Questions & Answers with Dr. Shaoulian
Blood Work Analysis Breakdown
IRVINE, Calif. (July 15, 2009) -- After graduating from the Sackler School of Medicine in Israel and completing his postgraduate training at Beth Israel Hospital and St. Vincent's Medical Center in New York City, Dr. Emanuel Shaoulian became board-certified in general and interventional cardiology and in critical care medicine. He has served as director of interventional cardiology at St. Vincent's Hospital and at the Heart Institute of the Desert in Rancho Mirage, California, and he currently serves as the director of the Cardiac Catheterization Laboratory at the University of California Irvine Medical Center. Dr. Shaoulian recently sat down with a member of ScanDirectory.com’s patient community to answer questions about the results of his blood test.
Question: What do things like Total Protein, Albumin, Globulin mean for the average person? This number 7.7 is in the normal range for Total Protein but what does it mean?
Answer: The three numbers are representative of all the protein in the cells. They represent different parts for example, Globulin is mostly involved with antibodies and fighting infections. Albumins are carries of different monitors in the body. In general, they indicate either normality or abnormality of the immune system and the nutritional system. So if they are normal, you just skip it. If it’s abnormal, you start looking to see what’s in trouble.
Question: It’s not like the white blood cell count is it?
Answer: No, it's a different thing, very different.
Now the next numbers that you have, they are a series of numbers: Bilirubin, Alkaline Phosphatese, AST & ALT SGPT, Bilirubian Direct, and Bulirubian Indirect are all various indexes of liver function. In fact, that’s the sole purpose of that panel, to indicate how well the liver is doing. If there are abnormalities of liver function, then there could be infection, inflammation of the lever, or effects from the drug. The most frequent cause of liver function abnormalities these days is the use of medication that are metabolized in the liver. For example, if you use potassium, we watch liver function to make sure they don’t have an abnormal cause and effect on the liver.
Folic acid (Folate) and B12 are various vitamins we check. They have implications in many different systems including the heart system. We check them in order to check the level of vitamins. There are other vitamins we check, but these are the ones we check usually for the cardiovascular system.
Then we have what we call the Cholesterol panel. Total Cholesterol is composed of good Cholesterol and bad Cholesterol. And that index of how much total Cholesterol, usually if the total Cholesterol is abnormal, we want to go to the next stage and see which component is abnormal; if it is the good Cholesterol or the bad Cholesterol.
Question: You just basically look at the range to see which one is abnormal?
Answer: That is correct. The good Cholesterol is called HDL (High-Density Lipoprotein). That is very important that it be normal. If it is low, it’s directly associated with Atherosclerosis, to get plaque in the body. So the higher the HDL, the more protective effect there is against Atherosclerosis.
LDL is also called bad Cholesterol. It is exponentially related with incidence of coronary arteries. The higher the LDL, the more in trouble you are.
Question: What do Triglyceride levels indicate?
Answer: The Triglycerides are an interesting component. They are composed of both part that are made of sugar and part that is made of fat. Triglycerides could be high in a primary way if your genetics are high or if you have diabetes, are an alcoholic or consume too much sugar. Regardless of the mechanism, high Triglycerides, like in this case, are associated with coronary artery disease and Atherosclerosis as an independent risk factor.
Question: Independent from the proteins?
Answer: Independent from Cholesterol and HDL.
Next we have the various components of VLDL, which is a Very Low Density Lipoprotein is another thing that is associated with disease when it’s low.
Then you have Apolipoprotein A and Apolipoprotein B, and the ratio between the two (APO B / APO A-1 Ratio) are other indexes that essentially genetically indicate through this position for Atherosclerosis.
An interesting thing here is called CRP, which stands for C-reactive protein and essentially an index of inflammation somewhere in the body. We know that high CRP indicates more tendency for future heart risk. Which means if you have plaque, then there is more tendency for this plaque to build up. So when you see high CRP, we get concerned with imminent events that could happen like heart attacks.
Question: Does this mean there is no normal range for CRP?
Answer: There is a normal range actually but it depends on how high it is. The higher it is, the more risk.
Then there is the amino acid Homocysteine which also if it is too high, it is also associated with Atherosclerosis and another risk factors.
Then there is something called LDL Subfractionation. We can now strip down the molecule of LDL and look and see how big it and how many patterns it has. There are certain patterns of LDL that are smaller and are associated with more plaque in the body.
The next thing we look at is the thyroid function test all the T3, T4, T7 and TSH. We talk about the integrity of the thyroid gland and the thyroid access and thyroid hormone secretion. Why is this important? The thyroid gland has so many different implications in so many different organs including the heart.
Next is what we call the blood panel that shows the white [blood] count, also known WBC. White cells are involved in protection from infection. RBC (Red Blood Cells), Hemoglobin, Hematocrit, MCV, MCH, MCHC all talk about the qualities of the blood cells in the body. The size of the Hemoglobin and also how big and strong they are. By looking at these numbers, you can tell if a person has anemia and guess what type of anemia.
Question: If the size of the Hemoglobin is larger, is this a better thing?
Answer: Not for the normal type. If they are very small, then usually that is from iron deficiency. If they are very large, then there is anemia and there is another type of deficiency.
Next there is the platelet count. Platelets are involved with clotting of an injured body. There is a normal range. If your platelet count is too low, then you have a tendency for bleeding.
The following numbers under it Segs, Lymphs, Monocytes, Eosinophils, Basophils and Bands are all different components of the white blood cell. There are normal percentages for each. If one of the percentages is abnormal, then this could indicate some type of infection or if it is very abnormal means some type of, what we call, Lymphoproliferative disease which include lymphoma, leukemia and all these bad things which you don’t want to have.
Next, we have Testosterone level which is hormone...
Question: It’s not the same thing as epinephrine is it?
Answer: No, Testosterone is an indicator of your virility and has effects on other things such as libido sexual functions, your heart and others.
The last number is the PSA, which is the Prostatic Specific Androgen. That is elevated in prostate cancer and also elevated in prostate inflammation and infection. That’s a test to detect prostate cancer.
