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  1. Anemia

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    WHAT IS

    Anemia is characterized as a condition where there is a low hematocrit – hemoglobin.

     

    ESSENTIAL CASES OF APPEARANCE 

    Anemias are among the main topics of hematology, with multidimensional etiology and translation. We briefly mention:

    a. At younger ages, anemia is mainly observed by:

    • gene type – thalassemia (Mediterranean anemia marker)
    • poor nutrition – lack of hematopoietic factors (eg diets in animal derivatives)
    • malabsorption of hemopoietic trace elements (iron, folic acid, vitamin B12) due to stomach disorders (celiac disease, intolerances, gastritis etc.)
    • pregnancy
    • gynecologically intense blood loss during menstruation

    b. In older ages, anemia can be caused inter alia by:

    • loss of blood (mainly from the gastrointestinal tract)
    • bone marrow dysplasia  – haematological diseases
    • prolonged immobility – renal failure
    • autoimmune diseases and malignant diseases
    • use of drugs that suppress the bone marrow or cause malabsorption of hematopoietic trace elements

     

    LABORATORY HEMATOLOGICAL TESTING (basic blood tests)
    • Complete Blood Count (CBC)

    Anemia diagnosis relies on low hematocrit (HCT) and hemoglobin (HGB) measurement .

    Aadditional red blood cell parameters give information on the etiology – type of anemia

    • mean volume of red (MCV) with indirect information on iron deficiency (-), lack of hematopoietic vitamins (+), dysplasia (+), Mediterranean stigma (-) etc
    • mean content and hemoglobin concentration (MCH, MCHC) that is mainly evaluated for iron
    • (RDW-CV), which is mainly evaluated for the signs of Mediterranean anemia, medullary dysplasia and red cell renewal

     

    • Microscopic blood test:

    Morphology and quality of all blood cells (red, white, platelets) with microscopic examination is used for  further categorization of anemia, while assessment for possible underline hematologic disease or dysplasia is done.

    • Erythrocyte sedimentation rate (ESR)

    It is used to detect long-term inflammatory disease or serious disease of the marrow, or other central disease that may have caused anemia.

    • Reticulocytes (ECC)

    They show the red cell renewal rate by giving information on marrow productivity

    • Iron (Fe) and its basic stores ferritin (Ferr) and transferrin (Trf)

    These tests assess the adequacy of iron in the body with conclusions of possible loss or malabsorption. Simple iron measurement is not enough, since iron is very fluctuating from day to day, and is heavily influenced by possible inflammations with ‘falsely low’ values. T

      • Iron Ties (TIBC) and Transferrin Saturation (TfS)

    Provide information on the adequate transfer of iron into the body, and its ability to absorb it.

    • C Reactive Protein (CRP)

    Auxiliary test for detection

    – inflammation that can give ‘false’ values ​​in iron, ferritin and transferrin

    – detection of serious diseases that can cause anemia

    • Folic acid and vitamin B12 (Vit B12)

    Thease are the most essential hematopoietic vitamins. We often find them low in people with poor nutrition or malnutrition and in people who have difficulty absorbing them due to stomach upset, malabsorption, age or drug use.

    • Lactic dehydrogenase (LDH) and total bilirubin (TBil) :

    These tests examine the normal blood regeneration pathway, and exclude hemolysis – destruction of blood within the body.

    • Autologous Celiac disease (IgG / IgA antibodies, IgG / IgM tissue traglutaminase, and intramuscular IgG / IgM antibodies)

    These antibodies detect possible celiac disease, a condition characterized by gluten intolerance and inhibition of the absorption of iron, vitamin B12 and folate. The tests are particularly recommended in cases of undetectable long-term failure to maintain ferritin levels, B12 after treatment.

    •  Femoral hemoglobin (HGBocc)

    Recommended for acute phase iron deficiency and for suspected people for gastrointestinal blood loss.

    ————————————

    Information selected from :

    •  MayoClinic.org
    • Labtestsonline.org
    • Interpretation of Diagnostic Tests – J.Wallach

    The exact choice of tests required, is under the responsibility of your treating physician

    Editor: I. Gratsias  Lab Director / Clinical Biochemist

    Last Update May 2019

     

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  3. Autoimmune desease Screening

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    autoanosa_nosimataWHAT IS

    Antibodies normal functionis  to selectively attack external contaminants, staying inactive in all other non-pathological elements, as well as in the elements of the organism itself.

    In autoimmune diseases, this selectivity is lost, resulting in attack on the body itself and its organs.

    They are chronic diseases, with hereditary predisposition, and have varying expression and severity. There are 80-100 different types, and many times they are combined in many ways.

    Multiple tests are often required for diagnosis and follow up.

