The following is a brief explanation of the various studies performed on the SMAC and CBC. THIS SHOULD NOT BE USED FOR DIAGNOSIS OF DISEASES WITHOUT A PHYSICAL EXAMINATION BY A PHYSICIAN AND COMPLETE MEDICAL HISTORY. Comprehensive Metabolic Panel GLUCOSE - Shows how well the body handles carbohydrate metabolism. Glucose may be burned directly or stored as fat. The primary source of glucose is through conversion of the glycogen stored in the liver. Higher sugar urine may mean that food sugar is not being used normally, a warning sign of diabetes or possibly other diseases. Decreased sugar levels (Hypoglycemia) can be caused by pancreatic disorders and excess insulin. This condition often manifests itself in fatigue and depression. BUN - BUN is used to assess kidney function, and is the end product of protein metabolism. BUN is the main waste product produced by the liver during breakdown of protein. Elevated BUN levels are found in urinary tract obstruction, congestive heart failure, gastrointestinal bleeding, and in individuals on a high protein diet. Antibiotics and a number of drugs can increase levels as can stress, gout, internal bleeding and ulcers. It varies with dietary protein intake. Low levels may be caused by diet, malnutrition, liver failure, and increased pituitary activity. Diets low in protein and high in carbohydrates can also be responsible for low BUN levels. CREATININE - Creatinine is the breakdown product of creatine, which is used for skeletal muscle contraction. Excreted entirely by the kidneys, presence may suggest a kidney problem. EGFR African American – (Keloid) Epidermal growth factor receptor (EGFR) is a key driver in the processes of cell proliferation, and increased tumor EGFR levels have been associated with advanced disease, resistance to chemotherapy, and poor clinical prognosis. For patients who have values within the normal reference range, the patient eGFR result is reported as "greater than 60 mL/min/1.73m2". *eGFR results <60 are reported as a numeric value. The interpretive guidelines for numeric values are as follows: *eGFR 30 - 59 = Stage 3 CKD (chronic kidney disease), or moderate kidney disease. *eGFR 15 - 29 = Stage 4 CKD (chronic kidney disease), or severe kidney disease. *eGFR <15 = Stage 5 CKD (chronic kidney disease), or kidney failure. EGFR Non-African American - (Keloid) Epidermal growth factor receptor (EGFR) is a key driver in the processes of cell proliferation, and increased tumor EGFR levels have been associated with advanced disease, resistance to chemotherapy, and poor clinical prognosis. For patients who have values within the normal reference range, the patient eGFR result is reported as "greater than 60 mL/min/1.73m2". *eGFR results <60 are reported as a numeric value. The interpretive guidelines for numeric values are as follows: *eGFR 30 - 59 = Stage 3 CKD (chronic kidney disease), or moderate kidney disease. *eGFR 15 - 29 = Stage 4 CKD (chronic kidney disease), or severe kidney disease. *eGFR <15 = Stage 5 CKD (chronic kidney disease), or kidney failure. SODIUM (SALT) - Sodium content of the blood is a balance between sodium intake and kidney excretion. Therefore, water and sodium are physiologically interrelated. Increased levels found may indicate endocrine disorders, dehydration, steroid drugs and others. Kidney and heart disease can be due to various causes such as diarrhea, cirrhosis, kidney problems, etc. POTASSIUM - Potassium is a major ion within the cell. Maintains balance of fluids in cells and helps carry out enzyme reactions. Highly elevated levels, secondary to kidney failure or liver disease, can lead to heart failure. Decreased levels can be caused by diabetes, vomiting and diarrhea. Blood potassium levels depend on many factors including: • Aldosterone (this hormone tends to increase the kidney losses of potassium.) • Sodium reabsorption (as sodium is reabsorbed, potassium is lost.) • Acid-base balance (acidotic states tend to raise the blood potassium levels.) CHLORIDE - A salt of hydrochloric acid. Along with bicarbonates, potassium, and sodium, chloride helps control the body's acid-base system and control water metabolism. Elevated with kidney disease, dehydration, aspirin toxicity; decreased with vomiting, diarrhea, heart disease, and diabetes. CARBON DIOXIDE - In the process of normal breathing, CO2 is eliminated through the lungs. Increased primarily by conditions such as emphysema and asthma where sufficient CO2 is not exhaled. Can also be increased with metabolic alkalosis caused by diuretic drugs, antacids, and steroid hormones. CO2 is decreased with metabolic acidosis caused by drug poisoning (especially aspirin), diarrhea, liver and kidney diseases. CALCIUM - Calcium is a mineral important for bone formation, muscle contraction and blood clotting. In addition, calcium is involved with maintaining the stability of nerve cells. Calcium levels in blood are strictly controlled by various substances called hormones. Abnormal blood calcium levels may be the results of excessive vitamin D, antacids, magnesium, etc. Low values could mean malabsorption/diarrhea, renal or digestive problems. TOTAL PROTEIN - Special combination of amino acids whose balance is important for cell growth and repair. Total protein is one way to assess liver function. More important, the measure of total protein is a measure of albumin, one of the proteins synthesized by the liver. When disease affects the liver cells, the cells lose their ability to make albumin. Therefore, the measure of total protein is a rather indirect and inadequate indication of liver function. Measuring the level of albumin is much more reliable. ALBUMIN - Albumin is the major protein of the blood. Presence in urine is often a sign of kidney disease. Decrease of ten indicates liver damage. Albumin levels are also used as an indication of general health and nutritional status. GLOBULIN - A simple protein found in the blood. Includes alpha, beta and gamma globulin. Some globulins function as antibodies, others are responsible for the transport of lipids, iron, and copper in the blood. Abnormal values could reflect a liver problem, such as cirrhosis, mononucleosis, and cancer. A/G RATIO - The Albumin Globulin Ratio is another indicator of liver function since the presence of these two proteins in the blood should be constant. TOTAL BILIRUBIN - A gold colored pigment and body waste product. It is formed by the spleen from the hemoglobin in blood cells when they break down. Increased total bilirubin is associated with cirrhosis, gallstones, or cancer of the pancreas, total bilirubin is increased and "indirect" bilirubin is usually within normal range. ALKALINE PHOSPHATASE - An enzyme found in almost all tissue of the body. Highest levels are found in the intestine, kidney, bone and placenta. The enzyme form present in serum comes from the liver and bone. Therefore, measurements of serum alkaline phosphatase are particularly useful in the evaluation of liver and bone diseases. Minor increases in the level of alkaline phosphatase are sometimes observed during the normal aging process. AST (SGOT) - The enzyme SGOT is found in very high concentration in the heart and in the liver and in moderately large amounts in the skeletal muscle, kidneys, and pancreas. A characteristic rise in SGOT level occurs in more than 95% of patients with proven myocardial infractions. ALT (SGPT) - An enzyme that speeds up chemical organic reactions that occur within cells. CBC (Complete Blood Count) WBC - White Blood Count - Part of the immune system. Fights infection. RBC - Determines the number of red blood cells in one cubic meter of blood. MCV, MCH, and MCHC are indices that help diagnose the cause of anemia. HEMOGLOBIN - Iron-containing protein in red blood cells. Hemoglobin level is a good index of the blood's oxygen carrying capacity. Carries oxygen from lungs to tissue. HEMATOCRIT - Part of the blood that is in the red blood cells. Excessive amounts may be due to insufficient oxygen, carbon monoxide, or chronic lung disease. Decreased levels may mean anemia. MCV - Average free white blood cell and red cell volume. Indicates whether cells are of normal size. MCH - The weight of hemoglobin in an average red blood cell. MCHC - The amount of hemoglobin in an average cell. RDW - Red cell distribution width (RDW) is a calculation of the variation in the size of your RBCs. In some anemias, such as pernicious anemia, the amount of variation (anisocytosis) in RBC size (along with variation in shape – poikilocytosis) causes an increase in the RDW. NEUTROPHILS - Primary cells that destroy microorganisms and toxic/disease causing substances. LYMPHOCYTES - Cells that represent antibody activity in producing immunity to disease. MONOCYTES - These cells are old lymphocytes and typically represent the body's chronic disease processes. EOSINOPHILS - Ratio is related to allergies and parasitic infections. BASOPHILS - Only 1% of corpuscular volume. Function not understood. PLATELET COUNT - A protoplasmic disk, smaller than a red blood cell, necessary for coagulation. LDH - An enzyme which is found in human tissues, especially the heart, kidneys, liver and muscle. Elevated in a number of diseases and drug reactions. PHOSPHOROUS - Necessary for many body functions and directly related to calcium metabolism. Hyperphosphatemia (high levels of serum phosphorus) can be caused by hypoparathyroidism, kidney