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So I have a slip of paper. Let's go through these lab values.

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I actually put down a number of values that we're going to pretend for a moment are my labs.

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And you can see the range and the units next to them.

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So let's go through it piece by piece, and actually while I do it I'm actually going to

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show you some short hand techniques so you can understand, if you ever see this in the future, what it refers to.

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So some short hand that people have come up with, this isn't necessarily something I've come up with.

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I learned it from folks ahead of me, but it's been used, not just in the U.S., but most parts of the world.

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It's pretty uniform.

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So if you're looking at these labs, here's a quick way to transcribe them. So imagine you

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have to quickly put it on a piece of paper and move on. This is how you would do it.

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So you draw a little stick diagram like that and in the far left you'd put the number "5."

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And this refers to the first row, the white blood cell row. And we know the value is 5000 so

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that's what the 5 represents. And it's understood that that number is in thousands of cells per milliliter.

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So if you see a 5, you know we're talking about thousands of cells per milliliter.

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And the next question is well, what are those types of cells if you were to actually look at them? We know they're

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white blood cells, but exactly what type they are is actually in the six rows beneath.

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So these six rows tell you the breakdown of this number.

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So that's why they're percents. And so the 5000 cells break down into:

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Segmented neutrophils (I'm gonna write that as an S with a 61).

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And Bands, there are 3% bands.

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Lymphocytes are 29%, and then we have monocytes at 4%, basophils at 1%, and Eosinophils at 2%.

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So these percentages for the different types of white blood cells are going to add up to 100. Right?

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So let's just double check. We've got 7 and 29 is 36 and 3 is 39. Yep 100%.

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So that's how you quickly can see the different types of white blood cells floating around in your body.

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That's what those numbers represent.

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So then the next two numbers: hemoglobin and hematocrit go in the top and bottom of this stick diagram.

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And again when you see these numbers like this I could look at that and immediately figure out that's the red blood cell content.

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Those two numbers both reflect red blood cell content in the blood.

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And then the last cell, on this side, represents the platelet count.

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And 227 represents 227 thousand cells per microliter. So before we were talking about milliliters (for the white blood cells)

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but now for the platelets we're talking about microliters. And in fact I'll put cells in quotes because we know it's

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not really cells, it's these are little cell fragments that are the platelets.

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So that 227,000 tells you about how many platelet cell fragments are floating around in one microliter of blood.

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So that's the first chunk of data. So that's all of this information kind of summarized

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very quickly in that stick diagram.

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Now let's move on to the chemistries.

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So if someone orders a chem 7, then that'd be the first seven of these. And if they order a chem 10

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then that would be all ten of these.

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So this is how you would kind of draw this out as a stick diagram. It kind of goes like this.

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And the chem 10, the last three go in here.

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So the Sodium goes in the top left, and below that is the 4.3 for Postassium.

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And you're just going systematically all the way through it. So for Chloride it's 103, and bicarbonate goes, it's 22, right below that,

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and the Creatinine goes in this cell, 0.8, and the blood urea nitrogen, sometimes they call that the BUN,

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that's just the first letter of these three- is 15. And then the fasting glucose is 92.

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And then the Calcium goes in the top of this little wishbone shaped stick diagram. That goes right there.

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The Magnesium goes on this side, and the Phosphate goes on this side. So that's the Chem 7 on top,

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and the Chem 10 would be all of that kind of together.

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And then the bottom we have some liver enzymes, and also there's a stick diagram for that as well, kind of a fast way to draw it.

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And it is basically just an X. So the top of the X is two numbers, so you usually write the total bilirubin like this

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1.1 and then you put a slash and you put the other number there, the direct bilirubin, 0.1.

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And then on the left you put the AST and on the right you put the ALT, and at the bottom you

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put the Alkaline phosphatase, 76. This is how the numbers kind of break down, so again if you ever see any of these stick

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diagrams and you're wondering what they refer to. Now you kind of have broken the code, you know what number goes where.

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So if you see, for example, this number, the 22, you immediately know that they're talking about the ALT.

