Transcription:
Importance of Routine Lab Draws: Your Blood Tells a Story

Prakash: Did you know your blood can tell a story about your health? As a patient, you've likely had routine blood draws ordered by your medical provider. Dr. Glenda Maurer is a family physician at Norton County Hospital in rural Northwest Kansas. In this episode, she discusses the importance of blood draws and what your test results mean to your overall health and well-being.

From the plains of rural Northwest Kansas to you, this is Health in the Heartland, presented by Norton County Hospital where medical experts aim to empower health at any stage of life. I'm your host, Prakash Chandran. So Dr. Maurer, great to have you here today. I definitely am familiar with these routine lab draws, but maybe let's start by you telling us why it's important to get them, and especially why it's important for a medical provider to review them.

Dr Glenda Maurer: Thank you for asking. I'm so glad to be able to help out. So routine is anything but routine when we're talking about blood work. We often will order a set or a panel of blood work that discovers certain areas of your health. With certain health conditions, diabetes, for example, we need to know how good your blood sugar control is. With a simple blood test, we can tell what your blood sugars were for the last three months. That seems amazing what labs can tell us. It can also tell us how your kidney function is and, depending what lab has been drawn, we may discover things that we weren't even looking for, perhaps your liver health, your hemoglobin, which is how much oxygen your blood can carry. So routine gives us a very good picture, depending what has been ordered of the patient's health conditions.

I do want to caution that if the test has not specifically been ordered, for example, people will often ask me what's my blood type. We may not order that unless the person is donating blood or needs a blood transfusion. So the reason for medical providers review this is to compare it to the last one to look for changes, to look for cautionary conditions or to be reassured that the treatment we are using is working.

Prakash: Okay. Understood. And, you know, when we talk about routine, when I think about myself, like maybe I'll get my blood drawn once, maybe twice a year. How often, like what's best practice around how often a patient should have their blood checked?

Dr Glenda Maurer: That's another very good question. So generally, as your practitioner recommends. We know that if you have, as I mentioned before, diabetes, for example, it might be as often as every quarter, every three months. For people who are otherwise healthy or who may have no ongoing medical conditions, once a year or even every two years is what the recommendation is by the College of Family Physicians. We don't need to draw more often than that unless you've had a change in health or a change in your condition. So a screening blood draw is different than a blood draw for an active ongoing condition. So I would say screening blood draw once a year, even to every two to three years, if you have remained healthy.

The things that you would look for, for example, are, as I've previously mentioned, you want to know your kidney function, your liver function, your hemoglobin, which is your amount of iron in your blood. And possibly, if you have a family history, you might want to look for cholesterol, elevated cholesterol levels. Or if you've lost or gained weight, you might look at a thyroid test. So those are some of the fairly routine ones. Not knowing your particular health, I would go with what your practitioner recommends, and we do recommend an annual wellness checkup.

Prakash: Yeah, that makes a lot of sense. You know, I want to go into what exactly the lab results mean, because you mentioned things like kidney function and liver function, but it doesn't necessarily represent itself that way. It actually feels a little confusing to read. I will look at things like cholesterol and HDL and LDL, which I'm still trying to learn what all that means. But let's go over kind of the common things that you look for when reviewing a patient's lab work and how they can follow along with you to understand for themselves.

Dr Glenda Maurer: Okay. I will give, shall we say blood work 101? My simplest explanation. If it's more complex than that or you have several things, your family physician or your primary care is always the person who knows you personally and can apply this to you personally. But for example, one of the most common ones is called a CBC, complete blood count. This tells the health of your bone marrow, which makes your white blood cells, they're the ones that fight infection. So if you have a high white blood cell count, it could mean either a bacterial or a viral infection or it could mean you have infectious mono. It's a pretty broad, test, but it helps us to understand how the body is responding. The other part are the red blood cells, which are the oxygen-carrying cells. So that might say hemoglobin or Ht for hematocrit. That tells how much iron is in each blood cell. Are they healthy? Are they doing their job? And then another area would be your platelets, which have to do with clotting factors. And if you're having, for example, lots of bruising, or if you're on a medicine that makes your platelets more sticky than usual or makes them not work as well, you might have bruising, we would look at platelet health.