failure, or increased dietary intake. Hypophosphatemia (low levels of phosphorus) can be caused by inadequate dietary intake, vitamin deficiency, alcoholism, chronic antacid ingestion, and hyperthyroidism. Symptoms may include retarded skeletal growth in children, anorexia, dizziness, and muscle weakness. URIC ACID - Uric acid is a product formed mainly by the liver during the breakdown of nucleic acids. Following handling by the kidney, it is excreted in the urine. Acid is an end product of the body's metabolism. High levels might indicate gout, arthritic condition, or kidney problems. Amounts can vary with certain diseases and diets overly rich in some types of fish and gland foods. High levels can be considered a high risk factor, particularly if accompanied with high triglyceride and low HDL. CHOLESTEROL - the cholesterol (solid alcohol, not a true fat) in our bodies is carried around and attaches to five major fat particles that are called lipoprotein. TRIGLYCERIDES - A true fat and heart risk factor. This is an important lipid component which takes the available cholesterol and makes it "stick" to the artery walls causing fat deposit build up. High triglycerides are generally caused by high dietary intake of carbohydrates, alcohol, sugars, and yeast breads and are best treated with a low-carbohydrate diet. HDL (Good cholesterol) - A lipoprotein that accepts free cholesterol from the tissue for transport to the liver. HDL helps remove lipids (fats) from artery tissues and also protects plasma LDL from damaging the artery, thus limiting plaque buildup. LDL (Bad cholesterol) - Elevated levels of LDL are strongly associated with heart disease. The LDL typically contain 60-70% of the total serum cholesterol and therefore its concentration closely correlates with the concentration of total cholesterol. LDL/HDL RATIO - A ratio of total cholesterol divided by the High Density lipids (HDL) establishes this important heart risk factor. T3 UPTAKE - T3, one of two iodine containing hormones produced by the thyroid gland. T4 - Thyronine, one of two iodine containing hormones produced by the thyroid gland. T7 CALCULATION - Calculated by multiplying the T4 x T3. Excessive may mean hyperthyroidism. Lower may indicate hypothyroidism. BUN/CREATININE RATIO - The daily production of creatine, and subsequently creatinine depends upon muscle mass, which fluctuates very little. With normal kidney excretory function, the serum creatinine level should remain constant and normal. Therefore only kidney disorders (as mentioned before) will cause an abnormal elevation of creatinine. The normal BUN/Creatinine ratio is 20:1. GGTP - Enzyme primarily in heart and liver. Released in blood when there is heart muscle damage, liver cell damage or some parasitical or bacterial infections. Also elevated with pancreatitis, infections, mononucleosis, and certain muscle diseases. IRON - Iron in the body picks up oxygen and delivers it to body tissues. Abnormal levels of iron are characteristic of many diseases, including iron deficiency anemia. Most of the iron in the body is in the hemoglobin of the red blood cells. Iron deficiency anemia has many causes, including: • Insufficient iron intake. • Inadequate absorption of iron from the intestines. • Increased requirements of iron (as in growing children). • Loss of blood (as in excessive menstruation, bleeding peptic ulcer, or colon cancer). Because serum iron levels may vary during the day, specimens should be drawn in the morning, especially when the results are used to monitor iron replacement therapy. Urinalysis W/ Reflex Micro Color – Unusual color due to medications, foods, bacteria Appearance – Clear or slightly hazy Specific Gravity – The density of the urine. Greater could be excessive sugar or protein, lower could be excessive fluid intake or kidney disease. Leukocyte Esterase – Positive may indicate urinary infection, large doses of Vitamin C or antibiotics. Nitrite – Positive may indicate urinary infection, large doses of Vitamin C or medications. PH – Measures acidity or alkalinity. Reflects type of foods eaten and function of lungs, kidneys & metabolism. Protein – Under normal conditions, protein is not extracted in the urine. Glucose – Sugar level. Excessive due to medication or diabetes. Ketone – Waste products of fat breakdown. Measured in blood or urine. Greater than normal may indicate diabetes, starvation, low-carbohydrates, diarrhea, severe stress, or too long fasting. Urobilinogen – Can determine whether jaundice is caused by liver disease, obstruction of bile ducts, destruction of red blood cells. Bilirubin – Indicates liver disease often before symptoms appear. Occult Blood – Presence of blood cells in urine.