NACB - Scientific Shorts
NACB - Scientific Shorts (formerly NACB Blog)
By William Winter, MD, DABCC, FACB

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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Posted by
On 4/22/2011

NYS's lab oversight program has been advising certain "fringe" practitioners regarding the unapproved status of this test and levying sanctions accordingly; basically NYS takes the same stand as CLIA. LBA users have been unable to sunstantiate analytical and clinical validity for the procedure using generally accepted standards, and is certainly not used as a screening test, since the test results in the "diagnosis" of a problem and in most cases, the recommendation for some sort of supplements. The U Penn comment regarding LBA replacing other conventional (and validated) tests is a mockery of lab science. This comment was approved by the NACBLOG editorial board. Please remember to add your name and affiliation!

Posted by
On 4/21/2011

Te LBA test is the greatest screening test available to diagnose all kinds of digestive and nutritional diseases and more! According to the link above, it potentially obviates the following tests: 1) Automated CBC with blood cell indices with statisticall valid MCV, MPV, etc 2) Manual differential and observations of stained glass slide, including looking for macro or microcytosis, anisocytosis, hypochromia, neutrophil hypersegmentation, Heinz bodies, rouleaux, etc 3) Platelet aggregometry 4) Vitamin B12 and folate measurements 5) Liver function tests 6) Lipoprotein electrophoresis and ultracentrifugation, LDL- and HDL-cholesterol measurements 7) Fecal fat and triolein, xylose absorption tests 8) Screening for inflammation with ESR or CRP 9) Allergen profiling tests 10) Lymphocyte phenotyping with flow-cytometry and lymphocyte activation tests In addition it provides unique information on neutrophil mobility, a clear problem in depressed patients, and on increased eosinophils and basophils, which the authors have correlated with allergies. It can diagnose the 90% of individuals in the community that have nutritional deficiencies, and based on "stickyness" propose nutritional supplements and low dose aspirin to correct the problem. It can suggest the presence of an abnormal intestinal flora which may be an indication for stopping chemotherapy or providing some herbs and probiotics. It clearly indicates defects in immunity which can be easily treated with herbal immunostimulants. Worried about the scientific validity of this test? Look no further than the references in the link, including the landmark publication by Pinskaia, et al, Khirurgiia (Mosk), 1973; 49(3): 24-7. I am sure the authors of the link will be able to provide you with countless other publications suporting the superior accuracy of this screening test. Jorge Sepulveda, U. Pennsylvania William Winter's response to this comment: Response - The reference cited supporting the use of "Live Blood Analysis" (Pinskaia, et al, Khirurgiia (Mosk), 1973; 49(3): 24-7) is found in PubMed. However since this reference 38 years ago, there are no references in PubMed concerning the "Bolen" test. If this test were clinically valid, I would expect continued publications on the topic and evidence-based medicine studies to support its use. In the absence of such data, it can only be concluded that - "Live blood analysis" (as described in the internet reference in the article) has no scientific usefulness for the diagnosis or management of disease.

Posted by
On 4/12/2011

Tammy from Reid Hospital, Richmond IN gave a link to our website earlier which gave some information on the benefits of a LBA done properly. As any test this should be done by a technical or scientific officer with haematology training. It is most useful for identification of gastro-intestinal tract dysfunction and nutritional deficiencies. It is not to my knowledge possible to gain any insight into thyroid function. The HLB however is a very different test and is based on the Bolan's Clot Retraction Test. There are ref's in PubMed on this test which was originally a test for neoplasm detection. Jennie Burke Australian Biologics Testing Services

Posted by
On 4/10/2011

while I agree that LBT test in it's current form and practice lacks scientific credibility, be mindful of a very rapidly growing literature around the analysis of extracellular exosomes (aka microbodies, prostasomes, etc) are being shown to have significance in a number of diseases. While LBT may fall short of sophisticated analyses of these components in blood and other biological fluids, there is fairly compelling evidence that they harbor specific diagnostic information ranging from prion-related conditions to malignancies. M. Fritzler PhD MD William Winter's Response to this comment: "Live blood analysis" (according to the internet reference in the article), is the observation of clotted blood under the microscope. "Live blood analysis" has nothing to do with exosomes.

Posted by
On 4/10/2011

A manual diff would NOT be a live cell analysis because we kill those poor cells when we spread them on a slide, allow them to dry, pickle them in alcohol and then stain them. I suppose an MCV determined by an instrument is a live cell analysis since we do nothing more than dilute them and run them past a laser or an electrical current. K. Doig, Michigan State University