Dr.

Satyen Bhattacharyya
Assistant Professor : BIMLS,Burdwan
www.fitofine.org
Hemoglobin
Hb is the iron containing coloring matter of RBC
If the count is low -
chronic inflammation(inflammation is a body process that
can result in pain swelling warmth or redness)
Low hematocrit and hemoglobin counts may be signs that
your medication is causing a loss of blood from your
stomach and passing through your bowel. Low counts also
may indicate a decrease in red blood cell production.
bone marrow problem
If the count is more –
blood volume increase
in case of smoking
high altitude
Normal Count : 14 – 16 g/dL
but it can vary from age to age
At birth : 25g/dL
After 3rd month : 20g/dL
After 1 year : 17g/dL
from puberty onwards : 14 – 16g/dL
it can also vary in age –

Adult males : 15g/dL

Adult females : 14.5g/dL
 WBC
WBC tests measure the number of white blood cells
present. When you have an infection your body makes
more white blood cells. Some medications can decrease
the number of white blood cells which could increase your
chances of getting an infection
 Normal Values
total count(TC)-
4000 – 11000/cu mm of blood
differential count(DC)-
% Absolute
volume/cu mmof
blood

neutrophils 50-70 3000-6000

eosinophils 2-4 150-450
basophils 0-1 0-100
monocytes 2-6 200-600
lymphocytes 20-30 1500-2700
 SIGNIFICANS
If the count is less-
may be due to some medications
decrease count indicate more prone for infection

If the count is more-

disease in bone marrow
disorder in immune system
acute lymphocytic leukemia
acute myelogenous leukemia(AML)
Allergy, especially severe allergic reactions
Chronic lymphocytic leukemia
Chronic myelogenous leukemia
Drugs, such as corticosteroids and epinephrine
Infections, bacterial or viral
Myelofibrosis
Polycythemia vera
Rheumatoid arthritis
Smoking
Stress, such as severe emotional or physical stress
Tuberculosis
Whooping cough
 Platelet count

This test measures the number of "sticky" cells or platelets

that help the blood to clot (aspirin and some other
medications make the platelets less "sticky"). If the
number of platelets is low you could have too much
bleeding. Some powerful arthritis medications in rare
instances lower the platelet count.
 Normal Values

2,50,000/cu mm of blood

range- 2,00,000 – 4,00,000/cu mm of blood

 Significance
If the count is less- (thrombocytopenia)
more bleeding
TB
infections and otherdisease
If the count is more- (thrombocytosis)
allergic conditions
hemorrhage
bone fracture
rheumatic fever
trauma
 Erythrocyte sedimentation rate (ESR)

This test also called "sed rate determines if you have

inflammation. The sed rate can measure the amount of
inflammation present. The test measures how fast red
blood cells cling together, fall, and settle toward the
bottom of a glass tube in an hour's time, like sediment.
The higher the sed rate, the greater the amount of
inflammation. As inflammation responds to medication,
the sed rate usually goes down. This is an example of a
test your doctor might order several times. Another test
used to measure this is the C-Reactive Protein (CRP) test.
 Normal Values
by westergen method-

in males- 3-7 mm in one hour

in females- 5-9 mm in one hour
in infants- 0-2 mm in one hour
 Significance
 if the count is more - (more inflammation)
TB
anemia
malignant tumors
RA
Rheumatoid fever
liver disease
If the count is less-
allergic conditions
sickle cell anemia
polycythemia(increase in RBC)
peptone shock
severe leukocytosis
 Salicylate level

This measures the amount of salicylate in the blood to find

out if enough is being absorbed to reduce inflammation
(salicylate is the main ingredient in aspirin and some other
NSAIDs). This is a helpful test for people who are taking
large doses of these medications for a long time. High
salicylate levels can be harmful with or without such
symptoms as ringing in the ears nausea vomiting or even
fever
Muscle enzyme tests (CPK aldolase)

These tests measure the amount of muscle damage (in

some rheumatic diseases damaged muscles release
certain enzymes into the blood). These tests also can
show how effective medication has been in reducing
inflammation that causes muscle damage.
Normal Values

1.0 – 7.5 units/liter

 Significance
decrease amount signifies prone for muscle fatigue and
inflammation

it is diagnostic test forfibromyalgia

it signifies liver or muscle damage

Liver enzyme tests (SGOT SGPT)
bilirubin alkaline

These tests measure the amount of liver damage.

