Tests and Procedures
Understanding the benefits and results of blood work
For a true partnership to exist between doctor and patient, there has to be a free flow of information in both directions. Here is where we often hit a snag. While there is practically no barrier to keep your doctor from understanding you as a patient, you might be at a disadvantage in trying to understand your doctor. Sooner or later, the doctor’s explanations will involve medical language and concepts with which few patients are familiar.
This is especially true in the highly specialized field of medical testing. You may have heard of cholesterol, glucose, or Triglycerides tests, but are likely unfamiliar with bilirubin, alkaline phosphatase, or hematocrit tests. These lesser known tests could be far more important to finding out specifically what is going on for you than any of the more common tests. This is why it matters to be informed.
There are more than fifty common laboratory tests, all which could play a decisive role in diagnosis and treatment. Over five hundred other tests are done far less frequently, but nevertheless could prove important in individual cases.
Most doctors do not have the time to explain very much about your tests. An explanation could well take longer than the entire examination. With a waiting room full of patients, doctors often are in no position to attempt to teach a quick course in biology. A broad generalization is usually the best you can expect. For example: “Your urine and blood chemistry are fine. Only your red blood cells are slightly on the low-side, but you should not worry about it.” Or: “your creatinine—that is, your kidney-function test—was a bit high. I would like to run it again.”
Why in the world should you not worry if your red blood cells were low? Why does the doctor want to run the creatinine test again, without more information, you can be confused and frustrated.
There are also doctors who believe that your test results are not your concern. A little knowledge, they warn, could be a dangerous thing; you might draw the wrong conclusion and worry needlessly. After all, it has taken them years of training and experience to interpret test results properly. So, they tell you nothing.
And they have a valid point. Unless you do get a complete explanation, you might be better off not knowing anything at all. Even if they did have the time, most doctors probably could not give you such a thorough explanation. They are usually familiar with these tests in term of highly technical language, and would find it difficult to translate them into everyday words and concepts.
The Importance of Testing
Of all the hundreds of different laboratory test your doctor can choose form, the most common are the basic screens. These consists of urinalysis, with a half dozen different tests; a blood chemistry profile, which includes up to twenty-one different tests; and a complete blood count, which usually adds up to another dozen tests. Two important points to keep in mind:
First, urine and blood tests are not merely checks to see whether your urine and blood are all right. They are much more than that. Your blood and your urine accumulate form throughout your body. In one way or another, they have come in contact with virtually every cell of your body, and thus carry within them many of the countless by-products of the various organs. By examining your blood and urine for different factors, your doctor is, in effect, taking a look at some of the most inaccessible organs of your body.
Second, your doctor will rarely, if ever, order just these screening tests without giving you a thorough physical before making a diagnosis. During the physical, the doctor has more tangible ways of checking your organs and the state of your health in general. These are all probably familiar to you. They range from looking into your eyes, ears, and throat to listening to your heart, feeling for your liver—and always, asking a lot of questions.
Thus you are really getting two physicals: the blood and urine screening tests and the doctor’s actual examination. What usually happens is that the one confirms or amplifies the findings of the other.
For example, if we give you an examination and find you in top-notch health, the chances are that your tests will come back essentially normal, confirming those findings. If, on the hand, if you go to the Dr. with a yellowish tinge to your skin and eyeballs, complaining of nausea and pain in the abdominal area, the blood and urine tests would most likely confirm the diagnosis of jaundice due to liver disorder.
From the doctor’s point of view, lab tests have another purpose; they provide a measurable record of your state of health, at this particular time. This information also protects Drs. from unwarranted malpractice suits. Tests make it more likely that if you get a second opinion in a similar time frame, the results will generally be the same.
But protecting the doctor by confirming a diagnosis is by no means the main reason for such a large assortment of tests: the best doctors are more intent on helping patients than constantly worrying about the legal ramifications of illness. The main reason for testing is to uncover illnesses, which would otherwise go undetected, possibly until it was too late. Numerous diseases, such as leukemia or diabetes, can make themselves known through subtle changes in the blood or urine months, or even years before they could be detected through a routine physical examination.
Some illnesses could be a life threatening or could be merely something to watch. Early diagnosis through medical tests may enable the doctor to head off the disease altogether, or to start treatment at an early stage when there is a much better chance of recovery.
Getting informed about medical testing offers you an advantage. You may learn how to avoid some of the hazards of our technological environment, which can drastically alter test results, and, in fact in many cases cause severe illness. You could learn how to give your doctor highly pertinent information which might otherwise have been thought unimportant, even under direct prodding. Such information could provide your doctor with the missing link that helps makes a proper diagnosis.
There is still another reason for knowing as much about medical testing as you possibly can. It will give you a unique view of how your body works; what principles it seems to obey; how intricate are its countless processes; how delicate the balance between functioning and malfunctioning. You may realize how precious your health is and begin to care of yourself properly and with the devotion you deserve.
The following test results are explained in lay terminology, to make it easier to understand the reasons for many of the life style changes we at Natural Cures are recommending.
