Neutrophils are a type of white blood cells, which protect the body against infectious agents by migrating toward

the source of irritation. Neutrophilia refers to a higher than normal number of neutrophils for age or sex of the individual. The increase in their number may be a result of a shift of cells from the capillaries and organs to the blood (shift neutrophilia) or from a true increase in their number caused by increased production (true neutrophilia). Shift neutrophilia is usually transient, may occur in association with vigorous exercise or stress (following meals, pregnancy, smoking, seizures or tachycardia) and usually lasts 20-30 minutes. True neutrophilia is usually related to infections and leads to increased production of cells in the marrow. If the demand of cells is high, immature neutrophils escape from the marrow into the blood (called a shift to the left in the differential count). Neutrophilia can occur from 1. Acute infections caused by bacteria (staphylococci, pneumococci, streptococci, meningococci, gonococci, Escherichia coli, Pseudomonas aeruginosa, Actinomyces species); certain fungi (Coccidioides immitis); spirochetes; viruses (rabies, poliomyelitis, herpes zoster, small pox, varicella); rickettsia; and parasites (liver fluke) 2. Non-infectious inflammatory states (like burns, post-operative state, acute myocardial infarction, acute attacks of gout, acute glomerulonephritis, intestinal obstruction, strangulated hernia, rheumatic fever, collagen vascular diseases, hypersensitivity reactions) 3. Metabolic states (diabetic ketoacidosis, pre-eclampsia, uraemia) 4. Poisoning 5. Acute haemorrhage (into body spaces such as the peritoneal cavity, pleural cavity, joint cavity, intracranial space 6. Myeloproliferative disorders (chronic myeloid leukaemia, polycythaemia vera, myelofibrosis, myeloid metaplasia) 7. Malignant tumours 8. Medications like acute or chronic administration of corticosteroids 9. Chronic idiopathic neutrophilia and Hereditary neutrophilia - neutrophilia present without an identifiable cause. As you can see the list of causes is large. You need a meticulous clinical examination followed by relevant investigations so that appropriate treatment can be instituted. It is important to remember that one treats an individual and not an abnormal test result.

Increased neutrophil count An increased need for neutrophils, as with an acute bacterial infection, will cause an increase in both the total number of mature neutrophils and the less mature bands or stabs to respond to the infection. The term "shift to the left" is often used when determining if a patient has an inflammatory process such as acute appendicitis or cholecystitis. This term is a holdover from days in which lab reports were written by hand. Bands or stabs, the less mature neutrophil forms, were written first on the lefthand side of the laboratory report. Today, the term "shift to the left" means that the bands or stabs have increased, indicating an infection in progress.

For example, a patient with acute appendicitis might have a "WBC count of 15,000 with 65% of the cells being mature neutrophils and an increase in stabs or band cells to 10%". This report is typical of a "shift to the left", and will be taken into consideration along with history and physical findings, to determine how the patient's appendicitis will be treated. ESR HIGH Yes, multiple joint pain could be due to arthritis, especially since it runs in thefamily. An ESR around 43 merely indicates a chronic disease in the body like arthritis. Multiple joint pain can be seen in hypothyroidism, low Vitamin D levels, Low Vit B12 levels, anemia, Hasimotos thyroiditis, gout, rheumatoid arthritis,osteoarthritis, SLE, electrolyte disturbance particularly those involving calcium and magnesium, parathyroid gland problems, chondrocalcinosis, fibromyalgia and chronic fatigue syndrome. All these can raise the ESR too. I think you should discuss these possibilities with your doctor (rheumatologist when you see him). It is difficult to comment beyond this without examining. A comprehensive investigation is required keeping all the points in mind. Hope this helps. Please let me know if there is any thing else and do keep me posted. Take care! What are triglycerides? Triglycerides are a type of fat found in your blood. Your body uses them for energy. You need some triglycerides for good health. But high triglycerides can raise your risk of heart disease and may be a sign of metabolic syndrome. Metabolic syndrome is the combination of high blood pressure, high blood sugar, too much fat around the waist, low HDL ("good") cholesterol, and high triglycerides. Metabolic syndrome increases your risk for heart disease, diabetes, and stroke. A blood test that measures your cholesterol also measures your triglycerides. For a general idea about your triglycerides level, compare your test results to the following:

Normal is less than 150. Borderline-high is 150 to 199. High is 200 to 499. Very high is 500 or higher.

What causes high triglycerides? High triglycerides are usually caused by other conditions, such as:

Obesity. Poorly controlled diabetes. An underactive thyroid (hypothyroidism). Kidney disease. Regularly eating more calories than you burn. Drinking a lot of alcohol.

