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Labs Interpretation

Adrenocorticotropic Hormone (ATCH)  

 

Description
ACTH is created in the pituitary gland in response to another hormone, corticotropin-releasing hormone (CRH), by the hypothalamus. When this occurs adrenal glands make a hormone called cortisol, which helps the body manage stress. Cortisol is important for life, and its levels in the blood are closely controlled. When cortisol levels rise, ACTH levels fall. When cortisol levels fall, ACTH levels normally rise. ACTH level is normally highest in the early morning and lowest in the evening. Also ACTH is released in bursts, and consequently its levels in the blood can vary from minute to minute. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm.

Purpose of the test
This test measures the level of adrenocorticotropic hormone (ACTH) in the blood to check for problems with the pituitary gland or the adrenal glands. A test to measure ACTH is done to check for: A problem with the adrenal glands or pituitary gland. A high level of ACTH and a low level of cortisol (or low ACTH and high cortisol levels) could be caused by a problem with the adrenal glands. Low levels of ACTH and cortisol could be caused by a problem with the pituitary gland. Overproduction of ACTH. This may be caused by an overactive pituitary gland. In response, the adrenal glands release too much cortisol (one form of Cushing's syndrome).

Reference range values:
6 a.m. to 8 a.m. < 80 pg/mL (< 18 pmol/L)
6 p.m. to 11 p.m. < 50 pg/mL ( < 11 pmol/L)

Abnormal findings:
High levels of ACTH may be caused by:
- Emotional or physical stress.
- Addison's disease, Cushing's disease, or a tumor in the adrenal glands or the pituitary gland.
Low levels of ACTH may be caused by:
- Damage to the pituitary gland.
- An increased amount of cortisol from a tumor in the adrenal glands (Cushing's syndrome).

AFP Tumor Markers

Known as: AFP, Total AFP, AFP-L3%
Formal name: Alpha-fetoprotein, Alpha-fetoprotein-L3%
Purpose
AFP is a protein produced by fetal tissue (especially the liver) and by tumors. Increased amounts of AFP are found in the vast majority of patients with a type of liver cancer called hepatocellular carcinoma.
They are also found in some patients with cancer of the testes and ovaries.
AFP exists in several different variants. Traditionally when a doctor orders an AFP test, he is ordering a total AFP, one that measures all of the AFP variants together. This is the primary AFP test in the United States.
One of the variants is called L3 because of its ability, in the laboratory, to bind to a particular protein called Lens culinaris agglutinin. The AFP-L3% test is a new test that compares the amount of total AFP to the amount of AFP-L3.
An increase in the percentage of L3 to total AFP is associated with increased risk of developing hepatocellular carcinoma in the near future and of having a poorer prognosis, as the L3-related cancers tend to be more aggressive.
The AFP-L3% test is being ordered by a few doctors in the U.S. and is in wider use in some other countries, such as Japan.

How is it used?
AFP is used to detect tumors that mark cancers of the liver, testes, and ovaries. Patients with chronic liver diseases such as cirrhosis or chronic hepatitis B must be monitored at regular intervals because they have a lifetime risk of developing liver cancer. A doctor may order an AFP test, along with imaging studies, to try to detect liver cancer when it is in its earliest, and most treatable, stages. An AFP-L3% test may be ordered by some doctors to help further evaluate the risk of patients with chronic liver disease developing hepatocellular carcinoma in the near future.
If a patient has been diagnosed with hepatocellular carcinoma or another form of cancer, an AFP test may be ordered periodically to help monitor a patient's response to therapy.

Alanine Aminotransferase (ALT, SGPT, GPT)

Description
Alternative name: Serum glutamic-pyruvic transaminase, SGPT.
It is an enzyme that is present in liver and heart. Also in the kidneys and muscles. Also present in high concentration into blood when heart or liver are damaged (hepatitis or heart attack for example). Some medications also increase ALT concentration in blood.
Its concentration is measured by means of analysis of a blood sample drawn from vein in the arm.

Purpose of the test
The main purpose of the test is to check for high levels of ALT, as a result of liver or heart damage.
Normally concentration in blood of ALT is low. When liver or heart suffer damage as a result, for example, of hepatitis virus or heart attack ALT is released into blood flux.
This high level of ALT is previous to other visible effects as yellow color on the eyes and skin (jaundice), nausea, vomiting, dark urine, abdominal pain, abdominal swelling and unusual weight gain. This test is also prescribed to persons who:

  • have a history of known or possible exposure to hepatitis viruses,
  • drink too much alcohol
  • have families with history of liver disease
  • take drugs that might occasionally damage the liver.
ALT concentration is compared to levels of other enzymes, such as alkaline phosphatase (ALP) and aspartate aminotransferase (AST), to determine what kind of health problem is present.
Reference range values (North America)
6 - 41 units per liter (U/L)
Abnormal findings Increased in: Acute viral hepatitis (ALT>AST), Biliary tract obstruction (cholangitis, choledocholithiasis), Alcoholic hepatitis and cirrhosis (AST>ALT), liver abscess, metastatic or primary liver cancer; Right heart failure, Ischemia or hypoxia, Injury to liver ("shock liver"), extensive trauma. Drugs causing cholestasis and other hepatotoxic drugs.
Very high levels of ALT are caused by:
  • Severe liver damage, such as viral hepatitis (ALT>AST) 
  • Lead poisoning.
  • Drug.
  • Exposure to carbon tetrachloride.
  • Decay of a large tumor.
  • Shock liver
High ALT levels are caused by:
  • Mononucleosis.
  • Hepatitis.
  • Alcoholism.
Slightly high levels ALT levels are caused by:
  • Fatty deposits in liver.
  • Aspirin, statins, antibiotics, chemotherapy, narcotics, and barbiturates.
  • Chronic liver diseases, such as cirrhosis.

Albumin

Description Albumin is an important protein present in the blood plasma. It prevents fluid from leaking out of blood vessels Also it transports substances such as hormones, vitamins, drugs, and ions like calcium. Albumin is produced in the liver, and its concentration is sensitive to liver damage. Its concentration is measured by means of analysis of a blood sample drawn from vein in the arm.
Purpose of the test This test helps detecting a liver disease such as kidney disease. It is also applied in order to evaluate nutritional status. It is prescribed when you have a rapid weight change, or prior to a planned surgery. Albumin concentration drops with damaged liver or kidney disease also when a person is malnourished or experiences inflammation in the body, or shock. Albumin increases when a person is dehydrated. Albumin testing is used in a variety of situations to diagnose disease and to monitor changes in health status with treatment. Doctor orders a blood albumin test after symptoms of liver disorder or nephrotic syndrome.  Also in order to check a person's nutritional status, for example, after an important lose of weight.
Reference range values (North America)
3.7-4.7 g/L
Abnormal findings  
Increased 
Dehydration,
shock,
hemoconcentration. 
Decreased in:
Decreased hepatic synthesis (chronic liver disease, malnutrition, malabsorption, malignancy, congenital analbuminemia [rare]).  
Increased losses (nephrotic syndrome, burns, trauma, hemorrhage with fluid replacement, fistulae, enteropathy, acute or chronic glomerulonephritis).  
Hemodilution (pregnancy, CHF).
Drugs (eg, estrogens).
Additional: Serum albumin gives an indication of severity in chronic liver disease. Useful in nutritional assessment if no impairment in production or increased loss.

Alkaline Phosphatase

Description This test is prescribed to monitor results of treatment for liver or bone disorder. Alkaline phosphatase (ALP) is an enzyme. Different kinds of this protein are present on different parts of the body.   The different forms of ALP are called isoenzymes.  ALP is found especially in bone cells and liver cells. Smaller amounts of ALP are present in the placenta and in the bowels. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm.
Purpose of the test The measurement of the ALP protein concentration in blood is import to determine whether a person has certain types of liver disease. Very high ALP levels can mean that bile ducts are blocked. ALP is also high in persons who have cancer that has spread to the liver or the bones. If the person recovers from the illness, ALP levels decrease. ALP is generally proposed as part of a set of test in order to determine liver or bone disorder.
Reference range values Person over 18 years old :      37 – 116 U/L Below 18 years old (U/L) : Male:
1D-30D         75 - 316
31D-365D     82 - 383
1Y-3Y          104 - 345
4Y-6Y           93 - 309
7Y-9Y           86 - 315
10Y-12Y       42 - 362
13Y-15Y       74 - 390
16Y-18Y       52 – 171
Female:
1D-30D              48 - 406
31D-365D           124 - 341
1Y-3Y                108 - 317
4Y-6Y                96 - 297
7Y-9Y                69 - 325
10Y-12Y             51 - 332
13Y-15Y             50 - 162
16Y-18Y             47 – 119
Abnormal findings High ALP levels usually can mean: ·         Bone or liver damage. o       If bilirubin test, AST test, or ALT test are also high it can mean liver damage. o       If calcium and phosphate measurements are abnormal it can mean bone damage. ·         Use of psychiatric drugs. Increased 
Obstructive hepatobiliary disease, hepatotoxic drugs, bone disease (physiologic bone growth, Paget's disease, osteomalacia, osteogenic sarcoma, bone metastases),
hyperparathyroidism, rickets. Benign familial hyperphosphatasemia, pregnancy (3rd trimester), GI disease (perforated ulcer or infarct).  Decreased in: Hypophosphatasia. Additional: Normal in osteoporosis. Alkaline phosphatase isoenzyme separation by electrophoresis or differential heat inactivation is unreliable. Use g-glutamyl transpeptidase (GGT), which increases in hepatobiliary disease, to infer origin of increased alkaline phosphatase (ie, liver or bone).

