How to Read, Interpret and Understand Medical Records or Blood Test Reports

Hemoglobin A1 c

Hemoglobin A1 c measures the average glucose levels over the lifespan of the red blood cells for about 120 days. Its normal value is from 4 to 6%. Any value higher than 6.5% is regarded as pre-diabetes.

Fasting Blood Glucose

Blood Glucose test measures how much glucose (GLU), a type of sugar, remains in the blood. In healthy adults, its level is measured from 70 to 100 mg/dl. Generally, your blood glucose level will rise slightly just after your meal, and this increase will then force your pancreas to produce insulin to bring down your blood glucose level, so that it won’t stay too high.

The increased value of blood glucose is normally seen in 2-hour postprandial blood sugar (or 1 to 2 hrs after your meal) which is always measured from 70 to 145 mg/dl or less than 7.9 mmol/L, and the increase may also cause by emotional stress, injection of glucose or epinephrine (also called adrenaline, a drug which is normally used to treat cardiac arrest), lack of insulin (particularly obvious among the diabetics), stroke, heart attack, excessive production of growth hormone (acromegaly), increased intracranial pressure (IP, a pressure that occurs within the cranium), severe stress, Cushing’s syndrome, dehydration and etc. In contrast, the decreased level of blood glucose is always seen in physiological hunger, pancreatic cancer, decreased thyroid hormone levels (hypothyroidism), kidney failure, the presence of a tumor in the pituitary gland, an eating disorder (such as anorexia), Addison’s disease, injection or excessive use of insulin or oral hypoglycemic agents (OHAs, drugs which are used to manage people with diabetes type II), severe liver disease (such as cirrhosis) and etc.

Either your blood glucose level remains too low or too high, over the time, it can definitely harm your health or may also cause certain underlying health concerns. When blood glucose level remains too high for a longer period, it can lead to the damage in nerves, blood vessels and eyes. Abnormally lower blood glucose level can mean the presence of hypoglycemia (low blood sugar level). If your fasting glucose level reads below 40 mg/dl or 2.2 mmol/L (in female) or below 50 mg/dl or 2.8 mmol/L (in male), accompanying by signs of hypoglycemia, then you may have your tumor functions abnormally in producing high volume of insulin or also called insulinoma. In a case that your fasting blood glucose level reads from 100 mg/dL (5.5 mmol/L) to 125 mg/dL (6.9 mmol/L), you’re more likely to get an impaired fasting glucose or pre-diabetes, signifying the possibility for you to get diabetes.

Blood Urea Nitrogen (BUN)

BUN measures how much urea (synthesized by the liver) nitrogen, a waste product of protein metabolism, remains in the blood. In healthy adults, BUN is measured from 6 to 22 mg/100ml (note: male has slightly higher value than female; newborn babies have BUN values slightly lower than adults, elderly may also have values slightly lower than adults due to their poor renal function, while pregnant moms may have a 25% decreased value than the adults).

The rise in the BUN value is called azotemia, and the elevated value of BUN may be due to severe dehydration (lack of fluid volume to help excrete waste product), shock, acute myocardial infarction, stress, impaired renal function or damaged kidneys (may mean unable to eliminate urea from the bloodstream), congestive heart failure or hypovolemic shock (caused by a poor renal perfusion), protein catabolism or excessive protein intake (such as high-protein tube feeding), and hemorrhage or extensive bleeding into the gastrointestinal (GI) tract (GI bleeding will significantly elevate the BUN level due to the presence of protein level in the blood. For example, an extensive bleeding of one liter blood into the GI tract may result in the BUN to rise up to 40mg/ml). The decline in BUN value may be due to the use of anabolic steroid, malnutrition, overhydration, severe liver failure (due to a reduction of urea in the blood), syndrome of inappropriate anti-diuretic secretion (SIADH, the anti-diuretic hormone may stimulate the kidneys to store water causing excess water being retained in the bloodstream instead of being excreted into a form of urine, and thereby increasing the fluid volume of the bloodstream significantly), impaired nutrient absorption, and pregnancy (caused by increased plasma volume).