Certain medicines may also raise triglycerides. These medicines include:

Tamoxifen. Steroids. Beta-blockers. Diuretics. Estrogen. Birth control pills.

In a few cases, high triglycerides also can run in families. What are the symptoms? High triglycerides usually don't cause symptoms. But if your high triglycerides are caused by a genetic condition, you may see fatty deposits under your skin. These are called xanthomas (say "zan-THOH-muhs"). How can you lower your high triglycerides? You can make diet and lifestyle changes to help lower your levels.

Stay at a healthy weight. Limit fats and sugars in your diet. Be more active. Quit smoking. Limit alcohol.

You also may need medicine to help lower your triglycerides, but your doctor likely will ask you to try diet and lifestyle changes first.

holesterol. The body uses cholesterol to help build cells and producehormones. Too much cholesterol in the blood can build up inside arteries, forming what is known as plaque. Large amounts of plaque increase your chances of having a heart attack or stroke. HDL (high-density lipoprotein) helps remove fat from the body by binding with it in the bloodstream and carrying it back to the liver for disposal. It is sometimes called "good" cholesterol. A high level of HDL cholesterol may lower your chances of developing heart disease or stroke. LDL (low-density lipoprotein) carries mostly fat and only a small amount of protein from the liver to other parts of the body. It is sometimes called "bad cholesterol." A high LDL cholesterol level may increase your chances of developing heart disease. VLDL: (very low-density lipoprotein) contains very little protein. The main purpose of VLDL is to distribute the triglyceride produced by your liver. A high VLDL cholesterol level can cause the buildup of cholesterol in your arteries and increases your risk of heart disease and stroke. Triglycerides are a type of fat the body uses to store energy and give energy to muscles. Only small amounts are found in the blood. Having a high triglyceride level along with a high LDL cholesterol may increase your chances of having heart disease more than having only a high LDL cholesterol level.

Some medical experts recommend routine cholesterol and triglyceride testing to screen for problems that affect the way cholesterol is produced, used, carried in the blood, or

disposed of by the body. Others may choose to routinely measure only total cholesterol and HDL levels. HOW TO REDUCE VLDL CHOLESTEROL The acronym VLDL stands for very-low-density lipoproteins. This is one of the three types of lipoproteins that flow through your body. The other two are high-density lipoproteins (HDL) and low-density lipoproteins (LDL). All three of these contain a combination of protein, cholesterol and triglycerides. Triglycerides are a type of blood fat that is found in high amounts in VLDL. According to the Mayo Clinic, by lowering your triglycerides, you also lower your VLDL cholesterol levels. This can be done by making several lifestyle adjustments. Step 1 Avoid simple carbs. Carbohydrates get converted to glucose in the body when you eat them. This in turn causes your blood sugar levels to rise and your pancreas releases insulin to stabilize your levels. Carbs that are "simple" cause a fast increase in blood sugar and a high release of insulin. This can cause your triglyceride levels to rise along with your VLDL. To lower your levels, avoid simple carbs in the form of white bread, candy, cakes, cookies, doughnuts and muffins. Also avoid sweetened beverages like soda and processed juices. Low GI Diet eBook Control blood sugar and reduce hunger to lose weight. Only $8.99 www.motleyhealth.com/lowGI Sponsored Links Step 2 Give up drinking alcohol. When consumed in moderation, alcohol does not cause a major impact on the body. But when you have high VLDL, you should avoid it altogether as it can raise your triglyceride levels. Step 3 Cut back on your overall calorie intake. Being overweight can increase your chances of VLDL and triglycerides elevating even higher. If you are overweight, aim to lose excess pounds to get down to your normal range. To lose a pound of weight a week, reduce your daily intake by 500 calories. In order to lose a pound, you must create a 3500 calorie deficit. Step 4 Increase your activity levels. Exercise cane help lower your VLDL levels and triglycerides, and it can also increase your HDL which is your good cholesterol. Get at least 30 minutes of moderate intensity activity daily. Examples of things you can do include running, weight training, biking, elliptical training, stair climbing and brisk walking. Step 5 Cut back on the fatty foods. Avoid foods that are high in saturated fat, trans fat and cholesterol. Examples of these include deep fried foods, processed meats like ham, bacon and cold cuts, eggs, sausage and whole-fat dairy products. How is it used? In adults and older children, bilirubin is measured to diagnose and/or monitor liver diseases, such as cirrhosis, hepatitis, or gallstones. It is also used to evaluate people with sickle cell disease or other causes of hemolytic anemia who may have episodes when excessive red blood cell destruction takes place, increasing bilirubin levels.

