Lupus

Tuesday, January 3, 2012

What do my blood tests mean?

This is a question almost everyone with lupus will ask especially at the beginning of their journey to better health.  Unless you are in the medical field and studied rheumatic diseases, you probably have never heard of some of the blood tests associated with diagnosing, and managing lupus.  Due to the complexities of SLE, there are many blood tests that need to be regularly run just to keep track of where, how, and how badly the disease is affecting your body.  Lupus can go into any part or organ of the human body, making it impossible to predict, but with the use of proper and continual testing, our specialists can keep track of lupus and manage it properly.

http://www.hopkinsmedicine.org/healthlibrary/conditions/adult/arthritis_and_other_rheumatic_diseases/systemic_lupus_erythematosus_lupus_85

Lupus is difficult to diagnose because of the vagueness of the symptoms each person might have. There is no single test that can diagnose lupus. A diagnosis is usually confirmed based on a complete medical history, reported symptoms, and a physical examination that may include the following:

  • Blood test (to detect for certain antibodies that are present in most people with lupus)
  • Blood and urine tests (to assess kidney function)
  • Complement test (to measure the level of complement, a group of proteins in the blood that help destroy foreign substances; low levels of complement in the blood are often associated with lupus)
  • X-rays - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
  • Erythrocyte sedimentation rate (also called ESR or sed rate) - a measurement of how quickly red blood cells fall to the bottom of a test tube. When swelling and inflammation are present, the blood's proteins clump together and become heavier than normal. Thus, when measured, they fall and settle faster at the bottom of the test tube. Generally, the faster the blood cells fall, the more severe the inflammation.
  • C-reactive protein (CRP) - is a protein that is elevated when inflammation is found in the body. Although ESR and CRP reflect similar degrees of inflammation, sometimes one will be elevated when the other is not. This test may be repeated to test your response to medication.

    This information is from a wonderful lupus group I joined years ago, it gives some of the best and most in depth info on lupus.  I have not been able to find any other blog or site with better or more SLE facts and details.
    http://www.itzarion.com/lupusgroup.html 

More on CRP rates:

Why the Test is Performed

The CRP test is a general test to check for inflammation in the body. It is not a specific test. That means it can reveal that you have inflammation somewhere in your body, but it cannot pinpoint the exact location.
Your doctor may order this test to:
  • Check for flare-ups of inflammatory diseases such as rheumatoid arthritis, lupus, or vasculitis
  • Determine if anti-inflammatory medicine is working to treat a disease or condition
However, a low CRP level does not always mean that there is no inflammation present. Levels of CRP may not be increased in people with rheumatoid arthritis and lupus. The reason for this is unknown.
A more sensitive CRP test, called a high-sensitivity C-reactive protein (hs-CRP) assay, is available to determine a person's risk for heart disease. Many consider a high CRP level to be a risk factor for heart disease. However, it is not known whether CRP is merely a sign of cardiovascular disease or if it actually plays a role in causing heart problems.

Normal Results

Normal CRP values vary from lab to lab. Generally, there is no CRP detectable in the blood.
Your doctor may also use a highly sensitive test called hs-CRP to help determine your risk of heart disease. According to the American Heart Association:
  • You are at low risk of developing cardiovascular disease if your hs-CRP level is lower than 1.0mg/L
  • You are at average risk of developing cardiovascular disease if your levels are between 1.0 and 3.0 mg/L
  • You are at high risk for cardiovascular disease if your hs-CRP level is higher than 3.0 mg/L
Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.
The examples above show the common measurements for results for these tests. Some laboratories use different measurements or may test different specimens.

What Abnormal Results Mean

A positive test means you have inflammation in the body. This may be due to a variety of different conditions, including:
This list is not all inclusive.
http://www.itzarion.com/lupusdiagnostics.html


Diagnostic Tests for Lupus

Blood count:
This test measures the amount of hemoglobin, red blood cells, white blood cells and platelets in your blood. Results may indicate you have anemia, which commonly occurs in lupus. Low white blood cell counts may occur as well. Erythrocyte sedimentation rate:
This blood test determines the rate at which red blood cells settle to the bottom of a tube. A faster-than-normal rate may indicate a systemic disease such as lupus. The sedimentation rate is not specific for one disease but may be elevated in lupus, other inflammatory conditions or with infection.
Kidney and liver assessment:
A blood test can assess how well your kidneys and liver are functioning. Lupus may affect these organs as well as other systemic organs.
Urinalysis:
An examination of a sample of your urine may show an increased protein level, which may occur if lupus has affected your kidneys.
Antinuclear antibody (ANA) test:
A positive test for the presence of these antibodies  .. produced by your immune system .. indicates a stimulated immune system and is common if you have lupus or another autoimmune disease. Your doctor may advise more specific antibody testing and refer you to a rheumatologist. (More info here..  http://www.itzarion.com/lupusana.html )
Chest X-ray:
An image of your chest and pleura, which surrounds your lungs, may reveal abnormal shadows or inflammation of your lungs, which may occur with lupus.
Electrocardiogram (ECG):
This test measures the pattern of electrical impulses generated in your heart. It can help identify irregular rhythms, damage to your heart or enlargement of your heart, any of which may occur with lupus.
Syphilis test:
If your doctor orders a syphilis test, it's not because he or she thinks you might have syphilis. Rather, a false-positive to a syphilis test can indicate antiphospholipid antibodies in your blood. The presence of antiphospholipid antibodies has been associated with an increased risk of blood clots, strokes and recurrent miscarriages.






C-Reactive Protein test C-reactive protein is a test that measures the concentration of a protein in blood serum that indicates acute inflammation.
C-reactive protein is a special type of protein produced by the liver that is only present during episodes of acute inflammation.
C-reactive protein is a sensitive marker of inflammation, the process whereby the body responds to injury. The most important role of CRP is its interaction with the complement system, which is one of the body's immunologic defense mechanisms.
While this is not a specific test, it does give a general indication of acute inflammation. Your health care provider might use this test to check for rheumatoid arthritis, rheumatic fever exacerbations, lupus flares, or heart problems. The test might also be useful to monitor response to therapy.
Normally there is no CRP in the blood serum.
What abnormal results mean:
Since the CRP is a general test, a positive CRP may indicate any of a number of things:
 

  • Rheumatoid arthritis
  • Rheumatic fever
  • Cancer
  • Tuberculosis
  • Pneumococcal pneumonia
  • Myocardial infarction (Heart attack)
  • SLE (Lupus)

Positive CRP results also occur during the last half of pregnancy or with the use of oral contraceptives.