Creatinine (CRE)

CRE refers to a protein in the blood that should remain at a constant level. Its normal range is from 0.4 to 1.0 mg/dl. Any changes in CRE are indicative of kidney problems. Elevated CRE value may indicate the possibility of getting a kidney related illness.

Uric Acid (UA) Levels

The uric acid in your blood, or always called serum uric acid, tells you how well your body breaks down cells or how capable your body eliminates uric acid out of the body. Sometimes, uric acid also forms kidney stones or crystals that can definitely damage the kidneys. Its normal range is from 2.0 to 6.0 mg/dl. Any value below 6 is considered good, because at this state, the uric acid is inhibited to form and dissolve into the existing crystals. At 6.0 to 7.0 mg/dl, it tells you a warning sign that prompts you to watch for skin redness, itching, numbness, tingling and gout flares as well. At the reading over 7.0mg/dl, there’s a higher risk of uric acid crystals formation in your body. That is to say, the higher the value, the greater the risk is. 

Increased concentrations of uric acid can lead to join pain and inflammation, most often in toes, thumb and large toes joints, a type of arthritis called gout. Higher levels of uric acid in the blood (also called hyperuricemia) are seen much more commonly to increase the risk of developing heart disease, leukemia, stroke, multiple myeloma, polycythemia, renal dysfunction, peripheral vascular disease, eclampsia, high blood pressure, kidney failure, and even death. Lower levels of uric acid, however, may cause hereditary xanthine in urine.  Low values are often associated with exposure to toxic compounds, inherited metabolic defect, some kinds of kidney or liver diseases.

High-density lipoprotein (HDL)

Being one of the five major groups of lipoproteins (LDL, VLDL, IDL, chylomicrons, HDL), HDL or “good cholesterol”, is beneficial for the cardiovascular health. At high HDL level, above 60 mg/dl (or above 1.55 mmol/L), it’s the most preferred optimal condition to protect against heart disease. Low HDL, less than 40 mg/ dl for males and less than 50 mg/ dl for females (or less than 1.03 mmol/L), can be a warning indicator for an increased heart disease risk. The medium HDL level, 40 to 59 mg/dl (or between 1.03 and 1.55 mmol/L), shows a decreased risk of developing any heart diseases. 

Triglycerides (TG)

Triglycerides are a form of fat (lipid) found in the bloodstream, which contain three (”tri-”) molecules of fatty acid with a molecule of the alcohol glycerol (”-glyceride”), carrying throughout body by a lipoprotein called chylomicron. Higher TG levels are typically identified among people with obesity, heart disease, high LDL (bad) cholesterol level, high total cholesterol level, low HDL (good) cholesterol level, and diabetes. Elevated TG levels can be indicative of artherosclerosis (the formation of fatty plaques that cause the narrowing of the arteries), stroke, congenital defects in lipoprotein lipase deficiency, nephritic syndrome and heart disease. Markedly elevated TG levels may lead to pancreatitis and fatty liver disease and in either case; a treatment regime (particularly low fat diets and medications) should be prescribed immediately. According to my previous article entitled the knowledge of lipid is essential for a healthier life, TG levels which are less than 1.70mmol/L (or 150mg/dl) are regarded as normal, while levels of more than 1.70mmol/L (or 150mg/dl) are abnormal. At 150-199 mg/dl, the values are considered borderline-high, values of 200-299 mg/dl are regarded as high while values of 500 mg/dl or more are considered as markedly elevated TG levels.

C-Reactive Protein (CRP)

CRP is a special type of protein produced by the liver in response to acute infection, inflammation, injury or other inflammatory stimuli, and obviously, it’s one of the body’s immunologic defense mechanisms. Low CRP level doesn’t always mean the absence of inflammation as the presence of inflammatory diseases such as systemic lupus erthematosus and rheumatoid arthritis may not always cause CRP level to be elevated. The normal level of CRP in the bloodstream is somewhere around 10 mg/l or less, but in individuals with an acute illness, it can be as high as 100 mg/l. Typically, elevated CRP levels have been associated with conditions such as stroke, obesity, blood sugar disorder, Alzheimer’s, atherosclerosis, viral disease, arthritis, cancer, heart disease, dental disease and the use of Estradiol (either with or without Progestagens) among post-menopausal females. 

