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Test Results Analysis Documentation 

Detailed information for the items in the Red Blood Cell (RBC) Analysis panel including a bibliography supporting the possible root causes in the RBC Insights panel.

RBC Insights

The RBC Insights panel evaluates the likelihood of Suboptimal Blood Oxygen Delivery and displays that likelihood on a color-coded gauge.

  • Suboptimal Blood Oxygen Delivery refers to the delivery of oxygen by red blood cells to all cells of the body being suboptimal. This condition is known as anemia.
  • The likelihood is determined using the values for RBC, HGB, and HCT.
  • Likelihood categories are Less Likely (green), Possible (yellow), Likely (orange), and Highly Likely (red).

Below the gauge are two boxes that represent the color and size of the red blood cells.

  • RBC Size – uses MCV to identify microcytic, normocytic, or macrocytic
  • RBC Color – uses MCHC to identify hypochromic, normochromic, or hyerpchromic

Likelihood Gauge

Easy to interpret gauge indicating the likelihood of suboptimal blood oxygen delivery based on the severity of the values for red blood cells (RBC), hemoglobin (HGB), and hematocrit (HCT).

Blood oxygen delivery is the process through which blood delivers oxygen to all cells of the body.

RBC Size and RBC Color

RBC size represents the average volume of all RBCs, is calculated using MCV, and displays either microcytic, normocytic, or macrocytic.

RBC color represents the amount of hemoglobin inside the RBC based on the RBC size, is calculated using MCHC, and displays either hypochromic, normochromic, or hyperchromic.

RBC Size Variation (Nutrient Insufficiency or Inflammation is Likely)

The variation in the average size of RBCs, which is determined by the RDW, is used to identify the likelihood of a nutrient insufficiency being a possible root cause of suboptimal blood oxygen delivery. If suboptimal blood oxygen delivery is less likely and RDW > optimal, inflammation is likely.

Possible Root Causes

The key differentiator of LabSmarts is our sophisticated pattern recognition engine that determines the possible root causes of suboptimal blood oxygen delivery based on various markers.

Accurate Reference Ranges – Age and Gender

An accurate analysis starts with using reference ranges that represent a healthier population rather than the ranges shown on the lab results. Based on this clinical research study, lab reference ranges for red blood cell related markers are adjusted based on age and gender (ages 1 to 79+).

Accurate Reference Ranges – High Elevation and Pregnancy Trimester

Clients who live at elevations above 3,281 feet (1,000 meters) tend to have higher RBC, HGB, and HCT because the body is overcompensating for the lack of oxygen.

Normal physiological changes in pregnancy result in a reduction of hemoglobin concentration. As a result, pregnant women tend to have lower RBC, HGB, and HCT.

 LabSmarts adjusts the reference ranges for these three markers upward depending on elevation and downward depending on trimester of pregnancy based on the correction factors recommended by the World Health Organization and the elevation ranges based on this study from Sullivan et al.

Values Plotted on Easy to Read Bar Graphs with Optimal, Lab, Outside Lab, and Alarm Ranges

Lab reference ranges refer to the ranges found next to each marker on the bloodwork. They are typically referred to as the “normal” or “healthy” ranges but in reality, they simply represent 95% of the population tested at that lab and have no basis for defining optimal health.

Since the majority of the population is unhealthy, values in the low and high ends of the lab range justifiably represent suboptimal health and indicate an imbalance in a body system function. Optimal body system function happens when values are within the “optimal” range, which is inside the low and high ends of the lab range, closer to the average (mean) population.

LabSmarts defines the optimal range for each marker using validated clinical research correlating threshold values to imbalances in body system function. If evidence for the optimal range is not listed in the bibliography, the optimal range values are calculated using one standard deviation from the lab mean. This covers 68% of the population, a much more realistic range for representing optimal body system function than the lab range which is two standard deviations from the lab mean representing 95% of the population.

