BLOOD (CBC and Peripheral Smear)
BLOOD (CBC and Peripheral Smear)
1. Blood is a bodily fluid that delivers necessary substances such as nutrients and oxygen to the cells
2. It transports metabolic waste products away from those same cells.
3. An average adult has about 5 to 6 liters of blood.
In addition to CBC, Diabetes Testing, Lipid Profile, Renal Profile, Liver Function Test etc., are all dependent on Blood.
There are three types of Blood Cells viz.
1. Red Blood Cells (Erythrocytes) carry oxygen Types of Cells in Blood
2. White Blood Cells (Leukocytes) fight infection.
3. Platelets (Thrombocytes) stop bleeding in injuries
Blood cells are made in the Bone Marrow which is a spongy tissue filling the centre of your bone.
Classification of blood based on the presence or absence of inherited antigenic substances on the surface of the red blood cells (RBCs).
The presence (+) or absence (-) of the RhD (Rhesus D) antigen is indicated by the plus or minus signs when your Blood Grouping is done.
1. Is an iron-containing bio-molecule Haemoglobin
2. It carries oxygen from the lungs to the tissues and the oxygen so released will burn nutrients to provide energy.
3. It is expressed as grams per deciliter and a low count is indicative of Anemia.
Leukocyte means White Blood Cells. The Total Count of WBC is given in this test. The number of leukocytes in the blood is often an indicator of disease.
Total Leukocyte Count (TLC)
1. There are five different types of WBC in the blood viz. Neutrophil, Eosinophil, Basophil, Lymphocyte and Monocyte. Differential Leukocyte Count (DLC)
2. Differential Count refers to the count of each of these types of WBC.
3. All white cell types are given as a percentage and as an absolute number per litre.
1. Erythrocyte means Red Blood Cells. Erythrocyte Sedimentation Rate (ESR)
2. ESR is the rate at which RBC sediments in one hour.
3. It is indicative of the presence of inflammation and many diseases and is slightly higher in Females.
1. A count of the number of red cells Red Blood Cells (RBC)
2. It is given as an absolute number per litre of blood.
3. Low RBC count indicates Anemia.
1. Platelets, or thrombocytes are small, disc shaped, cell fragments found in the blood. Platelet Count
2. Platelets help to clot blood.
3. In addition to its numbers, which is expressed as concentration per microlitre, their size and range of size is also given.
This is the volume percentage of the red blood cells in blood. It is about 45% for males and 40% for females. An intregral part of CBC along with WBC, RBC and Platelet Count.
Packed Cell Volume (PCV)
It is the average volume of the red cells, measured in femtolitres. Its volume decides how anemia is classified.
Mean Corpuscular Volume (MCV)
This is the average amount of hemoglobin per red blood cell, measured in picograms.
Mean Corpuscular Haemoglobin (MCH)
This is the average of the Haemoglobin Concentration in the blood.
Mean Corpuscular Haemoglobin Concentration (MCHC)
This is the process of converting food to energy. Higher the rate of metabolism, the better. The rate of metabolism decides the quantity and type of food intake.
A blood film or peripheral blood smear is a thin layer of blood smeared on a microscope slide and then stained in such a way to allow the various blood cells to be examined microscopically. Blood films are usually examined to investigate haematological problems (disorders of the blood) and, occasionally, to look for parasites within the blood such as malaria and filaria.
1. Urine is a sterile liquid by-product of the body secreted by the kidneys and excreted through the urethra.
2. By-products generated by cellular metabolism which have to be eliminated, are expelled during urination.
3. An average adult produces about 1 to 2 liters of urine a day.
4. Urine is a solution of greater than 95% water, with the remaining constituents, in order of decreasing concentration urea, chloride, sodium, potassium, creatinine and other dissolved ions, inorganic and organic compounds.
Color and Odour of urine plays a very important part in urinalysis or urine analysis. Normal urine is pale yellow in color. Dark yellow urine is often indicative of dehydration. An individual with Diabetes may present a sweetened urine odour.
