profiles have become a fashion in the medical
circles. SMA 12/60 or SMA 18 or SMA 26 or any
form of SMA you ask for and it is available with
Pathologists or private hospitals and
Since the Arabs, in addition
to a specific illness, often come for a routine
health check up, such tests are being asked for
very frequently. Fifteen years back when I saw my
first Arab patient, this facility was not
available. In the last ten years, however, I must
have asked for these tests in more than two
thousand five hundred Arabs. There is a tendency
amongst the doctors to label their patients as
suffering from a disease, diagnosed, by the
presence of an abnormal SMA 12 report. In many of
such patients, a lot of undesired anxiety and
mental trauma have been caused.
are the factors which can alter the readings of
SMA 12 reports
Arabs do not give their blood sample
"fasting" as required for the
laboratory procedure. This is either due to
language problem or more often because the
patient does not realise the importance of total
fasting. A 'non-fasting' specimen often shows
raised 'levels' of the following:
they are labelled as "abnormal"
on a number of occasions, the patient can be
helped to get rid of his anxiety by coaxing him
to repeat the blood test (which many Arab
patients, specially females, grumble to do) on a
'proper' empty stomach.
that usually an Arab does not like to re-visit
the same laboratory.
number of pathological laboratories are located
on fifth or sixth stored and facilities for the
use of the elevator are not adequate. Many a
times, the Arabs do not mind climbing the steps.
Off and on, these patients' blood reports will
show elevated C.P.K. levels after visiting such a
laboratory. Strenuous exercise not only elevates
blood levels of C.P.K. but can also raise
creatinine or uric acid levels of blood.
Haemolysis in blood can occur from a venepuncture
or an improper collection of blood and the blood
report mav show the following high levels
liver" is over-diagnosed in
Arabs because of the reports of abnormal levels
of liver function tests. These patients are
afraid of the harmful effects of the alcohol.
Thus, the anxiety created by this diagnosis often
compels such a patient to have a second opinion.
Very often I find that he has had a heavy bout of
alcohol the previous night but he is not an
levels of the following blood constituents can
occur after a heavy alcoholic bout:
Arab patients go to more than one laboratory.
When they see the conflicting reports, they fly
into a rage. They have to be convinced that no
two laboratories give the same report.
following are the additional factors which will
help in calming down the Arab patient while
interpreting SMA 12 reports.
sensitive is this test that in a patient
suspected to have secondary deposits in the liver
even if all imaging tests like isotope liver
scan, sonography and computerized tomography of
the liver are found normal. a raised alkaline
phosphatase would call for a liver biopsy.
in an obstruction of the common bile duct, I have
off and on seen this enzyme rising without
elevated serum bilirubin.
the reason for the elevation of serum alkaline
phosphatase can be suspected, to be due to any of
them are on injection therapy of Androgens.
chlorpropamide for control of diabetes. This is
the most popular therapy for diabetes in Arab
population. (It should not be forgotten that
diabetes itself can cause elevated levels of
serum alkaline phosphatase).
patients, especially from Bahrain, Saudi and
Qatar have been consuming Methyldopa, which is a
popular drug for long-term treatment of
patients have been consuming tablets containing
serum alkaline phosphatase is one of the most
notorious tests, known for being reported as
"high" for "no obvious
reason". I have found this in about ten to
fifteen percent patients of mine.
can pick up the disease of haemolytic anaemia
from raised levels of L.D.H. After the other
causes of elevated L.D.H. mentioned above are
ruled out, tests like sickle cell test,
Haemoglobin electrophoresis and G6PD levels
should always,be asked for specially if the
reticulocyte count is high.
levels are found so commonly in elderly Arabs and
are a normal phenomenon at this age. Also,
because of the dietetic habits, these levels are
lower in Yemenis.
S.G.O.T. levels can often be seen in Arabs
because of the following
- Use of
injections of androgens for sex weakness.
investigations have been done where
radioopaque contrast media have been
used. The most common investigation in
such patients is intravenous pyelography.
who have been on Methyldopa therapy for
who have been consuming sedatives like
a number of patients, I found the levels of
S.G.O.T. slightly elevated for no reason at all.
If all other tests are normal, I am not disturbed
by a reading of S.G.O.T. upto 50 units.
occasions I picked up patients with raised
creatinine levels and labelled as chronic renal
failure, consuming clofibrate for hyperlipedemia.
Once in a while use of methyldopa can also
elevate creatinine levels.
the factors mentioned above, one of the common
causes of an elevated reading of C.P.K. is the
intramuscular injections (of tonics etc.), which
these patients have been on, and which the Arab
population is very fond of.
very sensitive test for diagnosis of an
"alcoholic", off and on, I find it
elevated in many others and often in young Arab
women who have never tasted alcohol. Also, a
single heavy bout of alcohol can cause its
elevation by "enzyme induction".
subject has been discussed in detail in the
chapter on Diabetes.
say here that I have often found readings of
blood glucose elevated in SMA 12 reports upto 130
mg in patients, whose full blood sugar curve done
later, showed no evidence of diabetes.
ulcer syndrome is extremely common in this
population. Also most of them consume a lot of
antacids and one may be tempted to blame the
antacids for an incidentally raised B.U.N.
important to realise that you would over-diagnose
this condition unless the following levels are
also found elevated:
population, as mentioned elsewhere, does not
believe in taking "long-term treatment"
the above situation is rare.
A few Arabs
would be seen where the mildly elevated B.U.N. is
due to one of the following:
where radio opaque contrast media were
used (e.g. I.V.P.)
on methyldopa therapy
on long-term thiazide therapy
(Nephril-popular at Bahrain) for
all the above factors are absent and the blood
creatinine levels are normal, levels of B.U.N.
upto 25 mg can be passed off as normal. Of
course, it will be worthwhile asking for
creatinine clearance levels in these patients, to
make doubly sure of the diagnosis.
to causes mentioned above, increased bilirubin
levels are a common indication of presence of
haemolytic anaemias in Arab population. Off and
on I have investigated these patients
thoroughlyand detected the following causes
resulting in rise of bilirubin
on injections of Androgens.
having had investigations where radio
opaque contrast media were used.
who were on Nitrofurantoin or
chlordiazopoxide, or methyldopa therapy.
all the above causes have been excluded,
bilirubin levels upto 1.2 mg can be accepted as
normal in these patients.
drugs like methyldopa, thiazide or other
diuretics, which these patients are consuming,
off and on can raise uric acid levels, I find
levels upto 8 or 8.5 mg. in this population as
the variations discussed above, occasionally you
would spot a patient where the level of serum
calcium was more than 11 mg. and he is on high
doses of "Androgenic steroid" therapy
which is known to raise serum calcium. Also after
seeing and investigating hundreds of patients
with renal stones (to exclude
hyperparathyroidism), I have come to the
conclusion that in a thoroughly investigated case
(including blood P.T.H levels), one should not
mind accepting levels of serum calcium upto 11.2
or 11.3 mgm as normal, in this population.
would stress that the problems of blood chemistry
and SMA 12 reports are more in Arab population,
because they are fond of investigations. Moment
they find a laboratory reporting more number of
tests, they would like to visit the same.