Blood Work: a Complete Guide for Monitoring
Total Page:16
File Type:pdf, Size:1020Kb
BLOOD WORK: A COMPLETE GUIDE FOR MONITORING HIV PUBLISHED BY JANUARY 2011 Lab tests, or blood work, can give im Nearly all lab reports make it portant clues about your overall health simpler to understand test results and HIV disease. Many of these tests by including a “normal” range, should be done shortly after learning or high and low values. The results that you’re HIV-positive. This will establish that fall outside normal ranges are likely a “baseline” measure of your immune health and show the most important ones. Those that are above or below how active HIV is. Knowing this information will help normal are often highlighted on your lab report by you watch for changes in your health over time as well being bolded, printed in a different color or printed in as check the impact of any treatments that you take. a different column. Factors such as age, gender, stress, medicines, active It is your right to have and keep copies of all of your infections and others can all affect these test results. Lab medical records. You can then keep track of your results results should be considered with these factors in mind. to look for overall trends. Ask for and keep copies of your Understanding your test results may seem difficult lab reports, and make a chart or table of them to note at first. However, they can help you take charge of your trends or changes. For examples of these charts, read health and understand why your doctor prescribes Project Inform’s publication, Personal Tracking Charts, certain tests and medicines. With practice over time, it available at 1-800-822-7422 or www.projectinform.org. becomes easier to understand these results. WHAT’S INSIDE Complete blood count: 3; Platelet count: 3; What do CD4+ cell counts mean?: 3; Red blood cells: 4; White blood cells: 5; Chemistry screen: 6–7; Lymphocyte subsets and viral load: 8–9; Resistance tests: 9; Other tests that may be done: 10; Table of common tests and ranges: 11; Interpreting your viral load numbers: 12. © PROJECT INFORM 1375 MISSION STREET SAN FRANCISCO, CA 94103 -2621 415 -558 -8669 FAX 415 -558 -0684 SUPPORT@PROJECTINFORM.ORG WWW.PROJECTINFORM.ORG Although this publication may seem long and involved, it gives a thorough background to the types of tests that you may need to take over time. There are 5 key points to keep in mind when reading this material: 3 Different labs can get different results from 1 2 the same blood sample because they use different methods or equipment. If for some “Normal” test values can No single test result provides reason you cannot use the same lab, you differ. For example, lower all the answers. Most results may need to establish a new baseline at the cholesterol values may need to be considered along new lab. In the case of viral load tests, try be considered normal in with other reports and within to have the same type of test (bDNA, PCR, an HIV-positive person the context of your overall etc.) done each time. If your doctor sends not on HIV treatment. Be health. you to the same place to give blood for test 2 sure to discuss these dif ing, it’s likely the same labs and types of tests ferences with your doctor. are being used. If you move or if you change Test results outside the lab’s doctors or health plans, it’s a good idea to “normal” range may not be check and see if your lab has changed as cause for alarm. well. If you ever see dramatic changes in your lab results, you might ask your doctor 4 if the lab or type of test have changed. Several things can impact your test results. For example, they can vary due to the time of day your blood is drawn. If possible, try to schedule blood draws 5 at the same time of day every time. If you’re sick or have an infection, like a cold or flu, these can also affect your test results. You may want to wait to have A dramatic change in results lab work done or repeat the tests after you’ve become well again. Getting a flu may be due to testing errors. B L O O D O K O R M L O T R B W C O . E F J N O I R P shot or other vaccination can also alter lab results, as it stimulates the immune As for CD4 cell counts and system and can increase how active HIV becomes. HIV levels usually return to HIV levels, it’s wise to have “baseline” within a month after a vaccination. the test run again and to not make therapy decisions from any one test result. TOLL -FREE HIV HEALTH INFOLINE 1 -800 -822 -7422 LOCAL & INTERNATIONAL 415 -558 -9051 MONDAY– FRIDAY 10 –4 PACIFIC TIME Complete blood count (CBC) Above 500 CD4+ cells The CBC is the most common blood test that doctors order. It checks › No unusual conditions likely. levels of white blood cells, red blood cells and platelets. Generally, Emphasize good health habits even people without symptoms of HIV disease should have a CBC and health care maintenance, including vaccines and nutrition. test done at least every 6–12 months. People whose blood work trends are changing may want to have their CBCs done every three 200–500 CD4+ cells B L O O D W O R K . P R O J E C T I N F O R M months, or more often. People with symptoms of HIV disease should › Increased risk for shingles have a CBC every 3–6 months. (zoster), thrush (candida), skin CBC testing is done more often in people with symptoms of low infections, bacterial sinus and red blood cells (anemia), low white blood cells (leukopenia) and low lung infections, and TB. platelets (thrombocytopenia). In each case, if a change occurs that › Life-threatening OIs (such as PCP, MAC and CMV) are rare. worries you or your doctor, the tests should be done again a few weeks HIV treatment is generally sug- later. Of the tests explained in this publication, the most important › gested at 300-500 CD4s and ones are the red blood cell, white blood cell and platelet counts. recommended when CD4 cell counts falls to 200 to 350. Platelet count 50–200 CD4+ cells Platelets are the part of the blood that helps it to clot. They travel Increased risk for PCP and to the site of an injury where they “stick” and help develop a clot or › 3 other life-threatening OIs. scab to stop the bleeding. A normal count is 150,000–440,000. A low › Preventive treatment for PCP count can be caused by HIV infection or by some drugs. is indicated. Although a platelet count below 150,000 is considered low, most › If counts are below 100, con- people are not at risk of uncontrolled bleeding with counts of 50,000 sider preventive treatment for or even lower. However, because platelets are necessary for blood MAC, CMV and invasive fungal infections. clotting, the chance of major bleeding rises as the platelet count drops. If your platelet count is very low (in the 10,000 range) and/or Below 50 CD4+ cells you have symptoms related › Increased risk for OIs, includ- to thrombocytopenia, your ing MAC and CMV. doctor may want to change › Continue preventive medica- your treatment, or may teach tions. you special ways to prevent bleeding. © PROJECT INFORM 1375 MISSION STREET SAN FRANCISCO, CA 94103 -2621 415 -558 -8669 FAX 415 -558 -0684 SUPPORT@PROJECTINFORM.ORG WWW.PROJECTINFORM.ORG Red blood cells: the oxygen carriers Red Blood Cell (RBC) Count RBCs are produced in your bone marrow, and they carry oxygen and carbon dioxide through your body. The RBC count is the number of red blood cells found in a small amount of blood called a cubic milliliter, or mL. Normal levels for men range from 4.5–6.1 million/mL, and for women 4.0–5.3 million/mL. It’s not uncommon for people with HIV to have RBC values below normal. Hematocrit Slightly lower values should not be cause for alarm. The hematocrit is another way to measure RBCs. It is the However, greatly lower numbers can be a sign of anemia. percentage of blood cells in your body that are red blood Symptoms include fatigue, shortness of breath, pale skin cells. Normal values range in men from 40–54% and in color and menstrual problems. Anemia can be caused by women 37–47%. Hematocrit values indicate the thickness some medicines and/or illness. Low RBC counts occur of the blood as well as its ability to carry oxygen. A low with lower hemoglobin and hematocrit levels. Anemia hematocrit also indicates anemia. 4 may be treated with iron supplements, erythropoietin (Epogen) or in severe instances, a blood transfusion. Mean Corpuscular Volume (MCV) The MCV measures the average size of red blood cells. Hemoglobin The average MCV ranges from 80–100 femtoliters (fL). Hemoglobin is a RBC protein that carries oxygen through A low MCV shows that cells are smaller than normal. the body. Normal levels in women are 12–16 grams per This may be due to an iron deficiency or chronic disease. deciliter (g/dl) and in men 14–18g/dl. It’s not uncom MCV is generally higher than normal in people taking mon for people with HIV to have lower than normal Retrovir (zidovudine, AZT) or in people with vitamin hemoglobin levels.