1. Lipids are a group of naturally occurring molecules that include fats, waxes, steroids, fat-soluble vitaminsand others.
2. They do not dissolve in water.
3. Even though the term lipid is often used as a synonym for fats, fats are actually a sub-group of lipids called the triglycerides (TG).
1. Total Blood Cholesterol is a measure of LDL cholesterol, HDL cholesterol and other lipid components like VLDL and Triglycerides. Total Cholesterol
2. It is recommended that the total cholesterol levels be below 200.
3. When too much cholesterol is present, plaque (a thick, hard deposit) may form in the body's arteries narrowing or blocking the space for blood to flow to the heart.
4. Heart Attack results if blood supply to the heart is cut off by blockageof an artery.
5. When not enough blood reaches the heart, chest pain, called angina, can result.
6. However, all Cholesterol is not bad for you. Some are actually good for you.
Cholesterol travels through the blood attached to a protein -- this cholesterol-protein package is called a lipoprotein. Depending on how much protein there is in relation to fat, Lipoproteins are classified as High Density and Low Density Lipoprotein.
1. Our Diet, Weight, Exercise, Age, Gender, Diabetes, Heredity and other causes like medication contribute to cholesterol build up.
2. Reduce weight and LDL will go down.
3. Eating of Tree Nuts contribute to high HDL which is very desirable.
4. Regular exercise reduces LDL and increases HDL levels.
5. Cholesterol levels can fall, if diabetes is effectively controlled.
HDL cholesterol protects againstheart disease by taking the "bad" cholesterol out of your blood and keeping it from building up in your arteries. So, higher the number of HDL cholesterol, the lower is your risk of heart disease. Optimal count of HDL should be above 60, but anything lesser than 40 is men and 50 in women is considered a risk factor for heart disease
HDL Cholesterol or “GOOD” cholesterol
LDL cholesterol can cause build-up of plaque on the walls of your arteries and increase your risk of heart disease. That is why LDL cholesterol is referred to as "bad" cholesterol. The lower your LDL cholesterol number, the lower your risk. If you have heart disease or blood vessel disease, your LDL should be below 70, whereas for people with diabetes, your optimal LDL level should be below 100.
LDL (Low Density Lipoprotein or “BAD” cholesterol)
VLDL is similar to LDL, only much worse. It contains mostly fat and no protein. The more LDL and VLDL is there in the blood, the greater the risk of heart disease.
VLDL (Very Low Density Lipoprotein or “BAD” cholesterol)
Triglycerides are the chemical form in which most fat exists in food and the body. A high triglyceride level has been linked to higher risk of coronary artery disease. Its level should be ideally less than 150 or at least 200. Anything higher is bad.
Triglycerides (They are Fats and too much is BAD)
1. The kidneys are bean shaped organs that serve several essential regulatory roles.
2. They are essential in the urinary system & are at the rear of the abdominal cavity.
3. They regulate electrolytes, maintain acid–base balance, and regulate blood pressure by way of maintaining salt and water balance. The kidneys also produce hormones.
4. They serve the body as a natural filter of the blood, and remove water soluble wastes, which are diverted to the urinary bladder as urine.
5. In producing urine, the kidneys excrete wastes such as urea and ammonium, and they are also responsible for the re-absorption of water, glucose, and amino acids.
1. The blood urea nitrogen (BUN) test measures the level of urea nitrogen in blood. Blood Urea Nitrogen
2. Urea is a substance that is formed in the liver when the body breaks down protein. Urea then circulates in the blood in the form of urea nitrogen. In healthy people, most urea nitrogen is filtered out by the kidneys and leaves the body in the urine. If the patient's kidneys are not functioning properly or if the body is using large amounts of protein, the BUN level will rise. If the patient has severe liver disease, the BUN will drop.
1. Creatinine is a chemical waste molecule that is generated from muscle metabolism. Creatinine
2. Creatinine is produced from Creatine, a molecule of major importance for energy production in muscles.
3. Creatinine is transported through the bloodstream to the kidneys. The kidneys filter out most of the Creatinine and dispose of it in the urine. Where the kidneys become impaired, the Creatinine levels in the blood will rise and hence elevated Creatinine levels in the blood signifies impaired kidney functioning.
