Preparations
for your Add on Test
• Wear sleeves that roll up easily • Fasting required 12 hours before your test
Kidney Health Profile
Normally functioning
kidneys (at least one) are necessary for a healthy life. The kidney performs
essential functions for the body in removing waste chemicals from metabolism of
our tissue cells in producing energy, chemicals that have been detoxified by the
liver (such as drugs, toxins and hemoglobin breakdown products) and has major
roles in maintaining the right amount of bodily water and salts, and in
regulating our blood pressure.
The kidneys can
be damaged as a result of disease processes occurring elsewhere in the body,
such as diabetes, infections, blood vessel diseases, high (or low) blood
pressure, diseases of the blood, cancer, immune diseases such as lupus, trauma,
etc.
The kidneys can also have diseases of their own such as infections,
structural abnormalities from birth that bring about abnormal function, cancer,
and can cause high blood pressure.
Kidneys are incredibly resilient in functioning sufficiently well
to keep the body alive even after great or continuing damage.
When the kidneys begin to fail, the first signs are usually chemical, in the
blood and urine. Consequently, periodic checking of the kidneys’ functioning,
along with checking other bodily functioning, can be very beneficial in
identifying problems early, when many are curable or controllable.
Metabolism of both fat and sugar eventually produces CO2, which
exits the body mainly through the lungs and a small amount through the skin.
However, the metabolic breakdown product of proteins, after conversion in the
liver into a substance called urea, is chemically such that it must be excreted
in water. Likewise, creatine in muscle is metabolized into a chemical called
creatinine, which is also excreted in water. If the kidneys are not functioning
properly, the concentrations of these chemicals will rise in the blood.
Our laboratory uses the Blood Uurea Nitrogen (BUN) and
Creatinine to assess kidney function, and an optional
Urinalysis can be done to measure kidney output function and health of
the collecting system (lower portion of kidney, ureters and bladder).
The Kidney Health Panel
includes the measurement of the Blood Urea Nitrogen (BUN), Creatinine and BUN/Creatinine
ratio.
Blood Urea Nitrogen (BUN)
The major breakdown product of bodily protein (e.g., in that
hamburger you had for lunch) is Urea, which is first formed in the
liver. Urea contains nitrogen and together, in excess quantity, they are
both toxic to the body and must be removed.
Kidneys normally do an excellent job of removing urea, but when
they start to fail, the blood concentration of urea begins to rise. The
reference range (or range within which most normal people's test values
fall) for BUN is 10-20 mg/dL. Other circumstances, such as blood in the
intestinal tract, a big meal of cooked meat, simple dehydration (too little
water in the tissues), or any condition which decreases blood flow to the
kidneys, can cause the concentration of blood urea to rise and suggest there
is something wrong in kidney function. Therefore, a second blood test is
done at the same time.
Creatinine
Creatinine is a normal blood chemical that is a breakdown product of muscle
metabolism. Kidneys are normally very efficient filters of Creatinine. Unlike
urea, the blood Creatinine concentration is much less sensitive to the degree of
bodily hydration, blood or meat in the intestinal tract. The reference range for
blood Creatinine is 0.3-1.5 mg/dL.
Considered
together, the BUN, blood Creatinine and their ratio give very good evidence of
the filtering function of the kidneys and also, a measure of the degree of
bodily hydration.
BUN/Creatinine
The ratio of
BUN/Creatinine
is normally 10:1. With
dehydration, the ratio can increase to 20:1 or even higher.
An increased BUN/Creatinine ratio may also be due to certain types
of kidney disease, breakdown of blood in the intestinal tract, increased dietary
protein, or any clinical circumstance in which insufficient blood is flowing
through the blood vessels to the kidneys (such as heart failure or kidney artery
disease).
The BUN/Creatinine ratio is decreased in certain types of kidney
disease, liver disease, malnutrition and in a condition known as Sickle Cell
Anemia.
The
electrolyte panel is used to detect, evaluate, and
monitor electrolyte imbalances. It may be ordered as
part of a routine exam or to help evaluate a chronic or
acute illness. It may be ordered at intervals to help
monitor conditions, such as kidney disease and
hypertension, and to monitor the effectiveness of
treatment for known imbalances.
As part of routine health
screening, when your doctor suspects that you have an
excess or deficit of one of the electrolytes (usually
sodium or potassium), or if your doctor suspects an
acid-base imbalance.
Electrolytes are electrically charged minerals that are
found in body tissues and blood in the form of dissolved
salts. They help move nutrients into and wastes out of
the body’s cells, maintain a healthy water balance, and
help stabilize the body’s pH level. The electrolyte
panel measures the main electrolytes in the body: sodium
(Na+), potassium (K+), chloride (Cl-), and carbon
dioxide (total CO2).
The
Fluids & Electrolytes Panel includes:
Sodium
- One of the major salts in the body fluid; sodium is
important in the body's water balance and the electrical
activity of nerves and muscles.
Sodium is a mineral that is vital to normal body
function. It is an electrolyte, a positively charged
molecule that works with other electrolytes, such as
potassium, chloride and total carbon dioxide ( CO2), to
help regulate the amount of fluid in the body. Sodium is
present in all body fluids but is found in the highest
concentration in the blood and in the fluid outside of
the body’s cells. We get sodium in our diet, from table
salt (sodium chloride or NaCl), and to some degree from
most of the foods that we eat. Most people have an
adequate intake of sodium. The body uses what it
requires and the kidneys excrete the rest in the urine
to maintain sodium concentration within a very narrow
range. It does this by: producing hormones that can
increase (natriuretic peptides) or decrease (aldosterone)
sodium losses in urine, producing a hormone that
prevents water losses (antidiuretic hormone [ADH), and
controlling thirst. (Even a 1% increase in blood sodium
will make you thirsty and cause you to drink water,
returning your sodium level to normal.)
Abnormal blood sodium is usually due to some problem
with one of these systems. When the level of sodium in
the blood changes, the water content in your body also
changes. These changes can be associated with
dehydration or excess fluid (edema), especially in the
legs.
Chloride
- Similar to sodium, it helps to maintain the body's
electrolyte balance.
