General Instructions for Patients Receiving Chemotherapy:

• Monitoring a patient’s laboratory values is an important part of monitoring for side effects of therapy and/or the disease. Your laboratory results are reviewed by a provider and abnormal results will be reported to the patient. If you would like to keep track of your lab values, we encourage you to use the patient portal.
• Due to the effects of chemotherapy on your bone marrow, you will need to have your blood checked prior to the beginning of each treatment cycle, at a minimum, and possibly more frequently depending on your chemotherapy regimen.  
• If you have an appointment to see the provider, we would ask that you come 20 minutes prior to your appointment time, to have your blood drawn. The results will be processed and would be available for review within 20-60 minutes, depending on what is ordered and how busy the laboratory machine is processing other blood samples.
• If you have a Vascular Access Device (VAD) such as an implantable port, or PICC, you will be taken to a room in the chemotherapy suite to have your blood drawn by a nurse. Your appointment will be made on the “VAD” schedule instead of the “Lab” schedule.
• If you do not have a VAD or you have an implantable port and are not due for treatment, you will be taken to the lab and your blood will be obtained from your arm veins or your finger by a laboratory technician. Your appointment will be made on the “Lab” schedule.
• If your laboratory results are within a specific range, determined by your physician, you will receive your scheduled treatment. If your laboratory results fall outside the parameters, the nurse will consult with the physician for further instructions.

General Instructions for Patients on routine follow-up (not on treatment):

• The cancer patient not on treatment, requires monitoring on a periodic basis, to monitor the status of the cancer/hematology diagnosis and for monitoring of side-effects from prior therapy.  
• If the lab results are not available by the end of your appointment, once the physician has reviewed those results and releases them, you will be able to view them on your patient portal. If there are abnormal results that your physician wishes to discuss, a nurse or physician will call you with an explanation and instructions.
   

The complete blood count provides the count of each type of blood cell in the circulation and measurements of different characteristics of the red blood cell and white blood cell. 

Components of the CBC:

• White Blood Cell (WBC) count: The white blood cell count is the total number of five types of white blood cells (leukocytes) in the blood. The white blood cell count is a general indicator of infection, inflammation, or bone marrow activity. This is expressed as 1/1000 of the total value (multiple the white blood cell count by 1000 to get the actual value).
• Neutrophils: Neutrophils are the cells that are most active in fighting bacterial infections. This value is expressed as a percentage of the entire white blood cell count. Neutrophils may be elevated in response to infection or when a person receives a growth factor medication (i.e. Neupogen or Neulasta), which is designed to stimulate the bone marrow to produce more neutrophils. Neutrophils may be decreased after a severe infection or when the bone marrow is damaged by chemotherapy. When the neutrophils are extremely low, a person is at risk of infection because the body does not have the cells needed to fight the infection.
• Lymphocytes: Lymphocytes recognize foreign cells in the blood and attack and destroy them or carry them to the lymph system to be destroyed. These cells make antibodies against foreign matter. This value is expressed as a percentage of the entire white blood cell count.
• Monocytes: Monocytes remove debris and foreign particles from the blood, and they participate in the immune response. This value is expressed as a percentage of the entire white blood cell count.
• Eosinophils: Eosinophils are cells that contain toxic substances used to kill foreign cells in the blood. This value is expressed as a percentage of the entire white blood cell count.
• Basophils: Basophils are activated during allergic reactions and anaphylaxis. This value is expressed as a percentage of the entire white blood cell.
• Differential: A complete blood count with a differential provides the counts of each type of white blood cell. An “auto diff” or automated differential is performed by a machine and a manual diff is performed by a technician looking at the blood under a microscope.
• Absolute Neutrophil Count (ANC): This value is the total number of neutrophils and is calculated by multiplying the percentage of neutrophils by the total white blood cell count.
• Red Blood Cell (RBC) count: The red blood cells (erythrocytes) carry oxygen from the lungs to the cells and transport carbon dioxide from the cells to the lungs. Red blood cells normally live 120 days in the bloodstream. When the red blood cells are destroyed faster than the body can replace them, anemia can result.
• Hemoglobin (Hgb): Hemoglobin is the oxygen-carrying compound in each red blood cell, consisting of the protein, globin, and the iron-containing pigment, heme.
• Hematocrit (Hct): Hematocrit is a measurement of the proportion of whole blood volume occupied by the red blood cells, expressed as a percentage (i.e. Hct of 40 indicates that 40% of the cells in the complete blood count are red blood cells). 
• Mean corpuscular volume (MCV): MCV is the average size of the red blood cells.
• Mean corpuscular hemoglobin (MCH): MCH is the weight of hemoglobin in the average red blood cell.
• Mean corpuscular hemoglobin concentration (MCHC): MCHC is the average concentration (percentage) of hemoglobin in the red blood cells.
• Red cell distribution width (RDW): RDW is the numeric calculation of the range of sizes of red blood cells. An elevated RDW, meaning the red blood cells vary greatly in size, is very common for patients undergoing chemotherapy and may be an early indicator of anemia.
• Platelet count (PLT): Platelets initiate the process of coagulation. When a cut occurs, platelets rush to the opening in the blood vessel and plug the opening.
   