Allergy Testing

Known as: Allergy screen Formal name: Allergen-specific IgE antibody test
Purpose: Immunoglobulin E (IgE) is a protein associated with allergic reactions; it is normally found in very small amounts in the blood. IgE is an antibody that functions as part of the body's immune system, its defense against "intruders." When someone with a predisposition to allergies is exposed to a potential allergen (such as food, grass, or animal dander) for the first time, they become sensitized. Their body perceives the potential allergen as a foreign substance and produces a specific IgE antibody that binds to mast cells (specialized cells in your tissues) and basophils (a type of white blood cell) in your blood stream. The mast cells are found in tissues throughout your body but are highest in concentration in your skin, respiratory system, and gastrointestinal tract. With the next exposure, these attached IgE antibodies recognize the allergen and cause the mast and basophil cells to release histamine and other chemicals, resulting in an allergic reaction that begins at the exposure site. The allergen-specific IgE antibody test is used to screen for an allergy to a specific allergen. It measures the amount of that suspected IgE antibody in the blood. Each selection is one separate test, and the tests are very specific: honeybee versus bumblebee, egg white versus egg yolk, giant ragweed versus western ragweed. Groupings of these tests, such as food panels or regional weed, grass, and mold panels, can be done. Alternatively, you and your doctor may pick and choose selectively from a long list of individual allergens suspected of causing your allergies. The allergen-specific IgE test can be done using a variety of methods. The traditional method that has been used is the RAST (radioallergosorbent test), but it has been largely replaced in most laboratories with the newer IgE-specific immunoassay method. Some doctors refer to all IgE allergy tests as RAST even though this is a specific methodology and may not be the exact assay that the testing lab is using.
How is it used? The allergen-specific IgE antibody test is done to screen for an allergy (a type I hypersensitivity) to a specific substance or substances when a patient presents with acute or chronic allergy-like symptoms. The allergen-specific IgE antibody test may be done (instead of other medically supervised allergy testing) when the patient has significant dermatitis or eczema (also a sign of allergies), is taking necessary histamines or anti-depressants that would make other testing more difficult, or if a dangerous allergic reaction could be expected to follow another test. The allergen-specific IgE antibody test may also be done to monitor immunotherapy or to see if a child has outgrown an allergy, although it can only be used in a general way; the level of IgE present does not correlate to the severity of an allergic reaction, and someone who has outgrown an allergy may have a positive IgE for many years afterward.

Alpha-1 Antitrypsin

Description Alpha-1 antitrypsin (AAT) is a protein produced in the liver and released into the blood. This test is prescribed to search the origin of early onset emphysema and/or liver disorder. Also in order to the check risk of developing alpha-1 antitrypsin-related emphysema and/or liver disease in persons with close relatives affected by these problems. AAT concentration is measured by means of analysis of a blood sample drawn from vein in the arm.
Purpose of the test AAT helps to block certain proteins called enzymes, for example elastase. Elastase is produced by neutrophils.  It destroys proteins and its concentration is regulated by AAT.   In case of lack of AAT, elastase can cause damage lung tissue.  This problem is normally associated with a genetic disease, which causes risk of emphysema in early adulthood. In case of abnormal AAT production, this protein accumulates in the liver and can damage it. Different AAT tests are used to measure the amount and type of AAT present and determine the genetic problems which are related: Alpha-1 Antitrypsin: Test that measures concentration of AAT
Alpha-1 Antitrypsin Phenotype: Test that determines the different variants of AAT
Alpha-1 Antitrypsin DNA testing: In order to identify which protease inhibitor gene mutations are present.
Reference range values 89 – 199 mg/dL
Abnormal findings
Low AAT levels usually mean:
  • risk of emphysema
  • risk of Liver disease
How low the levels are and how abnormal the AAT is determines the higher the risk is. DNA Testing indicating presence of one or two abnormal copies of Pi gene means less AAT and abnormal AAT is produced.   Nevertheless people with the same gene copies may have different disease developed.
Other situations on which low AAT levels are obtained are:
  • neonatal respiratory distress syndrome 
  • kidney disease
  • malnutrition
  • some cancers
High AAT levels can mean:
  • Important or chronic inflammatory conditions, infections and some kind of cancers
  • Effect of oral contraceptives, pregnancy, stress, and thyroid infections

Alpha-fetoprotein

Description This test serves to monitor results of treatment for liver, testes or ovaries cancer. AFP is a protein produced by tumors and by fetal tissue. High AFP concentrations are found on testes and ovaries, cancer and on hepatocellular carcinoma. This cancer is usually developed by people with chronic damage of the liver, called cirrhosis.  This is mostly caused by chronic infection from hepatitis B or hepatitis C virus. Alcohol also increases the risk of cirrhosis There are different AFP types that are measured on the same test: Total AFP test. Another different test is AFP-L3% test.   It compares the ratio between total AFP and an important variant of AFP called L3.  A high L3 concentration is related to risk of hepatocellular carcinoma. Tests are performed by means of analysis of a blood sample drawn from the vein in the arm.
Purpose of the test AFP tests are used to detect tumors on the liver, testes, and ovaries. They are prescribed in patients with chronic liver diseases such as cirrhosis or chronic hepatitis B, due to their increased risk o developing these types of cancers. An AFP test tries to detect liver cancer at its earliest stages. Also it serves to monitor evolution of disease with therapy. An AFP-L3% test may be ordered to determine the risk of patients with chronic liver disease developing hepatocellular carcinoma.
Reference range values 0.6 - 6.6 mcg/L
Abnormal findings
High AFP levels can mean:
  • liver, testes or ovary cancer
  • cirrhosis, hepatitis
  • stomach, colon, lung or breast cancers or lymphoma
High AFP and L3% levels in a patient with chronic liver disease means an increased risk of developing hepatocellular carcinoma in less than two years. Higher the AFP level in patients with cancer, bigger the tumor. AFP levels are higher also in pregnant women and in newborns

Ammonia

Description Ammonia is produced by digestion of protein. It is normally transported to the liver, where it is transformed into urea and glutamine. Urea is evacuated from the blood by means of the kidneys and finally excreted in the urine. If the decomposition of ammonia is incomplete it increases its concentration in the blood and passes through the blood/brain barrier causing severe problems such as hepatic encephalopathy, that leads to confusion, sleepiness, and eventually to coma and death. Children with high ammonia levels vomit frequently, are irritable, and can be increasingly lethargic. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Ammonia tests on arterial blood are told to be more useful but there is no agreement on this respect.
Purpose of the test To meassure concentration of Amonia in blood in order to detect several possible problems such as severe liver disease, renal failure, and others in patients who experiment changes in consciousness, severe liver problems and other symtoms. Also help to detect  hepatic encephalopathy and Reye's syndrome.
Reference range values
11 – 35 mcmol/L
Abnormal findings
 High levels of amonia can be caused by:
In infanta:
  • inherited urea cycle enzyme deficiency or defect.
  • hemolytic disease of the newborn.
Also high ammonia levels and decreased glucose levels may indicate presence of Reye's syndrome in symptomatic children and adolescents. Both in children and adults, high levels of ammonia can also indicate liver or kidney damage. High levels of amonia can also be caused by: ·        Gastrointestinal bleeding ·        Muscular exertion ·        Drugs : including  alcohol, barbiturates, diuretics, valproic acid, and narcotics ·        Smoking Low levels of ammonia can be the result of: ·        hypertension ·        use of some antibiotics, such as neomycin

Amylase

Description Amylase is usually present in the blood and urine. It is produced by the pancreas, as many other enzimes, and helps digesting fats, proteins and carbohydrates. If pancreas`s cells are damaged or the pancreatic duct is closed, this enzyme increases its concentration in the blood and the urine. Amylase is produced also by salivary glands. Amylase blood analysis is ordered when a patient has symptoms of a pancreatic problems such us abdominal pain, fever, loss of appetite, or nausea.  Also an urine amylase test may be ordered in orther to monitor the evolution of the disease with the treatment. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm.  Also can be meassured by an urine sample.
Purpose of the test Amylase test measures the concentration of amylase in the blood or urine. It helps to diagnose and monitor pancreatitis or other pancreatic problems. Amylase tests are also used to monitor pancreas cancer treatment and after removal of gallstones on  gallbladder attacks.
Reference range values 25 – 115 U/L
Abnormal findings High levels of blood amylase can be caused by: ·        acute pancreatitis ·        chronic pancreatitis ·        pancreatic duct obstruction ·        cancer of the pancreas High levels of blood or urine amylase can also be caused by: ·        ovarian cancer ·        lung cancer ·        tubal pregnancy ·        mumps ·        intestinal obstruction ·        perforated Low levels of blood and urine amylase can be caused by permanent damage to the amylase-producing cells in the pancreas. High levels of blood amylase together with low values of urine amylase can be caused by decreased kidney.