ANA Test: What does it mean?
Titers
Stain Patterns
Antinuclear antibody (ANA) test: ANA stands for Antinuclear Antibody. This literally means 'substance against the cell nucleus'. The nucleus is the 'headquarters' of the living cell, therefore the ANA can damage or destroy cells and tissues. If the ANA destroys the nucleus of the cell, the cell dies. If enough cells die, then the organ tissue dies.
One lab test will not be enough because of the systemic nature of lupus. Systemic Lupus Erythematosus (SLE) can affect many systems, or parts, of the body. The auto-antibody blood tests are the most helpful for diagnosing lupus. As an autoimmune disease, lupus causes the body to attack itself. The test causing the most concern and frustration to the patient, is the Antinuclear antibody (ANA) test.
The ANA (anti-nuclear antibodies) blood test is one of the ruling factors in diagnosing Lupus, but it is not the only test that is considered when diagnosing Lupus. A person can have a positive ANA and NOT have Lupus. A person can have a negative ANA and still have all the other clinical symptoms of Lupus. Some medications, infections, and other diseases can cause the test to be positive. A positive ANA is just one piece of the diagnosis puzzle. Other auto-antibody tests are more specific to lupus.
Getting a diagnosis of lupus can take weeks, or even years. The clinical history is most important. That's why it's so important that your doctor is a rheumatologist familiar with treating lupus. It is important  you keep a record of your symptoms, so you can tell the doctor what has been going on.
To diagnose lupus, the physician has to look very carefully at the titer (number) and pattern of the ANA test. The pattern of the cell is the determining factor in whether the diagnosis will be Lupus, arthritis, polymyositis, scleroderma, or another connective tissue disease.




What's all this talk about titers?
The titer shows how many times the technician had to mix fluid from the patient's blood to get a sample free of ANAs. Thus a titer of 1:640 shows a greater concentration of ANA than 1:320 or 1:160, since it took 640 dilutions of the plasma before ANA was no longer detected.
A negative ANA is any number LESS than 1:80 (this is "pronounced" one to 80 parts). (Plasma was diluted 1 part plasma with 8 parts diluting solution.)
Since each dilution involves doubling the amount of test fluid, it is not surprising that titers increase rapidly. In fact, the difference between titers of 1:160 and 1:320 is only a single dilution. And it doesn't necessarily represent a major difference in disease activity.
Lower than 1:20 is considered a negative result.
1:80 is considered a "low positive" and more tests should be ordered.
1:16 is considered positive and if SED rates and Complement tests are positive, Lupus is considered.
1:32 is a definite positive and mean the disease is active.
1:64 is considered very high and tissue damage is imminent.
Q1. My question is "What is considered a high ANA titer for lupus? My blood work will say 'Titers of 1:160 and greater should be considered highly suggestive of connective tissue disease'. But my ANA's sometimes are 1:160 and 1:320 and then last time it was less than 1:40.
A1. ANA reports include a titer (number) and a pattern. The titer tells us how many times the technician had to dilute plasma from the patient's blood to get a sample free of the anti-nuclear antibodies.
Thus, a titer of 1:640 shows a greater concentration of anti-nuclear antibodies than a titer of 1:320 or 1:160. ANA titers go up and down during the course of the disease, and a high or low titer does not necessarily mean the disease is more or less active.  A titer above 1:80 is usually considered positive for lupus.




What Does the Stain Pattern Mean?
The cells are also examined to determine the pattern of the nucleus. Following is a chart indicating which pattern is associated with which disease or syndrome:
1. Rim Pattern
    A. Systemic Lupus Erythematosus (Most Specific)
2. Homogenous Pattern
    A. Systemic Lupus Erythematosus (Very specific)
    B. Tests for Further evaluation
        1. Anti-dsDNA
        2. Anti-ssDNA
        3. Anti-Smith
3. Speckled Pattern
    A. Most common, least specific
    B. Disorders Indicated
         1. Systemic Lupus Erythematosus
         2. Mixed Connective Tissue Disease
         3. Scleroderma
         4. Sjogren's Syndrome
    C. Tests for Further evaluation
         1. Smith Antibody (Anti-Smith)
         2. Ribonucleoprotein Antibody (Anti-RNP)
         3. Scl-70 kD kinetochore (Anti-Topoisomerase I)
         4. Anti-La (Anti-SSB)
4. Nucleolar Pattern
    A. Disorders
         1. Scleroderma
         2. CREST syndrome
    B. Further evaluation
        1. Scl-70 kD kinetochore (Anti-Topoisomerase I)
        2. PM-1
5. Diffuse Pattern
    A. Non-specific pattern
6. Centromere Pattern
    A. Seen in PSS with CREST syndrome
Q2. My rheumatologist doesn't help much because he goes a lot by whether my sed or sedimentation, rate is elevated and other factors. I always have ANA titers in speckled pattern - do not know what that is either?
A2. The pattern of the ANA test can sometimes be helpful in determining which autoimmune disease is present and which treatment program is appropriate. The speckled pattern is found in SLE and other connective tissue diseases, while the peripheral or rim pattern is found almost exclusively in SLE. Because the ANA is positive in so many conditions, the results of the ANA test have to be interpreted in light of the patient's medical history, as well as his or her clinical symptoms. Thus a positive ANA alone is NEVER enough to diagnose lupus. On the other hand, a negative ANA argues against lupus, but does not rule the disease out completely.
Remember the big picture in the process of diagnosing Lupus.
Diagnostic tools include:
 





  • Medical history
  • Complete physical examination
  • Laboratory tests:
  • Complete blood count Erythrocyte sedimentation rate (ESR) - an elevated ESR indicates inflammation in the body
  • Urinalysis
  • Blood chemistries Complement levels - often low in people with lupus, especially during a flare
  • Antinuclear antibody test (ANA) - positive in most lupus patients, but a positive ANA test can have other causes.
  • Other auto-antibody tests (anti-DNA, anti-Sm, anti-RNP, anti-Ro [SSA], anti- La [SSB]):
  • One or more of these tests may be positive in some people with lupus Syphilis test - may be falsely positive in people with lupus
  • Skin or kidney biopsy

  • Getting a diagnosis of lupus can be a pain-staking process. However, sometimes isn't it just better to know? Symptoms are managed for many with anti-inflammatory medications, and drugs to dampen down the immune system, like Plaquenil. Your doctor may want a definite diagnosis before proceeding with the treatment. Lupus is no longer a death sentence.
    From: Laboratory Tests Used in the Diagnosis of Lupus Morris Reichlin, M.D., Professor of Medicine and Chief, Immunology Section, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Published by the Lupus Foundation of America.






