How should I interpret a fasting glucose of 108 mg/dL, serum albumin 5.2 g/dL, alkaline phosphatase 112 U/L, RBC count 5.92 ×10⁶/µL, hematocrit 79 %, and MCH 26.5 pg, and what work‑up and management are recommended?

Laboratory Interpretation and Clinical Management

Immediate Assessment

Your fasting glucose of 108 mg/dL places you in the impaired fasting glucose (prediabetes) category, requiring lifestyle intervention and repeat testing to confirm the diagnosis. 1

Glucose Interpretation

Your fasting glucose of 108 mg/dL falls into the impaired fasting glucose range (100-125 mg/dL), which represents an intermediate metabolic state between normal glucose homeostasis and diabetes. 1, 2

• Normal fasting glucose is defined as <100 mg/dL 1
• Impaired fasting glucose (prediabetes) is 100-125 mg/dL 1, 2
• Diabetes diagnosis requires fasting plasma glucose ≥126 mg/dL on two separate occasions 1

The diagnosis should be confirmed by repeating the fasting plasma glucose test on a different day, as biological variation can cause a single value at 108 mg/dL to range from approximately 100-116 mg/dL (95% confidence interval). 1

Risk Implications

Patients with impaired fasting glucose have significantly elevated risk for progression to diabetes and cardiovascular events. 2, 3 Research demonstrates that fasting glucose levels >100 mg/dL show a continuous increase in risk of ischemic cerebrovascular disease, with an odds ratio of 1.27 for the 100-109 mg/dL range compared to 90-99 mg/dL. 3

Albumin Interpretation

Your serum albumin of 5.2 g/dL is elevated above the normal range (typically 3.5-5.0 g/dL). This elevation most commonly indicates:

• Dehydration (most likely cause of isolated elevation)
• Hemoconcentration from volume depletion

The elevated albumin should prompt assessment of hydration status and consideration of whether the blood sample was drawn after prolonged fasting or with tourniquet application. 4

Alkaline Phosphatase Interpretation

Your alkaline phosphatase of 112 U/L is mildly elevated (normal range typically 30-120 U/L, though this varies by laboratory and age).

In the context of impaired fasting glucose, this finding warrants attention because elevated alkaline phosphatase in diabetic patients often reflects bone-fraction isoenzyme elevation, which correlates with the severity of glucose dysregulation. 5 The mean fasting glucose is significantly higher in diabetic patients with elevated alkaline phosphatase, supporting an association with diabetic bone disease. 5

Hematologic Parameters

Critical Finding: Hematocrit 79%

Your hematocrit of 79.2% is severely elevated and represents a medical emergency requiring immediate evaluation. Normal hematocrit ranges are approximately 38-50% for men and 36-44% for women.

This extreme elevation suggests:

• Severe polycythemia (primary or secondary)
• Critical dehydration/hemoconcentration (though this alone rarely causes such extreme elevation)
• Laboratory error (must be excluded first)

Immediate actions required:

• Repeat complete blood count immediately to exclude laboratory error
• If confirmed, urgent hematology consultation
• Assessment for hyperviscosity symptoms (headache, visual changes, thrombotic events)
• Evaluation for underlying causes (polycythemia vera, chronic hypoxemia, erythropoietin-secreting tumors)

RBC and MCH

Your RBC count of 5.92 ×10⁶/µL is elevated (normal range approximately 4.5-5.5 for men, 4.0-5.0 for women), consistent with the elevated hematocrit. 4

Your MCH of 26.5 pg is at the lower end of normal (27-31 pg), suggesting the red blood cells are slightly hypochromic. This pattern (elevated RBC count with low-normal MCH) can occur in polycythemia or iron deficiency states.

Recommended Work-up

Immediate Priority

1. Repeat hematocrit/CBC stat to confirm the critically elevated value
2. Peripheral blood smear if hematocrit confirmed elevated
3. Erythropoietin level, JAK2 mutation testing if polycythemia confirmed
4. Oxygen saturation and arterial blood gas to assess for hypoxemia

Glucose Management

1. Repeat fasting plasma glucose within 1-2 weeks to confirm impaired fasting glucose diagnosis 1
2. HbA1c measurement to assess longer-term glycemic control 1
3. Lipid panel (total cholesterol, LDL, HDL, triglycerides) as dyslipidemia commonly coexists 1, 2
4. Blood pressure measurement to screen for hypertension 1, 2
5. Calculate BMI and assess for obesity 2

Additional Evaluation

1. Liver function tests (AST, ALT, GGT, bilirubin) to further characterize the alkaline phosphatase elevation
2. Alkaline phosphatase isoenzymes if liver tests are normal, to confirm bone origin 5
3. Comprehensive metabolic panel including creatinine to assess renal function
4. Assessment of hydration status to explain elevated albumin

Management Recommendations

Lifestyle Intervention (Primary Treatment)

You should lose 5-7% of your body weight and engage in at least 150 minutes of moderate physical activity per week. 2 This approach is more effective than pharmacologic therapy for preventing progression to diabetes.

Monitoring

• Repeat fasting glucose or HbA1c at least annually, or every 3 years if initial confirmation testing shows values closer to normal 1, 2
• Screen for cardiovascular risk factors including blood pressure and lipids 1, 2

Pharmacologic Consideration

Metformin may be considered for diabetes prevention, though lifestyle modification is superior and should be attempted first. 2 Metformin is most appropriate for patients with BMI >35 kg/m², age <60 years, or history of gestational diabetes. 2

Critical Caveat

The severely elevated hematocrit takes absolute priority over all other findings and requires immediate attention before addressing the glucose abnormality or other laboratory values.