     

    BASIC APPEARANCES – INDICATIONS – IMPORTANCE

    Autoantibodies are usually present in people with a family history of autoimmune deasease. They appear after an infection or after a long-term contact with toxic chemicals or prolonged – intense stress.

    Their appearance may be organoleptic (eg thyroid), but even systematic in all organs.

    The most common are:

    • Antiphospholipid syndrome
    • Autoimmune hepatitis
    • Type I diabetes
    • Rheumatoid arthritis
    • Sarcoidosis
    • Scleroderma
    • Systemic lupus erythematosus
    • Hashimoto thyroiditis
    • Serious
    • Sjogren

     

    In general, autoimmune diseases may cause

    • Fatigue, inability to concentrate – vision, food intolerances, weight disorders
    • Pain in joints – muscles – gastrointestinal, local or generalized
    • Skin pigmentation – inflammation, nausea, scalp, fever
    • Flushed pregnancies, infertility
    • High levels of inflammation markers, sugar, abnormal urine findings

     

    Early correct diagnosis and treatment of autoimmune, prevents their degenerative effects, and the possible occurrence of additional diseases.

     

    LABORATORY TESTING
    A. Systemically autoimmune diseases (affecting the whole body):

    Autoimmune have similar symptoms to each other, and they often appear in a combination of many different at the same time. The main tests used to detect and monitor are:

    • CBC, ESR, C-reactive protein (CRP): Detects any inflammatory reaction that may have resulted from systemic autoimmune disease and the balance of the hemodynamic-immune system.
    • Elements of complement C3, C4: Detection of long-term immune depletion,  caused by chronic activated autoimmune diseases.
    • Uric acid (UA), transaminases (ALT / AST), CK, LDH: Detects potential damage on ligaments, liver, and muscles, and hematopoietic system.
    • Urine test : Detects a possible kidney degredation – function, mainly with protein – album screening.
    • Rheumatoid factor (RF) and anti-CCP: Used in the detection of rheumatoid arthritis and Sjögren’s syndrome.
    • Antinuclear antibodies (ANA) and ANA profile: Used for detection of systemic lupus erythematosus, polymyositis, etc.
    • Anticardiolipin (aCL IgG, aCL IgA, IgM aCL ): Diagnostic tests for phospholipid syndrome (proposed particularlyin  venous or arterial thromboses – repeated miscarriages).
    B. Organo-specific autoimmune diseases

    Specialized tests are performed to detect the corresponding disease. The most common, are:

    • Peroxidase (anti-TPO), anti-Tg, TSH (TRAb) receptor autoantibodies : Detection and monitoring of Hashomoto / Graves autoimmune thyroiditis.
    • Antibodies to smooth muscle fiber (ASMA): Differential diagnosis of chronic active autoimmune hepatitis.
    • Anti-mitochondrial antibodies (AMA): Used to diagnose primary biliary cirrhosis.

    .

    IMAGING PRECAUTIONS

    They are used on a case-by-case basis, based on evidence, personal and family history

    More common due to simplicity and security in terms of technique, are ultrasound imaging tests:

    • Thyroid ultrasound imaging
    •  Upper and lower abdomen (liver – kidney – spleen) Ultrasound imaging

    ———————-

    Information selected with sources:

    •  MayoClinic.org
    • Labtestsonline.org
    • Interpretation of Diagnostic Tests – J.Wallach

    The exact choice of tets is the responsibility of your treating physician

    Editor: John Gratis Lab Director / Clinical Biochemist

    Last updated May 2019

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  5. Hair Growth Disorders ( loss & overgrowth )

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    WHAT IS

    As hair growth disorders are considered:

    • poor quality – loss of scalp
    • male alopecia
    • intense hair growth in hands, face, abdomen, legs in women – children

     

    INDICATIONS – IMPORTANCE

    Poor quality – Hair loss often comes from:

    • Lack of trace elements (eating disorders – malabsorption – increased losses)
    • Systemic diseases (autoimmune, chronic inflammation etc.)
    • Thyroid disorders
    • Genital factors
    • Strong psychological issues

     

    In male alopecia, the loss may come from:

    • The common reasons of poor quality – loss as mentioned above
    • Hormonal disorder

     

    In women and children, unexpected intense hair growth, especially in places where hair is not expected, is a sign of hormonal disturbance.

    LABORATORY TETS

    A. Low quality hair (nail and skin) or loss 

    Laboratory testing identifies potential chronic – systemic deseases, deficiencies in trace elements – vitamins, or thyroid disorders :

    Basic Check Up

    It is checked that there is no systemic disease that may be involved in low hair quality.