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So this is the way that people quickly diagram things. And now I know when people look at labs, the first thing they

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want to know is-hey is this good or bad? So they want to look at these values and they want to compare them to the ranges.

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They want to say- hey does this fit into the normal range that people expect?

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So let's talk about that. Let's talk about normal range, and what normal means exactly because I know that's the first thing

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most people will want to look at. So let me draw out what a normal curve would look like. So if you actually took

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everybody, let's say 10,000- but it's not everybody, but it's a big chunk of people- 10,000 people and asked them

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all to tell you their white blood cell count they will give you, of course, many different numbers.

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They're probably wondering what you're doing with that information. But let's say they give you their answer.

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And say you plot it all on a curve and you draw a little diagram. This would be basically what you would find.

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You'd say- okay most people have a white blood cell- and this is white blood cell count down here- and this is of course in thousands, we said.

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Thousands of cells per mililiter. And this is frequency, this is the number of people. I'll just write "f" for frequency.

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So you'd say- okay while there are a lot of people kind of in this range right here, and in fact 95% of people fall into this middle section

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In this area, so this is definitely the bulk of people that fit between 4.5 and 10.

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And that's actually how most of these ranges are decided upon. They say okay where do the bulk of folks lie.

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And it's usually between those numbers that are in the range and that also means, if you think about it,

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that there's of course somebody out here, and somebody up here. I mean that is by definition going to happen.

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You are going to have 5% of people in one of those two tails combined. So whenever you see a range, just keep in mind, there is some

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normal variance, they're called, that kind of go above or below that range. But that range usually captures the majority of folks.

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So when thinking about that, when thinking about what exactly goes into a normal range. Consider some of

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the things that could make what is "normal" different. So for example let's say I may check someone's hematocrit.

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Let's say I'm looking at the hematocrit and I want to find out if it's normal or not. If I look at a baby's hematocrit but I use an adult's range

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then it would be very very unusually high. So a newborn baby has a very high hematocrit.

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So I really should be comparing it to other newborn babies.

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So age is really important to consider. So you want to make sure that the range of values is age appropriate.

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You also want to make sure that gender is considered. So for example the normal range for men's hematocrit

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is a little bit higher than the normal range for women's hematocrit. So range matters for age and also for gender.

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Now different labs will also differ. So it's actually quite interesting, you can even go online and see what the normal ranges

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for a lot of these things that I have here, and the numbers will be a little different from what I have shown you.

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So if you go from one lab to another, you'll get different numbers. And in fact lab technique also matters. So even within

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a lab, depending on the technique they use to get an answer to something, the range could differ. And that actually matters

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particularly for things like this. So these IUs that I put down here, they stand for International Units.

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And that's specific to a type of lab assay that's done and again that depends on the exact assay that's done and that's

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going to change the range of values that you get there. So consider the technique.

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And finally consider the situation. So if you have, let's say a person who is

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supposed to come in for a fasting glucose and usually you're told, you know don't eat anything overnight and

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don't have breakfast and come in and get your blood taken first thing in the morning. It's a pretty common scenario.

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Then you would have a normal fasting glucose, and it should be below 100. But let's say by accident you

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decide to have a little snack in the morning because that's your usual thing, you have some toast.

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Umm, your blood glucose could go up as a result. So that glucose result could be okay if someone knows that you didn't fast really,

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you had a little snack. So that situation changed, so you're metabolism is going to make that range go up.

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So only for fasting glucose is the number below 100 normal. Otherwise it could be higher.

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Now consider a situation where you're taking a medication. Let's say you're on a medication that makes your potassium go down.

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So you're on a drug that causes potassium to leave your kidneys and go into your urine. Your potassium value would

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then go down. I would expect it to be lower right? Because you're taking your medication. So some of these ranges

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are going to change depending on what medications you take, what you had for breakfast that day, or not had for breakfast,

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what kind of medical conditions you have. So it's going to definitely depend on the situation.

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So whenever you look at ranges and values and you want to see if you're in the normal range, just consider all of these things

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that could explain why your number may or may not be within that range.