spreadsheet Ranges

[Raleigh59]

does anyone know if the ranges are different in the UK then the US? My HO dr does not agree with the ranges on the spreadsheet.

[AussieNeil Partner Administrator]

Hi Raleigh,

The reason for the differences is that pathology laboratories determine the reference ranges based on their clients. Mathematically, the limits are set assuming what's termed a normal or Gaussian distribution, which actually excludes about 5% of the population who are healthy with their results outside of the reference range. This is important if that's the case for you. Results that are outside the reference limits are generally highlighted on your blood test reports by stars, a H or L or colour highlighting.

There is nothing stopping you from changing the limits in the spreadsheet to those used by your lab, which are the limits your haematologist/oncologist doctor should accept.

There is a version of the spreadsheet with both UK and US ranges included, but it's not currently hosted.

Neil

[Raleigh59 in reply to AussieNeil]

Are you in New York ? I thought you were in Australia.

I will get a printout from my HO. Yesterday I said to him at my appt, every number of mine is below the normal range and he didn’t know what ranges spreadsheet I was looking at.

I didn’t know either till this morning it is fron Cllsociety.

I only have 3 abnormal results .

[AussieNeil Partner Administrator in reply to Raleigh59]

Yes, I'm in Australia and lankisterguy / Len is in New York. We worked together with a few others to set up a spreadsheet, the latest version of which supports both US and UK ranges. Both our spreadsheet and the CLL Society one have a common predecessor.While the CLL Society spreadsheet is set up for US labs, as was the spreadsheet it was based on, some test results can be reported in different units by pathology labs, particularly the biochemical results. You'll need to check the ranges and units of the differing tests in the spreadsheet and lab results, to identify the problem.

Neil

[Raleigh59 in reply to AussieNeil]

yes I understand I can change the limits. I picked up the paperwork today and I might adjust the limits .

[AussieNeil Partner Administrator in reply to Raleigh59]

Great! As the CLL Society spreadsheet CBC table says in the Ranges=> cell B:10, if you select the red comment dot; "These are typical "normal ranges". Different labs have slightly different ranges that they consider normal, you might want to change these to what your lab considers normal."

I've taken the time to go through your results and you are marginally low on typical US ranges for the following:-

Neutrophil count and hence White Blood Cell count. This is important, because you are at a slightly higher risk of infection, a risk which will increase if that count drops lower.

RBC and hence HGB - so you are slightly anaemic.

So, something might be suppressing your bone marrow production. If so, that could be any number of things, including drugs such as non-steroidal anti-inflammatory agents and antibiotics, which are fairly common causes.

Importantly for you, should you wish to continue using the CLL Society workbook, it will still be an excellent way for you to monitor your blood health after you've adjusted the limits in line with your pathology lab limits.

All the best,

Neil

[lankisterguy Volunteer]

Hi Raleigh59,

-

As  AussieNeil explained, the ranges are obtained by statistics ( you know that old saying of Lies, damned Lies and statistics- LOL)

Since I started using the original spread sheet in 2012, my hospital has changed the reference ranges for several of the tests. Each time I just enter the new range they use.

My hospital NY Presbyterian is directly across the street from Memorial Sloan Kettering- when another patient showed me her test results - I saw that several of those ranges were different, so I helped her modify her spreadsheet,

I use larger bold font for the results above range and smaller italics for below range, so we can scan the tables or the graphs to see when the values were outside of normal ranges.

-

Len

[stevesmith1964]

I stop my acalabrutinib for 10 day periods for dental work and SCC removals. Also its key to stop acalabrutinib type drugs immediately if you test positive for covid , for at least 10 days to significantly reduce the risk of a PE.

[Raleigh59 in reply to stevesmith1964]

did you mean this message in this spreadsheet conversation

[stevesmith1964 in reply to Raleigh59]

Yes, to explain why ranges could be different, depends if , when and where they were generated

[Raleigh59 in reply to stevesmith1964]

what is SCC and PE

[stevesmith1964 in reply to Raleigh59]

Skin cancer and pulmonary embulsism

[stevesmith1964]

Normal ranges to be determined are determined by each laboratory under ISO15189. This process ensures the normal range for each lab reflects the technology, assay method and population served. Thus some assays like PTH can have massive differences between laboratories. With Cancer markers all laboratories should do a cross over process when changing suppliers to base line all patients been monitored. Hope that helps, btw I had 40 yrs experience in laboratory services.

[Big_Dee]

Hello Raleigh59

I don't pay too much attention to variations in ranges. Just about all of my testing will have slightly different ranges depending on which lab did testing. I suspect that some of the range's differences are due to testing tolerances and therefore not concerned.

[SeymourB]

Raleigh59 -

As AussieNeil said, the ranges are statistical. The Low and High were never intended as flags for action. Hemo/oncos don't treat the numbers, they treat trends. They try to give us hope when numbers appear to improve, but may have a poker face when not, leaving us wondering why they don't comment.

The same tube of blood will result in different results even on the same instrument or lab tech doing a manual count. All automated tests have allowable repeatability and error parameters of a few percent that we don't see. I've had blood draws for my hemo/onco and immunologist done at the same time, and sent to the same lab, with slightly different results from automated analyzers.

cytosmart.com/resources/res...

Time since last maintenance cleaning and calibration on the instrument can make a difference. I've had trouble with my activated or reactive lymphocytes showing up as monocytes, eosinophils, or basophils sometimes. I really wish automated results would show the instrument and software version used. It's too much info for even the average hematologist for every day, but it helps spot quality control problems, in my opinion.

Manual differentials using a hemacytometer grid and microscope can have a variety of problems:

corning.com/catalog/cls/doc...

Time of day of the sample may make a slight difference as well.

onlinelibrary.wiley.com/doi...

Effects of circadian variation, lifestyle and environment on hematological parameters: A narrative review

Often, we'll see papers for various illnesses that cite fairly dramatic low and high values for action, because only at extremes do symptoms develop. i.e. the high and low on our blood counts do not exactly equate to symptoms, but when things get really high or low, they might.

So I figure that values within +/- 5% of previous values are insignificant. Trends are more important than single values.

My WBC and ALC went up 25% between early December and mid January. But the results were from different labs (Quest Diagnostics auto vs a hospital lab manual). So I'll be really curious to see the counts next week at M.D. Anderson.

If I had the time and energy, I might color code my results on some fuzzy continuum. I'll have to think about how to even accomplish that with Excel.

=seymour=