Total Cholesterol (TC)

As like triglyceride and other lipids, cholesterol, one of your body’s lipids (fats), play a major role in your body particularly in building blocks in the structure of cells, making hormones as well as producing energy. Even though having too much cholesterol in your blood is not considered as a disease, it can lead to life threatening diseases and it’s also a major risk factor for coronary heart disease, stroke, and atherosclerosis (narrowing and hardening of the arteries) in the major vascular systems. Hence, it’s vital for you to know your cholesterol level and get your level monitored regularly. Early detection of high levels of cholesterol is essential to help you to change your lifestyle to bring the levels down to the normal.

Basically, TC measures the level of your blood cholesterol and its desirable range lies from 120 to 200 mg/dl. A cholesterol level of 200-239 mg/dl is considered borderline high, while higher cholesterol level (hypercholesterolaemia) of 240 mg/dl or higher may increase twice time your risk of getting coronary heart disease.

TC level depends very much on what you eat, and also how your body produces cholesterol in the liver. The levels rise slightly over the age, and females are generally identified to have a higher HDL-cholesterol level than males. In a case that your total cholesterol is 200mg/dl or more (or your HDL cholesterol is less than 50mg/dl for males or less than 40 mg/dl for females) or both, you should get your doctor monitor your lipoprotein profile as a measure to determine the levels of your triglyceride and LDL cholesterol.

Serum Gamma-GTP

Serum Gamma-GTP is a measurement used to interpret the liver function and its normal range lies between 5 to 37 IU/L. People who are a heavy smoker, overweight and fail to exercise regularly, are obviously those who have oxidative stress present in their body. Later, this oxidative stress will cause plasma membrane-bound protein damage in their hepatic cells, and eventually causing the elevated levels of serum gamma-GTP. Thus, the serum level tells you the existence of liver cell damage. In a case of cardiac or liver damage, large amount of transamionase are released into serum, and this explains why the serum level tends to be elevated than its normal level. 

GPT (ALT)

GPT or also called Glutamate Pyruvate Transaminase, is a type of enzyme which is found in small amount in many parts of your body tissues, but it’s very concentrated in your liver. When the cells where it contains damaged, GPT will be released into the blood cells. It’s also known as alanine transaminase, or ALT medically. In the blood test, GPT test determines the amount of GPT to help examine the liver function, and thus it’s more likely to be known as an indicator of liver inflammation. The blood test is performed on blood serum to examine if your liver is injured, damaged or infected with any liver related disease. Its normal range is suggested at 5-45 UI/L and in adults; its level can be varied from the range 0-35 units per liter (U/L). Sometimes, the normal range may slightly different from lab to lab. If your GPT level is higher than normal which means its level is up to 50 times the upper limit of normal, suggesting that you may have liver damaged (due to medicines you’ve taken) or you may have liver damage on the cause of acute viral infections (such as viral hepatitis A, B, or C). 

Higher levels of GPT (ALT) are always observed among people who are suffering from hepatitis. Acute hepatitis individuals always have higher level remained for several months. Elevated GPT level can also be a case among those who have drunk too much alcohol, taken certain medications (such as acetaminophen, salicylates or aspirin, barbiturates, antifungal medicines, narcotics, methotrexate, and medicines used to reduce cholesterol levels), or those who have liver damage, chronic liver infection or inflammation, necrosis of liver cells (may cause the extensive release of GOT and GPT into the blood), congested blood flow through the liver (caused by heart failure), mononucleosis, gallstones or inflammation caused by gallstones, gallbladder or inflammation caused by gallstones, or certain type of cancer (such as liver cancer or other cancer that has spread to the liver). The levels can be varied according to the stage of the illness. In certain occasion, liver disease patients may have their levels remained normal for several months or years.