Bilirubin can be measured as a total level and/or as conjugated and unconjugated levels for these purposes. More commonly, the laboratory uses a chemical test to detect watersoluble forms of bilirubin, termed direct bilirubin, which is an estimate of the amount of conjugated bilirubin. By subtracting this from the total bilirubin, an indirect estimate (indirect bilirubin) of unconjugated bilirubin is obtained. In newborns with jaundice, bilirubin is measured to investigate the cause. Excessive unconjugated bilirubin damages developing brain cells in infants and may cause mental retardation, learning and developmental disabilities, hearing loss, or eye movement problems. It is important that an elevated level of bilirubin in a newborn be identified and quickly treated. In both physiologic jaundice of the newborn and hemolytic disease of the newborn, only unconjugated (indirect) bilirubin is increased. In the much less common cases of damage to the liver (neonatal hepatitis and biliary atresia), conjugated (direct) bilirubin elevations are present as well, often providing the first evidence that one of these less common conditions is present. ^ Back to top When is it ordered? A doctor usually orders a bilirubin test in conjunction with other laboratory tests (alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase) when someone shows signs of abnormal liver function. A bilirubin level may be ordered when a person: Shows evidence of jaundice Has a history of drinking excessive amounts of alcohol
Has suspected drug toxicity Has been exposed to hepatitis viruses

Other symptoms that may be present include:

Determining a bilirubin level in newborns with jaundice is considered standard medical care. The test may also be ordered when someone is suspected of having (or known to have) hemolytic anemia as a cause of anemia. In this case, it is often ordered along with other tests used to evaluate hemolysis, such as complete blood count,reticulocyte count, haptoglobin, and LDH.

^ Back to top What does the test result mean? Adults and children Increased total bilirubin that is mainly unconjugated (indirect) bilirubin may be a result of: Hemolytic or pernicious anemia Transfusion reaction Cirrhosis A common metabolic condition termed Gilbert syndrome, due to low levels of the enzyme that attaches sugar molecules to bilirubin If conjugated (direct) bilirubin is elevated more than unconjugated (indirect) bilirubin, there typically is a problem associated with decreased elimination of bilirubin by the liver cells. Some conditions that may cause this include: Viral hepatitis Drug reactions
Alcoholic liver disease

Conjugated (direct) bilirubin is also elevated more than unconjugated (indirect) bilirubin when there is some kind of blockage of the bile ducts. This may occur, for example, with:
Gallstones getting into the bile ducts Tumors Scarring of the bile ducts

Rare inherited disorders that cause abnormal bilirubin metabolism (Rotor, DubinJohnson, Crigler-Najjar syndromes) may also cause increased levels of bilirubin. Low levels of bilirubin are not generally a concern and are not monitored. Newborns An elevated bilirubin level in a newborn may be temporary and resolve itself within a few days to two weeks. However, if the bilirubin level is above a critical threshold or rapidly increases, an investigation of the cause is needed so appropriate treatment can be initiated. An elevated bilirubin level may result from the accelerated breakdown of red blood cells due to a blood type incompatibility between the mother and her newborn. Other causes include certain congenital infections,hypoxia, a number of different genetic disorders, and diseases that can affect the liver. In most of these conditions, only unconjugated (indirect) bilirubin is increased. An elevated conjugated (direct) bilirubin is

seen in the rare conditions of biliary atresia and neonatal hepatitis. Biliary atresia requires surgical intervention to prevent liver damage. ^ Back to top Is there anything else I should know? Although unconjugated bilirubin may be toxic to brain development in newborns (up to the age of about 24 weeks), high bilirubin in older children and adults does not pose the same threat. In older children and adults, the "blood-brain barrier" is more developed and prevents bilirubin from crossing this barrier to the brain cells. Elevated bilirubin levels in children or adults, however, strongly suggest a medical condition that must be evaluated and treated. Bilirubin is not normally present in the urine. However, conjugated bilirubin is watersoluble and therefore may be eliminated from the body in the urine when levels increase in the body. Its presence in the urine usually indicates blockage of liver or bile ducts, hepatitis or some other liver damage. The most common method for detecting urine bilirubin is the dipstick test that is part of a urinalysis. Bilirubin levels tend to be slightly higher in males than females, while African Americans show lower values. Strenuous exercise may also increase bilirubin levels. The drug atazanavir increases levels of unconjugated (indirect) bilirubin. Drugs that can decrease levels of total bilirubin include barbiturates, caffeine, penicillin, and high doses of salicylates.