ANA

Known as: Antinuclear Antibody test, Fluorescent Antinuclear Antibody, FANA, Extractable Nuclear Antigen Antibodies, ENA
Description  Heterogeneous antibodies to nuclear antigens (DNA and RNA, histone and nonhistone proteins).
Antinuclear antibody is measured in patient's serum by layering serum over human epithelial cells and detecting the antibody with fluorescein-conjugated
polyvalent anti-human immunoglobulin.
How is it used? The ANA test is ordered to help screen for autoimmune disorders and is most often used as one of the tests to diagnose systemic lupus erythematosus (SLE). Depending on the patient's symptoms and the suspected diagnosis, ANA may be ordered along with one or more other autoantibody tests. Other laboratory tests associated with presence of inflammation, such as erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP) may also be ordered. ANA may be followed by additional tests that are considered subsets of the general ANA test and that are used in conjunction with the patient's clinical history to help rule out a diagnosis of other autoimmune disorders.
Normal
Range: < 1:20 Elevated in: 1/3-3/4 of patients over age 65 (usually in low titers), systemic lupus erythematosus (98%), drug-induced lupus (100%), Sj?gren's (80%), rheumatoid arthritis (30-50%), scleroderma (60%), mixed connective tissue disease (100%),
Felty's syndrome, mononucleosis, hepatic or biliary cirrhosis, hepatitis, leukemia, myasthenia gravis, dermatomyositis, polymyositis, chronic renal failure.  Additional: A negative ANA test does not completely rule out SLE, but alternative diagnoses should be considered. Pattern of staining of ANA may give some clues to diagnoses,
but since the pattern also changes with serum dilution, it is not routinely reported. Only the rim (peripheral) pattern is highly specific (for SLE).
Not useful as a screening test. Should be used only when there is clinical evidence of a connective tissue disease    

ANCA (antineutrophil cytoplasmic antibodies), P-ANCA (perinuclear) C-ANCA (cytoplasmic)

Tests are on the blood serum.

C-ANCA is most seen in Wegener's granulomatosus.

C-ANCA suggests a systemic vasculitis disease, and is rarely seen in patients with lupus.

P-ANCA is most seen in necrotizing, crescentic glomerulonephritis and polyarteritis nodosa.

P-ANCA is found in some lupus patients.

Normal Range: none present 

Anti-Phospholipid ( Anti-Cardiolipin )

Anticardiolipin antibodies are a subset of a group of antibodies which react with negatively charged phospholipids.

Antibodies to cardiolipin have been associated with an incresased incidence of vascular thrombosis, thrombocytopenia and recurrent fetal loss in patients with SLE.

Normal Range for anti-IgG: 0 - 20 GPL
Normal Range for anti-IgM: 0 - 10 MPL

Increased in:

SLE,

some connective tissue diseases,

and in Antiphospholipid Syndrome.

Additional: Patients with acute and chronic infections (including syphilis, HIV, Lyme disease) may also have increased anti-cardiolipin antibodies

 

Anti-DNA

IgG or IgM antibodies directed against host double-stranded DNA.

Normal Range: < 1:10 titer

Increased in:

Systemic lupus erythematosus (60-70%, specificity 95%).

Anti-ds-DNA antibody is not found in drug-induced lupus.

Additional: High titers are seen only in SLE. Titers of anti-ds-DNA correlate well with disease activity and with occurrence of glomerulonephritis

Antinerythrocyte antibodies (anti-RBC) ( Coombs test)

The direct Coombs test measures the presence of antibodies that are bound to the surface of circulating RBCs.

Indirect Coombs measures *free* anti-RBC antibodies.

The sensitivity of this test is in question--but it remains the standard for detection of autoimmune anemia.

Normal Range: none present

Antineurofilament antibodies

Limited studies have been done with this test.

Antibodies against neurofilaments in blood serum. 60% of diffuse NP lupus patients have shown this antibody.

Normal Range: non present

 

Antineuronal antibodies

Most specifically, this is IgG neuron-reactive antibody radioimmunoassay performed on the cerebrospinal fluid.

In the general lupus population, 75% with neuro-psyciatric (NP) lupus are detected, as compared to 10% without NP lupus--*false positive*.

Highest titers are found in patients with diffuse NP lupus (seizures, organic brain syndrome)--90%. 40% of focal NP are positive (stroke, cranial neuropathy, transverse myelitis)

Normal Range: non present

Anti-ribosomal P

Antibodies to ribosomal P protein from blood serum. 80 - 90% positive in NP lupus that manifests with psychosis or depression.

Normal Range: Negative

 


 AST Aspartate Aminotransferase (AST, SGOT, GOT)


Description AST is found in red blood cells, liver, heart, muscle tissue, pancreas, and kidneys. Formerly it was called serum glutamic oxaloacetic transaminase (SGOT). Low levels of AST are normally found in the blood. When body tissue or an organ such as the heart or liver is diseased or damaged, additional AST is released into the bloodstream. The amount of AST in the blood is directly related to the extent of the tissue damage. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm.
Purpose of the test This test is normally done to:
- Check for liver damage.
- Check for liver disease, especially hepatitis and cirrhosis.
- Check on the success of treatment for liver disease.
- Keep track of the effect of medicines that can damage the liver.
Reference range values
8-35 U/L
Abnormal findings High levels of AST may be caused by:
- Recent or severe liver damage, such as hepatitis caused by a viral infection or drug reaction.
- Decay of a large tumor (necrosis).
- Shock.
Moderately high levels may be caused by:
- Chronic diseases affecting the liver, such as cirrhosis.
- Heart attack or heart failure.
- Alcohol abuse.
- High doses of vitamin A.
- Kidney or lung damage.
- Mononucleosis.
- Duchenne muscular dystrophy.
- Some types of cancer.
- Myositis.
Slightly high levels of AST may be caused by:
- Fatty deposits in the liver.
- Medicines, such as statins, antibiotics, chemotherapy, aspirin, narcotics, and barbiturates.
- Alcohol abuse.
AST levels are high when a disease first develops, which is often when tissue damage is most severe. Decreasing levels of AST in the blood may be a sign of recovery from the disease or injury. Other conditions, including severe burns, traumatic injuries, pulmonary embolism, or heat exhaustion and heatstroke, and ingestion of poisonous mushrooms may cause elevated AST levels.

Bilirubin Direct

Description Alternative Name : Conjugated bilirubin. Bilirubin is a dark yellow substance included in the bile and the blood. Red blood cells (RBCs) normally degrade after 120 days in the circulation. Then, a component of the RBCs called hemoglobin breaks down into unconjugated bilirubin. Unconjugated bilirubin is transported to the liver, sugars are added to it, so it becomes water soluble, producig conjugated bilirubin. Conjugated bilirubin pass to the bile and then to the intestines, where a bacteria degrades it.   Furtherwards it is excreted in the feces given them its brown color.
Bilirubin is found then in two variants:
1. Indirect (or unconjugated) bilirubin. Insoluble in water.  It travels through the bloodstream to the liver, where it is converted into direct or conjugated bilirubin.
2. Direct (or conjugated) bilirubin. Soluble in water. Total and direct bilirubin levels are measured directly in a blood sample.  Indirect bilirubin is calculated from these meassurements. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. In newborns, a blood sample from a heel stick. Purpose of the test With high bilirubin levels, the skin and whites of the eyes may appear yellow (jaundice). This must mean liver disease, blood disorders, or blockage of the bile ducts. Very high bilirubin levels in a newborn can cause brain damage, hearing loss, physical abnormalities, and death. High bilirubin levels in newborns are not rare, typically 1 to 3 days old. This is called physiologic jaundice of the newborn. After birth, since liver is not very mature, it is unable to process the whole bilirubin, causing the high bilirubin levels
Reference range values 0.0 – 3.4 mcmol/L
Abnormal findings High levels of Bilirubin in newborns are caused by: ·        Accelerated breakdown of red blood cells due to a blood type incompatibility between the mother and her newborn. High levels of Bilirubin in adults and children are caused by: ·        Liver damage/disease ·        Gilbert's, Rotor's, Dubin-Johnson or Crigler-Najjar syndromes High levels of unconjugated bilirubin are caused by: ·        Pernicious anemias ·        Transfusion reaction. High levels of conjugated bilirubin means some kind of blockage of the liver or bile ducts, caused by : ·        Hepatitis ·        Liver trauma ·        Cirrhosis ·        Drug reaction ·        Alcohol abuse
Additional: Assay of total bilirubin includes conjugated (direct) and unconjugated (indirect)
bilirubin plus delta bilirubin (conjugated bilirubin bound to albumin).
It is usually clinically unnecessary to fractionate total bilirubin. The fractionation is unreliable by the diazo reaction and may underestimate unconjugated bilirubin. Only conjugated bilirubin appears in the urine and it is indicative of liver disease; hemolysis is associated with increased unconjugated bilirubin. Persistence of delta bilirubin in serum in resolving liver disease means that total bilirubin does not effectively indicate time course of resolution.

