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Anemia Testing Overview:

In order to gauge your current state of health, our clinic will often request copies of your last two years of medical testing and will often recommend further testing as needed.  Our clinic does request some testing that is and not commonly performed in more "mainstream" medical clinics.  24-hour heavy metal testing with provoking agent, neurotransmitter analysis, food sensitivity testing, comprehensive stool testing and Candida antigen testing are commonly recommended by our medical staff.   Some of these are discussed in detail in the links in this section.

What to Expect on Your First Visit:

First office visits typically last 45-60 minutes.  Your doctor will review your intake form with you and gather a detailed medical history.  A partial physical exam is usually performed and medical records are often requested from your primary care physician and/or other doctors.  Specialty laboratory testing may be recommended.  Most clients are offered an initial protocol consisting of nutritional supplementation, dietary and life style recommendations.

First Visit: Blood Test

To assess and identify kidney, liver, blood sugar and other key factors such as blood cholesterols. The results are explained to the patient, giving him/her a fuller understanding of the blood chemistry, so that they may take control.

Patients are required to fast for 14 hours before the test. Water may be drunk freely, but not tea, coffee, juices or other beverages. Appointments are normally arranged for mid-morning so that food and drink can be consumed up to 8pm the previous evening. On the day of the appointment, any prescribed medication should be taken with water as normal.

Patients are recommended to bring food to eat after the blood sample has been taken. Diabetics should advise the clinic, and separate arrangements will be made.

First Visit: Urine Analysis

To establish exactly how the kidneys are functioning. Patients are required to collect urine over a period of 24 hours. This should be as near the date of the blood test as possible, but must not include the 14 hours fasting period prior to the appointment.

A recommended timetable is that the first urine of the day should be excluded, than all subsequent urine for the next 24 hours collected in clean plastic containers. (If collection starts at 8am, this process must be followed until 8am the following day.) Eg. Appointment 10am Friday, fasting commences Thursday 8pm. Urine collection starts Wednesday 8am. until Thursday 8am.

Containers should be clearly labeled with the patient’s names and brought to the clinic at the time of their appointment.

First Visit: Resting ECG for Doctors Report

The electrocardiograph (ECG) determines the condition of the heart and measures its actions and the pulse.

The doctor in charge reports any findings in his medical notes.

Specific Anemia Testing:

Anemia is a disorder of the blood that occurs when there is a deficiency of hemoglobin in the red blood cells (RBC). As anemia progresses, the organs in the body will lack oxygen. Additionally, the body also develops a deficiency in iron.  

A. Complete Blood Cell (CBC) Count

What is a Complete Blood Cell Count?

A complete blood cell (CBC) count is a series of blood tests that provides extensive information about the hemotologic system and other organ systems. It measures the number of the red blood cells (RBC), white blood cells (WBC), hemoglobin, hematocrit, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and platelets in the body.

Indications and Contraindications

A complete blood count is routinely done during medical and physical exams to assess a number of diseases and conditions. It is useful in determining conditions such as:

• Anemia
• Dehydration
• Arthritis, Rheumatoid arthritis
• Blood diseases (Leukemia)
• Kidney diseases
• Infections   

How do you prepare for a Complete Blood Cell Count?

No special preparation such as fasting or sedation is required before the test.  However, it is recommended that you avoid eating foods that are high in fat prior to getting tested. Notify your physician if you are taking medications as it may be necessary for you to stop taking them before the test.

How does it feel? How long will it take?

The blood sample is taken from a vein in your arm. An elastic band is wrapped around your upper arm. It may feel tight. You may feel nothing at all from the needle while your blood is being drawn, or you may feel a quick sting or pinch depending on your sensitivity to pain. Drawing a blood sample for the complete blood cell (CBC) count may last for a few minutes.

Expected effects after the test:

Normally, there are no major effects after the test. Commonly, patients may feel a little sore and slight bleeding may occur on the needle site. Bruising or swelling may occur. 

Special instructions after the test:

After drawing blood, cover the needle site with a clean and dry bandage. If advised by the health care professional, apply pressure or warm compress on the area several times a day to minimize swelling and bruising.

Interpretation of Results:

Normal Findings

Test	Normal Value	Interpretation
RBC (red blood cell)	1.5-5.3 million/mm3	High values of RBC occurs in conditions such as renal disease, extrarenal tumors, cardiovascular disease, pulmonary disease, alveolar hypoventilation, carboxyhemoglobin, dehydration Low values of RBC occurs in conditions such as autoimmune diseases (rheumatoid arthritis), anemia, hemorrhage, bone marrow failure, hemolysis, leukemia , malnutrition, multiple myeloma, Addison’s disease
Hemoglobin	13.0-18.0 grams/100 mL	Same as RBC result
Hematocrit	37-49% (men), 36-46% (women)	Same as RBC result
Platelet count	150,000-400,000/mm3	Increase in the number of platelets occurs in conditions such as iron-deficiency anemia, hemolytic anemia Hodgkin’s disease, renal failure, acute infections, inflammatory diseases, asphyxiation, splenectomy, primary thrombosis, granulocytic leukemia, rheumatoid arthritis, SLE Decrease in the number of platelets occurs in viral and bacterial infections, cancer chemotherapy, HIV infection, eclampsia, renal insufficiency, alcohol toxicity, congestive heart failure, congenital heart disease
WBC (White Blood Cell)	4,500-11,500/mm3	High values of WBC occurs in conditions such as infections, inflammations, physical and emotional stress, lupus, tuberculosis, rheumatoid arthritis, malnutrition, leukemia, tissue injury, uremia Low values of WBC occurs in conditions such as viral infections, bone marrow disorders, malaria, AIDS, lupus, Cushing’s syndrome
Mean corpuscular volume (MCV)	82-98 fL	Low values of MCV occurs in conditions such as iron-deficiency anemia, anemia of chronic disease, Shahidi-Nathan-Diamond Syndrome High values of MCV occurs in conditions such as vitamin B12 deficiency, folate deficiency pernicious anemia, lymphoma, celiac disease, chronic pancreatic disease, hyperthyroidism
Mean corpuscular hemoglobin (MCH)	26-34 pg/cell	High values of MCH occur with macrocytic anemia. Low values of MCH occur with microcytic anemia
Mean corpuscular hemoglobin concentration (MCHC)	32-36 g/dL	Low values of MCHC occur in conditions such as hypochromic anemia. High values of MCHC occur in conditions such as spherocytosis and in newborns.