Chloride is an electrolyte, a negatively charged
molecule that works with other electrolytes, such as
potassium, sodium, and total carbon dioxide (CO2),
to help regulate the amount of fluid in the body and
maintain the acid-base balance. Chloride is present in
all body fluids but is found in the highest
concentration in the blood and in the fluid outside of
the body’s cells. Most of the time, chloride
concentrations mirror those of sodium, increasing and
decreasing for the same reasons and in direct
relationship to sodium. When there is an acid-base
imbalance, however, blood chloride levels can change
independently of sodium levels as chloride acts as a
buffer. It helps to maintain electrical neutrality at
the cellular level by moving into or out of the cells as
needed.
Chloride is taken into the body through food and table
salt, which is made up of sodium and chloride molecules.
Most of the chloride is absorbed by the gastrointestinal
tract, and the excess is excreted in urine. The normal
blood level remains steady, with a slight drop after
meals (because the stomach produces acid after eating,
using chloride from blood).
Potassium
- Helps to control the nerves and muscles. Potassium is
an electrolyte, a positively charged molecule that works
with other electrolytes, to help regulate the amount of
fluid in the body, stimulate muscle contraction, and
maintain a stable acid-base balance. Potassium is
present in all body fluids, but most potassium is found
within your cells. Only about two percent is present in
fluids outside the cells and in the liquid part of the
blood (called serum or plasma). Because the blood
concentration of potassium is so small, minor changes
can have significant consequences. If potassium levels
go too low or too high, your health may be in
considerable danger: you are at risk for developing
shock, respiratory failure, or heart rhythm
disturbances. An abnormal concentration can alter the
function of neuromuscular tissue; for example, the heart
muscle may lose its ability to contract.
CO2
-
The CO2 test measures the total amount of carbon dioxide
in the blood, mostly in the form of bicarbonate (HCO3-).
Bicarbonate is a negatively charged electrolyte that is
excreted and reabsorbed by the kidneys. It is used by
the body to help maintain the body’s acid-base balance
(pH) and secondarily to work with sodium, potassium, and
chloride to maintain electrical neutrality at the
cellular level. Since the CO2 test measures all three
forms of carbon dioxide in the blood (bicarbonate, H2CO3
[also known as carbonic acid], and dissolved CO2) as a
total CO2, it will give a rough estimate but not an
exact determination of the bicarbonate concentration.
When
CO2 levels are higher or lower than normal, it suggests
that your body is having trouble maintaining its
acid-base balance or that you have upset your
electrolyte balance, perhaps by losing or retaining
fluid. Both of these imbalances may be due to a wide
range of dysfunctions.
Some
drugs may increase blood carbon dioxide levels
including: fludrocortisone, barbiturates, bicarbonates,
hydrocortisone, loop diuretics, and steroids.
Calcium
-
Blood calcium
is tested to screen for, diagnose, and monitor a range of conditions
relating to the bones, heart, nerves, kidneys, and teeth. Blood calcium
levels do not directly tell how much calcium is in the bones, but
rather, how much total calcium or ionized calcium is circulating in the
blood.
Calcium levels in the blood are regulated and stabilized by a
feedback loop that includes: calcium, Parathyroid Hormone (PTH) ,
Vitamin D, Phosphorus, and magnesium. All these elements need to be in
balance. Conditions and diseases that disrupt this feedback loop can
cause inappropriate elevations or decreases in calcium and lead to
symptoms of high (hyper) or low (hypo) blood calcium. For example, when
parathyroid hormone (PTH) from the parathyroid gland is released, PTH
level rises, calcium also rises, and phosphorus drops. In some kidney
problems, a high phosphorus level in blood can depress calcium levels.
Large fluctuations in free calcium can cause the heart to slow down or
to beat too rapidly, can cause muscles to go into spasm (tetany), and
can cause confusion or even coma.
Calcium can be used as a diagnostic test if you go to your doctor with
symptoms that suggest:
kidney stones,
bone disease, or
neurologic (nerve-related) disorders.
Your
doctor also may order a calcium test if:
you have kidney disease, because low calcium is especially common in
those with kidney failure;
you have symptoms of too much calcium, such as fatigue, weakness,
loss of appetite, nausea, vomiting, constipation, abdominal pain,
urinary frequency, and increased thirst;
you have symptoms of low calcium, such as cramps in your abdomen,
muscle cramps, or tingling fingers; or
you have other diseases that can be associated with abnormal blood
calcium, such as thyroid disease, intestinal disease, cancer, or
poor nutrition.
Your
doctor may order an ionized calcium test if you have numbness around the
mouth and in the hands and feet and muscle spasms in the same areas,
which are symptoms of low levels of ionized calcium. If calcium levels
fall slowly, however, many people have no symptoms at all.
This panel is used
to evaluate male hormonal status. The following tests are included in this
panel:
Total & Free
Testosterone
Testosterone is a steroid hormone (androgen) made by the testes in
males. Its production is stimulated and controlled by luteinizing
hormone (LH), which is manufactured in the pituitary gland. In males,
testosterone stimulates development of secondary sex characteristics,
including enlargement of the penis, growth of body hair and muscle, and
a deepening voice. It is present in large amounts in males during
puberty and in adult males to regulate the sex drive and maintain muscle
mass. Testosterone is also produced by the adrenal glands in both males
and females and, in small amounts, by the ovaries in females.
This test is used
to evaluate gonadal and adrenal function. It is also helpful in
diagnosing hypogonadism, hypopituitarism, Klinefelter's syndrome and
impotence. Low testosterone levels adversely affects mood, strength and
lean muscle mass. Men with low testosterone are also more likely to have
negative factors relating to cardiovascular disease such as higher total
and LDL cholesterol and triglycerides and lower HDL cholesterol.
Testosterone
testing is used to diagnose several conditions in men, women, and boys.
These conditions include:
delayed or
precocious (early) puberty (boys);
decreased sex
drive (men);
erectile
dysfunction (men);
infertility
(men and women);
testicular
tumors (men); and
excessive
body hair, also called hirsutism, and masculinization, also called
virilization (women).
The symptoms of a low
body temperature are classic for low thyroid function and they often get
better with thyroid medicine. Body temperatures are normally lower in the
morning, higher in the afternoon, and lower again in the evening. So if the
temperatures are low during the day when they're supposed to be at their
highest, that's better evidence that there's a problem. Temperature patterns
are also important and illuminating. How patients feel can be affected not
only by how high or low their temperatures are but also on how steady their
temps are. One temperature reading a day is not enough to see how widely the
temperature is fluctuating, but more than three a day can be too time
consuming.