Bilirubin Total

Bilirubin is a dark yellow substance included in the bile and the blood. Red blood cells (RBCs) normally degrade after 120 days in the circulation. Then, a component of the RBCs called hemoglobin breaks down into unconjugated bilirubin. Unconjugated bilirubin is transported to the liver, sugars are added to it, so it becomes water soluble, producig conjugated bilirubin. Conjugated bilirubin pass to the bile and then to the intestines, where a bacteria degrades it.   Furtherwards it is excreted in the feces given them its brown color. Bilirubin is found then in two variants: ·        Indirect (or unconjugated) bilirubin. Insoluble in water.  It travels through the bloodstream to the liver, where it is converted into direct or conjugated bilirubin. ·        Direct (or conjugated) bilirubin. Soluble in water. Total and direct bilirubin levels are measured directly in a blood sample.  Indirect bilirubin is calculated from these meassurements. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. In newborns, a blood sample from a heel stick. Purpose of the test To meassure blood concentration of bilirubin. With high bilirubin levels, the skin and whites of the eyes may appear yellow (jaundice). This must mean liver disease, blood disorders, or blockage of the bile ducts. Very high bilirubin levels in a newborn can cause brain damage, hearing loss, physical abnormalities, and death. High bilirubin levels in newborns are not rare, typically 1 to 3 days old. This is called physiologic jaundice of the newborn. After birth, since liver is not very mature, it is unable to process the whole bilirubin, causing the high bilirubin levels
Reference range values 1.7 - 17.1 mcmol/L
Abnormal findings High levels of Bilirubin in newborns are caused by: ·        Accelerated breakdown of red blood cells due to a blood type incompatibility between the mother and her newborn.
High levels of Bilirubin in adults and children are caused by: ·        Liver damage/disease ·        Gilbert's, Rotor's, Dubin-Johnson or Crigler-Najjar syndromes High levels of unconjugated bilirubin are caused by: ·        Pernicious anemias ·        Transfusion reaction. High levels of conjugated bilirubin means some kind of blockage of the liver or bile ducts, caused by : ·        Hepatitis ·        Liver trauma ·        Cirrhosis ·        Drug reaction ·        Alcohol abuse
Additional:
Assay of total bilirubin includes conjugated (direct) and unconjugated (indirect) bilirubin plus delta bilirubin (conjugated bilirubin bound to albumin).
It is usually clinically unnecessary to fractionate total bilirubin.
The fractionation is unreliable by the diazo reaction and may underestimate unconjugated bilirubin.
Only conjugated bilirubin appears in the urine and it is indicative of liver disease; hemolysis is associated with increased unconjugated bilirubin.
Persistence of delta bilirubin in serum in resolving liver disease means that total bilirubin does not effectively indicate
time course of resolution.

Blood Gases, Arterial

Description Blood flux transports gases such as oxygen gas (O2)  and carbon dioxide gas (CO2).  This test determines the concentration of these gases on the arterial blood, and if so, an imbalance in the amount of O2  or CO2 or acid-base imbalance, indicative of a respiratory, metabolic or kidney problem.
A blood sample is collected ussually from the radial artery in the wrist.   On babies, capillary blood from a heelstick is commonly used. What is meassured on a Blood Gases Arterial test : pH (level of hydrogen ion H+). It indicates the acid/base balance on blood.   If pH goes down, your blood is more acidic. If it goes up, your blood is more alkaline. 
PO2 (partial pressure of O2). It indicates the amount of oxygen gas dissolved in blood. 
PCO2 (partial pressure of CO2). It indicates the amount of carbon dioxide gas dissolved in the blood.  Also increasing PCO2 levels make blood pH levels decrease, becoming more acidic, and more alkaline if PCO2 decreases.
O2 saturation. It represents in percentage, how much oxygen is attached to hemoglobin in the red blood cells and available to be carried through the arteries to feed the body's cells.
HCO3-. Bicarbonate.   This is the most important form of CO2 in the body. HCO3- is excreted and reabsorbed by the kidneys in response to pH imbalances.
Base excess/deficit. This is a calculated parameter that represents a total sum of anions in the blood such as hemoglobin, proteins, phosphates, and HCO3-. Purpose of the test This test is ordered when you have symptoms such us  difficulty breathing, shortness of breath, or rapid breathing in order to determine your oxygenation and acid/base status. It is also ordered to monitor the effectiveness of oxygen therapy and during certain surgeries. If you have some respiratory problem your body can not restore gas and pH imbalance by itself. Then you may need for example teraphy with pure O2. Then your doctor may order blood gas tests in order to monitor the effectiveness of the therapy. Reference range values
pH arterial           7.35 – 7.45
PCO2:      males :      4.655kPa – 6.384kPa PCO2:   females :      4.256kPa – 5.985kPa
pO2 arterial         11.039 – 14.364 kPa HCO3 arterial      22 – 26 mmol/L O2 Saturation       94% – 98% Abnormal findings Abnormal gas concentrations may mean that your body is not able to get enough oxygen, or is not able to get rid of enough carbon dioxide.   Also can mean there is a problem with kidney function. A pH imbalance may be cause by respiratory disease. Lower pH and an increased PCO2 can mean respiratory depression (not enough oxygen in and CO2 out), caused by: ·        Pneumonia ·        chronic obstructive pulmonary disease (COPD) ·        over-sedation from narcotics Raised pH and a decreased PCO can mean over ventilation caused by: ·        hyperventilating ·        pain ·        emotional distress ·        certain lung diseases Lower pH and decreased HCO3- can mean the blood is too acidic on a metabolic/kidney level, due to: ·        diabetes ·        shock ·        renal failure · Elevated pH and increased HCO3- can mean: ·        hypokalemia ·        chronic vomiting ·        sodium bicarbonate overdose

Blood Gases, Venous

Description Blood flux transports gases such as oxygen gas (O2) and carbon dioxide gas (CO2). This test determines the concentration of these gases on the venous blood, and if so, an imbalance in the amount of O2 or CO2 or acid-base imbalance, indicative of a respiratory, metabolic or kidney problem. Arterial blood gas analysis has been a useful tool for doctors managing acutely ill patients with presumed acid-base imbalances since automated blood gas analyzers appeared in the early 1960s. Despite this, in specific scenarios, a Venous blood gas analysis can provide enough information to make correct diagnosis, with some advantages over ABG analysis. The most important advantage of a VBG instead of an ABG is decreased pain for the patient. Also a VBG sample can be drawn using the same intravenous line used to extract blood for other lab tests. No need of extra puncture. Consequently less costs, work, risk of arterial laceration and pain. Normal venous pH, PCO2, and HCO3 are useful to check severe acid-base disturbances without the necessity of an ABG analysis. On the contrary, in some cases such as cardiac arrest, the disparity between arterial and venous values is important. In this situation, tissue hypoxia is reflected by the lower pH and higher PCO2 on the venous analysis in comparation with ABG. Also, in general, Venous PO2 values do not reflect arterial PO2 levels very accurately.
Purpose of the test This test is ordered when you have symptoms such us difficulty breathing, shortness of breath, or rapid breathing in order to determine your oxygenation and acid/base status. It is also ordered to monitor the effectiveness of oxygen therapy and during certain surgeries. If you have some respiratory problem your body can not restore gas and pH imbalance by itself. Then you may need for example therapy with pure O2. Then your doctor may order blood gas tests in order to monitor the effectiveness of the therapy.
Reference range values pH 7.32 – 7.45 PCO2: 5.05kPa – 6.65kPa Abnormal findings
Abnormal gas concentrations may mean that your body is not able to get enough oxygen, or is not able to get rid of enough carbon dioxide. Also can mean there is a problem with kidney function.
A pH imbalance may be cause by respiratory disease.
Lower pH and an increased PCO2 can mean respiratory depression (not enough oxygen in and CO2 out), caused by:
- Pneumonia
- chronic obstructive pulmonary disease (COPD)
- over-sedation from narcotics
Raised pH and a decreased PCO can mean over ventilation caused by:
- hyperventilating
- pain
- emotional distress
- certain lung diseases
Lower pH and decreased HCO3- can mean the blood is too acidic on a metabolic/kidney level, due to:
- diabetes
- shock
- renal failure
Elevated pH and increased HCO3- can mean:
- hypokalemia
- chronic vomiting
- sodium bicarbonate overdose

Blood Typing

Formal name: ABO Grouping and Rh Typing   What is being tested?
Red blood cells (RBCs) have markers or antigens on the surface of the cells. The two major antigens or surface identifiers on human RBCs are the A and B antigens. Your blood is grouped according to the presence or absence of these antigens. People whose red blood cells have A antigens are considered to be blood group A; those with B antigens are group B; those with both A and B antigens are group AB; and those who do not have either of these markers are considered to have blood group O. Another important surface antigen is called Rh factor. If it is present on your red blood cells, your blood type is Rh+ (positive); if it is absent, your blood is type Rh- (negative). Our bodies naturally produce antibodies against the A and B antigens we do not have on our red blood cells. For example, a person who is blood type A will have antibodies directed against the B surface antigens on red blood cells and someone who is type B will have anti-A antibodies and so on. The following table indicates the type of antibodies a person is expected to have based on their blood type. A person with bloodtype ...
Will have antibodies to ...