    What Do All the Blood Test Results Mean?
    Explaining the Blood Test Results

    Blood count:
    This test measures the amount of hemoglobin, red blood cells, white blood cells and platelets in your blood. Results may indicate you have anemia, which commonly occurs in lupus. Low white blood cell counts may occur as well. Erythrocyte sedimentation rate:
    This blood test determines the rate at which red blood cells settle to the bottom of a tube. A faster-than-normal rate may indicate a systemic disease such as lupus. The sedimentation rate is not specific for one disease but may be elevated in lupus, other inflammatory conditions or with infection.
    Kidney and liver assessment:
    A blood test can assess how well your kidneys and liver are functioning. Lupus may affect these organs as well as other systemic organs.
    Urinalysis:
    An examination of a sample of your urine may show an increased protein level, which may occur if lupus has affected your kidneys.
    Antinuclear antibody (ANA) test:
    A positive test for the presence of these antibodies  .. produced by your immune system .. indicates a stimulated immune system and is common if you have lupus or another autoimmune disease. Your doctor may advise more specific antibody testing and refer you to a rheumatologist. (More info here..  http://www.itzarion.com/lupusana.html )
    Chest X-ray:
    An image of your chest and pleura, which surrounds your lungs, may reveal abnormal shadows or inflammation of your lungs, which may occur with lupus.
    Electrocardiogram (ECG):
    This test measures the pattern of electrical impulses generated in your heart. It can help identify irregular rhythms, damage to your heart or enlargement of your heart, any of which may occur with lupus.
    Syphilis test:
    If your doctor orders a syphilis test, it's not because he or she thinks you might have syphilis. Rather, a false-positive to a syphilis test can indicate antiphospholipid antibodies in your blood. The presence of antiphospholipid antibodies has been associated with an increased risk of blood clots, strokes and recurrent miscarriages.






    EXPLAINING BLOOD TESTS
    Complete Blood Count (CBC):
    White Cell Count relates to the body's immune system. Recent colds, allergies, infections, or chemical exposures may cause this value to be  high or low.
    Red Cell Count refers to the red blood cells. These cells carry oxygen in the blood. Low values are commonly seen in individuals with certain types of anemia.
    Hemoglobin (HgB) is the oxygen carrying component in the red blood cell. It is formed in the bone marrow. Low values are commonly seen in individuals with certain types of anemia.
    Hematocrit (Hct) - is the volume (percentage) of red blood cells in whole blood. Low values are commonly seen in individuals with certain types of anemia.
    MCV stands for mean cell volume. This is a measure of the average size of the red blood cells.
    MCH stands for mean cell hemoglobin. This is a measure of the amount of hemoglobin associated with each red cell.
    MCHC stands for mean cell hemoglobin concentration. This value represents the mean hemoglobin concentration in each red blood cell.
    Platelet Count refers to the disk shaped structures found in the blood, primarily known for their role in the coagulation process.
    Neutrophils, Lymphocytes, Monocytes, Eosinophils, and Basophils are the different types of white blood cells. A detailed look at all of the white cells will provide a physician with useful information regarding the status of the immune system.
    RBC Morphology refers to the size and the shape of the red blood cells obtained in your blood sample.
    Blood Chemistry Panel:
    Glucose is a measure of sugar content in your blood. This value is watched closely to evaluate diabetes or hypoglycemia. This test needs to be performed in a fasted(no eating) state. Your blood sugar should be between 60-120 mg/dl to be considered normal.
    Urea Nitrogen (BUN) is a waste product of protein metabolism. It is produced in the liver and excreted by the kidneys. When protein metabolism is not working properly, high values may occur. Low values need not always be followed with your personal physician.
    Creatinine is another waste product of protein metabolism. It represents the function of the kidneys. A low value is not clinically significant.
    Iron is the most sensitive indicator of your iron stores (in the absence of liver disease or inflammation). Low values may represent certain types of anemia and should be evaluated by your personal physician.
    Calcium is involved in many physiologic processes. A normal blood calcium level is essential for normal function of the heart, nerves, and muscles. It is also involved in the coagulation process.
    Phosphorus is an essential element in the diet. It is a major component of the mineral phase of bone and occurs in all tissues, being involved in almost all metabolic processes. Calcium is controlled by the kidneys and parathyroid glands. Processing errors may affect this value.
    Uric Acid is a constituent in the blood which transports nitrogen in the body. It is normally excreted in the urine to rid the body of nitrogen. Values that are high may indicate gout, arthritis or certain kidney problems. A low value is not clinically significant.
    Sodium is an ion that is important in the conduction of nerves, contraction of muscles, and functioning of cells. It is controlled primarily by the kidneys and adrenal glands.
    Potassium is important for muscles and nerves to function properly. It is controlled by the kidneys. This value is watched very closely if one is taking diuretics or cardiovascular medications. If the blood sample is not processed properly, high values may occur.
    Chloride, like sodium and potassium, is an ion that is important in the functioning of cells. It is primarily controlled by the kidneys and adrenal glands.
    Total Protein is the total amount of protein circulating in the blood. This value represents your general nutritional habits.
    Albumin is a carbohydrate-free plasma protein which transports fatty acids, bilirubin, and poorly saturated hormones. It also serves as a reserve store of protein. High values are not clinically significant.
    Globulin is a protein fraction. Elevated values may indicate chronic infections and should be followed-up by your personal physician.
    A/G Ratio is a ratio between Albumin and Globulin. Provided Albumin and Globulin values are normal, a high or low ratio is not significant.
    Total Bilirubin is a bile pigment. It normally circulates in the plasma and is taken up by liver cells. High levels of bilirubin may result in jaundice.
    LDH stands for lactate dehydrogenase. It is an enzyme involved in the breakdown of lactic acid. Anything which causes cellular damage, including heart attacks, liver disease, and blood drawing itself, may cause higher values.
    Alkaline Phosphatase is an enzyme found primarily in bones and the liver. Values for pregnant women have found to be elevated, however low values are probably not significant.
    SGOT stands for serum glutamic oxaloacetic transaminase.
    SGOT is a liver enzyme involved in cellular functions of the heart muscle and liver. Alcohol consumption, liver disease, and other normal factors have been shown to raise this value. Low values are probably not clinically significant.
    SGPT stands for serum glutamic pyruvic transaminase. SGPT, like SGOT, is an enzyme involved in the functions of heart, liver, and muscle cells. Alcohol consumption has been shown to increase this value.
    GGT stands for Gamma Glutamyl Transpedtidase. Similar to SGOT and SGPT, GGT is an enzyme involved in the function of the liver, heart, and muscle cells. Alcohol consumption, liver disease, heart attacks, recent heavy physical exertion, and other normal factors have been shown to raise this value. Low values are probably not significant.
    Cholesterol is used to make essential body substances, such as cell walls and hormones. High levels of cholesterol have been associated with an increased risk for heart disease. Low levels of cholesterol are preferred.
    Triglycerides are blood fats that are the usual storage form of lipids in the body. This value can be dramatically affected by a recent meal or recent physical activity. Thus, an eight hour fast with no significant activity is required for accurate results.
    HDL Cholesterol is a High Density Lipoprotein, which is commonly referred to as the "good" cholesterol. HDL Cholesterol is a transport protein that carries cholesterol away from the artery walls for removal from the body. The higher the HDL value, the lower the risk of cardiovascular disease. Exercise and weight loss have been shown to increase your HDL level, while smoking has been shown to decrease it.
    LDL Cholesterol is a Low Density Lipoprotein, which is commonly referred to as the "bad" cholesterol. LDL Cholesterol, like HDL Cholesterol, is a transport protein. However, LDL transports cholesterol to the arteries. The lower the LDL Cholesterol concentration, the lower the  risk of cardiovascular disease. A low-fat, low-cholesterol diet has been shown to decrease this value.
    Cholesterol/HDL Ratio is a ratio of Total Cholesterol to HDL Cholesterol. This ratio has been shown to be a good predictor of cardiovascular disease risk, with the lower the ratio the better. Combinations of regular aerobic exercise and good nutritional practices have been shown to improve this ratio.
    Hematology:
    HEMATOCRIT (HCT)