Notes:

If you are pregnant, this may cause you to have a lower RBC value and a higher WBC value.

The WBC count may be affected due to exercise, smoking, or physical and emotional stress.

B. Vitamins and Minerals Testing

What is the Vitamins and Minerals Testing?

Vitamin tests measure the levels of certain vitamins in an individual's blood. They are generally used to aid in the diagnosis of vitamin deficiencies or in detecting toxic amounts of a vitamin in a patient's system.

Vitamin tests are used to assess the level of certain vitamins in an individual's blood so that doctors can more accurately diagnose vitamin deficiency diseases or vitamin overdoses and devise effective therapy. The vitamins that are most commonly measured by doctors are folate, vitamin B12, vitamin D, and vitamin A.

Indications and Contraindications

The Vitamins and Minerals Testing is usually done to patients who have symptoms of anemia and deficiencies of Vitamin B12 and folate. This test can also be done to evaluate an individual’s nutritional status.

How do you prepare for the Vitamins and Minerals Testing?

Most vitamin tests require no preparation; however, some may require that the patient fast for at least eight hours before giving a blood sample, or stop using some medications.

How does it feel? How long will it take?

The blood sample is taken from a vein in your arm. An elastic band is wrapped around your upper arm. It may feel tight. You may feel nothing at all from the needle while your blood is being drawn, or you may feel a quick sting or pinch depending on your sensitivity to pain. The Vitamins and Minerals Testing may last for a few minutes.

Expected effects after the test:

After drawing the blood, cover the needle site with a bandage and apply pressure on it for several minutes. If the site becomes swollen, do warm compresses few times a day. You may resume your regular diet and your daily activities after the test. However, it is recommended to avoid strenuous activities and to report persisting pain, bleeding and swelling on the needle site.

Interpretation of Results:

In interpreting data on plasma vitamin levels, it should also be noted that different normal ranges may exist for different age groups and genders. For example, the normal range for plasma vitamin B6 for males is 7-52 nanograms per milliliter (ng/mL) for males and 2-26 ng/mL for females.

The normal ranges for levels of certain vitamins are as follows. Please note that, by convention, the units referring to the levels of each of the vitamins may differ from each other. The units picogram/milliliter (pg/mL), nanogram/milliliter (ng/mL), and micrograms per deciliter (micrograms/dL) refer to the weight of vitamin in the specified volume. The units nanomoles/liter (nmol/L) and micromoles/liter (M/L) refer to the concentration of vitamin in the specified volume.

• Folate (folic acid): 3.1-18.0 ng/mL
• vitamin B12: 200-1100 pg/mL
• thiamin: 9-44 nmol/L
• riboflavin: 6.2-39 nmol/L
• vitamin B6: 7-52 ng/mL
• vitamin C (asorbic acid): 28-84 M/L
• vitamin A: 28-94 micrograms/dL
• vitamin D (25-hydroxy-vitamin D): 40-100ng/mL
• vitamin K: 80-1160 pg/mL

A low value of vitamin B12 and folate indicates that there is a deficiency of these vitamins in the body. Low values also detect the presence of anemia.

A high value of vitamin B12 may indicate liver dysfunction and leukemia.

Notes:

In all cases, abnormal results fall below or above the normal concentration range. However, as noted above, values that are considered to be borderline or severely abnormal can differ according to the discretion of the medical laboratory or physician.

The Right Diagnosis and Treatment for Anemia

Once the comprehensive review is completed for each patient, our doctors and our team of medical professionals will evaluate your diagnosis. At this point, our doctors will spend one on one time with you to interpret and explain your results. Together you will explore your goals and discuss your treatment plan options. These treatment plans can be implemented using multiple modalities such as medications, hormones, diet, supplements, behavior and lifestyle changes, and alternative therapies. Our doctors will prescribe a preventative and comprehensive treatment plan that is tailored to your needs and fits into your lifestyle.

Patients Medical’s  Personal Approach to Anemia

Our doctors and our team at Patients Medical will regularly monitor your progress and track the effectiveness of your program making adjustments if necessary. Our goal is to support you and advise you every step of the way.

We work in conjunction with your existing doctors. Any gaps between specialists are filled to ensure we support your overall health and well-being. While we treat serious medical conditions such as Alzheimer’s, Diabetes, Parkinson’s, Multiple Sclerosis, anxiety, depression, and heart disease; the primary objective of our staff is prevention and early detection of disease.

We are located at: Patients Medical PC, 800 Second Avenue, Suite 900 (Between 42nd & 43rd Street), Manhattan, New York, NY 10017.