T3 uptake
This test measures the
amount of triiodothyronine, or T3, in the blood. T3 is one of two
major hormones produced by the thyroid gland (the other hormone is called
thyroxine,or T4). The thyroid gland is a small butterfly-shaped organ that
lies flat across your windpipe. The hormones it produces control the rate at
which the body uses energy. Their production is regulated by a feedback
system. When blood levels of thyroid hormones decline, the hypothalamus (an
organ in the brain) releases thyrotropin releasing hormone, which stimulates
the pituitary (a tiny organ below the brain and behind the sinus cavities)
to produce and release thyroid-stimulating hormone (TSH). TSH then
stimulates the thyroid gland to produce and/or release more thyroid
hormones. Most of the thyroid hormone produced is T4. This hormone is
relatively inactive, but it is converted into the much more active T3 in the
liver and other tissues.
If the thyroid gland
produces excessive amounts of T4 and T3, then the patient may have symptoms
associated with hyperthyroidism, such as nervousness, tremors of the hands,
weight loss, insomnia, and puffiness around dry, irritated eyes. In some
cases, the patient’s eyes cannot move normally and they may appear to be
staring. In other cases, the patient’s eyes may appear to bulge.
If the thyroid gland
produces insufficient amounts of thyroid hormones, then the patient may have
symptoms associated with hypothyroidism and a slowed metabolism, such as
weight gain, dry skin, fatigue, and constipation. Blood levels of hormones
may be increased or decreased because of insufficient or excessive
production by the thyroid gland, due to thyroid dysfunction, or due to
insufficient or excessive TSH production related to pituitary dysfunction.
Fatigue
Headaches &
Migraines
PMS
Easy Weight Gain
Depression
Irritability
Fluid Retention
Anxiety & Panic
Attacks
Hair Loss
Poor Memory
Poor
Concentration
Low Sex Drive
Unhealthy Nails
Dry Skin & Hair
Cold Intolerance
Low Motivation
Low Ambition
Insomnia - Heat
Intolerance
Allergies
Acne
Carpal Tunnel
Syndrome
Hives.....and
many others
About 99.7% of the T3
found in the blood is attached to a protein (primarily thyroxine-binding
globulin ( TBG) but also several other proteins) and the rest is free
(unattached). Separate blood tests can be performed to measure either the
total (both bound and unattached) or free (unattached) T3 hormone in the
blood.
When TBG is increased, T3 uptake is decreased, and vice versa. T3 Uptake
does not measure the level of T3 or T4 in serum.
Increased T3 uptake (decreased TBG) is seen in chronic liver disease,
protein-losing states, and with use of the following drugs: androgens,
barbiturates, bishydroxycourmarin, chlorpropamide, corticosteroids, danazol,
d-thyroxine, penicillin, phenylbutazone, valproic acid, and androgens. It is
also seen in hyperthyroidism.
Decreased T3 uptake (increased TBG) may occur due to the effects of
exogenous estrogens (including oral contraceptives), pregnancy, acute
hepatitis, and in genetically-determined elevations of TBG. Drugs producing
increased TBG include clofibrate, lithium, methimazole, phenothiazines, and
propylthiouracil. Decreased T3 uptake may occur in hypothyroidism
T4
T4 is one of two major
hormones produced by the thyroid gland (the other is called triiodothyronine,
or T3). The thyroid is a small, butterfly-shaped gland located just below
the Adam's apple. This gland plays a vital role in controlling the rate at
which your body uses energy.
The body has a
feedback system that turns thyroid hormone production on and off. When the
level of T4 in the bloodstream decreases, the hypothalamus (an organ in the
brain) releases thyrotropin releasing hormone, which stimulates the
pituitary gland (an organ below the hypothalamus) to release
thyroid-stimulating hormone (TSH), which in turn stimulates the thyroid
gland to make and/or release more T4. As blood concentrations of T4
increase, the amount of TSH released decreases.
T4 makes up nearly all
of what we call thyroid hormone, while T3 makes up less than 10%. Inside the
thyroid gland, T4 is produced, bound to a protein called thyroglobulin, and
stored. When the body requires thyroid hormone, the thyroid gland produces
some T4 or T3 and/or releases stored T4 into circulation. In the blood, T4
is present in a free (not bound) and protein-bound form (primarily bound to
thyroxine-binding globulin). The concentration of free T4 is only about 0.1%
of that of total T4, but the free T4 is the portion of thyroxine that is
active. T4 only becomes an active thyroid hormone when it is converted into
T3 in the liver or other tissues.
If the thyroid gland
does not produce sufficient T4 (due to thyroid dysfunction or to
insufficient TSH), then the affected patient experiences symptoms of
hypothyroidism such as weight gain, dry skin, cold intolerance, irregular
menstruation, and fatigue. If the thyroid gland produces too much T4, the
rate of the patient’s body functions will increase and cause symptoms
associated with hyperthyroidism such as increased heart rate, anxiety,
weight loss, difficulty sleeping, tremors in the hands, and puffiness around
dry, irritated eyes.
The most common causes
of thyroid dysfunction are autoimmune-related Graves' disease causes
hyperthyroidism and Hashimoto's thyroiditis causes hypothyroidism. Both
hyper- and hypothyroidism can also be caused by thyroiditis (thyroid
inflammation), thyroid cancer, and excessive or deficient production of TSH.
The effect of these conditions on thyroid hormone production can be detected
and monitored by measuring the total T4 (includes bound and free portion) or
the free T4 (only unbound).
This is a measurement of the total thyroxine in the serum, including both
the physiologically active (free) form, and the inactive form bound to
thyroxine-binding globulin (TBG). It is increased in hyperthyroidism and in
euthyroid states characterized by increased TBG (See "T3 uptake," above, and
"FTI," below). Occasionally, hyperthyroidism will not be manifested by
elevation of T4 (free or total), but only by elevation of T3 (triiodothyronine).
Therefore, if thyrotoxicosis is clinically suspect, and T4 and FTI are
normal, the test "T3-RIA" is recommended (this is not the same test as "T3
uptake," which has nothing to do with the amount of T3 in the patient's
serum).
T4 is decreased in hypothyroidism and in euthyroid states characterized by
decreased TBG. A separate test for "T4" is available, but it is not usually
necessary for the diagnosis of functional thyroid disorders.