    Hematocrit is the percentage of red blood cells in whole blood. It is an important determinant of anemia (decreased), polycythemia (decreased), dehydration (elevated), increased R.B.C. breakdown in the spleen (elevated), or possible dehydration (elevated).  The word hematocrit means, 'to separate blood,' a procedure followed after the blood is drawn through the proper use of a centrifuge.
    Normal Adult Female Range: 37 - 47% Optimal Adult Female 42%
    Normal Adult Male Range 40 - 54% Optimal Adult Male: 47
    Normal Newborn Range: 50 - 62% Optimal Newborn Reading: 56
    HEMOGLOBIN (HGB)
    Hemoglobin is the main transport of oxygen and carbon dioxide in the blood. It is composed of globin a group of amino acids that form a protein and heme which contains iron atoms and the red pigment, porphyrin. As with Hematocrit, it is an important determinant of anemia (decreased), dehydration (increased), polycythemia (decreased), poor diet/nutrition, or possibly a malabsorption problem.
    Normal Adult Female Range: 12 - 16% Optimal Adult Female: 14
    Normal Adult Male Range: 14 - 18% Optimal Adult Male Reading: 16
    Normal Newborn Range: 14 - 20% Optimal Newborn Reading: 17
    MCH (Mean Corpuscular Hemoglobin)
    MCH = Hemoglobin x 10/R.B.C. Mean Corpuscular Hemoglobin (MCH) gives the average weight of hemoglobin in the red blood cell. Due to its use of red blood cells in its calculation, MCH is not as accurate as MCHC in its diagnosis of severe anemias. Decreased MCH is associated with microcytic anemia. Increased MCH is associated with macrocytic anemia.
    Normal Adult Range: 27 – 33 pg Optimal Adult Reading: 30
    MCV (Mean Corpuscular Volume)
    MCV = Hematocrit x 10/R.B.C. The Mean Corpuscular Volume reflects the size of red blood cells by expressing the volume occupied by a single red blood cell. Increased readings may indicate macrocytic anemia, Pyridoxine or Folic Acid deficiency. Decreased readings may indicate microcytic anemia, possibly caused by iron deficiency.
    Normal Adult Range: 80 - 100 fl Optimal Adult Reading: 90
    Higher ranges are found in newborns and infants
    MCHC (Mean Corpuscular Hemoglobin Concentration)
    MCHC = Hemoglobin x 100/Hematocrit This test measures the average concentration of hemoglobin in red blood cells. It is valuable in evaluating therapy for anemia because Hemoglobin and Hematocrit instead of R.B.C. are used in the calculation. Low MCHC means that a unit of packed R.B.C.’s contains less hemoglobin than normal and a high MCHC means that there is more hemoglobin in a unit of R.B.C.'s. Increased MCHC is seen in spherocytosis, and not seen in pernicious anemia. Decreased levels may indicate iron deficiency, blood loss, B6 deficiency of thalassemia.
    Normal Adult Range: 32 - 36 % Optimal Adult Reading: 34
    Higher ranges are found in newborns and infants
    R.B.C. (Red Blood Cell Count)
    The red blood cells main function is to carry oxygen to the tissues and to transfer carbon dioxide to the lungs. This process is possible through the R.B.C. containing hemoglobin which combines easily with oxygen and carbon dioxide.
    Normal Adult Female: 3.9 - 5.2 mill/mcl Optimal Adult Female: 4.55
    Normal Adult Male Range: 4.2 - 5.6 mill/mcl Optimal Adult Male: 4.9
    Lower ranges are found in Children, newborns and infants Immune System
    W.B.C. (White Blood Cell Count)
    The white blood cell's main function is to fight infection, defend the body by phagocytosis against invasion by foreign organisms, and to produce, or at least transport and distribute, antibodies in the immune response. There are a number of types of leukocytes (see differential) that are classified as follows; Granulocytes Nongranulocytes Band Neutrophils Lymphocytes Neutrophils Monocytes Eosinophils Basophils
    Each cell, or leukocyte, has a different job in the body, which is explained in the Differential section. An increase in all types of white blood cells simultaneously is rarely seen. Some diseases such as measles, pertussis and sepsis, have increased white blood cell counts so high that it suggests leukemia. This is a type of temporary leukocytosis which must be distinguished from leukemia by running more than one blood test.
    Other potential causes of leukocytosis include leukemia, malignancies, drugs, toxins, tissue necrosis and polycythemia vera. Decreased levels of white blood cells, leukopenia, may occur during certain viral infections, hypersplenism, drugs, primary bone disorders, fungal infections, metastatic tumors, and iron deficiency anemia.
    Normal Adult Range: 3.8 - 10.8 thous/mcl Optimal Adult Reading: 7.3
    Higher ranges are found in children, newborns and infants.
    NEUTROPHILS NEUTROPHIL COUNT
    Also known as Granulocytes or segmented  neutrophils, this is the main defender of the body against infection and antigens. High levels may indicate an active infection. A low count may indicate a compromised immune system or depressed bone marrow (low neutrophil production).
    Normal Adult Range: 48 - 73 % Optimal Adult Reading: 60.5
    Normal Children's Range: 30 - 60 % Optimal Children's Reading: 45
    LYMPHOCYTES LYMPHOCYTE COUNT
    Lymphocytes are involved in protection of the body from viral infections such as measles, rubella, chickenpox, or infectious mononucleosis. Elevated levels may indicate an active viral infection. Depressed levels may indicate an exhausted immune system or an active infection if the neutrophils are elevated.
    Normal Adult Range: 18 - 48 % Optimal Adult Reading: 33
    Normal Children's Range: 25 - 50 % Optimal Children's Reading: 37.5
    MONOCYTES MONOCYTE COUNT
    These cells are helpful in fighting severe infections, are considered the body's second line of defense against infection and are the largest cells in the blood stream. Elevated levels are seen in tissue breakdown, chronic infections, carcinomas, leukemia (monocytic) and lymphomas. Low levels may be indicative of a state of good health.
    Normal Adult Range: 0 - 9 % Optimal Adult Reading: 4.5
    EOSINOPHILS EOSINOPHIL COUNT
    Eosinophils are used by the body to protect against allergic reactions and parasites. Therefore, elevated levels may indicate an allergic response. A low count is normal. Normal Adult Range: 0 - 5 % Optimal Adult Reading: 2.5
    BASOPHILS BASOPHIL COUNT
    Basophilic activity is not fully understood but it is known to carry histamine, heparin and serotonin. High levels are found in allergic reactions. Low levels are normal.