Then there's usually comprehensive metabolic panel that will tell your liver and your kidney function. Usually, it says Na for sodium, Cl for chloride. Those are your electrolytes. And those are very important for heart and muscle action, for dehydration. In that panel, sometimes they call it a chem panel or a chem 18, depending on the many things on the lab that is ordered or on the machine that runs the blood work. It will tell us how is your liver functioning, and there will usually be several liver function tests, which have letters like ALT, AST. We shortened those because the actual word would be 17 syllables.

Then, often with that one, we'll have your calcium. So that has to do possibly with your bone health. That is very important for us to know. There might be a letter under TSH or thyroid-stimulating hormone that talks about the health of the thyroid. If we find something in that screening process, we may order a more specific test for that.

And then to your favorite, cholesterol, that will usually be divided up. If we know a total cholesterol, a total might mean you have lots of good cholesterol, but it will break down the cholesterol into good, bad cholesterol basically and the various types of cholesterol. So think of HDL high. "I want my good cholesterol to be high." So that's HDL. The LDL is the low density lipoprotein, or you want that one to be lower, and that's your less healthy cholesterol. So again, those in ratio to each other are very important numbers for us to know. So just because you have high cholesterol, isn't necessarily a bad thing. It's more important to know what we call the fractionation or dividing up those numbers, dividing up those types of cholesterol.

And once again, in isolation, you know, I can look at somebody's cholesterol and say, "Oh, that's not very good." But if it's improved from the last test that they had, then it's a good thing, right? Or it shows that our treatment is working. So again, it's individualized. And with your context, people with blood pressure, with diabetes, with several health conditions are obliged to have a lower cholesterol and may have to be treated with medication.

Prakash: Yeah, absolutely. And thank you so much for that education. It's actually my personal belief that we should all kind of have at least a high level understanding of all these things. Because just like you get your car checked up, you know, on a particular cadence, you want to make sure that it's functioning properly. And it's the same thing with our bodies. You know, we want to make sure that all of our levels and our health metric are where they should be. So getting this done on some sort of cadence is important, wouldn't you say?

Dr Glenda Maurer: I totally agree. And with that, I would say keep a little file perhaps, or a lot of people come in with their phone and say, "These were my last health results. Compare them for me." And then we can follow that improvement or changes. And so I do recommend that people, know your cholesterol, just like you know what your blood pressure is. Those are some important health factors that can indicate -- they don't guarantee health, but they help us to preserve and maintain and provide good healthcare.

Prakash: Fantastic. So, we talked about some of the functions that this lab work tests, but what are maybe some common diseases or medical conditions of concern that can be actually detected from these lab draws?

Dr Glenda Maurer: Right. So that's a very good question. Some of these lab draws, we have often come across someone with a very high cholesterol who had no family history. So hyperlipidemia or high cholesterol, that would be a condition. High or low thyroid test, very important because your thyroid affects so many parts of your metabolism, of your mental health, of your physical health. Sometimes we can find someone who has low blood, they might be losing blood or not making it properly. They might even need a blood transfusion, but we have to know is this a problem of losing blood or is this a problem of not making blood? We have found several blood cancers on just a routine draw, so it's kind of like a little investigation, right? We're private investigators every time we look over these lab draws and even a normal draw will give us an indication of someone's health.

Prakash: Yeah, absolutely. And just kind of like a lay person question, you know, sometimes I notice that they take an awful lot of blood. And I know obviously people, you know, they get a little bit nervous around giving blood and seeing all of that blood leave their body. Can you maybe speak to why this is?

Dr Glenda Maurer: Right. So this is partly a lab question, but I have to have a basic understanding of what I'm ordering. And as I said earlier, for a certain type of blood work, I would order a certain test. So some blood can be in a certain type. And if you look at how many vials they might take, usually each one of the tops has a different color and that indicates in general what the lab is going to be about. So for your bone marrow health, like the CBC, they have a certain color top. For a metabolic or a chemistry panel, different kind of top. If it's someone who is on a blood thinner and the blood cannot be coagulated or must be measured for how long it takes to clot, that's yet another colored tube. So the number of tubes is not necessarily alarming. It just means we're looking at different areas of your blood.