The chemistry panel provides your physician with information regarding your general health. They help evaluate the body’s electrolyte balance and/or the status of several major body organs.

Components of a chemistry panel:

• Glucose - A simple sugar that the body makes from the food in the diet. Glucose is carried through the bloodstream to provide energy to all cells in the body. Cells cannot use glucose without the help of insulin. The body produces glucose from protein, fat, and carbohydrates. Ingested glucose is absorbed directly into the blood from the intestine. Fasting blood sugar or glucose levels are used to diagnose and manage diabetes mellitus. Certain medications that are commonly used during cancer treatment can elevate the glucose level such as corticosteroids.
• Calcium - One of the essential mineral elements in the body. Most of the calcium is concentrated in the bone but it is present in the blood as well. Calcium is essential for healthy bones and is also important for muscle contraction, heart action, and normal blood clotting. Food sources of calcium include dairy foods, some leafy green vegetables, canned salmon, clams, oysters, calcium-fortified foods, and soy foods.

Proteins:

• Globulin - Group of proteins in the bloodstream that help to regulate the function of the circulatory system. There are four basic groups of globulin proteins known as alpha-1, alpha-2, beta, and gamma proteins. These are used to help transport proteins through the lipoproteins and assist the blood in clotting. They also act as plasma cells which indicate whether there is an antibody deficiency in the bloodstream. The level of these proteins is measured against the levels of albumin, the other major type of protein in the bloodstream. A specific ratio is needed to maintain healthy circulatory function.
• Albumin - The main protein in human blood and is made by the liver as well as supplied in certain foods such as milk and eggs. Albumin plays essential roles in the body including proper distribution of liquids between the different structures like the blood vessels, tissues, and the space that separates them called the interstitial space. It also conveys a certain number of hormones, fatty acids, and bilirubin. The measurement of albumin is useful in the evaluation of the nutritional status of the body. The measurement of albumin levels assists your physician in the evaluation of the effects caused by renal and other chronic diseases.
• Total protein - Total serum protein measures the total amount of protein in the blood. It also measures the amounts of two major groups of proteins in the blood: albumin and globulin.    

Electrolytes:

• Sodium - Is both an electrolyte and a mineral. Serum sodium levels are used to monitor electrolyte balance, water balance, and acid-base balance in the body. The serum sodium levels are also used in the evaluation of disorders in the central nervous system, musculoskeletal disorders, or diseases of the kidneys or adrenal glands.
• Potassium - Is both an electrolyte and a mineral and is essential for proper muscle and nerve function. It also helps move nutrients into cells and waste products out of cells. Serum potassium levels are used to evaluate electrolyte balance, acid-base balance, hypertension, kidney disease or kidney failure, and endocrine disease.
• Chloride - Works with other electrolytes such as potassium, sodium, and carbon dioxide (CO2). These substances help keep the proper balance of body fluids and maintain the body’s acid-base balance.
• Carbon Dioxide (CO2) - Serum carbon dioxide is a measure of the combined forms of carbon dioxide transported in the blood. It is part of a bicarbonate-carbonic acid buffer necessary to maintain the acid-base balance in the body. The lungs regulate the level of carbon dioxide in the body and the kidneys regulate the concentration of bicarbonate.
• Phosphorus - A mineral that makes up 1% of a person’s total body weight. It is vital to several of the body’s physiologic processes. It helps with bone growth, energy storage, and nerve and muscle production. 

Kidney Tests:

• Blood Urea Nitrogen (BUN) - Urea nitrogen is a normal waste product in the blood that comes from the breakdown of protein from the foods you eat and from your body's metabolism. It is normally removed from your blood by the kidneys, but when kidney function slows down, the BUN level rises. BUN can also rise if you eat more protein, and it can fall if you eat less protein. 
• Creatinine - A waste product in your blood that comes from muscle activity. It is normally removed from your blood by your kidneys, but when kidney function slows down, the creatinine level rises.  