    Normal Adult Range: 0 - 2 % Optimal Adult Reading: 1
    LIPIDS:
    CHOLESTEROL
    Cholesterol is a critical fat that is a structural component of cell membrane and plasma lipoproteins, and is important in the synthesis of steroid hormones, glucocorticoids, and bile acids. Mostly synthesized in the liver, some is absorbed through the diet, especially one high in saturated fats. High density lipoproteins (HDL) is desired as opposed to the low density lipoproteins (LDL), two types of cholesterol. Elevated cholesterol has been seen in artherosclerosis, diabetes, hypothyroidism and pregnancy. Low levels are seen in depression, malnutrition, liver insufficiency, malignancies, anemia and infection.
    Normal Adult Range: 120 - 240 mg/dl Optimal Adult Reading: 180
    TRIGLYCERIDES
    Triglycerides, stored in adipose tissues as glycerol, fatty acids and monoglyceroids, are reconverted as triglycerides by the liver. Ninety percent of the dietary intake and 95% of the fat stored in tissues are triglycerides. Increased levels may be present in artherosclerosis, hypothyroidism, liver disease, pancreatitis, myocardial infarction, metabolic disorders, toxemia, and nephrotic syndrome. Decreased levels may be present in chronic obstructive pulmonary disease, brain infarction, hyperthyroidism, malnutrition, and malabsorption.
    Normal Adult Range: 0 - 200 mg/dl Optimal Adult Reading: 100
    LDL (Low Density Lipoprotein)
    LDL is the cholesterol rich remnants of the lipid transport vehicle VLDL (very-low density lipoproteins). There have been many studies showing correlations between high levels of LDL and arterial artherosclerosis. Due to the expense of direct LDL measurement, a calculation known as the Friedewald formula is used (Total Cholesterol - HDL Cholesterol -  Triglycerides/5). When Triglyceride levels are greater than 400, this method is not accurate.
    Increased levels are seen in high cholesterol diets, nephrotic syndromes, multiple myeloma, hepatic obstruction or disease, anorexia nervosa, diabetes chronic renal failure, and premature coronary heart disease. Decreased levels are associated with Tangier disease, Apo-C-II deficiency, hyperthyroidism, chrnic anemias, hepatocellular disease, Reye's syndrome, acute stress, inflammatory joint disease, and chronic pulmonary disease.
    Normal Adult Range: 62 - 130 mg/dl Optimal Adult Reading: 81 mg/dl
    HDL (High Density Lipoprotein)
    HDL is the cholesterol carried by alpha lipoproteins. A high level of HDL is an indication of a healthy metabolic system if there is no sign of liver disease or intoxication. Two mechanisms explain how HDL offers protection against chronic heart disease.
    First, HDL inhibits cellular uptake of LDL. Second, it serves as a carrier that removes cholesterol from the peripheral tissues and transports it back to the liver for catabolism and excretion. Decreased levels are associated with an increased risk for coronary heart disease, poorly controlled diabetes mellitus,  hypertriglycerdemia, hepatocellular diseases, chronic renal failure and nephrotic syndrome.
    Normal Adult Range: 35 - 135 mg/dl Optimal Adult Reading: 85 mg/dl
    CHOLESTEROL/HDL RATIO
    According to data from LabCorp of America, Data from various studies suggest that the ratio of total cholesterol/HDL may provide a 'rule of thumb' guide to predicting increased risk to coronary heart disease.
    Normal Adult Range: 1 - 6 Optimal Adult Reading: 3.5
    ENZYMES AND HEPATIC FUNCTION:
    BILIRUBIN, TOTAL
    A byproduct of the breakdown of red blood cells in the liver, bilirubin is a good indication of the liver's function. Excreted into the bile, bilirubin gives the bile its pigmentation. Elevated in liver disease, mononucleosis, hemolytic anemia, low levels of exposure to the sun, and toxic effects of some drugs. Decreased levels are seen in people with an inefficient liver, excessive fat digestion, and possibly a diet low in nitrogen bearing foods.
    Normal Adult Range 0 - 1.3 mg/dl
    SGOT (SERUM GLUTAMIC-OXALOCETIC TRANSAMINASE - AST)
    Serum Glutamic Oxalocetic Transaminase or AST is an enzyme found primarily in the liver, heart, kidney, pancreas, and muscles. Elevated levels are round n tissue damage, especially heart and liver. Decreased levels can be found in Vitamin B deficiency and pregnancy.
    Normal Adult Range: 0 - 42 U/L Optimal Adult Reading: 21
    SGPT (SERUM GLUTAMIC-PYRUVIC TRANSAMINASE - ALT)
    Serum Glutamic Pyruvic Transaminase or ALT is an enzyme found primarily in the liver but also in the heart and other tissues. It is more useful in diagnosing liver function than SGOT levels are. Decreased SGPT in combination with increased cholesterol levels is seen in congested liver cases. Increased levels are seen in mononucleosis, alcoholism, liver damage, kidney infection, chemical pollutants or myocardial infarction.
    Normal Adult Range: 0 - 48 U/L Optimal Adult Reading: 24
    ALKALINE PHOSPHATASE
    Produced in the cells of bone and the liver with some activity in the kidney, intestine, and placenta, it is mostly found in an alkaline state with a pH of 9. Increased levels are seen extensively as a tumor marker, in bone injury, pregnancy, or skeletal growth (elevated readings). Growing children have normally higher levels of this enzyme. Decreased levels are sometimes found in hypoadrenia, protein deficiency, malnutrition and a number of vitamin deficiencies. Normal Adult Range: 20 - 125 U/L Optimal Adult Reading: 72.5
    Normal Children's Range: 40 - 400 U/L Optimal Children's Reading: 220
    GGT (GAMMA-GLUTAMYL TRANSPEPTIDASE)
    GGT is believed to be involved in the transport of amino acids and peptides into cells as well as glutathione metabolism. GGT is mainly found in liver cells and as such is extremely sensitive to alcohol use. Elevated levels may be found in liver disease, alcoholism, bile-duct obstruction, cholangitis, drug abuse, and in some cases excessive magnesium ingestion. Decreased levels can be found in hypothyroidism, hypothalamic malfunction and low levels of magnesium.
    Normal Adult Female Range: 0 - 45 U/L Optimal Female: 22.5
    Normal Adult Male Range: 0 - 65 U/L Optimal Male: 32.5
    LDH (LACTIC ACID DEHYDROGENASE)