SGOT (AST)

Aspartate aminotransferase (AST), or also known as serum glutamic-oxaloacetic transaminase (SGOT) or glutamic-oxaloacetic transaminase (GOT) is a test used to detect liver damage. Often, it’s part of an initial screening for liver disease. The AST level is mainly examined along with other levels of liver enzymes, such as alanine transaminase (ALT), and alkaline phosphatase (ATP) to monitor which type of liver disease is present. AST is found in many tissues throughout the body, including the heart, muscles, kidney, liver and brain, but it’s found more concentrated in liver, skeletal muscle cells and heart with lesser amounts observed in other tissues. When any of these tissues or organs is affected by injury or disease, AST will be released into the bloodstream.

The normal range for AST level is from 10 to 40 UI/L. A rapidly developing liver disease (or called acute hepatitis is usually caused by a virus infection) is always causing markedly elevated levels of AST (more than 10 times the highest normal level). In a case of an acute hepatitis, AST levels normally remain elevated for up to 2 months, and in some cases, the levels may be as long as 3-6 months before returning to normal. AST can also be increased from liver damage due to alcohol (AST is always observed to be much higher than ALT, particularly among those with several liver related diseases), injections of medicine into muscle tissue, muscle injury, after heart attacks, strenuous exercise and the breakup of red blood cells (haemolysis). Meanwhile, in a slowly developing variety of liver disease, chronic hepatitis, AST rarely stays at elevated level, but often it’s less than 4 times the highest normal level. AST may remain to normal level in certain disease of liver, with the most commonly occurred situation during which the bile ducts are completely or partially blocked.

Total Protein (TP)

Total protein is a useful test that assesses the protein levels in the body, and this test is normally done to help detect the liver disorder. The disorder can be caused by the inability of the body to digest protein efficiently. Its normal range is suggested at 6.5-8.3 g/dl. When TP level is low, it’s a characteristic of kidney problems, liver disease or any liver related disease. The cause of the change in the body’s protein levels is always tested by the ratio of albumin to globulins. A low albumin to globulins may suggest cirrhosis or an autoimmune disease, while a high ratio of albumin to globulins may suggest low immunoglobulin’s which is often linked to a characteristic of leukemia. At this point, of course, more in dept test would be carried out for a further diagnosis.

Albumin (ALB)

The albumin test is ordered to evaluate liver function or when a person has symptoms of a liver disorder (such as weight loss, fatigue, jaundice, or symptoms of nephritic syndrome which includes a swelling around the legs, belly or around the eyes), along with BUN and CRE to monitor the kidney function, or may be carried out along with a prealbumin to assess one’s nutritional status. It’s also a test to help diagnose disease (because in many disorders and diseases, albumin is observed to be lower), to screen for certain stage of diseases and to monitor in one’s change of health state due to the progress of certain disease. Its normal range is recommended at 4.0-5.1 g/dl.

Lower ALB levels can be indicative of kidney problems or an indicator of liver disease. In the former case, a simple test is prompted to detect protein levels present in the urine, while in the latter case, further diagnosis need to be carried out to help detect which type of disease is present in the liver. Very often, lower ALB levels are linked with Chron’s disease or celiac disease (a condition when the body cannot properly absorb or digest the protein, or large amount of protein is lost from the intestines), malnutrition, shock or inflammation among the patients, in contrast to that, higher ALB levels can be indicative of a severe dehydration among the patients. The use of drugs such as androgens, growth hormones, insulin, and anabolic steroids can increase the ALB levels, and thus making the result to be inaccurate or overestimated.

For more terms and measurements used for hypertension, please refer to my previous article entitled practical handbook for hypertension one and for a thorough documentation related to medical records, kindly visit article written by Judy Sheldon, what’s in your medical record?.

Final remark:

The normal values for each case of occasion stated herein may be varied from individual to individual due to the factors of patient age, test method, sample population, gender, and existing health condition. Additionally, the numeric test results obtained from different labs may show a slightly different value as compared to values stated herein. Hence, the values stated herein are for reference purpose, and you should discuss your test results with your doctor. The information contained herein shouldn’t be used for the diagnosis or treatment of any medical condition or at times of any medical emergency cases.

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