You could easily give a donation of blood. I'm a big proponent of blood donations, which is another topic we could go to, but you could easily give a cup of blood and not feel the difference unless perhaps you're one of these people who has low blood to begin with. So, do not be alarmed, but be sure and ask what is this telling me? You know, ask either the lab tech or your physician who's going over these lab results with you to explain that.

Prakash: Yeah, absolutely. There's nothing wrong with taking an active role in your health and like wanting to understand what's happening, right? Like I would say that all health providers encourage that, wouldn't you say?

Dr Glenda Maurer: I would absolutely agree with that. There are the right times to ask questions, though in the middle of an emergency might not be the time. But if you have a casual, relaxed conversation just like we're having, ask the questions. And I might not know the exact answer, but I know when I can get back to you or we may provide another time to go over a very specific question that you have.

So family doctors are teachers. That's what we do. We also want you to be involved in your healthcare so that you take responsibility and ownership. Also, we're your partner. We're not just standing here, you know, just telling you what to do. We are the consultant. We are giving you information. Ultimately, what you do with your health is your choice. But we like to give you the information so you can make good choices.

Prakash: Absolutely. So one of the things that I've heard that's available through Norton County Health Department is kind of the ability for people to actually proactively get lab work done and sent to the patient's medical provider to review. What are the cases or what are some examples of this? And would you recommend taking advantage of this service?

Dr Glenda Maurer: That's another very good question. Thanks for asking. Our health department, and I'm sure other health departments, make available to our Norton community or anyone who is able to have a screening blood draw twice a year. Those results, if the patient has a primary care provider in Norton or surrounding area, are made available to their care provider. And if there's anything that is out of the normal range, it will be highlighted. Sometimes it's something very simple, but many times it has alerted the family doctor to one of the conditions we spoke of previously. So those results are made available to us.

And if it is an alarming result, I'll pick up the phone and call the patient, encouraging them to make an appointment. If it's something a little less urgent, we still encourage patients to come and discuss those routine labs. And then, the file that I talked about, keeping your information, you can compare it to your previous year. And some people are very happy to see their cholesterol goes down if they've started an exercise program or perhaps their thyroid health is improved by taking their medication properly. There are many advantages to having those drawn on a routine basis.

Prakash: Yeah, absolutely. So, Dr. Maurer, just before we close, one of the questions that I had is that when people get their results, oftentimes they'll want to Google or look it up for themselves. Do you recommend doing that or are there more credible resources that people can go to to like understand what's happening?

Dr Glenda Maurer: Right. So that's a very good question. There are more credible websites than others, and you'll notice that doctors don't just Google the first result. They may look into mayoclinic.com, WebMD, or visit with your own practitioner with the resources that they recommend, because some of the websites may not be well researched or may in fact contain harmful information. So definitely, before you diagnose yourself with something very dangerous and very serious, be sure and confer with your primary care provider in that regard.

Prakash: Yeah, absolutely. So, you know, we've covered a lot here around routine blood draws and what they test for, but is there anything else that you would like to leave the audience with around the importance of these routine blood draws?

Dr Glenda Maurer: There are hundreds of more things, but I think most basically the things that we have spoken about, be proactive, be involved in your own care, blood draw. Even if you're squeamish, we are professionals. The phlebotomist's do their job every day. It's not worse than a mosquito bite, I would say sometimes.

So, the actual procedure, I think the benefit is so much greater than any reason you could make not to go. I do encourage that conversation starter with your primary care physician, because sometimes they want something that is not on that screening routine, so be open to their recommendations as well.

Prakash: Well, Dr. Maurer, I couldn't agree more. And I really appreciate all this information today. Thank you so much for your time.

Dr Glenda Maurer: It's my pleasure. Thank you so much for the interview.

Prakash: That was Dr. Glenda Maurer, a family physician at Northern County Hospital. Thanks for listening to Health in the Heartland. You may find out more about Norton County Hospital online at ntcohosp.com. I've been your host, Prakash Chandran. Take care of yourself and others and be well.