    Lactic acid dehydrogenase is an intracellular enzyme found primarily in the kidney, heart, skeletal muscle, brain, liver and lungs. Increases are usually found in cellular death and/or leakage from the cell. In some cases it can be useful in confirming myocardial or pulmonary infarction (only in relation to other tests). Decreased levels of the enzyme may be seen in cases of malnutrition, hypoglycemia, adrenal exhaustion, or low tissue or organ activity.
    Normal Adult Range: 0 - 250 U/L Optimal Adult Reading: 125
    ELECTROLYTES:
    SODIUM
    Sodium is the most abundant cation in the blood and its chief base. It functions in the body to maintain osmotic pressure, acid-base balance and to transmit nerve impulses. Increased levels are associated with dehydration, Conn's syndrome, primary aldosteronism, coma, Cushing's disease, diabetes insipidus, and tracheobronchitis. Decreased levels are seen in severe burns, congestive heary failure, excessive fluid loss, Addison?s disease, severe nephritis, pyloric obstruction, malabsorption, diabetic acidosis, diuretics, edema, and hypothyroidism.
    Normal Adult Range: 135-146 mEq/L Optimal Adult Reading: 140.5
    POTASSIUM
    Potassium is the major intracellular cation in the blood. It, along with sodium, helps to maintain osmotic balance and in also involved in acid-base balance. It is needed for proper nerve and muscle action. Increased potassium is sometimes seen in renal failure, dehydration, obstruction, trauma, cell damage, Addison?s disease, uncontrolled diabetes and decreased insulin. Decreased levels are associated with diarrhea, starvation, vomiting, stress, malabsorption, severe burns, primary aldosteronism, excessive licorice ingestion, respiratory alkalosis, renal tubular acidosis, drugs, and treatment of megaloblastic anemia with vitamin B12 or folic acid..
    Normal Range: 3.5 - 5.5 mEq/L Optimal Adult Reading: 4.5
    CHLORIDE
    Chlorides significance relates to its maintenance of cellular integrity through it influence on osmotic pressure. It also helps monitor acid-base balance and water balance. Elevated levels are related to acidosis and excessive water crossing the cell membrane. Decreased levels with decreased serum albumin may indicate water deficiency (edema).
    Normal Adult Range: 95-112 mEq/L Optimal Adult Reading: 103
    CO2 (Carbon Dioxide)
    The CO2 level is related to the respiratory exchange of carbon dioxide in the lungs and is part of the body's buffering system. Generally when used with the other electrolytes, it is a good indicator of acidosis and alkalinity. Elevated CO2 is seen in severe vomiting, emphysema, aldosteronism and the use of mercurial diuretics. Decrease CO2 is associated with severe diarrhea, starvation, acute renal failure, salicylate toxicity, and diabetic acidosis.
    Normal Adult Range: 22-32 mEq/L Optimal Adult Reading: 27
    Normal Children's Range - 20 - 28 mEq/L Optimal Children's: 24
    CALCIUM
    The most abundant mineral in the body, it is involved in bone metabolism, protein absorption, fat transfer, muscular contraction, transmission of nerve impulses, blood clotting and cardiac  function. It is highly sensitive to elements such as magnesium, iron, and phosphorus as well as hormonal activity, vitamin D levels, alkalinity and acidity, and many drugs.
    Increased calcium levels may be associated with hyperparathyroidism, metastatic bone cancers, cancers of the lung, breast, thyroid, kidney, liver, and pancreas as well as Hodgkin's disease, lymphomas, leukemia, multiple myelomas, primary squamous cell carcinomas, tuberculosis, sarcoidosis, hyperthyroidism, Paget's disease, bone fractures, excessive vitamin D intake, and renal transplant.
    Decreased levels are associated with hypoparathyroidism, hyperphosphatemia, malabsorption, acute pancreatitis, renal failure, alkalosis, osteomalacia, vitamin D deficiency, malnutrition and alcoholism.
    Normal Adult Range: 8.5-10.3 mEq/dl Optimal Adult Reading: 9.4
    Normal Children's Reading: 9-11 mEq/dl Optimal Children's: 10
    PHOSPHORUS
    Phosphorus is an abundant element found in most tissues and cells. It is inversely related to the calcium level. When calcium is increased, phosphorus tends to decrease and vice versa. Proper blood draw procedures are necessary in order to avoid falsely elevated readings. Phosphorus is needed for its buffering action, calcium transport and osmotic pressure. Increased levels are seen in renal insufficiency, hypoparathyroidism, excessive intake of vitamin D, hypocalcemia, bone tumors, Addison's disease, acromegaly, and liver disease. Decreased levels are associated with hyperparathyroidism, rickets, osteomalacia, vitamin D deficiency, diabetic coma, liver disease, dialysis, vomiting, intravenous glucose in a nondiabetic patient, severe malnutrition and gram-negative septicemia.
    Normal Adult Range: 2.5 - 4.5 mEq/dl Optimal Adult Reading: 3.5
    Normal Children's Range: 3 - 6 mEq/dl Optimal Children's Range: 4.5
    NITROGEN B.U.N. (BLOOD UREA NITROGEN)
    The nitrogen component of Urea, B.U.N. is the end product of protein metabolism and its concentration is influenced by the rate of excretion. Excessive protein intake, kidney damage, certain drugs, low fluid intake, intestinal bleeding, exercise or heart failure can cause increases. Decreased levels may be due to a poor diet, malabsorption, liver damage or low nitrogen intake. Normal Adult Range: 7 - 25 mg/dl Optimal Adult Reading: 16
    CREATININE
    Creatinine is the waste product of muscle metabolism. Its level is a reflection of the body's muscle mass. Low levels are sometimes seen in kidney damage, protein starvation, liver disease or pregnancy. Elevated levels are sometimes seen in kidney disease, muscle degeneration, or some drugs involved in impairment of kidney function
    Normal Adult Range: .7 - 1.4 mg/dl Optimal Adult Reading: 1.05
    URIC ACID
    Uric acid is the end product of purine metabolism and is normally excreted through the urine. High levels are noted in gout, infections, kidney disease, alcoholism, high protein diets, and with toxemia in pregnancy. Low levels may be indicative of kidney disease, malabsorption, poor diet, liver damage or an overly acid kidney.
    Normal Adult Female : 2.5 - 7.5 mg/dl Optimal Adult Female : 5.0
    Normal Adult Male: 3.5 - 7.5 mg/dl Optimal Adult Male: 5.5
    PROTEIN, TOTAL
