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The treasure trove of blood chemistry… Neutrophil Lymphocyte Ratio (NLR)
By Dicken Weatherby, N.D. and Beth Ellen DiLuglio, MS, RDN, LDN
Blood carries everything from nutrients and oxygen, to clues that help practitioners solve the puzzle of disease and dysfunction. This is where functional blood chemistry analysis can help more fully evaluate a patient’s condition.
Using a readily available CBC with differentiation report, a practitioner can assess the neutrophil to lymphocyte ratio (NLR), a marker of systemic inflammation associated with more severe disease and complications.
In general, a higher NLR correlates with poor prognosis and higher mortality rates, even when white blood cell count is normal. Elevated NLR is associated with an increased probability of bacterial infection and lower probability of viral infection.
Neutrophils and lymphocytes participate in cell-mediated inflammatory responses and an increased NLR is associated with elevated inflammatory markers including tumor necrosis factor alpha, IL-6, IL7, IL-8, IL-12, and IL-17. 
Accumulating research suggests an association between an elevated NLR and worse outcomes for several cancers including breast, ovarian, gastroesophageal, pancreas, colon, colorectal, hepatocellular, biliary tract, kidney, and urothelium.   An elevated NLR also appears to reflect more aggressive disease associated with advanced tumor stage and metastases and reduced overall survival  
Increased ratio of neutrophils to lymphocytes is also observed in congestive heart failure, atherosclerotic changes, cardiovascular disease, diabetes mellitus, hypertension, severe acute pancreatitis, sepsis, and septic shock.     
Clinicians should investigate NLR values of greater than 2.2 in order to identify the potential significance of neutrophil lymphocyte ratios in their patients. A detailed account of a patient’s medical history and current symptomatology, along with further blood chemistry analysis, will help bring a patient’s full clinical picture into focus.
Calculating The Ratio - Let ODX Do the Work!
Good news! The Neutrophil:Lymphocyte ratio is now being automatically calculated by the Optimal DX software if both the absolute counts for Neutrophils and Lymphocytes are added into the system. No need to do any conversions as the software will do this for you and will now show the result in the Blood Test Results Report:
However, if you simply want to do the calculation manually then please follow these instructions:
- First off, the Neutrophil and Lymphocyte count must be the Absolute count and not the % count.
- If you only have the % count for neutrophils and lymphocytes along with the Total WBC count, you can calculate the absolute count:
(Total WBC count X % count for neutrophil or Lymphocyte) / 100
- For our example below: Total WBCs 5, Neutrophils 65% and Lymphocytes 30%
- Calculate absolute count for neutrophils: (5 x 65%) / 100 = 3.25
- Calculate absolute count for lymphocytes: (5 x 30%) / 100 = 1.5
- The neutrophil:Lymphocyte ratio is calculated by dividing the absolute count for neutrophils by the absolute count for lymphocytes.
- Using the example above, the Neutrophil:Lymphocyte ratio would be calculated as 3.25 / 1.5 = 2.17
Want to give the Neutrophil:Lymphocyte Ratio a test drive?
CLICK HERE to set up your FREE TRIAL today!
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