LIVER FUNCTION TEST
The liver performs more than 500 functions! It is as essential as your heart and lungs. Your liver is located on your right side just under the ribs. The liver helps break down food and convert it into energy. It produces bile, cholesterol, hormones, stores glucose as glycogen and releases it when needed, produces blood proteins, including albumin and helps regulate the levels of lipids (fats) in the blood. It helps in blood clotting. It stores vitamins and acids, breaks down toxin such as alcohol, medicines and chemicals. It helps fight infection.
Many people have liver damage and don’t know it. The liver is tough and, even when damaged, can perform the functions essential for life. However, if the liver is continuously injured or inflamed, it can’t repair itself.
A bilirubin test measures the amount of bilirubin in a blood sample. Bilirubin is a brownish yellow substance found in bile. It is produced when the liver breaks down old red blood cells. Bilirubin is then removed from the body through the stool (feces) and gives stool its normal color.
Bilirubin circulates in the bloodstream in two forms:
• Indirect (or unconjugated) bilirubin. This form of bilirubin does not dissolve in water (it is insoluble). Indirect bilirubin travels through the bloodstream to the liver, where it is changed into a soluble form (direct or conjugated).
• Direct (or conjugated) bilirubin. Direct bilirubin dissolves in water (it is soluble) and is made by the liver from indirect bilirubin.
Total bilirubin and direct bilirubin levels are measured directly in the blood, whereas indirect bilirubin levels are derived from the total and direct bilirubin measurements.
SGOT Test:It measures an enzyme, known as GOT in the blood. It is found in the liver, muscles (including the heart), and RBC. It is released into the blood when cells that contain it are damaged.
SGPT Test:It measures an enzyme, known as GPT in your blood. It is found in many body tissues in small amounts, but it is very concentrated in the liver
Alkaline Phosphatase (ALP):It measures the amount of Alkaline Phosphatase (ALP), a protein found in all body tissues.. High levels of ALP are normally seen in children undergoing growth spurts and in pregnant women
Total Protein:This measures Albumin and all the other proteins in the blood.
Albumin:This is the main protein made by the liver, and it circulates in the bloodstream. The ability to make albumin (is affected in some types of liver disorder.
Globulin:Globulin carries essential metals through the bloodstream and carries them to the various parts of the body and helps the body to fight infections. Globulin proteins include enzymes, antibodies and more than 500 other proteins
AG Ratio:This is the Albumin:Globulin Ratio and is derived from the above tests
GGT:It is found in many tissues, the most notable one being the liver, and has significance in medicine as a diagnostic marker. Gamma-GlutamylTranspeptidase (GGT) is a test to measure the amount of the enzyme GGT in the blood.
Diabetes (diabetes mellitus) is classed as a metabolism disorder. Metabolism refers to the way our bodies use digested food for energy and growth. Most of what we eat is broken down into glucose. Glucose is a form of sugar in the blood - it is the principal source of fuel for our bodies.
When our food is digested, the glucose makes its way into our bloodstream. Our cells use the glucose for energy and growth. However, glucose cannot enter our cells without insulin being present - insulin makes it possible for our cells to take in the glucose.
Insulin is a hormone that is produced by the pancreas. After eating, the pancreas automatically releases an adequate quantity of insulin to move the glucose present in our blood into the cells, as soon as glucose enters the cells blood-glucose levels drop.
A person with diabetes has a condition in which the quantity of glucose in the blood is too elevated (hyperglycemia). This is because the body does not produce enough insulin, produces no insulin, or has cells that do not respond properly to the insulin the pancreas produces. This results in too much glucose building up in the blood. This excess blood glucose eventually passes out of the body in urine. So, even though the blood has plenty of glucose, the cells are not getting it for their essential energy and growth requirements.
The body does not produce insulin. People usually develop type 1 diabetes before their 40th year, often in early adulthood or teenage years. Type 1 diabetes is nowhere near as common as Type 2 diabetes. Approximately 10% of all diabetes cases are Type 1.
