What the ranges of blood test say about your health?
Even though you have normal ranges in your blood work report, chances are that they may not be optimal for overall performance, longevity, mental and physical health. Values for most of the tests fall well within normal range but they may still be combined with the high risk of diseases and mortality. This is the reason why you should maintain optimal blood test range. We have certain reasons to show why you shouldn’t count on normal lab test range and how they can be misleading and confusing to you. There are certain markers in which normal ranges are very harmful.
Reasons You Shouldn’t Rely on Normal Ranges
Over 95% of the population in the world relies on normal lab ranges. Actually, they do nothing but help doctors to make treatment and diagnosis decisions. They shouldn’t use to tell what’s optimal to ensure your longevity and health. They don’t include the research on a large population about mortality and risks for disease.
In this research, you will get a different result on the basis of a group of people with the least risk of diseases. But most doctors are too busy to stay ahead with this type of research and implement it. Sometimes, normal ranges are depending on groups which include a large number of unhealthy people and these ranges are not good for your health. Due to these reasons, you shouldn’t count on normal ranges, especially if you want to keep track of your health and live a healthy and long life.
Common Markers in Blood Test with Unreliable and Confusing Normal Ranges
Thyroid-stimulating Hormone (TSH)
The pineal gland in your body releases this hormone which signals your thyroid to make more hormones. What should be the normal TSH levels is still the matter of debate for most researchers. In most cases, normal ranges remain somewhere around 0.4 to 6 mlU/L. In some studies, the upper limit should reduce to around 2.5 to 3 mlU/L. The levels above 2.5 mlU/L are relevant with the high risk of hypothyroidism (underactive thyroid), mortality and Alzheimer’s disease are one of the main reasons.
Another reason is undiagnosed autoimmune thyroid because a lot of people rely on the original normal range. High TSH levels are usually not a healthy range. But recent researches have still found that well-screened group of individuals have the upper limit of thyroid dysfunction from 2.1 to 3.7 mlU/L.
Another important fact is that more than 30% of individuals with around 3mlU/L of TSH levels have autoimmune thyroid disease in some form. If you get a normal range, it doesn’t mean thyroid levels are working well. If you really want to be healthy, there is no point hoping for blood test to fall off the normal range to work. You have to be practical to maintain your TSH levels in a specific range which shows the least risk of hypothyroidism and allied problems.
Folic Acid (Folate)
It is another type of blood test marker with confusing normal range. Folate is a vitamin in your DNA to create fresh blood cells and it is also important for overall brain development. It also helps reduce a molecule associated with heart disease, named homocysteine.
A lot of labs use around 3 ng/mL of a lower limit to diagnose deficiency in folate. But the limit should be above 13 ng/mL, according to the researchers. In countries which strengthen grains and other foods containing folic acid, the lack of folate is rare. However, the range goes beyond 3 ng/mL is not good.
If you want optimal health and longevity, what levels you need to target? According to research, an optimal lower limit should be higher than the one which is already present limit. For example, levels under 13 ng/mL shown the high risk of mortality in a survey conducted on 28,845 people. In levels from 17.6 to 20 ng/mL, lowest risk was observed.
According to a study conducted on 1921 people, there is the least risk of heart disease in individuals with around 9.6 ng/mL.
Levels beyond 11.3 ng/mL shown 39% lower risk of lung cancer than levels under 7 ng/mL. It means optimal lower folate levels are a lot higher as comparing to the existing normal lower range. It is yet another reason why it is not good to rely on the normal range establishing to figure out if levels are healthy.
An upper normal limit is 150 mg/dL for triglycerides. More than 60 studies were conducted by scientists on 726,030 people which shows that levels under 90 mg/dL are relevant to least risk of mortality. Another study on 13,957 individuals shows that people with the lowest risk of mortality had levels below 88 mg/dL.
Along with this, levels under 88 mg/dL also shows least heart attack risks. Levels beyond this shows the heart attack risk when there are high levels of cholesterol. In simple words, high levels of cholesterol are a lot harmful when they are associated with triglyceride levels beyond 88 mg/dL. There is also a high risk of diabetes when triglyceride levels go above 90 mg/dL.
All in all, depending on normal ranges could be harmful with markers like this. These types of normal levels do more harm than good as you might ignore disease precautionary steps by relying on them. It gives a wrong feeling of security.
Have your blood test come normal and you are worrying instead of being relieved, as you know that something was going wrong but the doctor couldn’t find anything?