Types and Interpretations of Blood Test Results
Blood has four major components: red and white blood cells, platelets and serum.
Complete Blood Count (CBC) indicates the total number of read and white blood cells. It will identify and name several different type white blood cells, analyze their functions, and percentage levels. The “normal or average range” listed on your test report represents an average of all people tested, including the HEALTHY and UNHEALTHY. To simply imply or indicate an average range to be “normal” is misleading and inaccurate.
- White Blood Cells (WBC) TestWHITE BLOOD CELLS, also known as leukocytes are an important part of your body’s immune (defense) system. Healthy white blood cells are the body’s main line of defense against infection and cancer. They move freely through the blood stream eating bacteria, viruses, cancer cells, abnormal wastes, and your body’s own damaged and sick cells. A cytotoxic (cyto means cell; toxic means poison) condition exists when white blood cells are destroyed by exposure to specific allergic foods, chemicals and various drugs. Deviation above or below the range suggests therapeutic support for: the immune system, spleen, thymus, lymph, bone marrow.
- Red Blood Cells (RBC) TestRED BLOOD CELLS transport oxygen, glucose, carbohydrates, fats, proteins, etc. to the cells, and remove carbon dioxide and normal metabolic poisonous wastes. Healthy red blood cells regulate the body’s water and temperature balance. Low red blood cell count (anemia) is cause by poor iron assimilation, impaired RBC production, internal bleeding and cytotoxic damage caused by food or chemical allergies. Deviation above the range suggest therapeutic support for: liver, spleen. Deviation below the range suggest therapeutic support for: liver, spleen, bone marrow.
- Hemoglobin (HGB) TestHEMOGLOBIN is the oxygen and carbon dioxide carrying components of red blood cells. Its ability to carry oxygen is chemically destroyed by carbon monoxide (cigarette smoke, vehicle exhausts, natural gas appliance fumes, etc.). The test measures the amount of iron contained in you red blood cells making it valuable test in determining anemia. Elevated levels are seen in macrocytic anemia. Increased hemoglobin levels will cause blood sludging and increase the risk of stroke. Decreased hemoglobin levels indicated a reduced oxygen carrying capacity and possible deficiency as seen in microcytic anemia (refer to related iron tests). Deviation above the range suggests therapeutic support for: liver. Deviation below the range suggests therapeutic support for: liver, spleen, bone marrow.
- Hematocrit (HCT) TestHEMATOCRIT is the portion or percentage of your blood that is made up of red blood cells. Decreased levels are termed anemia. Deviation above the range suggests therapeutic support of: electrolyte minerals. Deviation below the range suggests therapeutic support for: spleen.
- Mean Corpuscular Volume (MCV) TestMEAN CORPUSCULAR VOLUME relates to the average size of your red blood cells. During a cytotoxic reaction RBCs often become enlarged, causing them difficulty passing through the small capillaries. This elevated condition contributes to pernicious or macrocytic anemia. Decreased levels indicate microcytic anemia. Deviation above the range suggests therapeutic support for: liver. Deviation below the range suggests therapeutic support for: spleen.
- Mean Corpuscular Hemoglobin (MCH) TestMEAN CORPUSCULAR HEMOGLOBIN indicates the weight of hemoglobin in each red blood cell.
- Mean Corpuscular Hemoglobin Concentration (MCHC) TestMEAN CORPUSCULAR HEMOGLOBIN CONCENTRATION is the average percentage of hemoglobin in each red blood cell.
- Poly or Segmented Neutrophil TestSEGMENTED NEUTROPHILS are reflections of the body’s ability to fight infection. POLYS are the white blood cells that suffer the most damage in cytotoxic reaction. Deviation above or below the range suggests therapeutic support for: spleen, thymus, lymph, immune system.
- Lymph TestLYMPHOCYTES are the white blood cells that fight infection and toxins. Deviation above or below metabolic ranges are seen in cytotoxic food or chemical reactions. Deviation above or below the range suggests therapeutic support for: spleen, thymus, lymph, immune system.
- Stab or Band Neutrophil TestBANK NEUTROPHILS are seen in impending infection, and re known to increase after stressful situations, as in too little sleep, missed or hastily eaten meals, junk food, etc. BANDS are normally not seen in the STAB test so elevated levels may indicate a need for cytotoxic testing. Deviation above metabolic range suggests therapeutic support for: pancreatic enzymes, HCI, fat emulsifier.
- Mono TestMONOCYTE is the white blood cell that handles normal tissue breakdown and is influenced by your liver. MONO is another WBC damaged by cytotoxic reaction. Deviation above or below the range suggest therapeutic support for: liver.
- EOS TestEOSINIPHILS are the white blood cells vital for the preservation of the life of your body, subject to its immune response. Elevated levels are seen in acute allergic responses, skin inflammations, respiratory infection, and parasites. Deviation above the range suggest therapeutic support for: pancreatic enzymes, hydrochloric acid, fat emulsifier.