    Proteins are the most abundant compounds in serum. The protein makeup of the individual is of important diagnostic significance because of proteins involvement in enzymes, hormones and antibodies as well as osmotic pressure balance, maintaining acid-base balance and as a reserve source of nutrition for the bodies tissues and muscles. The major serum proteins measured are Albumin and Globulin (alpha1, alpha2, beta and gamma). Decreased levels may be due to poor nutrition, liver disease, malabsorption, diarrhea, or severe burns. Increased levels are seen in lupus, liver disease, chronic infections, alcoholism, leukemia, and tuberculosis amongst many others. Careful review of the individual albumin, globulin and A/G ratios are recommended.
    Normal Adult Range: 6.0 -8.5 g/dl Optimal Adult Reading: 7.25
    ALBUMIN
    Albumin is the major constituent of serum protein (usually over 50%). It is manufactured by the liver from the amino acids taken through the diet. It helps in osmotic pressure regulation, nutrient transport and waste removal. High levels are seen in liver disease, shock, dehydration, or multiple myeloma. Lower levels are seen in poor diets, diarrhea, fever, infection, liver disease, inadequate iron intake, third-degree burns and edemas or hypocalcemia.
    Normal Adult Range: 3.2 - 5.0 g/dl Optimal Adult Reading: 4.1
    GLOBULIN (CALCULATED)
    Globulin, a larger protein than albumin, is important for its immunologic responses, especially its gamma portion (IgA, IgG, IgM, and IgE). Globulins have many diverse functions such as, the carrier of some hormones, lipids, metals, and antibodies. When chronic infections, liver disease, rheumatoid arthritis, myelomas, and lupus are present, elevated levels are seen. You may find lower levels in immune compromised patients, poor dietary habits, malabsorption and liver or kidney disease.
    Normal Adult Range: 2.2 - 4.2 g/dl Optimal Adult Reading: 3.2 A/G
    RATIO (ALBUMIN/GLOBULIN RATIO) (CALCULATED)
    A/G ratio is an important indicator of disease states although a high level is not considered clinically significant. Low levels may be indicative of liver disease malabsorption, leukemia, rheumatoid arthritis, lupus, or bacterial pneumonia.
    Normal Adult Range: 0.8 - 2.0 Optimal Adult Reading: 1.9
    ANION GAP (Sodium + Potassium - CO2 + Chloride)
    The anion gap is used to measure the concentration of cations (sodium and potassium) and the anions (chloride and CO2) in the extracellular fluid of the blood. Numerous clinical implications can be gathered from the Anion Gap. An increased measurement is associated with metabolic acidosis due to the overproduction of acids (a state of alkalinity is in effect). Decreased levels may indicate metabolic alkalosis due to the overproduction of alkaloids (a state of acidosis is in effect).
    Normal Adult Range: 4 - 14 Optimal Adult Reading: 9
    BUN/CREATININE
    A high reading in this calculation is normally indicative of too much BUN being formed. A low reading may show that the creatinine is not being cleared effectively by the kidney. This calculation is a good measurement of kidney and liver function.
    Normal Adult Range: 6 -25 Optimal Adult Reading: 15.5
    CALCIUM/PHOSPHORUS (Calculated)
    Due to the delicate balance between calcium and phosphorus in the system, this calculation is helpful in noting subtle and acute imbalances in the relationship between the two elements. Decreased levels are seen in some autoimmune disorders like fibromyaligia, while increased levels are found in over supplementation of Calcium.
    Normal Adult Range: 2.3 - 3.3 Optimal Adult Reading: 2.8
    Normal Children's range: 1.3 - 3.3 Optimal Children's Reading: 2.3
    SODIUM/POTASSIUM (Calculated)
    These are the two major blood electrolytes, sodium is the extracellular cation and potassium is the intracellular cation. This is an important ratio to review and act upon when subtle or acute imbalances are noted.
    Normal Adult Range: 26 - 38 Optimal Adult Reading: 32
    THYROID THYROXINE (T4)
    Thyroxine is the thyroid hormone that contains four atoms of iodine. It is used to evaluate thyroid function. It is the direct measurement of total T4 concentration in the blood serum. Increased levels are found in hyperthyroidism, acute thyroiditis, and hepatitis. Low levels can be found in Cretinism, hypothyroidism, cirrhosis, malnutrition, and chronic thyroiditis.
    Normal Adult Range: 4 - 12 ug/dl Optimal Adult Reading: 8 ug/dl
    T3-UPTAKE
    This test is an indirect measurement of unsaturated thyroxine binding globulin in the blood. Increased levels are found in hyperthyroidism, severe liver disease, metastatic malignancy, and pulmonary insufficiency. Decreased levels are found in hypothyroidism, normal pregnancy, and hyperestrogenis status.
    Normal Adult Range: 27 - 47% Optimal Adult Reading: 37 %
    FREE T4 INDEX (T7)
    This index is a calculation used to correct the estimated total thyroxine for the amount of thyroxine binding globulin present. It uses the T4 value and the T3 uptake ratio.
    Normal Adult Range: 4 - 12 Optimal Adult Reading:8
    THYROID-STIMULATING HORMONE (TSH)
    TSH, produced by the anterior pituitary gland, causes the release and distribution of stored thyroid hormones. When T4 and T3 are too high, TSH secretion decreases, when T4 and T3 are low, TSH secretion increases. Increased TSH levels are seen in primary hypothyroidism, thyrotropin producing tumors, and thyrotoxicosis. Decreased levels are seen in hyperthyroidism and secondary and tertiary hypothyroidism.
    Normal Adult Range: .5 - 6 miliIU/L Optimal Adult Reading: 3.25 miliU/L
    OTHER GLUCOSE (FASTING)
    Glucose, formed by the digestion of carbohydrates and the conversion of glycogen by the liver is the primary source of energy for most cells. Insulin, glucagon, thyroid hormone, liver enzymes and adrenal hormones regulate it. It is elevated in diabetes, liver disease, obesity, pancreatitis, steroids, stress, or diet. Low levels may be indicative of liver disease, overproduction of insulin, hypothyroidism, or alcoholism.
    Normal Adult Range: 60 - 115 mg/dl Optimal Adult Reading: 87.5
    IRON, TOTAL
    Iron is necessary for the formation of some proteins, hemoglobin, myoglobin, and cytochrome. Also it is necessary for oxygen transport, cellular respiration and peroxide deactivation. Low levels are seen in many anemias, copper deficiencies, low vitamin C intake, liver disease, chronic infections, high calcium intake and women with heavy menstrual flows. High levels are seen in hemochromitosis, liver damage, pernicious anemia and hemolytic anemia.
    Normal Adult Range: 30 – 170 mcg/dl Optimal Adult Reading: 100
     