A
B antigen

B
A antigen

AB
Neither antigen

O
A and B antigens These antibodies are useful for determining a person's ABO group and are significant in defining the types of blood that they can safely receive. How is the sample collected for testing
A sample of blood is drawn from a vein in your arm or from the tip of your finger (fingerstick). In newborns, blood from the umbilical cord or a small amount of blood from a heelstick may be used for testing. How is it used? Blood typing is used to determine your blood group and what type of blood or blood components you can safely receive. It is important to ensure that there is compatibility between a patient who requires a transfusion of blood or blood components and the ABO and Rh type of the unit of blood that will be transfused. A potentially fatal transfusion reaction can occur if a unit of blood containing an ABO antigen to which a patient has an antibody is transfused to that patient. For example, people with blood group O have both anti-A and anti-B antibodies in their blood. If a unit of blood that is group A, B, or AB is transfused to this patient, the antibodies in the patient's blood will react with the red cells, destroying them and causing potentially serious complications. If an Rh-negative patient is transfused with Rh-positive blood, it is likely that the patient will produce antibodies against Rh-positive blood. Although this does not cause problems for the patient during the current transfusion, a future transfusion with Rh-positive blood could result in a serious transfusion reaction. Rh typing is especially important during pregnancy because a mother and her fetus could be incompatible. If the mother is Rh-negative but the father is Rh-positive, the fetus may be positive for the Rh antigen. As a result, the mother's body could develop antibodies against the Rh antigen. The antibodies may cross the placenta and cause destruction of the baby's red blood cells, resulting in a condition known as hemolytic disease of the fetus and newborn. To prevent development of Rh antibodies, an Rh-negative mother is treated with an injection of Rh immune globulin during her pregnancy and again after delivery if the baby is Rh-positive. The Rh immune globulin "masks" any Rh antigen from the fetus that the mother may be exposed to during her pregnancy and delivery and prevents her from becoming sensitized and developing antibodies against the Rh antigen. Blood typing is also used to determine the blood group of potential donors at a collection facility. Units of blood that are collected from donors are blood typed and then appropriately labeled so that they can be used for patients that require a specific ABO group and Rh type.

Blood Urea Nitrogen (BUN)

Urea, an end product of protein metabolism, is excreted by the kidney.

BUN is directly related to protein intake and nitrogen metabolism and inversely related to the rate of excretion of urea.

Urea concentration in glomerular filtrate is the same as in plasma, but its tubular reabsorption is inversely related to the rate of urine formation

Normal Range: 8-20 mg/dL

Additional: Urease assay method commonly used. BUN/Cr ratio (normally 12:1-20:1)

Decreased in acute tubular necrosis, advanced liver disease, low protein intake, following hemodialysis. BUN/Cr ratio

Increased in dehydration, GI bleeding, increased catabolism.

 

C3

The classic and alternative complement pathways converge at the C3 step in the complement cascade.

Low levels indicate activation by one or both pathways.

Most diseases with immune complexes will show decreased C3 levels. Test as usually performed is an immunoassay (by radial immunodiffusion or nephelometry).

Normal Range:

64-166 mg/dL

Increased in:

Many inflammatory conditions as an acute phase reactant,

active phase of rheumatic diseases (rheumatoid arthritis, SLE, etc),

acute viral hepatitis,

myocardial infarction,

cancer, diabetes,

pregnancy,

sarcoidosis,

amyloidosis,

thyroiditis.

Decreased by:

Decreased synthesis (protein malnutrition, congenital deficiency, severe liver disease), or

increased catabolism (immune complex disease, membranoproliferative glomerulonephritis [75%],

SLE,

Sjogren's,

rheumatoid arthritis,

disseminated intravascular coagulation,

paroxysmal nocturnal hemoglobinuria,

autoimmune hemolytic anemia,

gram-negative bacteremia) 

increased loss (burns, gastroenteropathies).

Additional:

Complement C3 levels may be useful in following the activity of immune complex diseases. The best test to detect inherited deficiencies is CH50. Levels can confirm specific C3 defect.

C4

C4 is a component of the classic complement pathway.

Depressed levels usually indicate classic pathway activation.

Normal Range: 15-45 mg/dL

Increased in:

Various malignancies: not clinically useful.

Decreased by:

Decreased synthesis,

Increased catabolism (SLE, rheumatoid arthritis, proliferative glomerulonephritis, hereditary angioedema), 

Increased loss (burns, protein-losing enteropathies).

Congenital deficiency.

Additional:

Low C4 accompanies acute attacks of hereditary angioedema, and C4 is used as a first-line test for the disease.

C1 esterase inhibitor levels are not indicated for the evaluation of hereditary angioedema unless C4 is low.

Congenital C4 deficiency occurs with an SLE-like syndrome.

Test as usually performed is an immunoassay and not a functional assay.


C-Peptide, Serum

Description C-peptide test measures the level of this peptide in the blood. It is generally found in amounts similar to insulin due to the fact that insulin and C-peptide are linked when first made by the pancreas. Insulin helps the body control the amount of glucose in the blood. Insulin allows glucose to enter body cells where it is used for obtaining energy. Level of C-peptide in the blood can show how much insulin is being made by the pancreas. C-peptide does not affect the blood sugar level in the body. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test The C-peptide test can be done when diabetes has just been found and it is not clear whether type 1 diabetes or type 2 diabetes is present. A person whose pancreas does not make any insulin (type 1) has a low level of insulin and C-peptide. A person with type 2 diabetes has a normal to high level of C-peptide. A C-peptide test can also help find the cause of low blood sugar, such as excessive use of medicine to treat diabetes or a noncancerous growth (tumor) in the pancreas (insulinoma). Because synthetic insulin does not have C-peptide, a person with a low blood sugar level from taking too much insulin will have a low C-peptide level. An insulinoma causes the pancreas to release too much insulin, which causes blood sugar levels to drop (hypoglycemia) . In this case, the patient will have a high level of C-peptide in the blood. Reference range values
0.78-1.89 microg/L (0.26-0.62 nmol/L) Abnormal findings High
- High levels of both C-peptide and blood glucose are found with type 2 diabetes or insulin resistance (such as from Cushing's syndrome).
- High levels of C-peptide with a low blood glucose level may mean an insulin-producing tumor of the pancreas (insulinoma) is present or the use of certain medicines such as sulfonylureas or meglitinides.
- If C-peptide levels are high after an insulinoma is taken out, it may mean that the tumor has returned or that the tumor has spread to other parts of the body.
Low
- Low levels of both C-peptide and blood glucose are found in liver disease, Addison's disease, or insulin therapy.
- Low level of C-peptide with a high blood glucose level is found in people with type 1 diabetes.
- Complete removal of the pancreas (pancreatectomy) causes a C-peptide level very low. Blood glucose level will be high, and insulin will be needed in order for the person to survive.

C- Reactive Protein (CRP)

Description C-reactive protein (CRP) test is a blood test that measures the amount of a protein called C-reactive protein in your blood. C-reactive protein test measures general levels of inflammation in the body. High levels of CRP are caused by infections and long-term diseases. But a CRP test cannot show where the inflammation is or what is causing it. Other tests are needed to find the cause and location. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test C-reactive protein (CRP) test is done to:
- Check for infection after surgery. Its levels normally rise within 2 to 6 hours of surgery and then go down by the third day after surgery.  If levels stay elevated 3 days after surgery, an infection may be present.
- Keep track of infections and diseases that cause inflammation, such as:
o Cancer of the lymph nodes (lymphoma).
o Diseases of the immune system.
o Painful swelling of the blood vessels in the head and neck.
o Rheumatoid arthritis.
o Swelling and bleeding of the intestines (inflammatory bowel).
o Bone infection.
- Check to see how treatment is working, such as treatment for cancer or for an infection. CRP levels go up and then become normal quickly if you are responding to treatment measures. A special type of CRP test, the high-sensitivity CRP test (hs-CRP), may be done to find out if you have an increased chance of having a sudden heart problem, such as a heart attack. Inflammation can damage the inner lining of the arteries and make a heart attack more likely. Reference range values
CRP <10 mg/L CRP levels Lowest risk
10 to 30 mg/L => Average risk
>30 mg/L => Highest risk Abnormal findings Any condition that results in sudden or severe inflammation may increase CRP levels. Some medicines may decrease CRP levels.

CA 125


Description Formal name: Cancer Antigen 125 CA-125 is a protein present on some normal tissues and on the surface of cancer cells of various types but specially on ovarian cancer cells. CA-125 levels can also be high in other situations apart from cancer, including menstruation, pregnancy, and pelvic inflammatory disease. It is normally prescribed before starting therapy for ovarian cancer or if at high risk for developing it, and afterwards during and after treatment in order to monitor evolution with treatment. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm.
Purpose of the test This test is used to follow women who have a family history of ovarian cancer. Also CA-125 is used to monitor therapy during treatment for ovarian cancer and to detect whether cancer has come back after treatment.
Before a patient starts treatment for cancer, the physician may order a baseline CA-125 to compare against future analysis. During therapy, physicians monitor response to therapy testing at intervals. CA-125 may also be measured periodically after therapy is completed. When an increase in CA-125 is detected, this may indicate that cancer has returned. Reference range values 1.9 - 16.3 kU/L
Abnormal findings CA-125 levels decreased during therapy generally means that the cancer is remitting with treatment. CA-125 levels increased during therapy generally means that the cancer may not be responding to therapy. High CA-125 levels after treatment is finished can be indicative that the cancer has returned.