Liver Tests:

• Bilirubin - A bile pigment that is orange-yellow in color. It is formed during the normal breakdown of red blood cells. After circulating in your blood, bilirubin then travels to the liver. In the liver, bilirubin is excreted into the bile duct and stored in the gallbladder. Bilirubin can be classified as indirect (free or unconjugated) while it is circulating and is considered as direct after conjugation in the liver with glucuronic acid. The purpose of the total bilirubin test is to evaluate liver function.
• Alkaline phosphatase (ALP) - Made mostly in the liver and in bone with some made in the intestines, kidneys, and by the placenta in a pregnant woman. An ALP test measures the amount of the enzyme ALP in the blood and is used to evaluate liver function and may serve as a nonspecific tumor marker, which may indicate rapid cell growth or accelerated function due to malignancy of the liver or bone.
• Aspartate Aminotransferase (AST-formally called serum glutamic oxaloacetic transaminase (SGOT)) - Enzyme found in red blood cells, liver, heart, muscle tissue, pancreas, and kidneys. AST is an indicator of inflammation, injury, or death of the tissues that contain the enzyme. It can also be used to monitor liver function.
• Alanine Aminotransferase (ALT-formally known as serum glutamic pyruvic transaminase (SGPT) - Enzyme found mainly in the liver, but also in smaller amounts in the kidneys, heart, muscles, and pancreas. ALT is measured to see if the liver is damaged or diseased. Low levels of ALT are normally found in the blood, but when the liver is damaged or diseased, it releases ALT into the bloodstream, which makes ALT levels go up. 

 Additional tests:

• Lactic acid dehydrogenase (LDH) - An enzyme that helps produce energy. It is present in almost all of the tissues in the body and its levels rise in response to cell damage. LDH levels help diagnose lung disease, lymphoma, anemia, and liver disease. They also help determine how well chemotherapy is working during lymphoma treatment.
• Uric Acid - Produced from the natural breakdown of your body’s cells and from the foods you eat. Most of the uric acid is filtered out by the kidneys and passes out of the body in urine. A small amount passes out of the body in the stool. If too much uric acid is being produced, or if the kidneys are unable to remove it from the blood normally, the level of uric acid in the blood increases. High levels of uric acid in the blood can cause solid crystals to form within joints and this painful condition is called gout.  High levels of uric acid may also cause kidney stones or kidney failure.
   

Tumor markers are substances that are produced by cancer or by other cells of the body in response to cancer or certain benign (noncancerous) conditions. Most tumor markers are made by normal cells as well as by cancer cells; however, they are produced at much higher levels in cancerous conditions.

• Carcinoembryonic antigen (CEA): CEA is normally produced during the development of a fetus. The production of CEA stops before birth and it usually is not present in the blood of healthy adults. The CEA test measures the amount of this protein that may appear in the blood of some people who have certain kinds of cancers, especially colorectal cancer. It may also be present in ovarian cancer, lung cancer, breast cancer, gallbladder, and pancreas cancers. If elevated, it can be used to monitor response or lack thereof, to chemotherapy, radiation, and/or surgery. If it rises from normal to an elevated level it can indicate relapsed disease.
• Cancer Antigen 125 (CA-125): CA-125 is a protein found in small amounts in normal tissue and on the surface of certain cancer cells. It is primarily elevated in ovarian cancer. Lung cancer and breast cancer may also show elevations, as well as some of the gastrointestinal cancers such as pancreatic and gallbladder. If elevated, it can be used to monitor response or lack thereof, to chemotherapy radiation, and/or surgery. If it rises from normal to an elevated level it can indicate relapsed disease.
• Cancer Antigen 27.29 (CA 27.29): CA 27.29 is a monoclonal antibody that is a specific type of protein that is produced by a gene called MUC-1. These proteins are glycoproteins that are present on the surface of epithelial cells like breast cancer cells. Breast cancer cells can shed copies of the CA 27.29 protein into the bloodstream. If elevated, it can be used to monitor response or lack thereof, to chemotherapy radiation, and/or surgery. If it rises from normal to an elevated level it can indicate relapsed disease.
• Cancer Antigen 15-3 (CA15-3): CA 15-3 is a protein that is a normal product of breast tissue. It is commonly elevated in breast cancer. If elevated, it can be used to monitor response or lack thereof, to chemotherapy radiation, and/or surgery. If it rises from normal to an elevated level it can indicate relapsed disease.
• Cancer Antigen 19-9 (CA19-9): Antigen found to be elevated in many epithelial cancers. It is commonly elevated in pancreatic cancer and some gastrointestinal cancers such as gallbladder. If elevated, it can be used to monitor response or lack thereof, to chemotherapy radiation, and/or surgery. If it rises from normal to an elevated level it can indicate relapsed disease.
• Prostate-specific antigen (PSA): is a protein that at an elevated level may be a sign of prostate cancer. A high reading may also indicate noncancerous conditions such as inflammation or enlargement of the prostate. If diagnosed with prostate cancer, PSA may be used to monitor the disease.