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Clinical · Bloodwork

Building a sensible monitoring schedule with your prescriber

SG
s.grimaldiTL2 Moderator17 Dec 2024#1

Building a sensible monitoring schedule with your prescriber — setting out what I have, and where I think it stops being reliable.

General question, not a request for advice about my own care — I know the difference and I would rather be told to see my prescriber than get an answer that pretends otherwise.

I have a panel in front of me with one value outside the reference interval and everything else within it. My instinct is that a single out-of-range result on a single draw is close to uninformative, and I would like to understand how the people who read these professionally think about that.

What I am actually asking is how to tell an interesting result from an uninteresting one before booking an appointment about it.

25 likes 19mo
R
RidgewayTL3Regular17 Dec 2024#2

I disagree with the reply above, and I think the disagreement is substantive rather than terminological.

The distinction being drawn does not survive when you look at the published data for this specific question. I would be glad to be shown wrong on this, because the version I am arguing against is more convenient.

5 likes 19mo
IG
i.grimaldiTL2 Moderator17 Dec 2024#3
Ridgeway, post #2: I disagree with the reply above, and I think the disagreement is substantive rather than terminological. The distinction being drawn does not survive when you look at the published data for this specific question. I would be glad to be shown wrong on this, because the version I am arguing against is more convenient. Go to post

Fasting state: some lab tests require fasting; others do not. Lipids on a fasting draw differ from lipids on a fed draw. Always note whether the test was fasting when comparing results.

0 likes in reply to #2 19mo
EF
erratum_fileTL3Regular17 Dec 2024 · edited#4

Time of day: some biomarkers vary across the day. Cortisol in the morning differs from cortisol in the evening. Comparing results from different times of day is comparing things that are not the same.

0 likes 19mo
AC
a.cabreraTL2 Moderator17 Dec 2024#5

Liver enzymes: elevation does not specify cause. ALT and AST can rise from many things. Bilirubin helps narrow down the cause. Multiple markers together are more informative than one alone.

19 likes 19mo
CD
c.draganovTL1Member17 Dec 2024#6
s.grimaldi, post #1: Building a sensible monitoring schedule with your prescriber — setting out what I have, and where I think it stops being reliable. General question, not a request for advice about my own care — I know the difference and I would rather be told to see my prescriber than get an answer that pretends otherwise. I have a panel in front of me… Go to post

TSH and free hormones: TSH is a reasonable screening test but does not tell you about actual free hormone levels. If TSH is abnormal, free thyroid hormones confirm whether there is a real thyroid problem.

8 likes in reply to #1 19mo
VK
v.kjaerTL2 Moderator18 Dec 2024#7
a.cabrera, post #5: Liver enzymes: elevation does not specify cause. ALT and AST can rise from many things. Bilirubin helps narrow down the cause. Multiple markers together are more informative than one alone. Go to post

Practical note that does not fit anywhere else. Whatever you conclude from this topic, write down what you did and when. The single most useful thing in your own records is not any individual result; it is that they are dated and consecutive.

2 likes in reply to #5 19mo
DB
d.bramleyTL3Regular18 Dec 2024#8

post #7 answers the question as asked. The question underneath it is different.

A single value outside interval: usually uninformative on a single draw. What makes a result interesting: a trend across multiple draws, a magnitude well beyond the interval, a pattern that coheres with other values, or symptoms that fit.

0 likes 19mo
MD
m.dumitruTL218 Dec 2024#9
DW
diluent_watchTL2Member18 Dec 2024#10
m.dumitru, post #9: HbA1c and glucose: HbA1c reflects average glucose over months; a spot glucose measurement reflects the moment. Trending glucose downward while HbA1c stays flat is a different picture than glucose going up with HbA1c. Go to post

This follows post #7 rather than contradicting it.

Lipid panel interpretation: total, LDL, HDL, triglycerides all on one panel. Reading them together is more informative than reading one value in isolation. An elevated triglyceride with low HDL is different from triglyceride elevation alone.

13 likes in reply to #9 19mo
BK
b.kowalskiTL2 Moderator18 Dec 2024#11

For anyone arriving from a search: the marked solution above is the direct answer, and the replies underneath it add the caveats that make it safe to use.

30 likes 19mo
JW
journalclub_wrenTL3Regular18 Dec 2024#12

I read post #10 twice before replying, because I had assumed the opposite.

Renal function markers: eGFR is estimated, not measured. It depends on creatinine, age, and weight. A small change in creatinine might not mean a real change in kidney function.

0 likes 19mo
HA
h.agyemanTL2 Moderator18 Dec 2024#13

post #12 is right about the mechanism and I think understates the practical bit.

Analytical imprecision: any measurement has an error margin. A small difference in consecutive tests is usually measurement noise, not a real change. Knowing the imprecision helps distinguish noise from signal.

3 likes 19mo
DH
dietitian_hollisTL3Dietitian18 Dec 2024#14
Ridgeway, post #2: I disagree with the reply above, and I think the disagreement is substantive rather than terminological. The distinction being drawn does not survive when you look at the published data for this specific question. I would be glad to be shown wrong on this, because the version I am arguing against is more convenient. Go to post

Reference intervals: constructed to contain the central 95% of a reference population, which means one in twenty healthy people falls outside one by definition. Add biological variation and analytical imprecision and the base rate of a meaningless flag is substantial.

10 likes in reply to #2 19mo
SV
s.vukovicTL2 Moderator18 Dec 2024#15

A single value outside interval: usually uninformative on a single draw. What makes a result interesting: a trend across multiple draws, a magnitude well beyond the interval, a pattern that coheres with other values, or symptoms that fit.