RBC Insights – Possible Root Causes Bibliography

Bone Marrow Suppression

    • The bone marrow produces red blood cells (RBC), white blood cells (WBC), and platelets. When RBC, WBC, and platelets are all below the lab range, something may be suppressing the bone marrow’s ability to produce these cells and cell fragments.
    • Logic: RBC < lab, WBC < lab, platelets < lab, normocytic, normochromic, RDW = optimal, hemoglobin and hematocrit < optimal.
    • Increased MCV and normal RDW seen in bone marrow suppression
    1. “It was observed that MCV was greater than 97 fl in 15 cases of aplastic anemia (mean MCV 109.7 fl), and 25 cases of megaloblastic anaemia (mean MCV 113.2 fl). Hb, MCV & MCHC were comparable in the two groups. However, mean RDW in megaloblastic anaemia (mean 87.7 fl) was significantly higher than those in aplastic anaemia (mean 71.4 fl). The difference in RDW of patients with megaloblastic anaemia and aplastic anaemia was statistically significant. We conclude that RDW can be of help to differentiate between the two conditions.” Gupta PK, Saxena R, Karan AS, Choudhry VP. Red cell indices for distinguishing macrocytosis of aplastic anaemia and megaloblastic anaemia. Indian J Pathol Microbiol. 2003;46(3):375-377. [PubMed]
    2. “Alcoholism was identified as the etiological factor in 65 cases (36.5%), Vitamin B12 deficiency in 43 cases (24.1%) and drug related in 23 cases (12.9%). These three conditions accounted for 73.6% of macrocytosis. Other causes identified were folate deficiency, liver disease, Myelodysplastic syndrome, chronic renal failure and Aplastic anemia. Veda P. Evaluation of macrocytosis in routine hemograms. Indian J Hematol Blood Transfus. 2013;29(1):26-30. [PubMed]
    • Low lymphocyte and neutrophil counts associated with bone marrow suppression
    1. “An absolute lymphocyte count (ALC) below the median of the population (1.2 × 109/l) was associated with lower counts of neutrophils (median 1.35 vs. 1.92 × 109/l, p < 0.001) and platelets (median 100 vs. 138 × 109/l, p < 0.001)… For low-risk myelodysplastic syndromes (MDS)… an ALC < 1.2 × 109/l was of additional prognostic value… together with age (< or ≥65 years) and LDH (< or ≥normal value of 240 U/l; HR 1.46, 95% CI: 1.03-2.08, p = 0.033).” Silzle T, Blum S, Schuler E, et al. Lymphopenia at diagnosis is highly prevalent in myelodysplastic syndromes and has an independent negative prognostic value in IPSS-R-low-risk patients. Blood Cancer J. 2019;9(8):63. [PubMed]
    • Copper insufficiency may cause bone marrow suppression
    1. “Perhaps some people with myelodysplastic syndrome have higher-than-average copper requirements and habitually eat too little copper. These people may require far more copper than average for recovery.” Klevay LM. “Myelodysplasia,” Myeloneuropathy, and Copper Deficiency. Mayo Clinic Proceedings. 2006;81(1):132. [PubMed]
    2. “We report 5 patients with clinical presentation consistent with MDS who were found to be deficient in copper and whose hematologic abnormalities resolved with copper supplementation.” Fong T, Vij R, Vijayan A, DiPersio J, Blinder M. Copper deficiency: an important consideration in the differential diagnosis of myelodysplastic syndrome. Haematologica. 2007;92(10):1429-1430. [PubMed]
    • B12 and/or folate insufficiency may cause bone marrow suppression (decrease in RBCs, WBCs, and platelets)
    1. Vitamin B12 Deficiency – Causes, Symptoms, Diagnosis, Treatment, Pathology. Video. Accessed October 29, 2019.

Thyroid Hormone Insufficiency

    • Logic for RBC size, color, and variation in size: normocytic, normochromic, and RDW = optimal or macrocytic
    • Logic: TSH > optimal AND/OR Free T3 > optimal AND/OR Free T4 > optimal
    1. “Anemia associated with hypothyroidism is usually normocytic or macrocytic. Because thyroid hormones stimulate the production of erythropoietin and affect hematopoiesis, a reduction in thyroid hormones may cause anemia.” Nagao T, Hirokawa M. Diagnosis and treatment of macrocytic anemias in adults. J Gen Fam Med. 2017;18(5):200-204. [PubMed]
    2. “Macrocytosis is found in up to 55% patients with hypothyroidism and may result from the insufficiency of the thyroid hormones themselves.” Antonijević N, Nesović M, Trbojević B, Milosević R. [Anemia in hypothyroidism]. Med Pregl. 1999;52(3-5):136-140. [PubMed]
    3. “Thyroid hormones stimulate the proliferation of erythrocyte precursors both directly and via erythropoietin production enhancement.” Szczepanek-Parulska E, Hernik A, Ruchała M. Anemia in thyroid diseases. Polish Archives of Internal Medicine. 2017;127(5):352-360. [PubMed]
    4. “After adjusting for potential confounding factors, participants with low-normal fT4 had 4.4 (P=0.003) and 2.8 times (P<0.001) higher risk for anemia than those with high-normal fT4 among men and women, respectively.” Kim M, Kim BH, Lee H, et al. Association between Serum Free Thyroxine and Anemia in Euthyroid Adults: A Nationwide Study. Endocrinol Metab. 2020;35(1):106-114. [PubMed]
    5. “A large cohort study revealed that, even in euthyroid patients, there is a significant positive relationship between the concentrations of free thyroid hormone and hemoglobin, hematocrit, and erythrocyte count, with a simultaneous negative correlation between TSH levels and the serum iron concentration and transferrin saturation.” Bremner AP, Feddema P, Joske DJ, et al. Significant association between thyroid hormones and erythrocyte indices in euthyroid subjects. Clin Endocrinol (Oxf). 2012;76(2):304-311. [PubMed]

Vitamin C Insufficiency Related to Macrocytic RBC Size

    • Logic for RBC size and color: macrocytic and normochromic or hypochromic
    1. “Vitamin C is involved in converting folate to its more active form, tetrahydrofolic acid, which is needed in the production of red blood cells. Therefore a macrocytic RBC size may indicate folate insufficiency possibly caused by a vitamin C insufficiency.” Lucock M, Yates Z, Boyd L, et al. Vitamin C-related nutrient-nutrient and nutrient-gene interactions that modify folate status. Eur J Nutr. 2013;52(2):569-582. [PubMed]

WBC Insights

The WBC Insights panel evaluates the likelihood of Immune System Abnormality and displays that likelihood on a gauge.

  • Immune System Abnormality refers some sort of abnormality with the WBC total and differential markers as well as globulin as it relates to immunoglobulins and alkaline phosphatase as it is an indirect measure of zinc status which is needed by the immune system.