CA-19-9 Carbohydrate Antigen

Description CA 19-9 is often produced by pancreatic cancers, and its level is elevated in more than 90% of pancreatic cancers. It's typically used to gauge how well a treatment is working in those diagnosed with pancreatic cancer. CA 19-9 may be ordered along with other tests, such as carcinoembryonic antigen (CEA), bilirubin, and/or a liver panel, when a patient has symptoms that may indicate pancreatic cancer, including abdominal pain, nausea, weight loss, and jaundice. If CA 19-9 is initially elevated in pancreatic cancer, then it may be ordered during cancer treatment to monitor response and, on a regular basis following treatment, to help detect recurrence. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test Once the diagnosis of pancreatic cancer is confirmed, routine blood studies are performed to assess liver and kidney function. Checking the CA 19-9 levels can be a useful gauge of how the treatment is working. After treatment, the doctor may check the CA 19-9 levels regularly as one indicator of whether the cancer has returned. However, CA 19-9 is not an absolute test for pancreatic cancers, and other conditions may cause a rise in the CA 19-9 levels. Likewise, a normal CA 19-9 level is not a guarantee that the cancer has not returned. Its main use is as a tumor marker:
- to help differentiate between cancer of the pancreas and bile ducts and other conditions, such as pancreatitis
- to monitor a patient's response to pancreatic cancer treatment
- to watch for pancreatic cancer recurrence.
Reference range values
0-37 U/mL Abnormal findings Moderate to high levels of CA-19-9 are found in pancreatic cancer, other cancers, and in several other diseases and conditions. The highest levels of CA 19-9 are seen in excretory ductal pancreatic cancer. Recurrent measurements of CA 19-9 may be useful during and following treatment because rising or falling levels may give the doctor important information about whether the treatment is working, whether all of the cancer was removed successfully during surgery, and whether the cancer is likely returning. Early pancreatic cancer gives few warnings. At the time a patient has symptoms and significantly elevated levels of CA 19-9, their pancreatic cancer is usually at an advanced stage. CA-27.29 Cancer Antigen

Description

CA 27.29 is a protein that is produced by the MUC-1 gene. Breast cancer cells will shed copies of the CA 27.29 protein in the bloodstream. During treatment, levels of CA 27.29 may fall, indicating that your treatment is effectively killing the cancer. If CA 27.29 levels rise, cancer may be progressing and it may be necessary to adjust treatments accordingly. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test Cancer antigen 27.29 test is a blood test that is given specifically for breast cancer. The antigen CA 27.29 is found in the blood of women who have breast cancer. If CA 27.29 levels rise, it may indicate that the cancer is progressing or spreading. One version of this test is called the "Truquant BR Radioimmunoassay test." The CA 27.29 test is used to monitor: - Response to treatment
- Status of the cancer
- Possibility of early recurrence It is often useful along with other tests, such as imaging, to evaluate recurrence and response to treatment. Reference range values 0-40 U/mL Abnormal findings If a cancerous tumor is present, levels of CA 15-3 may increase as the number of cancer cells increase. Tumor cells will shed copies of the CA 15-3 protein, which can be measured by this blood test and by a related test of cancer antigen 27.29. Other cancers can produce CA 27.29 (colon, liver, lung, pancreatic, ovarian and prostate), but some non life-threatening conditions may also cause CA 27.29 to show up in blood (ovarian cysts and benign conditions of the breast, liver and kidneys).

CA-15-3(Cancer Antigen)

Description This test is given during or after treatment for breast cancer. It is useful in monitoring advanced breast cancer and your response to treatment. CA 15-3 is not a blood test that screens for breast cancer. It is a tumor marker test that is helpful in tracking cancers that overproduce CA 15-3. Breast cancer starts in the cells of the breast in women and men. Worldwide, breast cancer is the second most common type of cancer after lung cancer and the fifth most common cause of cancer death. CA 15-3 is a protein normally produced on breast tissue, and it does not cause breast cancer. If a cancerous tumor (cells growing out of control) is present, levels of CA 15-3 may increase as the number of cancer cells increase. Tumor cells will shed copies of the CA 15-3 protein, which can be measured by this blood test and by a related test of cancer antigen 27.29 (CA 27.29). Not every breast tumor causes a rise in CA 15-3, so for some tumors that do not produce CA 15-3 or with early-stage breast cancer, this test is not useful. In patients with metastatic breast cancer, CA 15-3 can be found in 50 to 90% of all cases. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test This tests measures the level of CA-15-3 in blood in order to help monitor treatment for breast cancer. After completed treatment for breast cancer, the doctor may test blood for CA 15-3 on a regular schedule to see if levels of this antigen are rising or remaining steady. Rising levels of CA 15-3 may indicate a recurrence of breast cancer, but since other conditions can cause higher levels of this antigen, the test results must be taken in to consideration with the results of imaging studies, symptoms and other tests for hormone sensitivity, HER2/neu and BRCA genes. Reference range values 0-31 U/mL Abnormal findings In general, the higher the CA 15-3 level the more advanced the breast cancer and the larger the tumor burden. In metastatic breast cancer, the highest levels of CA 15-3 are seen when the cancer has spread to the bones and/or the liver. Mild to moderate levels of CA 15-3 also are seen in a variety of conditions, including liver and pancreatic cancer, cirrhosis, and benign breast disorders as well as in a certain percentage of apparently healthy individuals. Normal CA 15-3 levels do not ensure that a patient does not have cancer. It may be too. In addition, 25% to 30% of individuals with advanced breast cancer have tumors that do not show high CA 15-3. Pregnancy and lactation also increase levels of CA 15-3. Several noncancerous conditions (benign breast or ovarian disease, endometriosis, pelvic inflammatory disease and hepatitis) can rise levels of CA 15-3.

Calcium


Description Calcium is an important mineral in the body. It helps the proper functioning of muscles, nerves, and the heart and is required in blood clotting and in bones building. About 1% of calcium is found in the blood. Half of it is freely circulating in the bloodstream. The other half ("bound" calcium) is attached to albumin and other compounds. There are two tests to measure blood calcium. Total calcium test measures both free and bound forms. Ionized calcium test measures only the free form. Blood calcium is tested to diagnose and monitor a range of problems relating to the bones, heart, nerves, kidneys, and teeth.
Calcium concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. As some calcium is filtered out daily by the kidneys, a calcium test in urine can also be indicative of how the kidneys are working.
Purpose of the test To determine the concentration of calcium in the blood (or urine). This test is prescribed as part of a routine metabolic panel, in persons with kidney, bone, or nerve disease. Measuring urine calcium can monitor whether the kidneys are filtering out the proper amount of calcium, and testing for vitamin D, phosphorus, and/or magnesium can help determine whether other problems exist.
Measuring calcium and parathyroid hormone (PTH) can help determine whether the parathyroid gland is working properly.
Reference range values 2.05 - 2.5mmol/L
Abnormal findings
Hypercalcemia (High Total Calcium) can be caused by:
  • Hyperparathyroidism, an increase functioning of parathyroid gland
  • Cancer, when it spreads to the bones.
  • Hyperthyroidism
  • Sarcoidosis
  • Tuberculosis
  • Prolonged immobilization
  • Excess Vitamin D intake
  • Kidney transplant
Hypocalcemia (Low Total Calcium) can be caused by:
  • Low levels of blood protein, especially albumin. In this case Ionized calcium remains normal.
  • Hypoparathyroidism
  • Inherited resistance to the effects of parathyroid hormone
  • Extreme deficiency in dietary calcium
  • Decreased levels of vitamin D
  • Magnesium deficiency
  • Increased levels of phosphorus
  • Pancreatitis
  • Renal failure
  • Malnutrition
  • Alcoholism

Carbamazepine

Description Commercial names: Tegretol®, Carbatrol® This test measures the concentration of carbamazepine in the blood. Carbamazepine is a drug used to treat epilepsy.   It is also prescribed to stabilize the moods of patients with bipolar disease and to help on some types of nerve pain.
Epilepsy affect the brain's ability to transmit electrical impulses. During a seizure, a patient may experience changes in consciousness, alterations in sight, smell, and taste, and may experience convulsions.
Bipolar disorder is a mental condition characterized by alternative depression and euphoria that may last from days to years.
Carbamazepine concentration is monitored because the drug must be maintained within a narrow therapeutic range. Too low levels of the drug let the symptoms of the illness appear.  Too high levels can lead to intoxication effects. Side effects include:
  • Dizziness
  • Uncoordinated movement
  • Sleepiness
  • Double vision
  • Nausea
  • Diarrhea
  • Constipation
  • Headache
  • Confusion Carbamazepine concentration is measured by means of analysis of a blood sample drawn from the vein in the arm.
Purpose of the test
To determine the concentration of carbamazepine in the blood. It is prescribed at regular intervals to monitor the drug's level. Carbamazepine test measures "total" carbamazepine, this is, both protein-bound and free portions of the drug.
Doctors may order carbamazepine tests to help evaluate their patients for side effects and adverse reactions during initial treatment and to monitor evolution. Reference range values Therapeutic levels  16.92 – 50.56 mcmol/L Toxic level              >63.45 mcmol/L
Abnormal findings With high levels of Carbamazepine some people will experience seizures, mood swings, or nerve pain while other can experience this symptoms with slightly high levels of the drug. Dosage and adjustments must be evaluated on a case-by-case basis.