    Test / AnalyteDescription / Detects - Measures
    Complete Blood Count - Measurement Hematocrit, Red -White Blood Cells - Platelets and Morphology
    Detects Anaemias, Infections - Bone marrow disorders.
    Indications of chronic deseases
    Erythrocyte Sedimentation RateChronic Inflammations - infections
    CRP-hsAccute Inflammations - infections.
    Cardiovascular risk factor
    GlucoseDiabetes
    UreaRenal function
    CreatininineRenal function
    Uric AcidArthritis
    Nutritional assesment
    Total CholesterolCardiovascular Risk Factors
    Cholesterol Dietary intake
    Drug therapy assessment
    HDL Cholesterol
    LDL Cholesterol
    Triglycerides
    Atheromatosis Index
    Liver Enzyme γ-GTLiver function test
    Hepatitis B/C - drug -alcohol induced - fatty liver - cancer etc
    Liver enzymes ALT & AST
    UrineBladder health
    Kidney function
    Iron (Fe) , and iron stores with ferritin (Ferr)

    In cases of iron deficiency (dietary insufficiency, loss of appetite, loss) the hair thins, breaks, falls.

    The vitamins  folic acid and B12 (Vit B12)

    Possible vitamin deficiency, degrades the quality of hair.

    Zinc (Zn)

    Necessary trace element in healthy hair composition and hair maintenance.

    freeT4 (free thyroxine) and TSH (thyroid hormone) ,

    These are the basic tests for thyroid function and to rule out possible hyperthyroidism or hypothyroidism that potentially affect hair quality. 

    Optional Check in case of loss   

    If low levels of folic acid, vitamin B12, zinc are found, additional tests in vitamin A control, vitamin C and vitamin E could be useful in assessing dietary supplements that should be given to enhance hair growth.

     

    B. In male alopecia

    Additional tests of a possible hormonal disorder includes measurements of the androgens:

    • Testosterone / Free Testosterone
    • Dihydrotestosterone with DHT

     

    C. Increased hair growth in children – women 

    The hormonal profile is assessed with particular emphasis on the ratio of androgens to estrogens:

    • LH (luteinizing hormone) / FSH (follicle stimulating hormone) 
    • Testo (Testosterone) Main androgen
    • DHEA-S (dehydroepiandroster  sulfate) Secondary androgen
    • D4-Epiandrostenedione Secondary androgen
    • SHBG Foesdesmethylic protein
    • E2 (estradiol) Main estrogen
    • PRL (prolactin)

    ——————–

    Information selected from :

    •  MayoClinic.org
    • Labtestsonline.org
    • Interpretation of Diagnostic Tests – J.Wallach

    The exact choice of tests required is under the responsibility of your treating physician

    Editor: I. Gratsias  Lab Director / Clinical Biochemist

    Last Update May 2019

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  7. Diabetes I & II follow up panel

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    WHAT IS

    It is a set of metabolic disorders, that result from high levels of sugar over a long period of time.

    Diabetes is divided into two categories

    • Type 1 – appearing at younger age due to loss of insulin production capacity
    • Type 2 with a higher age due to insulin resistance. It has a ~9% prediction in the general population, mainly due to obesity – lack of exercise

    There is a special also the Pregnancy Diabetes. This certen type of Diabetew is transient, and it does not affect organs or causes metabolic disorders,  as it is a short time phenomenon. It is only monitored for the safety of pregnancy and fetus development.

     

    SYMPTOMS –  IMPLICATIONS

    The main signs of diabetes are

    • Polyurea – Polydipsia
    • Continuous hunger

    Increased levels of sugar have a long-lasting detrimental effect on the entire body’s vascular system. The most serious side effects of inefficiently controlled diabetes are:

    • Nephropathy
    • Loss of vision
    • Ulcers in the lower extremities

    .

    LABORATOTY TESTS

    The purpose of the tests used, is to establish the successful regulation of diabetes and avoid any organ damage. The proposed tests are intended only for diabetes I / II follow up. These tests are:

    The Basic Check up Panel

    Tests is used to detect if diabetes has a negative effect on kidney, liver or body metabolism and if has caused any inflammation.

    Test / AnalyteDescription / Detects - Measures
    Complete Blood Count - Measurement Hematocrit, Red -White Blood Cells - Platelets and Morphology
    Detects Anaemias, Infections - Bone marrow disorders.
    Indications of chronic deseases
    Erythrocyte Sedimentation RateChronic Inflammations - infections
    CRP-hsAccute Inflammations - infections.
    Cardiovascular risk factor
    GlucoseDiabetes
    UreaRenal function
    CreatininineRenal function
    Uric AcidArthritis
    Nutritional assesment
    Total CholesterolCardiovascular Risk Factors
    Cholesterol Dietary intake
    Drug therapy assessment
    HDL Cholesterol
    LDL Cholesterol
    Triglycerides
    Atheromatosis Index
    Liver Enzyme γ-GTLiver function test
    Hepatitis B/C - drug -alcohol induced - fatty liver - cancer etc
    Liver enzymes ALT & AST
    UrineBladder health
    Kidney function
    Glycosylated hemoglobin (HbA1-c)

    This test shows the average levels of sugar for the last 45 days. Based on HbA1c levels, the effectiveness of the treatment of diabetes is evaluated.