- BASO TestBASOPHILS are the white blood cells involved in intestinal allergies, skin eruptions, asthma, sinus, etc. Elevated levels indicate parasites. Deviation above the range suggest therapeutic support for: pancreatic enzymes, hydrochloric acid, fat emulsifier.
- Platelet EstimateThe PLATELETS are essential for the control of bleeding disorders. Man drugs, including aspirin, decrease the number of platelets. The estimates are given (a) decreased, (b) adequate, (c) increased.
- Cell MorphologyCELL MORPHOLOGY relates to a visual examination of your blood cells and comments are made regarding variations. Examples are (a) normal, (b) anisocytosis (refers to a variation in size and hemoglobin content of your red blood cells), (c) poikilocytosis (refers to abnormalities in the shape of your red blood cells), (d) schisocytes (fragments of red blood cells).
Chemistry Blood Profile
- Glucose TestGLUCOSE measures the sugar level of your blood. It is the primary test for diabetes. A high blood sugar level is termed hyperglycemia (diabetes); a low blood sugar level is termed hypoglycemia. Glucose affects all the organs, tissues and systems of your body. Deviation above the range suggests therapeutic support for: pancreas, liver. Deviation below the range suggests therapeutic support for: pancreas.
- Uric Acid TestURIC ACID measures the waste from protein metabolism. The spleen, liver and pancreas metabolize protein at the gut and blood vessel wall levels. This test is valuable in measuring gouty states as in arthritis and kidney excretion. Elevated levels are seen in kidney dysfunction, anemia, leukemia. Decreased levels are seen in poor protein enzymatic activity. Deviation above the range suggests therapeutic support for: kidney’s pancreas. Deviation below the range suggests therapeutic support for: liver, pancreas, thymus.
- Cholesterol TestCHOLESTEROL measures your liver and bile function, intestinal absorption, and assesses the risk of arteriosclerosis, or cardiovascular disease (stroke or heart attack). Its primary function is to produce hormones, enzymes and antibodies in combination with iodine and protein. Elevated levels are found in liver and cardiovascular disease, diabetes, stress and low thyroid function. Decreased levels are seen in anemia, acute infections and excessive thyroid functions. Deviation above the range suggests therapeutic support for: liver, thyroid. Deviation below the range suggests therapeutic support for: liver, adrenal.
- Triglyceride TestTRIGLYCERIDE is a blood fat sensitive to dietary intake, particularly or refined sugar. Your triglyceride and cholesterol levels are used to accurately predict the amount of any artery damage. Deviation above the range suggests therapeutic support for: liver, posterior pituitary, hypothalamus.
- Calcium TestCALCIUM relates to bone metabolism, fat and protein absorption. It assists in maintaining heart regularity and preventing muscle spasm. It is necessary for enzyme production, growth and development of teeth, bones and resistance infection. Toxic drugs such as aspirin destroyed Calcium. Elevated levels of calcium are seen in diseases of the bone, hyperparathyroidism and vitamin D excess. Decreased levels are seen in muscle spasms, heart palpitations, diseases of the bone, fat malabsorbtion, vitamin D deficiency, hypoparathyroidism and pancreatitis. Deviation above the range suggests therapeutic support for: parathyroid, spleen. Deviation below the range suggests therapeutic support for: hypothalamus, bone tissue.
- Inorganic Phosphorus TestINORGANIC PHOSPHORUS is associated with calcium metabolism i.e. bone and parathyroid function. Elevated levels are seen in hypoparathyroidism, kidney disease, and excess vitamin D. Decreased levels are seen in hyperparathyroidism and in softening of the bones. Deviation above the range suggests therapeutic support for: parathyroid, kidney. Deviation below the range suggests therapeutic support for: phosphorus, parathyroid, kidney.
- Total Protein TestPROTEINS are the building blocks of our body. They are produced in the liver and released for tissue needs, growth, repair, fluid balance and protection against infection. Deviation above the range suggests therapeutic support for: gonads, liver. Deviation below the range suggests therapeutic support for: anterior pituitary.
- Albumin TestALBUMIN is protein produced in the liver. Its primary function is in maintaining the pressure of your blood vessels. Secondary functions are the combining with certain minerals and amino acids. Deviation above the range suggests therapeutic support for: kidney. Deviation below the range suggests therapeutic support for: liver.
- Globulin TestGLOBULIN is the protein that is involved in antibody formation. It assists in the neutralization of toxins (poisons), and is necessary for the absorption of vitamin B12, iron, zinc and copper. Increased globulin levels are seen in acute (early stages) degenerative diseases as in: liver, heart disease, arthritis, diabetes, and malignancy. Decreased levels are seen in chronic (long time duration) diseases. Deviation above the range suggests therapeutic support for: thymus, spleen, thyroid. Deviation below the range suggests therapeutic support for: thymus, spleen, thyroid.