Fig: Blood Test Ranges
Along with traditional blood test , standard reference ranges are also the matter of concern for most naturopathic doctors and other practitioners in functional medicines. Reference ranges are usually very large with small practical value.
For standard labs, in order to fit 95% of Americans in the normal reference ranges, normal reference ranges are intended to diagnose and detect stages of disease only. The number of clinically normal people is larger and makes the definition of the disease or abnormal states relative as population goes sicker.
Is being normal is good enough for your body as comparing to the rest of sick people or do you have more healthy goals like being free of a headache, sleeping well, having the energy to live well, stable blood glucose, not eating unhealthy etc?
The Source of Optimal Reference Ranges
Optimal physiology is the source of optimal health ranges. These tighter ranges are derived from clinical trials and research studies. These are the ranges which are known to be normal since 20 to 30 years ago.
Optimal reference ranges are often referred for functional blood analysis and using them deeper knowledge on the common causes of physiological imbalances is provided. By testing most of the markers combine, dysfunctions like gastric inflammation, viral infection, thyroid dysfunction, gut problems, adrenal insufficiency, etc are revealing. When lab testing is a great tool to assess your health status, such lab tests must be used along with other modalities like functional evaluation and symptom analysis.
Should You Rely on Lab Test Values?
There are four common indicators to determine clinical test reliability. Accuracy and precision are two indicators which shows how well test is performed, on daily basis in a lab. Specificity and sensitivity are the other two indicators which deal with how well a test can differentiate disease from good health.
In each test approach, the precision and accuracy are established and monitored well by a professional. Specificity and sensitivity are usually find in literature and research studies. Each test is having its own uses and performance measures. Lab values are considered to be accurate, precise, sensitive and specific. These concepts are known to be the keys of reliability and to provide the feeling of confidence to the healthcare provider when it comes to using clinical laboratory test.
Precision and accuracy
The basic reliability is measured by the measurements of precision and accuracy. These terms are not interchangeable and they describe the sources of variability. A test approach is usually precise without being accurate.
When test value shows the true value of an analyte (a substance) to measure, it is supposed to be accurate. In each test, results are comparing to the control samples which have gone through several evaluations and are assessing with ‘gold’ standard for the same assay and are analyzing with the best testing standards possible.
When the same results are coming with repetitive analysis on the same sample, a test approach is considered to be precise. There is a small amount of random variation with the precise test method. Results are producing reliably over time to ensure that the test method is trustworthy.
Even though 100% precise and accurate test is perfect, there is still a chance of small changes in results due to instrumentation, test methodology, and lab operations. The small changes which usually take place during testing don’t usually detract from the value of the test. The level of accuracy and precision which can be achieved, is specific to each approach. Also, it is usually tested for reliability with complete quality assurance and control procedures.
When your blood is tested by the same lab more than once, test results shouldn’t vary much unless your condition is no longer the same. There may be some changes between labs in accuracy and precision because of different analytical methodologies or instrumentation. But the test results are reported with standard intervals of references that are specific for that lab. It is helpful to the health care provider to interpret details along with their relevance to that interval.
Specificity and sensitivity
The tests are ordered by the healthcare provider to monitor or diagnose medical condition. The conditions depends on their natural ability to differentiate whether you have a condition or not. According to the medical history and symptoms of the patient, tests with high sensitivity to verify the condition or tests with high specificity are ordered to rule it out.
Tests with high sensitivity
Sensitivity is an ability of a test to identify people who have a specific condition or health problem. Suppose a test is known to be 90% sensitive if 100 people have a disease, the test which is detecting the condition will do so correctly for 90% of cases. The rest of 10 people will not show the result expecting for the test. The normal result could be confusing for 10% of cases and it is known as a false negative. More sensitivity leads to fewer false-negative results.
Tests with high specificity
Specificity determines the ability of a test to exclude people correctly who doesn’t have given health condition or disease. Let’s take an example of a test which is 90% specific. If doctors test 100 healthy people with this approach. Only 90 people (90%) will be diagnosed with disease-free (found normal) by this test. The rest of the 10 people will seem to be positive (who don’t have the disease).
For those 10 % of people, the abnormal findings are found to be false-positive and misleading results. When it is important to confirm diagnosis which calls for a risky therapy. The specificity of the test is one of the main indicators. If a patient is notifying that their report is positive for a test but doesn’t have any problem, they may subject to harmful or painful treatment. Also, unwarranted anxiety and expense may need to retest. More specific test refers to fewer false-positive results.
