignancy

 

Discussion

 

Monocytes are secondary defense cells.

 

NEUTROPHILS

 

Optimal Range: 50-60% WBC

 

Causes of Increased

 

Physiologic

• Newborn

• Pregnancy and delivery

• Emotional and physical stress

• Nausea and vomiting

• UV light, cold stress, heat stress

 

Acute infections

• Bacterial

• Certain viral

• Mycotic

• Spirochetes (syphilis)

• Parasites

 

Acute Inflammation

• Acute RA, vasculitis, myositis

• Rheumatic fever

• Hypersensitivity reactions

 

Metabolic Abnormalities

• Uremia

• Diabetic acidosis

• thyrotoxicosis

• Polycythemia

• Adrenal dysfunction

• Gout

• Influenza

• Rheumatoid arthritis

 

Causes of Decreased

 

• Chronic infections

• Bone marrow depression

• Iron, Vitamin B12, Vitamin B6 and folic acid anemias

• Systemic lupus erythematosis

 

Discussion

 

Neutrophils are part of the body’s defense system, but originate in the immune system. They are one of the first to react to invading macrophages. Neutrophils are first to respond, so they will be elevated early in the infection and decrease with effective treatment.

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