More Blood Tests for the Liver Transplant Candidate and What they Mean.

More blood tests for the liver transplant candidate and what they mean. 

These values presented represent expected normal data. 

Blood Gases
	Arterial	Venous
pH	7.35–7.45	7.32–7.42
pCO2: millimeters of mercury, mmHg	35–45 mmHg	38–52 mmHg
pO2	70–100 mmHg	28–48 mmHg
HCO3–	19–25 mmol/L	19–25 mmol/L
O2 Sat %	90–95	40–70

CBC: Complete blood count, Adults
	Male	Female
Hemoglobin (g/dl)	13.5–16.5	12.0–15.0
Hematocrit (%)	41–50	36–44
RBC's ( x 106 /ml)	4.5–5.5	4.0–4.9
RDW (RBC distribution width)	11.5%–14.6%
MCV: mean corpuscular volume	82–98 femtoliters (fl)
MCH: mean corpuscular hemoglobin	26–34 picograms (pg)
MCHC%: mean corpuscular hemoglobin content	31–38 gm/dL or 31%–38%
Platelet count	100,000 to 450,000

WBC: White blood cell differential
WBC total: adults and children >2 years	4,500–10,000 or 4.5–10 x 109/liter (SI units)
WBC total: children <2 years	6,200–17,000 or 6.2–17 x 109/liter (SI units)
WBC total: neonates	9,00–30,000 or 9–30 x 109/liter (SI units)
Neutrophils	55%–70%	2500–8000 per ml
Band neutrophils (immature or stab neutrophils)	0%–3%	0–400 per ml
Lymphocytes	20%–40	1000–4000 per ml
Monocytes	2%–8%	100–700 per ml
Eosinophils	1%–4%	50–500 per ml
Basophils (also called mast cells)	0.1%–1%	25–100 per ml

Red blood cell (RBC) count
Men	4.7–6.1 x 106 RBCs per microliter (mcL, μL) or 4.7–6.1 x 1012/liter (L) (2nd value is in SI units)
Women	4.2–5.4 x 106 RBCs/µL or 4.2–5.4 x 1012/L
Children	4.0–5.5 x 106 RBCs/µL or 4.6–4.8 x 1012/L
Newborn	4.8–7.1 x 106 RBCs/µL or 4.8–7.1 x 1012/L

Platelet (thrombocyte) count
Children	150,000–450,000 platelets per mm3 or 150–450 x 109/L (SI units)
Adults	150,000–400,000 platelets per mm3 or 150–400 x 109/L (SI units)

Mean platelet volume (MPV)
Children	7.4–10.4 mcm3 or 7.4–10.4 fL
Adults	7.4–10.4 mcm3 or 7.4–10.4 fL

Blood coagulation time
partial thromboplastin time (PTT)	60–70 seconds
activated partial thromboplastin time (aPTT)	30–40 seconds
prothrombin time (PT)	11.0–12.5 seconds; 85%–100%

Hematocrit (HCT)
Men	42%–52% or 0.42–0.52 volume fraction (SI units)
Women	37%–47% or 0.37–0.47 volume fraction
Pregnant women	1st trimester: 35%–46% 2nd trimester: 30%–42% 3rd trimester: 34%–44% Postpartum: 30%–44%
Children	32%–44%
Newborns	44%–64%

Hemoglobin (Hgb)
in general, a normal hemoglobin level is about one-third the value of the hematocrit
Men	14–18 grams per deciliter (g/dL) or 8.7–11.2 millimoles per liter (mmol/L) (SI units)
Women	12–16 g/dL or 7.4–9.9 mmol/L
Pregnant women	1st trimester: 11.4–15.0 g/dL or 7.1–9.3 mmol/L 2nd trimester: 10.0–14.3 g/dL or 6.2–8.9 mmol/L 3rd trimester: 10.2–14.4 g/dL or 6.3–8.9 mmol/L Postpartum: 10.4–18.0 g/dL or 6.4–9.3 mmol/L
Children	9.5–15.5 g/dL
Newborn	14–24 g/dL

Electrolytes and blood chemistry
BUN: blood urea nitrogen	7–20 mg/dL or 3.6–7.1mM (mmol/L)
Calcium	8.8–10.3 mg/dL
Calcium, ionized	2.2–2.6mM
Chloride	95–107mM
Magnesium	1.6–2.4mM
Phosphate	2.5–4.5 mg/dL or 1.0–1.4mM
Potassium	3.5–5.2mM
Sodium	135–147mM
Ferritin  (ng/ml)	13–300
Folate  (ng/dl)	3.6–20
Glucose, fasting  (mg/dl)	60–110
Glucose (2 hours postprandial)  (mg/dl)	Up to 140
Hemoglobin A1c	6–8
Iron  (mcg/dl)	65–150
Lactic acid  (milliequivalents/liter, meq/L)	0.7–2.1
LDH (lactate dehydrogenase), international units/liter: IU/L	56–194 IU/L
Osmolality	289–308 mOsm/kg
SGOT (AST)	< 35 IU/L  (20–48)
SGPT (ALT)	<35 IU/L
Total iron binding capacity (TIBC)	250–420  μ/dl
Transferrin	> 200 mg/dl
Uric acid    (male)	2.0–8.0 mg/dl
Uric acid    (female)	2.0–7.5 mg/dl

Creatinine kinase (CK) isoenzymes
CK-BB	0%
CK-MB (cardiac)	0%–3.9%
CK-MM	96%–100%
creatine phosphokinase (CPK)	8–150 IU/L
creatinine (mg/dl)	0.5–1.4 or <133mM (mmol/L)

Serum Protein
Total protein	6–8.5g/dL
Albumin	3.2–5g/dL
Globulin	2.2–4.2g/dL
Albumin/Globulin ratio	1.1–2.4 (calculated)

Thyroid Function tests
Free T3	2.3–4.2 pg/ml
Serum T3	70–200 ng/dl
Free T4	0.5–2.1 ng/dl
Serum T4	4.0–12.0 μ/dl
TSH	0.25–4.30 microunits/ml

In the next blog I will include an alphabetical listing of numerous clinical values and a partial glossary.  Please try and stay awake.