T7 (FTI)
This is a convenient
parameter with mathematically accounts for the reciprocal effects of T4 and
T3 uptake to give a single figure which correlates with free T4. Therefore,
increased FTI is seen in hyperthyroidism, and decreased FTI is seen in
hypothyroidism. Early cases of hyperthyroidism may be expressed only by
decreased thyroid stimulation hormone (TSH) with normal FTI.
This test measures the
amount of thyroid-stimulating hormone (TSH) in your blood. TSH is produced
by the pituitary gland, a tiny organ located below the brain and behind the
sinus cavities. It is part of the body’s feedback system to maintain stable
amounts of the thyroid hormones thyroxine (T4) and triiodothyronine (T3) in
the blood. Thyroid hormones help control the rate at which the body uses
energy. When concentrations decrease in the blood, the hypothalamus (an
organ in the brain) releases thyrotropin releasing hormone (TRH). This
stimulates the release of TSH by the pituitary gland, and then TSH in turn
stimulates the production and release of T4 and T3 by the thyroid gland, a
small butterfly-shaped gland that lies flat against the windpipe. When all
three organs are functioning normally, thyroid production turns on and off
to maintain blood thyroid hormone levels.
If there is pituitary
dysfunction, then increased or decreased amounts of TSH may result. If TSH
concentrations are increased, the thyroid will make and release
inappropriate amounts of T4 and T3 and the patient may experience symptoms
associated with hyperthyroidism (overactive thyroid), such as rapid heart
rate, weight loss, nervousness, hand tremors, irritated eyes, and difficulty
sleeping. If there is decreased production of thyroid hormones
(hypothyroidism), then the patient may experience symptoms such as weight
gain, dry skin, constipation, cold intolerance, and fatigue. In addition to
pituitary dysfunction, hyper- or hypothyroidism can occur if there is a
problem with the hypothalamus (insufficient or excessive TRH). They may also
occur with a variety of thyroid diseases that affect thyroid hormone
production regardless of the amount of TSH present in the blood
Early cases of
hypothyroidism may be expressed only by increased TSH with normal T7 FTI.
Currently, the method of choice for screening for both hyper- and
hypothyroidism is the serum TSH. Modern methodologies ("ultra sensitive
TSH") allow accurate determination of the very low concentrations of TSH at
the physiological cutoff between the normal and hyperthyroid states
TSH has been recognized as an exquisitely sensitive indicator of thyroid
status. TSH assays (second or third generation) have therefore been widely
adopted as the front-line thyroid function test. In ambulatory patients with
intact hypothalamic and pituitary function, a normal TSH result excludes
hypo or hyperthyroidism; whereas elevated and suppressed TSH results are
diagnostic of hypo and hyperthyroidism, respectively.
Normal urine usually
ranges from a light yellow to a dark amber color
that may vary according to the concentration and
the type of food and drugs that are ingested.
The color of urine is attributed to its chief
pigment, "urochrome". Changes in urine may be
due to disease, but can also be caused by food
and drugs ingested.
Transparency
Freshly voided urine is
usually clear. Samples exposed to room
temperature for more than an hour or two may
become cloudy bur to bacterial growth or
precipitation of phosphates or urates. Possible
transparency are the presence of kidney stones,
bacteria, sperm, yeasts, or stool contamination.
Odor
The odor of a fresh
urine sample is normally Aromatic. The odor,
when unusual (Ammonia-like sweet and fruity),
may be due to a urinary tract infection, or the
presence of ketone bodies as in Diabetes,
starvation, strenuous exercise, vomiting,
diarrhea, malnutrition; or may be due to the
ingestion of certain food or to the
contamination of the urine container.
Specific Gravity
The specific gravity of
urine depends on the gravity and number of
molecules dissolved in solution of the urine
sample. The normal urinary specific gravity may
range from 1.002 to 1.030. Most of the molecules
dissolved in the urine are made of Sodium
Chloride and Urea. Urine is usually More
concentrated in the morning which, is a normal
phenomenon. Abnormally diluted urine may be
present in kidney disease whereas very
concentrated urine with high specific gravity
may be present in diabetes, vomiting, diarrhea,
and fever.
Leukocytes
Leukocytes are one of the white (Leuko) cells (Cytes)
present in blood stream which defend the body
from bacterial invasion. When present in the
urine may suggest the presence of an underlying
mild urinary tract infection. A repeated
presence of leukocytes indicate the needs for
further testing such as cultures or blood test.
Nitrates
The presence of
nitrates in the urine is due to the conversion
of nitrates in food by the action of the
bacteria. Therefore, a positive nitrate test is
a good indicator for the presence of a
significant amount of bacteria in urine. This
may be associated with a urinary tract infection
of a bladder or urethral the tube which connects
the bladder to the outside) infection.
Significant bacteriuria is estimated to affect
1%-2% of young girls,5%-10% of pregnant women
and is also associated with diabetes,
hypertension, herniation of the urinary bladder,
Prostate problems and the use of a catheter for
drawing certain anatomic abnormalities.
Ph
Normally freshly voided
urine is acid. Therefore, the PH which is a
measure of acidity may range from 4.0-7.0.
People who eat high protein diets produce a more
acid urine than those that consume mostly fruits
and vegetables. Increased urinary acidity (lower
PH) may also be present in diabetes, fever,
pulmonary emphysema, diarrhea and dehydration.
Alkaline PH (Higher PH) may also be noted in
chronic inflammation of the urinary bladder,
acute or chronic kidney failure, or for
intoxication of salicylate ( such as aspirin) or
other drugs.
Proteins
The presence of
proteins in the urine is called "Proteinuria"
and is an important sign of renal disease.
Proteinuria can be due to an increased
permeability of the walls of the filtering
components of the kidneys (The glomerulus).
Proteins may be present in a number of kidney
diseases. However a small amount of proteins,
mostly albumin, may appear in the urine in
response to excessive muscular exertion,
exposure to colds, or with extra ingestion of
proteins with food. In some people the presence
of proteins in the urine may occur upon arising
from a sitting position. This is called "
Orthostatic Proteinuria". Proteinuria may also
be present in acute inflammation of the kidneys
as acute nephritis, or in the presence of
malignant hypertension, heart failure and
diabetes.
Ketones
Ketones are called "Ketone bodies" and include
acetone, diacetic acid and beta hydrobutyric
acid and and appear in normal urine of patients
on a carbohydrate-deficent diet. When the body
can not find sufficient sugar for its metabolism
it turns to its fat stores for energy which in
turn are reduced to ketone bodies. Ketone bodies
appear in urine before they increase
significantly in blood and this is called "Ketonuria".