Patients with Type 1 diabetes will need to take insulin injections for the rest of their life. They must also ensure proper blood-glucose levels by carrying out regular blood tests and following a special diet.
Type I Diabetes:
The body does not produce enough insulin for proper function, or the cells in the body do not react to insulin (insulin resistance).
Approximately 90% of all cases of diabetes worldwide are of this type. Some people may be able to control their type 2 diabetes symptoms by losing weight, following a healthy diet, doing plenty of exercise, and monitoring their blood glucose levels. However, type 2 diabetes is typically a progressive disease - it gradually gets worse - and the patient will probably end up have to take insulin, usually in tablet form.
Overweight and obese people have a much higher risk of developing type 2 diabetes compared to those with a healthy body weight. People with a lot of visceral fat, also known as central obesity, belly fat, or abdominal obesity, are especially at risk. Being overweight/obese causes the body to release chemicals that can destabilize the body's cardiovascular and metabolic systems.
Being overweight, physically inactive and eating the wrong foods all contribute to our risk of developing type 2 diabetes. Scientists believe that the impact of sugary soft drinks on diabetes risk may be a direct one, rather than simply an influence on body weight.
Blood glucose levels that remain high over time can damage the eyes, kidneys, nerves, and blood vessels.The risk of developing type 2 diabetes is also greater as we get older. Experts are not completely sure why, but say that as we age we tend to put on weight and become less physically active. Genetically, people of Middle Eastern, African, or South Asian descent have a higher risk of developing the disease.
This type affects females during pregnancy.
Type II Diabetes:
Fasting means not eating or drinking anything other than water for eight hours prior to your test of FBS. During the test, a carbohydrate metabolism test is conducted which measures blood glucose levels. The purpose of fasting is to stimulate the hormone glucagon, which in turn increases the plasma glucose levels. A non-diabetic will produce enough insulin to rebalance the increased sugar levels, but people with diabetes during the test will have higher blood sugar levels.
A postprandial glucose test is a test that determines the amount of glucose in the blood after a meal. Glucose comes from carbohydrate foods. It is the main source of energy used by the body. Normally, blood glucose levels increase slightly after eating. This increase causes the pancreas to release insulin, which assists the body in removing glucose from the blood and storing it for energy. People with diabetes may not produce or respond properly to insulin, which causes their blood glucose to remain elevated. A 2-hour postprandial blood sugar test measures blood glucose exactly 2 hours after eating a meal. By this point, blood sugar would have usually gone back down in healthy people, but it may still be elevated in people with diabetes. Thus, it serves as a test of whether a person may have diabetes, or of whether a person who has diabetes is successfully controlling their blood sugar.
Random glucose test is a blood sugar test taken from a non-fasting subject. This test, also called random blood sugar (RBS), assumes a recent meal and therefore has higher reference values than the fasting glucose test. It is just to confirm pre-diabetes status of the subject and does not confirm diabetes in the absence of additional tests like FBS and PPBS. The reference valuesfor pre-diabetes is between 140 to 200 and for diabetes, it is more than 200. However, even a figure of more than 200 in RBS does not confirm diabetes, in the absence of FBS and PPBS values.
BLOOD PRESSURE (BP)
1. BP is the pressure of the blood in the vessels, especially the arteries, as it circulates through the body.
2. Blood pressure varies with the strength of the heartbeat, the volume of blood being pumped, and the elasticity of the blood vessels.
3. Arterial blood pressure is usually measured by means of a sphygmomanometer and reported in millimeters of mercury as a fraction, with the numerator equal to the blood pressure during systole and the denominator equal to the blood pressure during diastole.
• Systolic Pressure - The blood pressure during the contraction of the left ventricle ofthe heart. It should be 120.
• Diastolic Pressure - The blood pressure after the contraction, while the chambers refill with blood. It should be 80.
Adult Blood Pressure is considered normal at 120/80 where the first number is the systolic pressure and the second is the diastolic pressure. Heart failure is common in patients with high blood pressure.