Certain medications used in the treatment of arthritis
can damage the liver. Aspirin for example has been
known in rare instances to damage the liver especially
in children or in people who have had previous liver
damage. Other NSAIDs can cause liver inflammation
(hepatitis). Methotrexate can cause liver damage
especially in people who drink alcohol.
 Normal Values
SGPT –
male : upto 40 u/L
female : upto 31 u/L

SGOT –
male : upto 37 u/L
female : upto 31 u/L
 Creatinine tests

These measure kidney function. Creatinine is a normal

waste product of the muscles. A high level of it means that
the kidneys are not working well enough to remove waste
products from the body.
Normal Values

male - 0.9 – 1.4 mg/dL

female 0.8 – 1.2 mg/dL
 Uric Acid

These tests measure the amount of uric acid in the blood.

People with gout usually have high levels of uric acid
which forms into crystals that are then deposited in the
joints and other tissues. However not everyone with a high
uric acid level has gout.
Normal Values

male : 3.4 – 7.0 mg/dL

female : 2.4 – 5.7 mg/dL
Auto immune disease
 when immune system fights against his own body cells
and creates auto antibodies that react against body’s
own cell, then inflammatory conditionshappen.
the test includes are-
rheumatoid factor
antinuclearantibody
complement
human leukocyte antigen tissuetyping(HLA)
 Rheumatoid Factor(RF)
This measures whether a certain amount of abnormal antibody
called rheumatoid factor is in the blood. The majority of people
with rheumatoid arthritis (a common disease of inflamed joints
that can cause joint alignment problems and loss of function)
have a large amount of rheumatoid factor in their blood.
However up to 20 percent of adults with rheumatoid arthritis
may never have any rheumatoid factor in their blood. In
contrast about 85 percent of children with juvenile rheumatoid
arthritis (ERA) are negative for rheumatoid factor (ERA is a
group of diseases similar to rheumatoid arthritis that begin in
childhood). It is important to note that having a positive
rheumatoid factor will assist in the diagnosis but the test alone
is not conclusive.
 Method of testing

Latex agglutination
ELISA
Nephelometry –
use LASER light to detect RF &IgE
 Normal Values

Latex RF greater than 1 : 40 as positive

Nephelometry lesser than 20 IU is normal

 Significance

X-Ray shows same impression in polyarthritis & RA

but lab test signifiesthis
Also used in Sjogren’s disease to predict the
development of lumphoma
 Antinuclear antibody(ANA)
These detect a group of autoantibodies that are found in
most people with lupus and scleroderma and in a few
people with rheumatoid arthritis. These autoantibodies
react with antigens in the nuclei of cells. The antibodies
suggest that an autoimmune illness may be present
although many people test positive and have little
evidence of serious disease. Specific antinuclear antibody
tests are helpful in the diagnosis of certain rheumatic
diseases that involve abnormalities in the immune system.
The names of the following tests are abbreviations of
more complicated-sounding tests. The diseases for which
they are used include:
systemic lupus erythematosus (multiple-system illness may
involve the skin joints kidney etc.); anti-dsDNA anti-Sm anti-
Ro/SS-A and antihistone tests help confirm the diagnosis.
scleroderma (a marked thickening of the skin); the anti-Scl-70
test helps confirm the diagnosis.
polymyositis (inflammation of muscles resulting in muscle
weakness sometimes with joint inflammation); anti-Jo-l and anti-
PM-l tests may help confirm the diagnosis.
Sjogren's syndrome (disorder marked by dry eyes and dry
mouth); anti-Ro/SS-A and anti-La/SS-B tests may help confirm
the diagnosis.
mixed connective tissue disease (a syndrome with a variety of
symptoms including joint inflammation and swollen fingers); the
anti-Ul RNP test helps confirm the diagnosis.
 Complement tests

These tests measure the amount of complement

proteins circulating in the blood. Complement tests
involve the reaction of antibodies with antigens. These
tests usually are reserved for diagnosing or monitoring
people with active lupus. Those people with lupus
frequently have lower-than-normal amounts of
complementespecially if the kidneys are affected.
Human leukocyte antigen (HLA)
tissue typing tests
These tests detect the presence of certain "genetic
markers" or traits in the blood. For example B-27 is a
genetic marker that nearly always is present in people
with ankylosing spondylitis (a diseaseinvolving
inflammation of the spine and sacroiliac joint) and
Reiter's syndrome (a disease involving inflammation
of the urethra eyes and joints). This test also is positive
in 5 to 10 percent of the healthypopulation.
 References
Essentials of Medical Physiology bysembulingam
Wikipedia
www.mayoclinic.org
Thank You