Carbon Dioxide, Total

Description Formal name: Bicarbonate
Also known as: Total CO2, TCO2, Bicarb The total CO2 test measures the total amount of carbon dioxide in the blood, mainly in the form of bicarbonate (HCO3-). Bicarbonate is an electrolyte excreted and reabsorbed by the kidneys. It is used by the body to maintain the body's acid-base balance (pH) and also maintain electrical neutrality at the cellular level together with sodium, potassium, and chloride. This tests helps diagnose an electrolyte imbalance, acidosis or alkalosis as the result of a disease. It is prescribed in after symptoms such as weakness, confusion, prolonged vomiting, or respiratory distress that could indicate an electrolyte imbalance or acidosis or alkalosis. The bicarbonate test is usually ordered along with sodium, potassium, and chloride as part of an electrolyte panel. It may be ordered as part of a routine exam or to help evaluate a chronic illness such as kidney disease and hypertension, and to monitor the effectiveness of treatment. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm.
Purpose of the test To determine Bicarbonate concentration in blood. When an acid-base imbalance is foreseen, an electrolyte panel and blood gases may be ordered to evaluate the severity of the imbalance, determine whether it is from respiratory origin or metabolic, and monitor its treatment until the acid-base balance is restored.
Reference range values Carbon Dioxide, Total: 21 – 31 mmol/L
Sodium: 135-144 mmol/L
Potassium: 3.3 - 5.1 mmol/L
Chloride: 99 – 107 mmol/L   Abnormal findings
Possible causes of a low bicarbonate level include:
  • Addison's disease
  • Chronic diarrhea
  • Diabetic ketoacidosis
  • Metabolic acidosis
  • Kidney disease
  • Ethylene glycol or methanol poisoning
  • Salicylate (aspirin) overdose
Possible causes of high levels are:
  • Severe vomiting
  • Lung diseases
  • Cushing's syndrome
  • Conn's syndrome
  • Metabolic alkalosis

Carboxyhemoglobin


Description Carboxyhemoglobin test checks whether you have been exposed to carbon monoxide (CO). Carbon monoxide is a poisonous invisible gas. Red blood cells (RBC) have hemoglobin. This protein has the property of wrapping the oxygen.   Thanks to this, oxygen is transported throughout the entire body. Carbon monoxide replaces the oxygen in your RBCs, converting hemoglobin into carboxyhemoglobin. Carboxyhemoglobin cannot carry oxygen. The origin of CO is the incomplete combustion on combustion motors or gas furnaces, fires and tobacco smoke. Symptoms of CO intoxication are:
  • Headache.
  • Nausea or vomiting.
  • Irritability.
  • Dizziness.
  • Carboxyhemoglobin concentration is measured by means of analysis of a blood sample drawn from the vein in the arm.

Purpose of the test This test measures the concentration of carboxyhemoglobin in blood. This test is used to diagnose and manage carbon monoxide poisoning due to exposition to incomplete combustion gases (CO).
Reference range values
Reference values for non-smokers   0.005 – 0.015

Reference values for smokers: 1-2 packs/day        0.04 – 0.05 >2 packs/day         0.08 –0.09 Toxic levels                 >0.20
Abnormal findings High level of Carboxyhemoglobin in blood is usual among smokers. Heavy smoking lead to bigger test values. Also values above 4% (0.04) are indicative of possible hemolitytic anemia, while values over 20% (0.2) represent intoxication that can lead to revere damage and even to death.

CEA

Description Formal name: Carcinoembryonic Antigen Carcinoembryonic Antigen (CEA) is a protein found in embryonic tissues. After birth, detectable levels in the blood disappear. Consequently, It is normally not possible to detect CEA in the blood of a healthy person. If it appears in the blood it can indicate cancer, but it will not indicate which kind of cancer. CEA is most useful to check treatment of cancer patients. Used with patients who have had surgery it helps to measure response to therapy and to monitor whether the disease is recurring. Physicians can use CEA results to determine the stage and extent of cancer, especially gastrointestinal (GI) and, in particular, colorectal cancer. CEA is also helpful in monitoring patients with cancer of the rectum, lung, breast, liver, pancreas, stomach, and ovary.
Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test To determine whether cancer is present in the body and to monitor cancer treatment. When you have symptoms that suggest the possibility of cancer your doctor will prescribe this tests.   Also this test is performed before starting cancer treatment especially in patients with Gastro Intestinal cancer, as well as at intervals during and after therapy to monitor treatment and recovery. Reference range values Reference Values for non-smoking adults : 0.8 - 3.4  mcg/L Abnormal findings
CEA levels are high on embryonic tissues. Patients with smaller and early-stage tumors normally have low or normal CEA levels, while patients with more advanced tumors, or tumors that have spread throughout the body, are likely to have initially high CEA levels. CEA levels decreased to "normal" levels after therapy means that the tumor has been removed. If CEA levels return to rise steadily it can be the first sign of tumor recurrence.

Ceruloplasmin

Description Ceruloplasmin is also known as ferroxidase or iron(II):oxygen oxidoreductase. It is the major copper-carrying protein in the blood, and in addition plays a role in iron metabolism. Ceruloplasmin concentration test is primarily ordered along with blood and/or urine copper tests to help diagnose Wilson's disease, an inherited disorder associated with decreased levels of ceruloplasmin and excess storage of copper in the liver, brain, and other organs. Also it may be ordered to help diagnose or differentiate between conditions associated with copper deficiencies. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test It is ordered along with copper tests in front of signs and symptoms that the doctor suspects may be due to Wilson's disease such as:
- anemia
- nausea, abdominal pain
- jaundice
- fatigue
- behavioral changes
- tremors
- difficulty walking and/or swallowing
- dystonia
-
Rarely, ceruloplasmin may also be ordered along with copper tests when your doctor suspects that you have a copper deficiency and periodically if monitoring is recommended. Reference range values 0-17 years: 0,22-0,43 g/L 18 years and older: 0,17-0,54 g/L Abnormal findings
Low ceruloplasmin levels are not diagnostic of a specific condition and are usually evaluated along with copper tests. If ceruloplasmin and blood copper concentrations are decreased, urine copper levels are increased, then the patient may have Wilson's disease. If ceruloplasmin and urine and/or blood copper concentrations are low, then the patient may have a copper deficiency. Anything that interferes with the supply of copper or with the body's ability to metabolize copper has the potential to affect blood ceruloplasmin and copper concentrations.

 

CH50

The quantitative assay of hemolytic complement activity depends on the ability of the primary complement pathway to induce hemolysis of red cells sensitized with optimal amounts of anti-red cell antibodies.

For precise titrations of hemolytic complement, the dilution of serum that will lyse 50% of the indicator red cells is determined as the CH50.

This arbitrary unit depends on the conditions of the assay and is therefore laboratory-specific.

Normal Range: Laboratory-specific U/mL

Decreased with:

>50-80% deficiency of primary pathway complement components in congenital or acquired deficiency.

Normal in:

Deficiencies of alternative pathway, complement components.

Additional:

This is a functional assay of biologic activity.

Sensitivity to decreased levels of complement components depends on exactly how the test is performed.

It is used to detect congenital and acquired severe deficiency disorders of the primary complement pathway.

Chloride (CL)

Chloride, the principal inorganic anion of extracellular fluid, is important in maintaining normal acid-base balance and normal osmolality.

If chloride is lost (as HCl or NH4Cl), alkalosis ensues; if chloride is ingested or retained, acidosis ensues.

Normal Range: 98-107 meq/L

Increased in:

Renal failure,

nephrotic syndrome,

renal tubular acidosis,

dehydration,

overtreatment with saline,

hyperparathyroidism,

diabetes insipidus,

metabolic acidosis from diarrhea (loss of HCO3),

respiratory alkalosis,

hyperadrenocorticism.

Drugs: acetazolamide (hyperchloremic acidosis), androgens, hydrochlorothiazide, salicylates (intoxication).

Decreased in:

Vomiting,

diarrhea,

gastrointestinal suction,

renal failure combined with salt deprivation,

overtreatment with diuretics,

chronic repiratory acidosis,

diabetic ketoacidosis,

excessive sweating,

SIADH,

salt-losing nephropathy,

acute intermittent porphyria,

water intoxication,

expansion of extracellular fluid volume,

adrenal insufficiency,

hyperaldosteronism,

metabolic alkalosis.

Drugs: aldosterone, chronic laxative or bicarbonate ingestion, corticosteroids and ACTH (alkalosis), diuretics.

