To all readers: Important differences in blood test interpretation

To all readers

One important issue has occurred to me that I should say to all readers at the outset of this experiment we have embarked on …

It has to do with some major differences between the US (probably most readers of these threads) and ‘the rest of us’ out here in what is a very big, largely non-US, world.

US laboratories still report their biochemical data using a system which was the commonly used format in the 20th century … it is a system which expresses the test results as micrograms, milligrams or grams per deciliter or per litre (e: ugm/dL, mg/dL or g/dL (or per litre … -/L).

The rest of the world … all of us, in fact … changed to SI units somewhere around the 70s. The US did not. It is like you still use inches, feet and miles while we all use (the UK as an exception) the metric system of centimetres, metres and kilometers. This is not s criticism either of the US or of the ‘rest’ … it is simply what happened. But, it led to a bit of a schism in our ability to read/understand/interpret each others data.

Incidentally, you will note I spell differently too … Australians use British spelling for medical words (as in: anaemia, haemodialysis, metre etc.) and not US spelling (as in: anemia, hemodialysis, meter etc.) … you will just have to get used to that … even my spell check is set for the Australian spelling and NOT for the US spelling of words.

The laboratory measurement issue is a huge (and important) one. It means that most of us ‘out here’ (me too) struggle – or simply just don’t know – the ‘normal values’ for US biochemistry and most of you and the physicians in the US also haven’t a clue about our normal ranges. It also means that when a value is outside the normal range, it is hard for us all - at both ends of the spectrum - to have an easy appreciation of ‘just how far’ and how much that might matter!

It maybe one of the reasons why US doctors tend not to read papers that are not US-based or US-published … and this can be a shame, as a lot of good stuff is published in journals like our own ‘Nephrology’, the official journal of the Australia and New Zealand Society of Nephrology AND of the Asia Pacific Society of Nephrology (a society which includes such ‘useful’ research contributors as Australia and New Zealand, along with the emerging powerhouse(s) of China, Japan, South Korea, India, Thailand, Malaysia, Indonesia and South East Asia – to name but some).

Why such decisions were made, back then, to change to metric and SI units (all of ‘us’) or not to (the US), is beyond me … simply, it creates huge confusion, misinterpretation and a knowledge barrier that, especially at the US end, has tended to stifle outside interest and integration.

As you ask questions … and I attempt to reply … please keep this fundamental conflict in mid. As a result, I will likely refer to ‘ranges’ – like ‘upper end of normal’, ‘lower end of normal’, ‘mildly elevated’ etc and, where possible, not get into specific, exact levels. Specific and exact levels aren’t generally very useful anyway.

It is why you may find most of my answers couched in generality and not in the specific. Moreover, generality permits individual variation within a range … and that is what dialysis should be about anyway. Remember what I said to ‘Jane’ in my first answer … dialysis is an individual treatment, not a mass treatment. And … as my answers will be aimed at many dialyzors, ‘generality’ is also the most sensible approach for me to take.

John Agar