     24-hour urinary microalbumin (Alb-U-24h)

    It tests the kidney health of the diabetic patient, having a particular predictive value for their potential damage due to elevated levels of sugar.

     Creatinine clearance (cre – cle) 

    It is the best measure of effective kidney function with much greater sensitivity to classic urea and creatinine tests.

     Electrolytes (Na + / K +) 

    They are the main salts of the body, the concentration of which is regulated by the kidneys. Diabetic medications that may be combined with other treatments, can achange electrolyte levels significatly, with very serious consequences, especially in cardiac function.

     Urine test -Culture 

    The test additionally evaluates the health of the kidneys, and in particular to rule out possible asymptomatic urinary tract infection. Urinary infections in diabetic individuals are common as the sugar exits in the urine and creates a favorable environment for microbial growth.

    OPTIONAL ADDITIONAL BLOOD PREVENTION TESTS  

    The following tests are proposed based on age, social habits, staff – family medical history

    Fructosamine

    It estimates the average sugar levels in the last 5 days, and it is used :

    • in gestational diabetes
    • to directly check the effectiveness of change in the treatment regimen
    • in cases of hemoglobin types where glycosylated hemoglobin can not be measured
    Vitamine B12

    B12 levels are estimateed as a protective agent against diabetes neuropathy.

    .
    ULTRASOUND IMAGING 

    The following audits are based on criteria – age and staff – family history

    • Ultrasound Imgaing upper abdomen
    • Triplex Imaging of heart – carotid – lower limbs

    ——————–

    Information selected from :

    •  MayoClinic.org
    • Labtestsonline.org
    • Interpretation of Diagnostic Tests – J.Wallach

    The exact choice of tests required is under the responsibility of your treating physician

    Editor: I. Gratsias  Lab Director / Clinical Biochemist

    Last Update May 2019

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  9. Thyroid Disorders

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    WHAT IS

    Thyroid gland is the basic gland of metabolic regulation producing :

    • T3 and T4, hormones taken up by all body cells which regulate their metabolic rate.
    • Calcitonin hormone involved in calcium regulation.
    Most Common Disorders

    Thyroid function disorders are divided in:

    • Hypothyroidism, is the condition with low production of T3 and T4.  Hyporthyroidism symptoms may be a combination of fatigue, drowsiness, cold inconvenience, weight gain, bradycardia, hoarseness, confusion, nervousness, constipation, infertility, muscle stiffness, etc.

    The main reasons are:

    – Hashimoto desease – autoimmune hypothyroidism (young relative ages – often inherited)

    – Atrophic or post-surgical hypothyroidism

     

    • Hyperthyroidism, is  the condition where glandular hyperfunctions and high a production of T3 and T4. Hyperthyroidism is associated with unexplained weight loss, excessive sweating, fatigue, palpitations and tachycardia – hypertension, nervousness, generalized weakness, poor sleep, tremors in the hands, confusion, diarrhea etc

    The main reasons are:

    – Graves disease – Autoimmune desease

    – Toxic polycystic goiter

    – Single toxic adenoma

    LABORATORY HEMATOLOGICAL TESTING

    Thyroid screening tests may include:

    •  T3 (triiodothyronine), free-T3 (free triiodothyronine), T4 (thyroxine), free T4 (free thyroxine)

    These are the thyroid hormones that are responsible for the biological effect of the gland’s action.

    • TSH (thyroid stimulating hormone)

    It is the brain hormone that regulates the thyroid function, the measurement of which derives conclusions  hyper- or hypo- function.

    •  Anti-TPO (anti-thyroid antibodies), anti-TG (anti-thyroglobulin antibodies):

    They are the main anti-thyroid auto-antibodies that affect both the function and hormonal performance of the gland as well as the it’s histological integrity. Tests can predict at an early stage, the onset of gland subfunctions and are used in the differential diagnosis of Hashimoto’s thyroiditis and Graves’s disease.

     

    Optional Test for thyroid relatevly rare conditions, are :
    Tumor Markers

    Use in cases where there is evidence of neoplastic disease as well as in further assessment of nodules that increase in size.

    • Thyroglobulin (TG),
    • Calcitonin (CT),
    • CEA (carcinoembryonic antigen)
    Autoimmune antibodies
    • TSI Activation Antibodies to TSH

    ———————————————————-

    Information selected from :

    •  MayoClinic.org
    • Labtestsonline.org
    • Interpretation of Diagnostic Tests – J.Wallach

    The exact choice of tests required, is under the responsibility of your treating physician

    Editor: I. Gratsias  Lab Director / Clinical Biochemist

    Last Update May 2019

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