Blood Tests for the Liver Transplant Candidate and What they Mean.

Blood tests for the liver transplant candidate and what they mean. Let’s begin with the most important blood test indicator of liver health and the closest to the liver transplant. It is call the MELD score.  MELD, is a scoring system for assessing the severity of chronic liver disease. It was initially developed to predict death within three months of a certain shunt procedure, but has subsequently found to be useful in determining prognosis and prioritizing patients for receipt of a liver transplant.  This score is now used by the United Network for Organ Sharing (UNOS) and Eurotransplant for prioritizing allocation of liver transplants. The initials stand for Model for End-stage Liver Disease.  It is comprised of a combination of creatinine, bilirubin, and INR.   Creatinine is a kidney function measuring stick that is a broken down product that is filtered out of the body through the kidneys.  Bilirubin is a by product of a breakdown of red blood cells that are mainly filtered by the liver and eliminated from the system through the bowels and urine.  Elevated levels may indicate certain diseases, including cirrhosis.   It is responsible for the yellow color of bruises, urine, and the yellow discoloration in jaundice, which is yellowing of the skin.  INR, international normalized ratio for prothrombin time, is basically the time it takes the blood to clot.  In essence, the higher the INR, the more likely the liver transplant patient will bleed until normal clotting occurs.  In interpreting the MELD Score in hospitalized patients, the 3 month mortality is:

• 40 or more — 71.3% mortality
• 30–39 — 52.6% mortality
• 20–29 — 19.6% mortality
• 10–19 — 6.0% mortality
• <9 — 1.9% mortality

This is a tool that is used to determine at what point on the MELD score a liver transplant should be done.  The MELD scores for cirrhosis runs from 6 to 40.  Most schools of thought indicate a liver transplant should be performed at a score between 20 and 25.  Keep in mind that these numbers are not likely to suddenly change from say 15 to 25.  So one could say that, because of the progressive nature of cirrhosis, these number increases are gradual and relatively predictable, as long as abstinence is maintained and there no other diseases introduced that would cause an acute situation.  In the next blog, more analysis of blood test results will be presented.

How does the Liver Transplant Candidate Choose a Doctor?

How does the liver transplant candidate choose a doctor?  One chooses very carefully.  The last thing you need is a G.P., who knows just enough to be dangerous, yet not willing to refer you to the proper specialist for the treatment you need.  The key word is specialist.  The liver transplant candidate should be hooked up with a liver specialist.  Why?  For obvious, common-sense reasons.  The last thing you would do is shop for groceries in a drug store.  It just does not make sense, to seek answers in a place that you shouldn’t be in anyway.  I have been blessed to be within 100 miles of Ohio State University Medical Center in Columbus, Ohio.  This facility, not only has a liver disease specialist, but it has a team of specialists and different departments working in tandem in order to give the liver transplant candidate the latest and best treatment options, the best patient care,  and the best results. They also pay attention to patient needs, especially with frequent follow up tests and visits.  I even visit with the liver transplant team once per year.  Essentially, there is no stone left unturned, and nothing left to chance by using this team.  There are other ways to choose your doctor, such as asking your doctor for a referral, talking to friends, internet forums, and internet research. So, when choosing a doctor, the ideal situation is what I just described. The liver transplant candidate should always strive for the ideal situation too, just as if your life depended on it, which it does. As I have repeated before, your comments are always welcome.  Also, you might want to seed other information from the banners and text messages throughout this blog.

What are liver transplant common medications, their costs, and function?

What are liver transplant common mediations, their costs and function?  The most widely used medications in treating cirrhosis of the liver for liver transplant candidates are Furosimide (Lasix), and Spironolactone (Aldactone). Their costs are very reasonable at less than $14 per med for a 90 days supply.  They do come in different doses, which are administered by your doctor to get the desired results.  I get my prescriptions from Right Source Rx, which is a mail order company, and Wal Mart.  Depending on the type of insurance you have, these meds’ costs can be as low as zero.  There all kinds of programs out there that you should be able to find quite easily with a little hunting. Although my wife does not have cirrhosis, she does need to take certain medications at a cost of approx. $150 per month.  At a recent visit to her doctor, she was told she could get the generic equivalent for just $13 per month, a $137 per month savings!  That saves $1,644 per year.  Certainly no chump change for the budget we have.  So as they say, shop before you buy.   There is lots of information on obtaining these drugs, you guessed it, on the internet.  Just in case you do not have a computer, your local library usually has a bank of computers available to the public for internet usage, and for free.  If you are unsure of how to get on the internet, the local librarian or any of the users that are using the computers can help you out.  It is quite easy to surf the internet. 

The two commonly used drugs that I mentioned above for the liver transplant candidate, basically are designed to help keep the excess fluid buildup out of your body.  The cirrhosis prevents the liver to operate at capacity, including the filtering of blood and other fluids that pass through this miraculous organ.  The Lasix and Aldactone help remove the unfiltered fluids from the body. These meds provide an important function in preventing ascities(swelling of the abdomen) and edema(swelling of the feet, ankles and legs).  Working together, they also help keep blood pressure down, which is important.