Lab data is a simple resource to identify areas of possible impairment.  We have already seen how the hemogram (CBC) can locate blood disorders like anemia, leukemia and thrombocytopenia.  Another routine but very important lab test is the blood chemistry panel, or comprehensive metabolic panel (CMP).  The most recognized test is the glucose level, a hallmark for identifying new onset of diabetes, and also for monitoring control for known diabetes.  The glucose level indicates the amount of glucose in the blood stream.  Fasting labs are ordered to isolate what is in your blood stream and are unimpacted by the donut you just ate.  A common specialized lab test for diabetes is the A1c, which measures a 2-3 month average of glucose control. 

Blood urea nitrogen (BUN) and creatinine (CR) gauge the function of the kidneys.  Of the two, CR is more important, and when elevated, indicates renal dysfunction.  Chronic mild CR elevation is referred to as renal insufficiency.  More significant is chronic CR elevation, known as renal failure.  The glomerular filtration rate (eGFR) shows the efficacy of the kidney filtration system.  As the CR rises, the eGFR will decrease.  Treatment for either is to avoid dehydration (which can temporarily damage the kidney) and avoid NSAIDS and other nephrotoxic (nephro=kidney, toxic=you know) medications.  As the kidneys deteriorate, the buildup of toxins in the blood stream requires outside help, in the form of dialysis.

Electrolytes, also known as minerals, can reveal metabolic imbalances.  One of the more serious imbalances includes elevated potassium, because it affects impulse conduction in the heart and can cause palpitations.  Sodium (Na) and chloride (Cl) play major roles in water regulation in the body on a cellular level.  Decreased Na and Cl may be caused by dehydration, resulting in confusion and even seizures if left untreated.  Liver dysfunction can be readily identified by elevation of two liver enzymes with big, long names, simply abbreviated AST and ALT.  The elevations are caused by inflammation or damage to the liver cells.  Common causes of the damage are alcohol intake, hepatitis and fatty liver disease.  Additional liver markers, bilirubin and alkaline phosphatase, can also reveal liver problems.

Calcium is necessary for the function of nerves, muscles and heart.  Elevations may weaken bones and create renal stones.  Low levels of calcium can cause confusion, depression, and stiff, aching muscles.  Both hypercalcemia (hyper=increased) and hypocalcemia (hypo=decreased) can be caused by parathyroid gland dysfunction (don’t ask).

The takeaway from the above is this: the CMP can identify imbalances in the body’s blood chemistries and therefore, the body’s metabolism.  Any lab value that is not normal would then be followed up by treatment (ie increased electrolyte ingestion), follow up labs to monitor stability (ie glucose elevation) and/or further testing (ie ultrasound for elevated AST /ALT).

Lab data is a great resource for identifying and tracking health issues.  Routine lab analysis includes CBC (complete blood count), basic metabolic panel (BMP or blood chemistries), lipid panel and urinalysis.  There are a multitude of more specialized studies such as: A1c, done for diabetes control; blood coagulation test done for bleeding abnormalities or to monitor anticoagulant medications; and liver panel, done to monitor liver function.  Those are the easy ones!  Specialized lab tests require specialized equipment and include proteins studies like electrophoresis, immunoglobulins and light chains, often found in myeloma. 

But let’s keep it simple and focus on what we can learn from the CBC.  The obvious includes the white blood cell count (WBC), hemoglobin (HG), and platelet count (PLT).  The WBC, if elevated may indicate infection.  The type of infection would determine the type of treatment, typically antibiotics.  If the WBC remains elevated over time, it could possibly point to a leukemia, requiring treatment determined by more in-depth studies.  On the converse side, if the WBC is decreased, called leukopenia (leuko=white cell, penia= decreased), it may show bone marrow dysfunction, autoimmune disorders, or immunosuppression.  Of course, more tests and studies would ascertain the cause and therefore the treatment. 