- A/G Ratio TestThis is an abbreviation for the albumin to globulin ratio. This test indicates functions of the body’s defense system. A/G levels are decreased in liver problems, ulcerative colitis, intestinal problems, kidney disease, diabetes, pernicious anemia, severe infections, metastatic carcinoma, etc. Deviation above the range suggest therapeutic support for: thymus, thyroid, spleen, liver. Deviation below the range suggests therapeutic support for: thymus, thyroid, spleen, liver.
- Bilirubin Total TestThis test measures liver and spleen function for the breakdown products of red blood cells. Bilirubin levels are increased in liver disease. Deviation above the range suggests therapeutic support for: liver, thymus. Deviation below the range suggests therapeutic support for: liver, spleen.
- Bilirubin DirectThis is a more specific test of liver function. Elevated levels will indicate obstruction, i.e. gall stone, tumor, etc. Deviation above the range suggests therapeutic digestive support for: liver, heart, bile salts.
- Bilirubin IndirectThis is a measure of red blood cell breakdown as well as liver function. Elevated levels indicate various anemia, gall bladder disease, or liver disease. Deviation above the range suggests therapeutic support for: liver, heart, bone marrow, spleen.
- Bun or Blood Urea Nitrogen TestThis test measures the liver and kidney’s ability to rid your body of waste products from protein metabolism. Elevated levels are seen in kidney, thyroid, and anterior pituitary dysfunction. Moderate levels are seen in adrenal and liver dysfunction. Extremely low levels are seen in posterior pituitary dysfunction. Deviation above the range suggests therapeutic support for: kidney, liver. Deviation below the range suggests therapeutic support for: liver, adrenal.
- Creatinine TestThis test measures muscle metabolism and kidney excretion. Elevated levels are seen in arthritis, diabetes, kidney dysfunction and hyperthyroidism. Deviation above the range suggests therapeutic support for: gonads, kidney, anterior pituitary, possible excessive exercise. Deviation below the range suggests therapeutic support for: gonads.
- Bun/Creatinine TestThe ratio of Bun and Creatinine is an index of the kidney function. Elevated levels are seen in high protein low water intake diets, kidney diseases and prostate hypertrophy. Decreased levels are seen in DH (anti-diuretic hormone) deficiency. Deviation above the range suggests therapeutic support for: kidney, posterior pituitary. Deviation below the range suggest therapeutic support for: posterior pituitary.
- Sodium TestSODIUM is the electrolyte, which offsets kidney activity for the discharge of toxins. It is antagonistic to potassium, which is essential for adrenal gland function. Sodium is related to the function of cholesterol. It is essential for the balance of calcium to phosphorus ratio.
- Potassium TestPOTASSIUM is the mineral essential to heart and kidney function. It maintains heart rate, general muscle strength, normal nerve impulses, adrenal function, and the acid to base balance of the blood and urine. Potassium influences the posterior pituitary in regulating kidney function. Increased levels are seen in hart block, adrenal insufficiency and hypoventilation. Decreased levels are seen in diarrhea, hyperadrenal conditions, general weakness, fatigue, spinal hypotension (poor posture, irregular heartbeat, and chronic kidney disease. Deviation above the range suggests therapeutic support for: adrenals, liver, heart, posterior pituitary. Deviation below the range suggests therapeutic support for: adrenals, heart.
- Chloride TestPrimary considerations for chloride are adrenal, kidney, bladder and bowel functions. Elevated levels are seen in kidney and adrenal disorders, and bowel dysfunction. Decreased levels are seen in diarrhea, infection, diabetes, hypo-adrenalism. Deviation above the range suggests therapeutic support for: kidneys, adrenals, bowel. Deviation below the range suggests therapeutic support for: adrenals, bladder.
Enzymes levels in the blood stream
The next for tests, LDH, SGOT, SGPT, and Alkaline Phosphatase are measures of enzyme levels in your blood serum. A rise in enzyme levels reflect tissue damage.
- LDT TestLACTIC DEHYDROGENASE is an enzyme associated with carbohydrate metabolism. It is widely distributed in the kidney, liver, heart, skeletal muscles, red blood cells. Damage to any of the above will result in elevated levels of LDH. Elevated levels are seen in heart attack, liver dysfunction, anemia, cancer. Deviation above the range suggests therapeutic digestive support for: liver, heart.
- SGOT TestSGOT is an enzyme associated with protein metabolism. It is found in kidney, heart, skeletal muscle, liver, brain. Elevated levels are seen in heart and liver disorders. Deviation above the range suggests therapeutic support for: liver, heart. Deviation below the range suggests therapeutic support for: gonads.
- SGPT TestSGPT is an enzyme associated with liver function. Elevated levels are seen in liver dysfunction. Deviation above the range suggests therapeutic support for: liver. Deviation below range suggests therapeutic support for: liver.
- ALK. PROS. TestALKALINE PHOSPHATASE measures the metabolism of bone, liver and tumors. Elevated levels are seen in hyperparathyroidism, disease of the bone, hyperthyroidism and leukemia. Increased levels are also seen in healing of fractures and growing bones. Deviation above the range suggests therapeutic 1 support for: parathyroid, liver, bone tissue, immune system, adrenals. Deviation below the range suggest therapeutic support for: liver, bone.