The presence of ketones in the urine may occur
in uncontrolled diabetes and hyperthyroidism.
The quickest and simplest way to find out if you have Anemia
is to measure your
Hemoglobin and/or Hematocrit levels. This Health
Panel will measure both. Anemia indeed occurs when
you have a below-normal level of
Hemoglobin or Hematocrit.
Hemoglobin
Hemoglobin is the compound that carries oxygen from the lungs to
other parts of the body. The human body can survive three weeks
without food, three days without drinking, but only three
minutes without oxygen. Sufficient oxygen to each cell in the
body is the basis of life itself.
Anemia can be a temporary or long-term
disease/illness, and can range from mild to severe. If you have
mild anemia, there may be no symptoms or only mild symptoms, but
severe anemia can result in a major impact on the quality of
life
People often equate anemia with iron-deficiency.
While this is partially true, anemia is actually any condition
where red blood cells are reduced in number or volume or are
deficient in the oxygen-carrying red pigmented protein
Hemoglobin.
In this scenario, a lack of iron can either be a
cause or a result.
Most anemias reduce the oxygen available to the body's tissues,
leading to fatigue, dizziness, fainting and shortness of breath.
This condition usually occurs as a symptom of another health
condition.
There are nearly one hundred varieties of anemia.
Each can be classified according to its cause:
Water, nutrients, and oxygen are transported into
the mitochondria and burned there to produce energy. If not
enough oxygen is available when nutrients are burned, the burn
is incomplete.
The amount of oxygen in our blood is directly
proportional to the number of red blood cells. Red blood cells
carry hemoglobin, which carries oxygen. Iron is also necessary,
as the agent that carries oxygen.
Normal range
for Females 18 yr and up is
11.5 - 15.0 g/dL
Normal range
for Males 18 yr and up
is 12.5 -
17.0 g/dL
The single
most important measure of oxygen in our blood is called the
Hematocrit
Hematocrit is the volume of red blood cells as a percentage of
total blood volume.
Like a fireplace, our body needs sufficient oxygen
to burn food and produce energy efficiently. A lack of oxygen
can cause a lack of concentration, exhaustion, migraine
headaches, problems with digestion, poor muscle tone, a weak
immune system, accelerated aging, and chronic degenerative
diseases such as cancer.
The
value is expressed as a percentage or fraction of cells in
blood. For example, a Hematocrit value of 40% means that there
are 40 milliliters of red blood cells in 100 milliliters of
blood.
The Hematocrit reflects both the number of red cells and their volume (MCV).
If the size of the red cell decreases, so will the Hematocrit
and vice versa.
The Hematocrit rises when the number of red blood cells
increases or when the plasma volume is reduced, as in
dehydration. The Hematocrit falls to less than normal,
indicating anemia, when your body decreases its production of
red blood cells or increases its destruction of red blood cells
or if blood is lost due to bleeding.
A complete
blood count (CBC) provides important information about the kinds and numbers of
cells in the blood: red blood cells, white blood cells and platelets. A CBC can
help you and your health professional evaluate symptoms (such as weakness,
fatigue, or bruising) and diagnose conditions (such as anemia, infection, and
many other disorders).
A CBC test
includes:
White blood cell (WBC)
count.
White blood cells protect the body against infection. If an infection
develops, white blood cells attack and destroy the bacteria, virus, or
other organism causing it. White blood cells are bigger than red blood
cells and normally fewer in number. When a person has a bacterial
infection, the number of white cells can increase dramatically. The
white blood cell count shows the number of white blood cells in a sample
of blood. The number of white blood cells is sometimes used to identify
an infection or monitor the body's response to cancer treatment.
White blood cell types
(WBC differential).
There are five major kinds of white blood cells: neutrophils,
lymphocytes, monocytes, eosinophils, and basophils. Immature
neutrophils, called band neutrophils, are also included and counted as
part of this test. Each type of cell plays a different role in
protecting the body. The numbers of each one of these types of white
blood cells give important information about the immune system. An
increase or decrease in the numbers of the different types of white
blood cells can help identify infection, an allergic or toxic reaction
to certain medications or chemicals, and many conditions (such as
leukemia ).
Red blood cell (RBC)
count. Red
blood cells carry oxygen from the lungs to the rest of the body. They
also help carry carbon dioxide back to the lungs so it can be exhaled.
The red blood cell count shows the number of red blood cells in a sample
of blood. If the RBC count is low, the body may not be getting the
oxygen it needs. If the count is too high (a condition called
polycythemia), there is a risk that the red blood cells will clump
together and block tiny blood vessels (capillaries).
Hematocrit (HCT, packed
cell volume, PCV).
This test measures
the amount of space (volume) red blood cells occupy in the blood. The
value is given as a percentage of red blood cells in a volume of blood.
For example, a hematocrit of 38 means that 38% of the blood's volume is
composed of red cells.
Hemoglobin (Hgb).
Hemoglobin is the substance in a red blood cell that carries oxygen. The
hemoglobin test measures the amount of hemoglobin in blood and is a good
indication of the blood's ability to carry oxygen throughout the body.
Red blood cell indices.
There are three red blood cell indices: mean corpuscular volume (MCV),
mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin
concentration (MCHC). They are not measured directly but are determined
from other measurements noted during a CBC. The MCV shows the size of
the red blood cells. The MCH value is the amount of hemoglobin in an
average red blood cell. The MCHC measures the concentration of
hemoglobin in an average red blood cell. These numbers help in the
diagnosis of different types of anemia.
Add Ons to CBC
separate charges applied
Platelet (thrombocyte) count.
Platelets (thrombocytes) are the smallest type of blood cell. They play
a major role in blood clotting. When bleeding occurs, the platelets
swell, clump together, and form a sticky plug that helps stop the
bleeding. If there are too few platelets, uncontrolled bleeding may be a
problem. If there are too many platelets, there is a risk of a blood
clot forming in a blood vessel.
Blood smear. In
this test, a drop of blood is spread (smeared) on a slide and stained
with a special dye. The slide is then examined under a microscope. The
numbers, size, and shape of red blood cells, white blood cells, and
platelets are recorded. Blood cells with unusual shapes or sizes can
help diagnose many blood diseases, such as leukemia, malaria, or sickle
cells anemia.
