American Association for Clinical Chemistry
Better health through laboratory medicine
NACB - Scientific Shorts
NACB - Scientific Shorts (formerly NACB Blog)
By William Winter, MD, DABCC, FACB
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In a case reviewed by a state board of medicine, a woman of retirement age complained of "cramping from her knees to her hips" of several years duration. On physical examination, the patient had apparent weakness in her left arm with her right arm folded across her abdomen. However, there was no weakness in the left arm if the patient's right arm was at her side. After placing an unknown quantity of thyroid hormone under patient's tongue, the clinician noted that the weakness resolved.

 

The diagnosis of hypothyroidism was made by the clinician. No formal thyroid function tests were obtained. However, the following tests were ordered: HLB Live Blood Test, a LBA Part II Live Blood Test, and a urinary Indican Test.

 

Questions With Resolution (updated 4/11/11)

What is a HLB Live Blood Test?

According to a internet reference, "HLB" are the initials of the last names of three physicians who developed a dried blood examination technique between the 1930s and 1950s (Dr Heinz Heitan, Dr Philippe de LaGarde och, and Dr H Leonard Bolen). A search of PubMed for "HLB liver blood test" revealed no hits.

In this test, a drop of dried capillary blood is applied to a glass slide and is allowed to dry. The slide is then examined under the microscope for the pattern of red blood cell clustering and fibrin net formation. Healthy blood was said to spread evenly across the slide when dried.

Review of the the web sites for several major reference laboratories (eg, ARUP, Mayo Medical Laboratory, Quest Diagnostics) revealed no listing for an "HLB live blood test."

What is a LBA Part II Live Blood Test?

Apparently this is the same test as the HLB live blood test except that the slide is examined using a dark field technique. This test was not listed as an orderable test by several major reference laboratories (eg, ARUP, Mayo Medical Laboratory, Quest Diagnostics).

What is a urinary indican test?

Tryptophan in the gut is converted by intestinal bacteria to indole. Indole is absorbed from the intestine. The liver then solublizes indole by hydroxylation followed by sulfation (forming indican - a.k.a. - indoxyl sulfate) or by glucuronidation with excretion in the urine. Therefore, indican excretion in the urine is proposed as a reflection of intestinal bacterial activity. However, elevated levels of urinary indican are found in many conditions including: inflammatory bowel disease, celiac disease, hypo and achlorhydria, gastric ulcer, postgastrectomy, biliary and intestinal obstruction, pancreatic insufficiency jejunal diverticulosis, decreased peristalsis, small intestinal hypermotility, scleroderma, Hartnup disease and blue diaper syndrome. Qualitative urinary indicans is measured by ARUP.

Is this an appropriate evaluation for suspected hypothyroidism?

Live blood testing is not scientific and is considered to be a form of unproven or fraudulent medical testing. While the measurement of urinary indicant is a legitimate test, such testing has no role in the evaluation of patients with suspected thyroid dysfunction.

Note in closing - In the state where this case occurred, the physician was alleged to have provided substandard medical care because he/she failed to perform an appropriate physical examination (including palpation of the neck) and he/she diagnosed hypothyroidism without a proper evaluation.

 

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