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I need some urgent help and advice

I have always been told I have lupus coz I got ana positive blood but had loads ana positive blood tests but had biopsy come out negative now he put on letter of diagnosed of neurological weakness due to implegic migraines and scoliosis and chronic pain syndrome and benign joint hyper mobility and speckled ana greater than 1000 with a positive ro antibody and low lymphocyte count

the bit I am confused about is always told I had lupus now they say speckled ana greater than 1000 with a positive roro antibody and low lymphocyte count so what does this mean has anyone had this or knows what doctors saying

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You can read this article: australiandoctor.com.au/cms...

and the New York Times: nytimes.com/health/guides/d...


The following is general information and should not be taken as reliable medical information since this requires a lupus specialist.

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.


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 (ie 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. 95% of people with 1:80 ANA do not have Lupus. 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.

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.

Stain Pattern

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

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. Indeed, there are many patients classified as "sero-negative." There are also healthy people who have a positive ANA, just to add to the confusion, and therefore do not have any connective tissue disease! Therefore, you need to see a lupus specialist as not rheumatologists are expert in 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


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.

Source: 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.

Other lab tests:

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.

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.


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.

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


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

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


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

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



Pneumococcal pneumonia

Myocardial infarction (Heart attack)

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

Usually, a high CRP indicates an acute infection rather than inflammation from lupus.

In addition to the ANA, doctors trying to diagnose lupus often look for the following specific antibodies.

Antibodies to double-stranded DNA (anti-dsDNA) are antibodies that attack the DNA -- the genetic material -- inside the cell nucleus. Anti-dsDNA antibodies are found in half of the people with lupus, but lupus can still be present even if these antibodies are not detected.

Antibodies to histone -- a protein that surrounds the DNA molecule -- are sometimes found in people with systemic lupus but are more often seen in people with drug-induced lupus. This form of lupus is caused by certain medications, and usually goes away after the medication is stopped.

Antibodies to phospholipids (aPLs) can cause narrowing of blood vessels, leading to blood clots in the legs or lungs, stroke, heart attack, or miscarriage. The most commonly measured aPLs are lupus anticoagulant, anticardiolipin antibody, and anti-beta2 glycoprotein I. Nearly 30 percent of people with lupus will test positive for antiphospholipid antibodies. Phospholipids found in lupus are also found in syphilis, and the blood test cannot always tell the difference between the two diseases. A positive result to a syphilis test does not mean that you have or ever had syphilis. Approximately 20 percent of those with lupus will have a false-positive syphilis test result.

Antibodies to Ro/SS-A and La/SS-B (Ro and La are the names of proteins in the cell nucleus) are often found in people with Sjögren’s syndrome. Anti-Ro antibodies in particular will be found in people with a form of cutaneous (skin) lupus which causes a rash that is very sun-sensitive. It is especially important for your doctor to look for the Ro and La antibodies if you are pregnant, as both autoantibodies can cross the placenta and can cause neonatal lupus in the infant. Neonatal lupus is rare and not usually dangerous, but it can be serious in some cases.

Antibodies to Sm target Sm proteins in the cell nucleus. Found in 30-40 percent of people with lupus, the presence of this antibody almost always means that you have lupus.

Antibodies to RNP target ribonucleoproteins, which help to control chemical activities of the cells. Anti-RNPs are found in many autoimmune conditions and will be at very high levels in people whose symptoms combine features of several diseases, including lupus.

Some blood tests measure levels of proteins that are not antibodies. The levels of these proteins can alert your doctor that there is inflammation somewhere in your body.

Complement is the name of a group of proteins that protect the body against infections. They work by strengthening the body’s immune reactions. Complement proteins are used up by the inflammation caused by lupus, which is why people with inflammation due to active lupus often have low complement levels. There are nine protein groups of complement, so complement is identified by the letter C and the numbers 1 through 9. The most common complement tests are CH50, C3, and C4. CH50 measures the overall function of complement in the blood. Low levels of C3 or C4 may indicate active lupus.

Erythrocyte sedimentation rate (ESR or "sed" rate) is another test for inflammation. It measures the amount of a protein that makes the red blood cells clump together. The sed rate is usually high in people with active lupus, but it can also be high due to other reasons, such as an infection.


Very informative. Thank you

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Hi there Shakylove....... My HUGE sympathy in your confusion about diagnosis!

If you can make sense of all the info here (below) you have a brighter mind than me !!!

Are you able to talk with your Consultant for more than the 10-15 mins usually allotted? It would be good to ask him/her to try and explain the situation in a less complicated way. Have some of your prime concerns written down - as every person is different, and the medics cannot read your mind.

Having been on this Blog site (on and off) for quite a while now, I have reached the conclusion that not many of our GPs in this Country are very clued-up about Lupus, Fibromyalgia and other auto immune illnesses. My own GP just makes a joke of it - and I've ceased laughing about this thing which stops me from having a relatively "normal" life. Hopefully, your GP is one of the more sympathetic ones - and can help you in the long road to diagnosis.

Be patient - and if a prescribed drug gives you awful side-effects, do not continue with it. I'm not going to mention the names of drugs that have been "tried out" on me, but twice I have landed in hospital because of them. For many people, the "broad spectrum" drugs ARE a help - that is why the correct diagnosis is so important.

When you say " I have ALWAYS been told I have Lupus" - how long is that? Since childhood ? (This would be rare). Just curious.....

Stay strong......don't panic....there ARE people who can help!


I have been told since I was 16 now 22 n got told by doctor n rhmetoilogy but now seeing someone slightly higher n he said also think I have connective tissue disease n I do have implegic migraine I have hypermobiliy 8/9 n I have scoliosis had op for tht


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