A
liver panel, also known as liver (hepatic) function tests or LFT, is
used to detect liver damage or disease. It usually includes seven tests
that are run at the same time on a blood sample. These include:
Total Protein
The
total protein test is a rough measure of all of the proteins in the
palsma portion of your blood. Proteins are important building blocks of
all cells and tissues; they are important for body growth and health.
Total protein measures the combined amount of two classes of proteins,
albumin and globulin. Albumin is a carrier of many small molecules, but
its main purpose is to keep fluid from leaking out of blood vessels,
while globulin proteins include enzymes, antibodies, and more than 500
other proteins. The ratio of albumin to globulin (A/G ratio) is
calculated from values obtained by direct measurement of total protein
and albumin. It represents the relative amounts of albumin and
globulins.
Albumin
Albumin is the most abundant protein in the blood plasma It keeps fluid
from leaking out of blood vessels; nourishes tissues; and transports
hormones, vitamins, drugs, and ions like calcium throughout the body.
Albumin is made in the liver and is extremely sensitive to liver damage.
The concentration of albumin drops when the liver is damaged, with
kidney disease (nephrotic syndrome), when a person is malnourished, if a
person experiences inflammation in the body, or with shock. Albumin
increases when a person is dehydrated.
Albumin is made in the liver and is the major protein of the blood,
helping to keep water in blood vessels and transport substances.
Decreased albumin levels can be associated with malnutrition, liver
disease, and kidney disease.
Alkaline
Phosphatase
Alkaline phosphate is an enzyme, a protein that helps cells work. You
find alkaline phosphate in high concentrations in the cells that make
bone and in the liver. In the liver, it is found on the edges of cells
that join to form bile ducts (tiny tubes that drain bile from the liver
to the bowels where it is needed to help digest fat in the diet).
Smaller amounts of ALP are found in the placenta (afterbirth) of women
who are pregnant, and in the bowel. Each of these body parts makes
different forms of ALP. The different forms are called isoenzymes.
When a person has evidence of liver disease, very high ALP levels can
tell the doctor that the person’s bile ducts are somehow blocked. Often,
ALP is high in persons who have cancer that has spread to the liver or
the bones, and doctors can do further testing to see if this has
happened. If a person with bone or liver cancer responds to treatment,
ALP levels will decrease. When a person has high levels of ALP, and the
doctor is not sure why, s/he may also order ALP isoenzyme tests to try
to determine the cause.
In some forms of liver disease, such as heaptitis, ALP
is usually much less elevated than AST and ALT. When the bile ducts are
blocked (usually by gallstones, scars from previous gallstones or
surgery, or by cancers), ALP and bilirubin may be increased much more
than AST or ALT. In a few liver diseases, ALP may be the only test that
is high.
Total
Bilirubin
As
red blood cells normally age and break down, bilirubin—a by-product—is
released into the blood and is cleared by the liver. High bilirubin
values may indicate a liver function problem, bile duct blockage, or
excessive destruction of red blood cells.
Bilirubin is an orange-yellow pigment found in bile. Red blood cells
(RBCs) normally degrade after 120 days in the circulation. At this time,
a component of the RBCs, hemoglobin (the red-colored pigment of red
blood cells that carries oxygen to tissues), breaks down into bilirubin.
Approximately 250 to 350 mg of bilirubin is produced daily in a normal,
healthy adult, of which 85% is derived from damaged or old red cells
that have died, with the remaining amount from the bone marrow or liver.
Unconjugated bilirubin is carried to the liver, where sugars are
attached to it, producing conjugated bilirubin. This conjugated
bilirubin is passed to the bile by the liver and is further broken down
by bacteria in the small intestines and eventually excreted in the
feces, of which the characteristic color is due to the break down of
bilirubin. Some bile is stored in the gall bladder. As bilirubin levels
increase, the appearance of jaundice becomes more evident. Normally,
almost all bilirubin in the blood is unconjugated.
AST
{Aspartate
aminotransferase}
AST {Aspartate
aminotransferase} which used to be called SGOT is an enzyme found mostly
in the heart and liver, and to a lesser extent in other muscles. When
liver or muscle cells are injured, they release AST into the blood.
Testing for AST is usually used to detect liver damage.
AST levels are
also often compared with levels of other liver enzymes, alakline
phosphatase ( ALP) and alanine aminotransferase ( ALT), to determine
which form of liver disease is present.
Even though AST is
found in heart and other muscles, another enzyme, cratine kinase ( CK),
is present in much higher amounts and is usually used to detect heart or
muscle injury.
An AST test
is ordered along with several other tests to evaluate a patient who
seems to have symptoms of a liver disorder. Some of these symptoms
include jaundice(yellowing of the eyes and skin),
dark urine, nausea, vomiting, abdominal swelling, unusual weight gain,
and abdominal pain. AST can also be ordered, either by itself or with
other tests, for:
persons who
might have been exposed to hepatitis viruses,
those who
drink too much alcohol,
persons who
have a history of liver disease in their family, or
persons
taking drugs that can occasionally damage the liver.
Persons who have
mild symptoms, such as fatigue, may be tested for ALT to make sure they
do not have chronic liver disease. ALT is often measured to monitor
treatment of persons with liver disease, and may be ordered either by
itself or along with other tests.
Very high levels
of AST (more than 10 times the highest normal level) are usually due to
acute heaptitis, often due to a virus infection. In acute hepatitis, AST
levels usually stay high for about 1–2 months, but can take as long as
3–6 months to return to normal. In chronic hepatitis, AST levels are
usually not as high, often less than 4 times the highest normal level.
In chronic hepatitis, AST often varies between normal and slightly
increased, so doctors typically will order the test frequently to
determine the pattern.
In some diseases of the liver, especially when the bile ducts are
blocked, or with cirrhosis and certain cancers of the liver, AST may be
close to normal, but it increases more often than ALT. When liver damage
is due to alcohol, AST often increases much more than ALT (this is a
pattern seen with few other liver diseases). AST is also increased after
heart attacks and with muscle injury, usually to a much greater degree
than is ALT.
Pregnancy may
decrease AST levels. A shot or injection of medicine into muscle tissue,
or even strenuous exercise, may increase AST levels. In rare instances,
some drugs can damage the liver or muscle, increasing AST levels. This
is true of both prescription drugs and some “natural” health products.
If your doctor finds that you have high levels of AST, tell him or her
about all the drugs and health products you are taking.