- Iron Total TestIron is a mineral essential for the formation of red blood cells, hemoglobin, and body growth. Iron is necessary for the function of the liver and spleen to facilitate bile breakdown, fats, to control hemorrhage and to the energy systems of your body. Deviation above metabolic range suggests therapeutic support for: spleen, digestion. Deviation below metabolic range suggests therapeutic support for: an iron building formulation, spleen, bone marrow.
- T-4 (Thyroxine) TestTHYROXINE is a thyroid hormone essential for fat and protein digestion, absorption, growth, and endocrine function, especially that of—reproduction. Thyroxin is involved in the regulation of heart rate and the healthy maintenance of hair, skin, and bone. Deviation above the range suggests therapeutic support for: thyroid, liver. Deviation below the range suggests therapeutic support for: thyroid and liver.
- HDL TestHDL OR HIGH DENSITY LIPOPROTEINS are fat (lipids) and protein combinations. HDL’s are a part of the cholesterol complex and are considered to be the “good guys” since they help transport excess cholesterol to the liver for excretion. They are increased by exercise, weight loss, vitamin E, niacin, and a fish fatty acid called eicosapentanoic acid (EPA). They are decreased with a high carbohydrate diet, with the more refined the carbohydrate, the more the decrease. Elevated levels have been associated with a low rate of heart and artery disease. Conversely the lower the level, the greater the incidence of heart disease.
- LDL TestLDL OR LOW DENSITY LIPOPROTEIN are also fat and protein combinations but contain more fat than do HDL fractions. They are characterized as the “bad guys” of the cholesterol family. They are increased with a high carbohydrate diet, the more concentrated the carbohydrate, the higher the LDL’s will be. They are decreased with a high fish diet, EPA, exercise and weight loss. Elevated levels have been associated with a high rate of heart and artery disease. The lower the level, the lesser the incidence of heart disease.
Darkfield Microscopy or Live Blood Cell Analysis
This is an important blood test to be aware of and consider doing in addition to undergoing standard blood testing procedures. Live blood analysis is an excellent source of information and is excellent for confirming existing results, finding previously unsighted issues and is great for children.
Darkfield Microscopy of Live Blood Analysis is a way of studying live whole blood cells under a specially adapted microscope that projects the dynamic image onto a video screen. This allows you to view your inner terrain. Digestive, eliminative and immune functions can be assessed as well as the presence of bacteria and other micro-organisms.
The darkfield microscopic examination of the freshly taken live blood is one of the most important examinations of the holistic medicine. It enables one to view the inner terrain (milieu) and to examine the functions of the red blood cells. It also shows the evolutionary stages of the smallest proteins (endobionts), which are found in every human body. One will be able to see any developed structures such as bacterial, virus and fungus. The darkfield examination shows the state of the blood cells, endobionts and the plasma in a functional and structural way, making bacterial processes and fungal pre-stages in the blood clearly visible.
The darkfield examination is most suitable for the evaluation of patients with chronic diseases; for those who are prone to infections; for recurrent bacterial problems; for Candida and other fungal problems and also to answer questions concerning chronic problems of metal toxicity (e.g. amalgam disturbances).
The examination is very motivating for the patient because the results can be discussed and demonstrated live on the screen. It cannot be replaced by any other blood examination, neither by normal microscope examination, nor by blood tests sent to laboratories. The blood rapidly changes its function with changes of the inner terrain after taking a sample.
How is the examination carried out?
Using a small fine needle, a drop of blood is taken from the finger and directly placed on a glass slide. Without fixation or coloring, the blood is examined right after taking it through a special darkfield microscope with up to 1000x enlargement. The patient can follow the process via video transmission on a large screen. The standard examination lasts approximately 15 minutes. A skilled practitioner will watch the blood over a longer period of time to see how it evolves. The blood will then be examined again several hours after taking the sample. This procedure informs us about the speed of degeneration of the cells, it reveals cell resilience, immune system activity and degenerative tendency.
We recommend repeating this examination every 3 months during the isopathic and immune biological therapy. For general health maintenance once a year is ideal.
With this method it was proven that co-relations exist between blood parasites, symbionts, bacteria and fungi. The main proven fact is that chronic diseases are created by increasing sickness tendencies of the endobionts and that bacteria, viruses and fungi developed in the human body, or are changed to pathogenic agents of diseases depending upon the inner terrain (determined by acid-base balance, protein content and level of trace elements). The existence of pre-stages, which are not yet able to make one ill but that can endanger an illness, can also be found in the darkfield examination. Therefore, it is also an important preventative examination.
Understanding Ferritin and Iron deficiency
Ferritin is an iron binding protein as opposed to the inorganic iron, which is usually used in iron supplements. It is rapidly absorbed and free of the gastrointestinal side effects, namely constipation frequently found with other iron products. Ferritin does not promote oxidation to the extent of the inorganic irons, nor does it deplete antioxidant defenses.