An electrocardiogram is used to monitor your heart. Each beat of your heart is triggered by an electrical impulse generated from special cells in the upper right chamber of your heart. An electrocardiogram records these electrical signals as they travel through your heart to look for patterns among these heartbeats and rhythms to diagnose various heart conditions. An electrocardiogram is a non-invasive, painless test.
1. Abdominal ultrasound is a type of imaging test.
2. It is used to examine organs in the abdomen including the liver, gallbladder, spleen, pancreas, and kidneys.
3. The blood vessels that lead to some of these organs can also be looked at with ultrasound.
4. An ultrasound machine makes images of organs and structures inside the body. The machine sends out high-frequency sound waves that reflect off body structures. A computer receives these waves and uses them to create a picture. Unlike with x-rays or CT scans, this test does not expose you to ionizing radiation.
TREADMILL TEST (TMT)
A stress test, sometimes called a treadmill test or exercise test, helps a doctor find out how well your heart handles work. As your body works harder during the test, it requires more oxygen, so the heart must pump more blood. The test can show if the blood supply is reduced in the arteries that supply the heart. It also helps doctors know the kind and level of exercise appropriate for a patient.
ECHO CARDIOGRAPH (ECHO)
Echocardiogram, often referred to Cardiac Echo or simply an Echo is a sonogram of the heart. (It is not abbreviated as ECG, which usually refers to an electrocardiogram) Echocardiography uses standard two-dimensional, three-dimensional, and Doppler ultrasound to create images of the heart. Echocardiography is routinely used in the diagnosis, management, and follow-up of patients with any suspected or known heart diseases. It is one of the most widely used diagnostic tests in cardiology.
Spirometry (meaning the measuring of breath) is the most common of the pulmonary function tests (PFTs), measuring lung function, specifically the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled. It is used in the diagnosis and management of asthma, to detect respiratory disease in patients presenting symptoms of breathlessness, to distinguish respiratory from cardiac disease as the cause.
BODY MASS INDEX (BMI)
The Body Mass Index (BMI)measures the weight status of your body in relation to the fat. It is a simple tool that helps to figure out the amount of excess body fat and the associated risks of carrying this extra weight. It can be applied to both men and women. It is advisable to use ‘Body Mass Index’ along with ‘Waist to Hip Ratio’ to get a complete picture of your weight status.
BMI = -----------------------
If your weight is 80 kgs, and your height is 5’8’’, which comes to 173 cms, divide 80 by (1.73)2, which is 80/3 = 26.66.
Body Mass Index Chart
Below 18.5 Underweight
18.5 - 24.9 Optimal
25 - 29.9 Overweight
30 - 39.9 Obese
40 + Morbidly Obese
DIET & DIETARY ADVICE
Food is the single most important part of health management. Out of the basic needs of Food, Water and Shelter, food is the primary need. It nourishes us, gives us energy, supplies proteins, carbohydrates and what not to maintain our body and thus, ourselves. Every act of ours since the time of birth is directed towards acquiring food and ensuring we never go hungry.
So, can something as noble as food have an undesirable side-effect? Yes, it can and it does. Food starts as nourishment, but as we over-do the consumption, the extra calories and fat consumed starts piling up in our body with no way of expendability and we end up becoming over-weight. Being over-weight makes us sedentary and from then on, whatever we eat starts piling up without any means to expend itself, and we end up being obese. We send out and open invite to a host of diseases and conditions like BP, Cardio-vascular diseases, diabetes, osteoporosis etc.
We have now entered a vicious cycle. We are unable to exercise because of our weight and we keep putting on weight because we can’t exercise. It is not for nothing that our ancient saints always advised that the “Less We Eat, the Longer We Live” and now, with the peril of obesity affecting even our children, we think it is time to replace that positive saying with an analogous saying of “The More We Eat, The Earlier We Die”.
Food, by its very nature, is dictated by culture and palatability. So, each diet has to be individually designed to be wholesome by having the right composition of carbs, proteins, vitamins and fat. So, our health management has to per se start with Management of Intake of Food. This is where Dieticians who give Dieting Plans come into the picture.