    Searching for  ways to deal with the depression, the frustrations, the questions about lupus, I joined a support group online.  LUPIES has been a wonderful gift.  I have learned more from the information I found on the support web site from other sufferers of Lupus than I did from my doctor.


    Thank you fellow Lupies!    With a very special thank you to Deanna!
    May your days be pain free!



    Click to subscribe to LUPIES

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    unless otherwise noted, are the sole property of Brenda Sewell.
    I do not mind sharing but please ask me first.
    © 1998 - 2003 Brenda "Rion" Sewell
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    Back to LUPUS Main Page




    Searching for ways to deal with the depression, the frustrations, the questions about lupus, I joined a support group online.  LUPIES has been a wonderful gift.  I have learned more from the information I found on the support web site from other sufferers of Lupus than I did from my doctor.


    Thank you fellow Lupies!    May your days be pain free!

     
    Contact the Lupus Foundation of America or the local Chapter that serves your area for more information about lupus, or the programs and services the LFA offers including support group information and physician referral. Lupus Foundation of America., Inc.
    1300 Piccard Drive, Suite 200

    Rockville, MD 20850-4303

    301-670-9292  800-558-0121

    http://www.lupus.org
    Information gathered from :
    http://labtestsonline.org/understanding/analytes/cbc/tab/test
    Also known as: CBC; Hemogram; CBC with Differential
    Formal name: Complete Blood Count

    The Test


     http://health.yahoo.com/health/Diseases_and_Conditions/Disease_Feed_Data/Lupus



    17 comments:

    1. I'm still learning from you, as I'm trying to reach my goals. I absolutely love reading all that is posted on your website.Keep the posts coming. I enjoyed it!
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      1. Thank you so much for reading and commenting! I will continue to spread awareness. xo

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    2. Hi Marissa,
      I'm Paula..I really like your blog. I have SLE and now have some evidence of kidney involvement. I came across your blog while doing some research on lupus nephritis. I have a couple of Etsy shops with blogs and this is one of them. I donate a small portion of my profit to The Lupus Foundation. I also have a Facebook group called "Lupus Buddies" Look us up if you're interested~! I also belong to several other lupus groups and recently participated in a lupus awareness video. It should be on my blog somewhere in the vicinity of July-August, I believe. You are more than welcome to view it.. I have joined your blog and look forward to reading more about you!
      Kindest Regards,
      Paula Dee

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      1. It is funny that you just found my blog because I have a Mrs.lupus facebook site and I put your bracelets up on there and found them a few days ago. They are fab! Here is a link to my page, feel free to post your creations on my site. I am so sorry about your kidney involvement, sending love and prayers your way. xoxo https://www.facebook.com/Mrs.lupus

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    4. Thank you for posting all of this information. It helped me to really understand my labwork. Take care.

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      1. I am so glad it helped you. Gentle hugs. xo

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      1. I am glad you enjoyed this post. Gentle hugs.

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