BETA - What is a comprehensive metabolic panel test for?

Typically, in that panel, we will see the electrolytes and also the creatinine and BUN, so the kidney function and the electrolytes. Dexamethasone is a measure of the amount of sugar in the blood. As you know, in myeloma treatments, almost all the myeloma treatments have dexamethasone in it. Dexamethasone is known to increase the blood sugar. When we start patients on treatments with dexamethasone or other corticosteroids, we will typically check the blood sugars initially three times a day and make sure that they are not going too high. You do not want to have somebody go into a coma because the blood sugar is totally out of control, especially in diabetic patients. Calcium is a typical problem for myeloma because, as you know, myeloma cells destroy bone, and bone contains a lot of calcium, and that calcium is released in the blood. So when you have a high level of calcium in a myeloma patient, you can be sure that there is going to be a lot of breakdown of bone. And the high calcium levels cause problems. They can make people confused. They may make people go to the bathroom a lot, just like glucose that is out of control. They have to pee all the time and they dehydrate. And when they dehydrate, their kidney function can become poor and cause problems. So calcium is something that is typically related to multiple myeloma, and high calcium typically means that you have a high level of myeloma cells in your body that are destroying a lot of bone and releasing all that calcium of the destroyed bone into the bloodstream. If the calcium levels are over 10.5, it's something that should be looked at. If your calcium increases from 8 to 9, that doesn't mean anything. But if your calcium level is over 10.5 and especially over 12, that is certainly an emergency and should be looked at quickly. The albumin and the globulins are typically seen by protein electrophoresis, where you put blood or serum on the test kit, and then you see how quickly they migrate to the other pole. And the faster they migrate, the more they're going to be to the right, the slower they migrate, the more they're going to be to the left of the electrophoresis. And albumin is the major part of the total protein in the blood. And it should be around three and a half grams or more to be good. If it's lower than that, either you're losing a lot of albumin, mostly in the urine, sometimes in the bowel or urine bad general condition, and you don't make enough protein to get your albumin levels up. So typically when you have low albumin, those patients will have a poorer outcome with chemotherapy than those who have a normal albumin and are in good general condition. So it's a good measure of general condition of patients. The globulins, the ones that we are the most interested in, is the gamma globulin, which contains the immunoglobulins. So typically when the gamma globulins are high, you need to make sure that you do an electrophoresis and see whether this is a spike or whether this is a broad-based increase in gamma globulins. If it's a spike, then you obviously think myeloma, MGUS, smoldering myeloma, things like that. And typically when you have an IgG myeloma, it will be in the gamma region. If you have an IgA myeloma, it will be more in the beta globulin region. And IgM is in between. No, they can also be measured in the blood without doing a protein electrophoresis. But then you typically only have the albumin and the total globulins. But you have no idea whether it's alpha, beta or gamma globulins that are high, if the total globulins are high. Total protein is above the normal reference range. When it's above 10.5, something like that, then it's always a good idea to do a protein electrophoresis and see whether there's a spike in the either beta, when you have an IgA myeloma or gamma, when you have an IgG myeloma. And most of the people that are diagnosed with myeloma and have no symptoms are diagnosed because their total protein is up and somebody does a protein electrophoresis. The total protein is both together, the albumin and the globulins together. Sodium is salt. Typically, it's a mixture of the two. Sodium is salt. Typically, that is not very abnormal in patients with cancer or in most of the patients. What is much more common is that you have either a low or a high potassium. When you have a low potassium, it's usually due to diuretics or having laxatives or not taking in enough potassium. And that is important because a low potassium can cause heart problems, just like a high potassium can cause problems. High potassiums are usually related to kidney function. And when the potassium is high, one has to always check the kidney function and make sure that the potassium levels don't go too high because you will get arrhythmias if you have that. For potassium, if a potassium goes over five, it's too high. The carbon dioxide measures two things. One is the lung function and the other one is the kidney function. If you hyperventilate, your carbon dioxide typically will go down. If you don't breathe adequately because you are totally stuporous because of medications or whatever, then you typically will not breathe adequately and your CO2 will go up. Your carbon dioxide will go up. When your kidneys are failing, typically you will become a sedatic and your CO2 will be low. Chloride is the same as sodium. It's not something we pay a lot of attention to. BUN is the blood urea nitrogen concentration. And it was the first test for kidney function. Thereafter, people started to see that creatinine was actually a better way to measure kidney function than BUN. The only thing that was not good was the BUN. Creatinine