ALT
(Alanine Aminotransferase)
ALT (Alanine
Aminotransferase) which used to be called SGTP is an enzyme found mostly
in the liver; smaller amounts of it are also in the kidneys, heart, and
muscles. Under normal conditions, ALT levels in the blood are low. When
the liver is damaged, ALT is released into the blood stream, usually
before more obvious symptoms of liver damage occur, such as jaundice
(yellowing of the eyes and skin).
The ALT test detects
liver injury. ALT values are usually compared to the levels of other
enzymes, such as alkaline phsphatase ( ALP) and aspartate
aminotransferase ( AST) to help determine which form of liver disease is
present.
A physician
usually orders an ALT test (and several others) to evaluate a patient
who has symptoms of a liver disorder. Some of these symptoms include
jaundice, dark urine, nausea, vomiting, abdominal swelling, unusual
weight gain, and abdominal pain. ALT can also be ordered, either by
itself or with other tests, for:
persons who
have a history of known or possible exposure to Hepatitis Viruses,
those who
drink too much alcohol,
individuals
whose families have a history of lived disease, or
persons who
take drugs that might occasionally damage the liver.
In persons with
mild symptoms, such as fatigue or loss of energy, ALT may be tested to
make sure they do not have chronic liver disease. ALT is often used to
monitor the treatment of persons who have liver disease, to see if the
treatment is working, and may be ordered either by itself or along with
other tests.
PSA
is produced by normal, hyperplastic, and cancerous prostatic tissue.
Serum PSA has been found to be the most sensitive marker for monitoring
individuals with prostate cancer and to enhance efficacy in monitoring
progression of disease and response to therapy.
Blood
glucose testing can be used to screen healthy, asymptomatic individuals for
diabetes and pre-diabetes because diabetes is a common disease that begins
with few symptoms.
The blood
glucose test is ordered to measure the amount of glucose in the blood right
at the time of sample collection. It is used to detect both hyperglycemia
and hypogltcemia and to help diagnose diabetes. Blood glucose may be
measured on a fasting basis (collected after an 8 to 10 hour fast), randomly
(anytime), post prandial (after a meal), and/or as part of an Ooral
Glucose Tolerance Test (OGTT or GTT). An OGTT is a series of blood
glucose tests. A fasting glucose is collected; then the patient drinks a
standard amount of a glucose solution to "challenge" their system. This is
followed by one or more additional glucose tests performed at specific
intervals to track glucose levels over time. The OGTT may be ordered to help
diagnose diabetes and as a follow-up test to an elevated blood glucose.
The
American Diabetes Association recommends either the fasting glucose or the
OGTT to diagnose diabetes but says that testing should be done twice, at
different times, in order to confirm a diagnosis of diabetes.
Most
pregnant women are screened for gestational diabeetes, a temporary form of
hyperglycemia, between their 24th and 28th week of pregnancy using a version
of the OGTT, a 1-hour glucose challenge. If either fasting glucose or a
random glucose is above the values used to diagnose diabetes in those who
are not pregnant, the woman is considered to have gestational diabetes and
neither the screening nor the glucose tolerance test is needed. If the
1-hour level is higher than the defined value, a longer OGTT is performed to
clarify the patient’s status.
Diabetics
must monitor their own blood glucose levels, often several times a day, to
determine how far above or below normal their glucose is and to determine
what oral medications or insulin(s) they may need. This is usually done by
placing a drop of blood from a skin prick onto a glucose strip and then
inserting the strip into a glucose meter, a small machine that provides a
digital readout of the blood glucose level.
In those
with suspected hypoglycemia, glucose levels are used as part of the "Whipple
triad" to confirm a diagnosis. (See “Is there anything else I should know?”
section).
The urine
glucose is seldom ordered by itself. At one time, it was used to monitor
diabetics, but it has been largely replaced by the more sensitive and “real
time” blood glucose. The urine glucose is, however, one of the substances
measured when a urinalysis is performed. A urinalysis may be done routinely
as part of a physical, when a doctor suspects that a patient may have a
urinary tract infectio, or for a variety of other reasons. The doctor may
follow an elevated urine glucose test with blood glucose testing.
When is it
ordered?
Screening
for glucose may occur during public health fairs or as part of workplace
health programs. It may also be ordered when a patient has a routine
physical exam. Screening is especially important for people at high risk of
developing diabetes, such as those with a family history of diabetes, those
who are overweight, and those who are more than 40 to 45 years old.
The
glucose test may also be ordered to help diagnose diabetes when someone has
symptoms of hyper glycemia, such as:
Increased thirst
Increased urination
Fatigue
Blurred vision
Slow-healing infections
or
symptoms of hypoglycemia, such as:
Sweating
Hunger
Trembling
Anxiety
Confusion
Blurred Vision
Blood
glucose testing is also done in emergency settings to determine if low or
high glucose is contributing to symptoms such as fainting and
unconsciousness. If a patient has pre-diabetes (characterized by fasting or
OGTT levels that are higher than normal but lower than those defined as
diabetic), the doctor will order a glucose test at regular intervals to
monitor the patient’s status. With known diabetics, doctors will order
glucose levels in conjunction with other tests such as Hemoglobin A1c to
monitor glucose control over a period of time. Occasionally, a blood glucose
level may be ordered along with insulin and C-peptide to monitor insulin
production.
Diabetics
may be required to self-check their glucose, once or several times a day, to
monitor glucose levels and to determine treatment options as prescribed by
their doctor.
Pregnant
women are usually screened for gestational diabetes late in their
pregnancies, unless they have early symptoms or previously have had
gestational diabetes.. When a woman has gestational diabetes, her doctor
will usually order glucose levels throughout the rest of her preganancy and
after delivery to monitor her condition.
High
levels of glucose most frequently indicate diabetes, but many other diseases
and conditions can also cause elevated glucose. The following information
summarizes the meaning of the test results. These are based on the clinical
practice recommendations of the American Diabetes Association.