Iron is a structural component of hemoglobin, which carries oxygen to every cell in your body. About 70% of your total body iron is present as hemoglobin, 3% is present in your muscles as myoglobin, and the rest is found in ferritin, which, together with hemosiderin, forms the major storage sources of iron.
Women lose iron with menstruation and require a greater intake than men. Many pre-menopausal women have low ferritin (iron storage) levels. Infants, adolescents, pregnant women, the elderly, vegetarians, and those with low stomach acid are frequently iron deficient.
Iron deficiency is the most prevalent nutritional deficiency worldwide. Those at highest risk for iron deficiency are vegans, vegetarians, teenagers, children, junk food eaters, pre or peri-menopausal women, the elderly, those with recurrent infections, those chronically using aspirin or non-steroidal anti-inflammatory pain medicines, and those with chronic gastrointestinal disorders.
Chronically low iron causes numerous adverse changes in your immune system, resulting in recurrent colds, flues, and other infections. Many children with repeated infections are suffering form low iron levels.
Iron carries and releases oxygen from your red blood cells and is the main determinant of the oxygen supply to your cells.
Iron participates in the energy production systems in your body by several mechanisms and low iron leads to chronic fatigue and lethargy.
Iron status significantly relates to cognitive performance and mood by impacting your brain neurotransmitter function. Decreased iron levels lead to poor concentration, impaired attention span, poor learning, and low moods.
The best blood test for determining iron status is serum ferritin, which measures the level of stored iron available in your body.
Symptoms of Deficiency:
Urinalysis can reveal diseases that have gone unnoticed because they do not produce striking signs or symptoms. Examples include diabetes mellitus, various forms of glomerulonephritis, and chronic urinary tract infections.
The most cost-effective device used to screen urine is a paper or plastic dipstick. This microchemistry system has been available for many years and allows qualitative and semi-quantitative analysis within one minute by simple but careful observation. The color change occurring on each segment of the strip is compared to a color chart to obtain results. However, a careless doctor, nurse, or assistant is entirely capable or misreading or misinterpreting the result. Microscopic urinalysis requires only a relatively inexpensive light microscope.
The first part of a urinalysis is direct visual observation. Normal, fresh urine is pale to dark yellow or amber in color and clear. Normal urine volume is 750 to 2000 ml/24hr.
Turbidity or cloudiness may be caused by excessive cellular material or protein in the urine or may develop from crystallization or precipitation of salts upon standing at room temperature or in the refrigerator. Clearing of the specimen after addition of a small amount of acid indicates that precipitation of salts is the probable cause of turbidity.
A red or red-brown (abnormal) color could be from a food dye, eating fresh beets, a drug or the presence of either hemoglobin or myoglobin. If the sample contained many red blood cells, it would be cloudy as well as red.
Urine dipstick chemical
- PHThe glomerular filtrate of blood plasma is usually acidified by renal tubules and collecting ducts from a pH of 7.4 to about 6 in the final urine. However, depending on the acid-base status, urinary pH may range from as low as 4.5 as high as 8.0. The change to the acid side of 7.4 is accomplished in the distal convoluted tubule and the collecting duct.
- Specific Gravity (sp gr)Specific gravity (which is directly proportional to urine osmolality which measures solute concentration) measures urine density, or the ability of the kidney to concentrate or dilute the urine over that of plasma. Dipsticks are available that also measure specific gravity in approximations. Most laboratories measure specific gravity with a refractometer.Specific gravity between 1.002 and 1.035 on a random sample should be considered normal if kidney function is normal. Since the sp gr of the glomerular filtrate in Bowman’s space ranges from 1.007 to 1.010, any measurement below this range indicated hydration and any measure above it indicates relative dehydration.
If sp gr is not > 1.022 after a 12 hour period without food or water, renal concentrating ability is impaired and the patient either has generalized renal impairment or nephrogenicxc diabetes insipidus. In end-stage renal disease, sp gr ends to become 1.007 to 1.010.
Any urine having a specific gravity over 1.035 is either contaminated, contains very high levels of glucose, or the patient may have recently received high-density radiopaque dyes intravenously for radiographic studies or low molecular weight dextran solutions. Subtract 0.004 for every 1% glucose to determine non-glucose solute concentration.
- ProteinDipstick screening for protein is done on while urine, but semi=quantitative tests for urine protein should be performed on the supernatant of centrifuged urine since the cells suspended in normal urine can produce a falsely high estimation of protein. Normally, only small plasma proteins filtered at the glomerulus are reabsorbed by the renal tubule. However, a small amount of filtered plasma proteins and protein secreted by the nephron (Tamm-Horsfall protein) can be found in normal urine. Normal total protein excretion does not usually exceed 150 mg/24 hours or 10 mg/100 ml in any single specimen. More than 150 mg/day is defined as proteinuria. Proteinuria > 3.5 gm/24 hours is severe and known as nephritic syndrome.Dipsticks detect protein by production of color with an indicator dye, Bromphenol blue, which is most sensitive to albumin but detects globulins and Bence-Jones protein poorly. Precipitation by heat is a better semiquantitative method, but overall, it is not a highly sensitive test. The sulfosalicylic acid test is a more sensitive precipitation test. It can detect albumin, globulins, and Bence-Jones protein a low concentrations.