The HG, when decreased, commonly identifies anemia.  Treatment of anemia depends on the cause of the anemia.  Very common in the senior population, is iron deficiency anemia.  In that case, an iron supplement would be given, either orally or through an IV.  Severe anemia is treated with blood transfusions.  Since the HG carries oxygen, a person severely anemic could be short of breath.  At times, that symptom helps direct the diagnostician to cause and treatment.  An increase in HG is known as polycythemia (poly=many, cyt=cell, emia=blood).  Polycythemia, although rare, is very serious.  Without treatment, it could be fatal.  Treatment depends on severity, but also includes phlebotomy (blood letting in the old, old, old days) or medication.  HG may also be elevated d/t smoking or residing in a high altitude.

The function of platelets is to form clots to stop bleeding.  A decreased count is called thrombocytopenia (thrombo=plt, cyt=cell, penia=decreased). It makes sense that a decreased PLT count would put someone at risk for bleeding.  Common areas to first identify the problem might be frequent nose bleeds, bleeding gums or light bleeding from the GI tract.  It doesn’t take rocket science to realize this may present a simple problem like a nosebleed or a life-threatening emergency requiring hospitalization and transfusions.  Again, the cause of thrombocytopenia would determine appropriate treatment.  A condition of too many PLTs is call thrombocythemia (I bet you can figure that one out!).  This condition would cause more clots than needed by the body, a very dangerous situation that my end in a stroke or heart damage.  Medications are necessary to treat and prevent complications.

The central nervous system (CNS) consists of the brain and the spinal cord.  If the cardiac system is like a car, the central nervous system is like a mountain lake with lots of run-off rivers and streams.  The CNS runs the body, voluntarily like when we take in a deep breath and involuntarily, like how we breathe while we are sleeping, or how respiration continues during loss of consciousness.  There are 12 cranial nerves, designated as CN with a Roman numeral listed to depict the specific nerve.  They are the rivers that extend from the base of the brain (midbrain, pons, medulla).  These nerves connect the brain to the eyes, mouth, ears and other parts of the head, providing motor, as in movement of the eyes and tongue (CNIII, IV, VI), sensory as in smelling (CNI), or a combination of both motor: for chewing and sensory for the sensations in the face (CNV).  Trigeminal neuralgia is a chronic condition causing intense pain in the face often stimulated by chewing; it is a disorder of CNV.  Bell’s Palsy is a painless distortion of the face due to CNVII involvement.  ​

There are many more CNS disorders than the two mentioned above.  As the rivers and streams travel away from the brain and spinal cord, the flow of water (nerve conduction) may be obstructed.  The decrease in the flow may be progressive, caused by a loss of structure or function of nerve cells, and therefore, degenerative.  Motor neuron disease is one type of disruption, and as you may have guessed, it involves motor function.  The neurons (nerve cells) generate and die and slowly the muscles become weaker, eventually leading to paralysis.  These diseases are incurable and most often affect the older population.  Amyotrophic lateral sclerosis or Lou Gehrig’s disease (ALS, 2 in 100k) and Parkinson’s disease (1,900 in 100k (>80 yrs)) are in this category.  ALS is the most common lower motor neuron disease.  Progressive and degenerative, ALS will lead to respiratory failure (due to paralysis) and require ventilatory support.  The ALS Association lists average survival times at three years, with 5-year survival at 20%, 10-year at 10% and 5% will live 20 years or longer.  Longevity will depend on the speed of disease progression.  Atypical cases generally have slower disease progression and thus longer life expectancy.  Many of the cases I have seen through Life Settlements have a slower progression. 

Parkinson's disease often begins with a tremor, evidencing loss of motor control.  Characteristic progression includes lack of facial expression (flat affect), slowness, and balance problems with frequent falls.  Dementia may also occur.  Ultimately, the disease will leave a person confined to a wheelchair or bed bound.  Treatment consists of medications and at times brain stimulator implants.  Longevity depends on the rate of progression and treatment response.  Slow progression can occur over twenty plus years.