According to the FDA, manufacturers and developers of a test must provide specific values for results. Also, the evidence for the ranges. It also expects details on limitations of the test as well as factors which could give false results. Hence, it is vital for healthcare providers to correlate the results with the clinical health of a person to figure out if recommended for repeat testing.
There are different factors in lab testing which could affect the integrity of the sample adversely and prevent reporting of test result accuracy to the provider. These are usually grouping in three different areas which can track sample from beginning till the end.
– It covers the things take place from the moment test is ordered to the moment when the sample comes in the lab.
– It describes things which take place when analysis and management of sample take place.
– It describes the process after getting the result and how and when it is reported.
Some processes take place from the first moment of the test. It is important to conduct all such steps right to ensure that samples arrive at the laboratory. Here are some of the error-prone areas, even though those procedures take place to avoid those errors –
- A process of ordering the test – It is important for a provider to order the right test with right code or name of the test.
- Patient preparation – A patient should get proper instructions about fasting, diet, and medications to ensure that the sample won’t have substances which can affect the test.
- Identification of patient – A professional assigning to collect sample should understand that a person is a patient on whom the test was suggested. It means confirming the identity of the patient and checking for the wristband. When it comes to giving a name and some other information, be sure that samples are matching properly.
- Completeness of information – There are two identifiers to label the sample (i.e. name of the patient and medical record number or date of birth, as well as the date of service) to ensure the sample is matched with the right person.
- Collection of samples – It is important to collect the specimen in the right type of container and it should be mixed with the right preservative if need. The staff who is responsible to collect samples should have proper training in collecting samples for different types of tests.
- Sending samples to the lab – Some samples should store in cold and some should process and tested in a specific period. So, proper transportation and handling are important for the integrity of the sample.
Automated analyzers are used in most test methods in order to reduce chances for manual errors. Integrated technology is improving from some years for more accuracy and consistency to manage samples, the process of testing, and reporting of test results. These instruments can have surveillance systems to catch discrepancies or malfunctions and to help the lab staff regarding this matter. Quality assurance procedures are conducting to guide and keep track of all of the activities.
Fig: Analytic Process
- Valid test reagents – Mentioning the Expiry date in all test materials. There are routine procedures conducting in the lab to ensure that the test materials are fine. Also they are not crossing the expiry date.
- Operations of instruments – All instruments must be tested and calibrated well as per the standards regarding maintenance, quality control, and operation.
- Testing staff – The lab staff assigned to testing should have proper training and education. They should be certified well and licensed in some states to perform lab testing.
After completing the test, results should be delivered on a timely basis to the healthcare specialist –
- Transfer of reports to the concerned party – The healthcare provider who suggested the test should get the test report to diagnose and cure the disease and help the patient.
- Timely data reporting – A turn-around-time (TAT) is achieved and is monitored as part of quality assurance for most lab tests.
- Critical limits – Each lab is having a system in place for quick reporting. It is showing a life-threatening or critical condition. When test value falls within these limits, it needs doctors to take immediate action. Failure in reporting those values may take a toll on the patient’s life or medical condition.
- Reference intervals – Lab reports should also cover a framework to interpret results, which is also known as reference interval. A reference interval should be established in each lab for each test. They should also offer written details of test results. In these intervals, small variations are usually observed from lab to lab. This is because of the changes in testing methods or instrumentation methods. They may also change for biological factors like age, sex, or other clinical situations.
A lot of blood test are collected and managed by a Laboratory Information system which can send online detailed reports to the healthcare specialist. You can send the report directly in the clinic or healthcare provider with a printer, by faxing or by email. These systems are used to track test orders, helping in quality control, pre-analytical information, and report and store all results. Lab reports can also specify the values which fall off the reference or expected interval. Which is performed to focus on the tests which need the most attention.
Importance of Full Blood Test in Diagnosing Condition
A healthcare provider should evaluate all of the findings. Some information and lab test data from sources like -family and personal medical histories, physical exam, signs and symptoms. Also, the other examinations like x-rays before making a treatment plan. By considering the disease response and complex physiology, the diagnosis shouldn’t made only on basis of a single lab test. Does the data fit well with other puzzles? The diagnosis can be more reliable with careful consideration. Therefore, evaluation of test results should be done carefully to lower the risk of errors.
Do You Need Clear Interpretation of Blood Test
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- 4. https://labtestsonline.org/articles/laboratory-test-reliability