In rough terms, trace positive results (which represent a slightly hazy appearance in urine) are equivalent to 10mg/100 ml or about 150 mg/24 hours (the upper limit of normal). 1+ corresponds to about 200-500 mg/24 hours, a 2+ to 0.5-1.5 gm/24 hours, a 3+ to 2-5 gm/24 hours, and a 4+ represents 7 gm/24 hours or greater.
- GlucoseLess than 0.1% of glucose normally filtered by the glomerulus appears in urine (<130 mg/24 hour). Glycosuria (excess sugar in urine) generally means diabetes mellitus. Dipsticks employing the glucose oxidase reaction for screening are specific for glucose but glucose can miss other reducing sugars such as galactose and fructose. For this reason, most newborn and infant urines are routinely screened for reducing sugars by methods other than glucose oxidase (such as the Clinitest, a modified Benedict’s cooper reduction test).
- KetonesKetones (acetone, aceotacetic acid, beta-hydroxybutyric acid) resulting from either diabetic ketosis or some other form of calorie deprivation (starvation) are easily detected using either dipsticks or test tablets containing sodium nitroprusside.
- NitriteA positive nitrite test indicates that bacteria may be present in significant numbers in urine. Gram negative rods such as E coli are more likely to give a positive test.
- Leukocyte EsteraseA positive leukocyte esterase test results from the presence of white blood cells either as whole cells or as lysed cells. Pyuria can be detected even if the urine sample contains damaged or lysed WBCs. A negative leukocyte esterase test means that an infection is unlikely and that, without additional evidence of urinary tract infection, microscopic exam and/or urine culture need not be done to rule out significant bacteriuria.
A sample of well-mixed urine (usually 10-15 ml) is centrifuged in a test tube at relatively low speed (about 2-3,000 rpm) for 5-10 minutes until a moderately cohesive button is produced at the bottom of the tube. The supernate is decanted and a volume of 0.2 to 0.5 ml is left inside the tube. The sediment is resuspended in the remaining supernate by flicking the bottom of the tube several times. A drop of resuspended sediment is poured onto a glass slide and coverslipped.
The sediment is first examined under low power to identify most crystals, casts, squamous cells, and other large objects. The numbers of casts seen are usually reported as number of each type found per low power field (LPF). Example: 5-10 hyaline casts/L casts/LPF. Since the number of elements found in each field may vary considerably from one field to another, several fields are averaged. Next, examination is carried out at high power to identify crystals, cells, and bacteria. The various types of cells are usually described s the number of each type found per average high power field (HPF). Example: 1-5 WBC/HPF.
Red Blood Cells
Hematuria is the presence of abnormal numbers of red cells in urine due to: glomerular damage, tumors which erode the urinary tract anywhere along its length, kidney trauma, urinary tract stones, renal infarcts, acute tubular necrosis, upper and lower urinary tract infections, nephrotoxins, and physical stress. Red cells may also contaminate the urine from the vagina in menstruating women or from trauma produced by bladder catherization. Theoretically, no red cells should be found, but some find their way into the urine even in very healthy individuals. However, if one or more red cells can be found in every high power field, and if contamination can be ruled out, the specimen is probably abnormal.
Red Blood Cells (RBCs) may appear normally shaped, swollen by dilute urine (in fact, only cell ghosts and free hemoglobin may remain), or created by concentrated urine. Both swollen, partly hemolyzed RBCs and crenated RBCs are sometimes difficult to distinguish from WBCs in the urine. In addition, red cell ghosts may simulate yeast. The presence of dysmorphic RBCs in urine suggests a glomerular disease such as glomerulonephritis. Dysmorphic RBCs have odd shapes as a consequence of being distorted via passage through the abnormal glomerular structure.
White Blood Cells
Pyuria refers to the presence of abnormal numbers of leukocytes that may appear with infection in either the upper or lower urinary tract or with acute glomerulonephritis. Usually, the WBCs are granulocytes. White cells from the vagina, especially in the presence of vaginal and cervical infections, or the external urethral meatus in men and women may contaminate the urine.
If two or more leukocytes per each high power field appear in non-contaminated urine, the specimen is probably abnormal. Leukocytes have lobed nuclei and granular cytoplasm.
Renal tubular epithelial cells, usually larger than granulocytes, contain a large round or oval nucleus and normally slough into the urine in small numbers. However, with nephritic syndrome and in conditions leading to tubular degeneration, the number sloughed is increased.
When lipiduria occurs, these cells contain endogenous fats. When filled with numerous fat droplets, such cells are called oval fat bodies. Oval fat bodies exhibit a “Maltese cross” configuration by polarized light microscopy.