Fasting Blood
Glucose
Interpretation
From 70 to 99 mg/dL
(3.9 to 5.5 mmol/L)
Normal glucose
tolerance
From 100 to 125
mg/dL (5.6 to 6.9 mmol/L)
Impaired fasting
glucose (pre-diabetes)
126 mg/dL (7.0
mmol/L) and above on more than one testing occasion
Diabetes
Oral Glucose Tolerance Test (OGTT) [except pregnancy]
(2 hours after a 75-gram glucose drink)
Interpretation
Less than 140 mg/dL
(7.8 mmol/L)
Normal glucose
tolerance
From 140 to 200
mg/dL (7.8 to 11.1 mmol/L)
Impaired glucose
tolerance (pre-diabetes)
Over 200 mg/dL
(11.1 mmol/L) on more than one testing occasion
Diabetes
Some of
the other diseases and conditions that can result in elevated glucose levels
include:
Acromegaly
Acute
stress (response to trauma, heart attack, and stroke for instance)
Chronic renal failure
Cushing syndome
Drugs, including: corticosteroids, tricyclic antidepressants, diuretics,
epinephrine, estrogens (birth control pills and hormone replacement),
lithium, phenytoin (Dilantin), salicylates,
Excessive food intake
Hyperthyroidism
Pancreatic cancer
Pancreatitis
Low to
non-detectible urine glucose results are considered normal. Anything that
raises blood glucose levels also has the potential to elevate urine glucose
levels. Increased urine glucose levels may be seen with medications, such as
estrogens and chloral hydrate, and with some forms of renal disease.
Moderately increased levels may be seen with pre-diabetes. This condition,
if left un-addressed, often leads to type 2 diabetes.
Low glucose levels
(hypoglycemia) are also seen with:
Adrenal Insufficiency
Drinking alcohol
Drugs, such as acetaminophen and anabolic steroids
Extensive liver disease
Hypopituitarism
Hypothyroidism
Insulin overdose
Insulinomas (insulin-producing pancreatic tumors)
Starvation
Hypoglycemia
( Low glucose level) is characterized by a drop in blood glucose to a level
where first it causes nervous system symptoms (sweating, palpitations,
hunger, trembling, and anxiety), then begins to affect the brain (causing
confusion, hallucinations, blurred vision, and sometimes even coma and
death). An actual diagnosis of hypoglycemia requires satisfying the "Whipple
triad." These three criteria include:
Documented low glucose levels (less than 40 mg/dL (2.2 mmol/L) often
tested along with insulin levels and sometimes with C-Peptide levels)
Symptoms of hypoglycemia
Reversal of the symptoms when blood glucose levels are returned to
normal.
Primary
hypoglycemia is rare and often diagnosed in infancy. People may have
symptoms of hypoglycemia without really having low blood sugar. In such
cases, dietary changes such as eating frequent small meals and several
snacks a day and choosing complex carbohydrates over simple sugars may be
enough to ease symptoms. Those with fasting hypoglycemia may require IV
(intravenous) glucose if dietary measures are insufficient.
This
profile requires you to be fasting 12-14 hours. No appointment necessary.
Components of a Lipid Profile
Total Cholesterol
Cholesterol is a necessary
substance in your body from your first day of life. Experts recommend a
cholesterol level below 200 for good health. Between 200 and 239 is borderline
and above 240 is dangerous. When associated with at least two risk factors such
as high blood pressure, diabetes, previous heart disease or stroke, excess
weight and being a smoker, it increases the incidence of having coronary artery
disease and heart attacks.
HDL (Good Cholesterol)
High density lipoproteins
(HDL) are proteins coated "packages" that carry fat and cholesterol through the
body. The function of HDL is to remove cholesterol from the blood by
transporting it to the liver where it will be prepared for excretion through the
bile. HDL has a protective effect on the deposit of fat in the wall of blood
vessels. Increasing its level in the blood will reduce the risk of
cardiovascular disease. The use of polyunsaturated, monounsaturated fats (Olive
Oil), and physical exercise may increase the level of HDL.
Triglycerides
Triglycerides are a type
of fatty substance which must be measured together with your cholesterol for a
complete picture of your circulating blood fats. Blood triglycerides tend to be
elevated in people who have high cholesterol levels, in people with diabetes or
chronic kidney disease, and in those who are obese. The relationship between
triglycerides and coronary artery disease is still controversial. Some studies
suggest that high blood triglycerides might increase the risk of coronary artery
disease. If your blood level of triglycerides is elevated you should consult
your doctor for dietary changes and weight loss and exercise program or for the
use of medication which may be necessary in some cases.
LDL
(Bad Cholesterol)
Low density lipoproteins (LDL)
transport one half to two thirds of all blood cholesterol to various body
tissues. A certain amount of LDL cholesterol (up to 130) is normal. But when the
level increases, LDL promotes plaque development on the walls of the coronary
arteries, slowing the flow of blood and sometimes blocking the artery entirely.
Levels of 130-160 are considered borderline high and levels of 160 or higher are
definitely abnormal and should be reduced with rigorous diet, other lifestyle
changes, and/or with drug therapy.
Controversies are
now surfacing on the danger of having LDL blood levels which are too
low. The relation to some type of cancers and other diseases have
been noticed with LDL levels reduced below 90 and closer to 50.
Therefore is unclear today how safe is to lower your LDL blood
level. A safer level seems to be between 90-130 and should be
associated with an increase in the HDL levels.
VLDL (Very
Low Density Lipoprotein)
VLDL (Very Low Density
Lipoprotein) is a fraction of Triglycerides circulating in your blood stream.
Not as important as the LDL, this blood fats follows the levels of your
Triglycerides.
Tryglycerides levels may be elevated either for the presence of high
fats in your food which when absorbed in your intestine is
transformed as Chylomicrons and give a milky appearance to the
liquid part of your blood ( serum ) or for the presence of Very Low
Density Lipoproteins (VLDL) which is the part of Triglycerides
produced by your body and not ingested with food.
Cholesterol/HDL Ratio
The HDL in the blood is
believed to serve two functions: 1) it coats the inside of the artery wall and
provide a kind of protective layer of grease to prevent fat deposits from
building up and 2) it serves as scavenger by actually helping dissolve fatty
deposits when they occur. The basic rule of balance for your blood is to have a
relatively high amount of HDL in your body in relation to your total amount of
cholesterol. This is called the Cholesterol/HDL Ratio.
The ratio in men should
always be less than 5.0, and preferably less than 4.5. For women, the ratio
should be lower and always under 4.0 and preferably under 3.5. In other words
the man's HDL should always represent at least 20% of the total cholesterol
count (and preferably should be 25% or greater). For a woman the HDL cholesterol
should make up at least 25% (or preferably 30%) of the total cholesterol. The
Cholesterol/HDL Ratio is probably the best predictor of future coronary disease.
Active people with low levels of body fat tend to show the best cholesterol
balance (ratio) in their blood.