is clearly elevated and creatinine is normal. That can be a sign that people are dehydrated and that they need more fluids. The BUN will go up faster if you dehydrate it and the creatinine will go up. Creatinine measures the kidney function. If the kidneys don't eliminate enough carbon dioxide, it will start to increase. Normal creatinine is up to 1.4 for males and 1.2 for females. So when it's higher than that, it means that the kidneys are not working well. That there is something going on and that you need to find a way to increase the creatinine. So you need to find a way to increase the creatinine. If the kidneys are not working well, that there is something going on and that you need to find out what the reason is. For example, if people are hypercalcemic, typically their creatinines will go up. If you have a creatinine that's high, you will have to adjust the dose of Revlimid. Not of thalidomide, but you will have to adjust the dose of Revlimid and decrease the dose of Revlimid because it's mainly excreted through the kidneys. If they're not working well, they will not eliminate it properly and it will start to accumulate. If you don't adjust it, the white blood cell count and platelet count will start to drop tremendously. Pomelist is not as bad as Revlimid, but still you need to keep an eye on and see whether the white blood cell count and the platelet count are not dropping too fast on Pomelist. The main thing is to find out why you have this elevated creatinine. Is it calcium? Is it amyloidosis? Is it lichen deposition disease? Or is it a myeloma kidney? The calcium you can find out in the blood, but for most of the other things you will have to do a kidney biopsy and see whether there is any evidence of those diseases. There are four typical liver tests. One is ALT, one is AST, one is bilirubin, and the fourth test is alkaline phosphatase. Alkaline phosphatase is made by bones and by the liver. So if alkaline phosphatase is high, there is even a higher risk of heart disease. In adults, there is something wrong with the liver. In children who make bone all the time, alkaline phosphatase will always be elevated. In adults, it should be within the normal range, unless there is something wrong with bones or there is something wrong with the liver. The way to know if there is something wrong with the liver is to look at the blood. The way to know if there is a liver problem or a bone problem is by doing another test called gamma-glutamyl transferase or GGT. When that is also elevated, you know it is a liver problem. If that is normal, it is a bone problem. Of the other tests, ALT is the most specific for the liver. AST can also be elevated in situations where there is muscle destruction. There is also another test called LDH, lactate dehydrogenase, which is also part of the liver functions, but this can do many more things than liver functions. There are five different forms of LDH. One, two, three, four and five. If fractions one and two are elevated, it is typically because there is a heart problem or there is hemolysis, meaning breakdown of the blood cells. When fractions four and five are up, it is typically the liver. When LDH fractions three or four are up, that is what we typically see in cancer. We all know that an elevated LDH in myeloma patients is a bad prognostic factor. Billiard-Rubin is also a liver function test, but can also be elevated when people have breakdown of blood or a congenital condition, which we call Gilbert's disease. The way to know whether it is related to the liver or not is to distinguish between direct and indirect Billiard-Rubin. If it is an indirect Billiard-Rubin, it has nothing to do with the liver. If the direct Billiard-Rubin is up, then you know it is related to the liver. The reference range is determined by looking at multiple patients, at least 100. What you do then, when you get them all together, is you cut off the lowest 2.5% and the highest 2.5%, so that you have the 95% in the middle. The reference range is from 2.5 to 97%. Every lab has a different reference range because they have somewhat different instrumentation and they have a different population that they have used to determine the reference range. The reference ranges are different by gender and also to some degree by ethnicity. For example, a cancer patient is a patient with a different gender, and typically males have a higher muscle mass than females. So the normal ranges for creatinine will be higher for males than they are for females. There are also differences in, for example, hemoglobin. Typically, women have a lower normal reference range than men. There are differences in gender in that, for example, the highest creatinines are found in African Americans, then in Caucasians, then in Hispanics, and the lowest creatinine levels are found in Asian people. And if we look at the different levels of creatinine, for example, for Asians, then in Hispanics, and the lowest creatinine levels are found in Asian people. And if we have a creatinine of 1.2 for an African American male, it's totally normal, but for a small Asian female, it may already be way too high because that Asian female has a much smaller muscle mass than the African American male. Also for hemoglobin 1AC, typically African Americans have higher normal values than Caucasians. Well, you want to know whether your white cell count, platelet count, and blood cell count are within normal range. You want to know what your creatinine is doing, whether that's in normal range. And you also want to know whether your ALT is within normal range. Those are the important things to do. If they are out of normal range, there's a problem. It needs to be looked at.