Transitional epithelial cells from the renal pelvis, ureter, or bladder have more regular cell borders, larger nuclei, and smaller overall size than squamous epithelium. Renal tubular epithelial cells are smaller and rounder than transitional epithelium, and their nucleus occupies more of the total cell volume.
Squamous epithelial cells from the skin surface or from the outer urethra can appear in urine.
The significance is that they represent possible contamination of the specimen with skin flora.
Urinary casts are formed only in the distal convoluted tubule (DCT) or the collecting duct (distal nephron). The proximal convoluted tubule (PCT) and loop of Henle are not locations for cast formation. Hyaline casts are composed primarily of a mucoprotein (Tamm-Horsfall protein) secreted by tubule cells. The Tamm-Horsfall protein secretion (green dots) is illustrated in the diagram below, forming a hyaline cast in the collecting duct.
Even with glomerular injury causing increased glomerular permeability to plasma proteins with resulting proteinuria, most matrix or “glue” that cements urinary casts together is Tamm-Horsfall mucoprotein, although albumin and some globulins are also incorporated.
The factors which favor protein cast formation are low flow rate, high salt concentration, and low pH, all of which favor protein denaturation and precipitation, particularly that of the Tamm-Horsfall protein. Protein casts with long, thin tails formed at the junction of Henle’s loop and the distal convoluted tubule are called cylindroids. Hyaline casts can be seen even in healthy patients.
Red blood cells may stick together and form red blood cell casts. Such casts are indicative of glomerulonephritis, with leakage of RBCs from glomeruli, or severe tubular damage.
White blood cell casts are most typical for acute pyelonephritis, but they may also be present with glomerulonephritis. Their presence indicated inflammation of the kidney, because such casts will not form except in the kidney.
When cellular casts remain in the nephron for some time before they are flushed into the bladder urine, the cells may degenerate to become a coarsely granular casts, later a finely granular cast, and ultimately, a waxy cast. Granular and waxy casts are believed to derive from renal tubular cell casts. Broad casts are believed to emanate from damaged and dilated tubules and are therefore seen in end-stage chronic renal disease.
The so-called telescoped urinary sediment is one in which red cells, white cells, oval fat bodies and all types of casts are found in more or less equal profusion. The conditions which may lead to a telescoped sediment are: 1) lupus nephritis 2) malignant hypertension 3) diabetic glomerulosclerosis, and 4) rapidly progressive glomerulonephritis.
In end-stage kidney disease of any cause, the urinary sediment often become very scant because few remaining nephrons produce dilute urine.
Bacteria are common in urine specimens because of the abundant normal microbial flora of the vagina or external urethral meatus and because of their ability to rapidly multiply in urine standing at room temperature. Therefore, microbial organisms found in all but the most scrupulously collected urines should be interpreted in view of clinical symptoms.
Diagnosis of bacteriuria in case of suspected urinary tract infection requires culture. A colony count may also be done to see if significant numbers of bacteria are present. Generally, more than 100,000/ml of one organism reflects significant bacteriuria. Multiple organisms reflect contamination. However, the presence of any organism in catheterized or suprapubic tap specimens should be considered significant.
Yeast cells may be contaminants or represent a true yeast infection. They are often difficult to distinguish from red cells and amorphous crystals but are distinguished by their tendency to bud. Most often they are Candida, which may colonize bladder, urethra, or vagina.
Common crystals seen even in healthy patients include calcium oxalate, triple phosphate crystals and amorphous phosphates.
Very uncommon crystals include: cystine crystals in urine of neonates with congenital cystinuria or severe liver disease, tyrosine crystals with congenital tyrosinosis or marked liver impairment, or leucine crystals in patients with severe liver disease or with maple syrup urine disease.
General “crud” or unidentifiable objects may find their way into a specimen, particularly those that patients bring from home.
Spermatozoa can sometimes be seen. Rarely, pinworm ova may contaminate the urine. In Egypt, ova from bladder infestations with schistosomiasis may be seen.
Summary of Urine Testing
To summarize, a property collected clean-catch, midstream urine after cleansing of the urethral meatus is adequate for complete urinalysis. In fact, these specimens generally suffice even for urine culture. A period of dehydration generally precedes urine collection if testing of renal concentration is desired, but any specific gravity of 1.022 measured in a randomly collected specimen denotes adequate renal concentration, so long as there are no abnormal solutes in the urine.
Another important factor is the interval of time, which elapses form collection to examination in the laboratory. Changes in urine occur quickly after collection and include:
- Decreased clarity due to crystallization of solutes,
- Rising pH,
- Loss of ketone bodies,
- Loss of bilirubin, dissolution of cells and casts
- Overgrowth of contaminating microorganisms.
Urinalysis may not reflect the most accurate information if the urine sample is more than one hour old.
Therefore, make all attempts to get urine samples to the laboratory as quickly as possible.
A final word
We encourage and support you too be as informed as you can be. If after reading this article you still have questions regarding test procedures or test results be sure to ask your Dr. or primary care physician for more information. If you approach testing with a basic understanding, you put yourself into a better position to converse and know the questions to ask. This empowers you and everyone involved.