0 likes 19mo
SB
sharps_binTL2Regular18 Dec 2024#16

Reference intervals: constructed to contain the central 95% of a reference population, which means one in twenty healthy people falls outside one by definition. Add biological variation and analytical imprecision and the base rate of a meaningless flag is substantial.

0 likes 19mo
NC
n.cabreraTL2 Moderator18 Dec 2024 · edited#17
h.agyeman, post #13: post #12 is right about the mechanism and I think understates the practical bit. Analytical imprecision: any measurement has an error margin. A small difference in consecutive tests is usually measurement noise, not a real change. Knowing the imprecision helps distinguish noise from signal. Go to post

post #16 answers the question as asked. The question underneath it is different.

TSH and free hormones: TSH is a reasonable screening test but does not tell you about actual free hormone levels. If TSH is abnormal, free thyroid hormones confirm whether there is a real thyroid problem.

5 likes in reply to #13 19mo
SS
steady_stateTL3Regular18 Dec 2024#18
n.cabrera, post #17: post #16 answers the question as asked. The question underneath it is different. TSH and free hormones: TSH is a reasonable screening test but does not tell you about actual free hormone levels. If TSH is abnormal, free thyroid hormones confirm whether there is a real thyroid problem. Go to post

On post #14 — agreed on the reasoning, with one qualification.

Liver enzymes: elevation does not specify cause. ALT and AST can rise from many things. Bilirubin helps narrow down the cause. Multiple markers together are more informative than one alone.

15 likes in reply to #17 19mo
GA
g.amankwahTL2 Moderator18 Dec 2024#19
i.grimaldi, post #3: Fasting state: some lab tests require fasting; others do not. Lipids on a fasting draw differ from lipids on a fed draw. Always note whether the test was fasting when comparing results. Go to post

Biological variation: the person-to-person variation in a biomarker for a healthy person is larger than most people realize. Comparing your result to the reference interval is one thing; comparing your result today to your result from months ago is more sensitive to change.

0 likes in reply to #3 19mo
CT
cannula_traceTL318 Dec 2024#20
VM
v.malinowskiTL2 Moderator19 Dec 2024#21

I read post #19 twice before replying, because I had assumed the opposite.

Fasting state: some lab tests require fasting; others do not. Lipids on a fasting draw differ from lipids on a fed draw. Always note whether the test was fasting when comparing results.

0 likes 19mo
VS
vial_slopeTL3Regular19 Dec 2024#22

This follows post #19 rather than contradicting it.

I disagree with the reply above, and I think the disagreement is substantive rather than terminological.

The distinction being drawn does not survive when you look at the published data for this specific question. I would be glad to be shown wrong on this, because the version I am arguing against is more convenient.

22 likes 19mo
SD
s.demirTL2 Moderator19 Dec 2024#23

Time of day: some biomarkers vary across the day. Cortisol in the morning differs from cortisol in the evening. Comparing results from different times of day is comparing things that are not the same.

6 likes 19mo
LP
l.parkinsonTL2Member19 Dec 2024 · edited#24
vial_slope, post #22: This follows post #19 rather than contradicting it. I disagree with the reply above, and I think the disagreement is substantive rather than terminological. The distinction being drawn does not survive when you look at the published data for this specific question. I would be glad to be shown wrong on this, because the version I am… Go to post

HbA1c and glucose: HbA1c reflects average glucose over months; a spot glucose measurement reflects the moment. Trending glucose downward while HbA1c stays flat is a different picture than glucose going up with HbA1c.

1 like in reply to #22 19mo
MN
ma.nascimentoTL2 Moderator19 Dec 2024#25

Practical note that does not fit anywhere else. Whatever you conclude from this topic, write down what you did and when. The single most useful thing in your own records is not any individual result; it is that they are dated and consecutive.

31 likes 19mo
CP
citation_peakTL3Regular19 Dec 2024#26

Picking up post #23: that is the part I would want checked first.

Renal function markers: eGFR is estimated, not measured. It depends on creatinine, age, and weight. A small change in creatinine might not mean a real change in kidney function.

16 likes 19mo
FY
f.yildizTL2 Moderator19 Dec 2024#27
s.grimaldi, post #1: Building a sensible monitoring schedule with your prescriber — setting out what I have, and where I think it stops being reliable. General question, not a request for advice about my own care — I know the difference and I would rather be told to see my prescriber than get an answer that pretends otherwise. I have a panel in front of me… Go to post

Lipid panel interpretation: total, LDL, HDL, triglycerides all on one panel. Reading them together is more informative than reading one value in isolation. An elevated triglyceride with low HDL is different from triglyceride elevation alone.

3 likes in reply to #1 19mo
W
WendelboeTL2Member19 Dec 2024#28
vial_slope, post #22: This follows post #19 rather than contradicting it. I disagree with the reply above, and I think the disagreement is substantive rather than terminological. The distinction being drawn does not survive when you look at the published data for this specific question. I would be glad to be shown wrong on this, because the version I am… Go to post

HbA1c and glucose: HbA1c reflects average glucose over months; a spot glucose measurement reflects the moment. Trending glucose downward while HbA1c stays flat is a different picture than glucose going up with HbA1c.

0 likes in reply to #22 19mo
ZS
z.szaboTL2 Moderator19 Dec 2024#29

Lipid panel interpretation: total, LDL, HDL, triglycerides all on one panel. Reading them together is more informative than reading one value in isolation. An elevated triglyceride with low HDL is different from triglyceride elevation alone.

1 like 19mo
ER
eire_readerTL2Regional · IE19 Dec 2024#30

Renal function markers: eGFR is estimated, not measured. It depends on creatinine, age, and weight. A small change in creatinine might not mean a real change in kidney function.

0 likes 19mo