Cholesterol, HDL

Description Cholesterol is a steroid that is essential for life. It forms cellular membranes. It is also used by the body to make Vitamin D and hormones that are essential for development, growth, and reproduction. It also forms bile acids that are needed to absorb nutrients from food. A small amount of your body's fat circulates in the blood in the form of complex particles called lipoproteins. There are basically two important types of lipoproteins: High Density Lipoproteins (HDL) and Low Density Lipoproteins (LDL). Cholesterol, as a kind of fat, also has HDL and LDL varieties. Cholesterol type HDL-C is taken in excess for disposal. For this reason is called good cholesterol. LDL-C type deposits in tissues and organs (bad cholesterol).
The liver produces the cholesterol needed to work properly, but the source for some cholesterol is the diet. If you have a predisposition for high cholesterol levels or if you eat too much of foods are high in cholesterol, saturated fats, and trans unsaturated fats, then levels of cholesterol in your blood.
The extra cholesterol in your blood may deposit in plaques on the walls of blood vessels. This can narrow blood vessels, leading to hardening of the arteries (atherosclerosis) and increasing your risk of heart disease and stroke.
Cholesterol is not used to diagnose or monitor a disease but is used to estimate risk of developing a disease. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Sometimes cholesterol is measured using a drop of blood collected by puncturing the skin on a finger.
Purpose of the test To determine the concentration of different types of cholesterol in the blood with the intention of screen for risk of developing heart disease Adults should be tested at least once every five years if being treated for high cholesterol or have one or more risk factors for heart disease. Children and adolescents with risk factors should also have their cholesterol level checked. This test is usually ordered together with other tests. A full lipid profile includes measurement of the actual levels of each type of fat in the body: HDL-C, LDL-C, triglycerides and others. Cholesterol is tested at more frequent intervals in patients who have been prescribed diet and/or drugs to lower their cholesterol in order to know how well these measures are succeeding in lowering cholesterol to desired levels.
Reference range values Low (high risk) <1.036 mmol/L
High (low risk) >=1.554 mmol/L  
Abnormal findings
Most common causes of high cholesterol levels are:
  • Genetic predisposition
  • Excessive fat intake, saturated and trans unsaturated fats
  • Pregnancy
  • Consumption of some drugs such as anabolic steroids, beta blockers, epinephrine, oral contraceptives, and vitamin D.
Low levels can be the result of Malaria.
Test result levels are increased with age, male gender and during winter, while are lower during spring and summer

Cholesterol, LDL (Calculated)

Description   Cholesterol is a steroid that is essential for life. It forms cellular membranes. It is also used by the body to make Vitamin D and hormones that are essential for development, growth, and reproduction. It also forms bile acids that are needed to absorb nutrients from food.   A small amount of your body's fat circulates in the blood in the form of complex particles called lipoproteins. There are basically two important types of lipoproteins: High Density Lipoproteins (HDL) and Low Density Lipoproteins (LDL). Cholesterol, as a kind of fat, also has HDL and LDL varieties.   Cholesterol type HDL-C is taken in excess for disposal. For this reason is called good cholesterol. LDL-C type deposits in tissues and organs (bad cholesterol).
The liver produces the cholesterol needed to work properly, but the source for some cholesterol is the diet. If you have a predisposition for high cholesterol levels or if you eat too much of foods are high in cholesterol, saturated fats, and trans unsaturated fats, then levels of cholesterol in your blood. The extra cholesterol in your blood may deposit in plaques on the walls of blood vessels. This can narrow blood vessels, leading to hardening of the arteries (atherosclerosis) and increasing your risk of heart disease and stroke. Cholesterol is not used to diagnose or monitor a disease but is used to estimate risk of developing a disease. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Sometimes cholesterol is measured using a drop of blood collected by puncturing the skin on a finger.
Purpose of the test To determine the concentration of different types of cholesterol in the blood with the intention of screen for risk of developing heart disease Adults should be tested at least once every five years if being treated for high cholesterol or have one or more risk factors for heart disease. Children and adolescents with risk factors should also have their cholesterol level checked. This test is usually ordered together with other tests. A full lipid profile includes measurement of the actual levels of each type of fat in the body: HDL-C, LDL-C, triglycerides and others. Cholesterol is tested at more frequent intervals in patients who have been prescribed diet and/or drugs to lower their cholesterol in order to know how well these measures are succeeding in lowering cholesterol to desired levels.
Reference range values Optimal <2.59
Near or above optimal 2.59 – 3.34
Borderline high risk 3.37 – 4.12
High risk 4.14– 4.90
Very high risk >=4.92
Abnormal findings
Most common causes of high cholesterol levels are:
  • Genetic predisposition
  • Excessive fat intake, saturated and trans unsaturated fats
  • Pregnancy
  • Consumption of some drugs such as anabolic steroids, beta blockers, epinephrine, oral contraceptives, and vitamin D.
Low levels can be the result of Malaria.
Test result levels are increased with age, male gender and during winter, while are lower during spring and summer.

Cholesterol, LDL (Direct)

Description   Cholesterol is a steroid that is essential for life. It forms cellular membranes. It is also used by the body to make Vitamin D and hormones that are essential for development, growth, and reproduction. It also forms bile acids that are needed to absorb nutrients from food.   A small amount of your body's fat circulates in the blood in the form of complex particles called lipoproteins. There are basically two important types of lipoproteins: High Density Lipoproteins (HDL) and Low Density Lipoproteins (LDL). Cholesterol, as a kind of fat, also has HDL and LDL varieties.   Cholesterol type HDL-C is taken in excess for disposal. For this reason is called good cholesterol. LDL-C type deposits in tissues and organs (bad cholesterol). The liver produces the cholesterol needed to work properly, but the source for some cholesterol is the diet. If you have a predisposition for high cholesterol levels or if you eat too much of foods are high in cholesterol, saturated fats, and trans unsaturated fats, then levels of cholesterol in your blood. The extra cholesterol in your blood may deposit in plaques on the walls of blood vessels. This can narrow blood vessels, leading to hardening of the arteries (atherosclerosis) and increasing your risk of heart disease and stroke. Cholesterol is not used to diagnose or monitor a disease but is used to estimate risk of developing a disease.   Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Sometimes cholesterol is measured using a drop of blood collected by puncturing the skin on a finger.
Purpose of the test To determine the concentration of different types of cholesterol in the blood with the intention of screen for risk of developing heart disease Adults should be tested at least once every five years if being treated for high cholesterol or have one or more risk factors for heart disease. Children and adolescents with risk factors should also have their cholesterol level checked. This test is usually ordered together with other tests. A full lipid profile includes measurement of the actual levels of each type of fat in the body: HDL-C, LDL-C, triglycerides and others. Cholesterol is tested at more frequent intervals in patients who have been prescribed diet and/or drugs to lower their cholesterol in order to know how well these measures are succeeding in lowering cholesterol to desired levels.
Reference range values Optimal <2.59
Near or above optimal 2.59 – 3.34
Borderline high risk 3.37 – 4.12
High risk 4.14– 4.90
Very high risk >=4.92
Abnormal findings
Most common causes of high cholesterol levels are:
  • Genetic predisposition
  • Excessive fat intake, saturated and trans unsaturated fats
  • Pregnancy
  • Consumption of some drugs such as anabolic steroids, beta blockers, epinephrine, oral contraceptives, and vitamin D.
Low levels can be the result of Malaria.
Test result levels are increased with age, male gender and during winter, while are lower during spring and summer.

Cholesterol Total

Description   Cholesterol is a steroid that is essential for life. It forms cellular membranes. It is also used by the body to make Vitamin D and hormones that are essential for development, growth, and reproduction. It also forms bile acids that are needed to absorb nutrients from food. A small amount of your body's fat circulates in the blood in the form of complex particles called lipoproteins. There are basically two important types of lipoproteins: High Density Lipoproteins (HDL) and Low Density Lipoproteins (LDL). Cholesterol, as a kind of fat, also has HDL and LDL varieties.   Cholesterol type HDL-C is taken in excess for disposal. For this reason is called good cholesterol. LDL-C type deposits in tissues and organs (bad cholesterol). The liver produces the cholesterol needed to work properly, but the source for some cholesterol is the diet. If you have a predisposition for high cholesterol levels or if you eat too much of foods are high in cholesterol, saturated fats, and trans unsaturated fats, then levels of cholesterol in your blood. The extra cholesterol in your blood may deposit in plaques on the walls of blood vessels. This can narrow blood vessels, leading to hardening of the arteries (atherosclerosis) and increasing your risk of heart disease and stroke. Cholesterol is not used to diagnose or monitor a disease but is used to estimate risk of developing a disease. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Sometimes cholesterol is measured using a drop of blood collected by puncturing the skin on a finger.
Purpose of the test To determine the concentration of different types of cholesterol in the blood with the intention of screen for risk of developing heart disease Adults should be tested at least once every five years if being treated for high cholesterol or have one or more risk factors for heart disease. Children and adolescents with risk factors should also have their cholesterol level checked. This test is usually ordered together with other tests. A full lipid profile includes measurement of the actual levels of each type of fat in the body: HDL-C, LDL-C, triglycerides and others. Cholesterol is tested at more frequent intervals in patients who have been prescribed diet and/or drugs to lower their cholesterol in order to know how well these measures are succeeding in lowering cholesterol to desired levels.   Reference range values Desirable <5.17mmol/L (Children: <4.40mmol/L)
Acceptable 5.17 – 6.2
High risk >=6.22 Abnormal findings
Most common causes of high cholesterol levels are:
  • Genetic predisposition
  • Excessive fat intake, saturated and trans unsaturated fats
  • Pregnancy
  • Consumption of some drugs such as anabolic steroids, beta blockers, epinephrine, oral contraceptives, and vitamin D.
Low levels can be the result of Malaria.
Test result levels are increased with age, male gender and during winter, while are lower during spring and summer.

CK-MB, Creatine kinase-MB

  Description   Creatine Kinase–MB Also known as: CK MB, CPK MB
CK–MB is one of three forms of the enzyme creatine kinase (CK). It is found mainly in heart muscle.   CK-MB blood concentration rises when there is damage to heart muscle cells.   CK–MB levels, as well as total CK levels, are tested in persons who have chest pain to diagnose whether they have had a heart attack.   Since a high total CK could indicate damage to the heart but also to other muscles, CK–MB helps to distinguish between both cases.   If patient has symptoms of having had a heart attack, doctor usually gives the patient a "clot-dissolving" drug. Then CK–MB test can help the doctor tell if the drug worked. When the clot dissolves, CK–MB tends to rise and fall faster. By measuring CK–MB in blood several times, your doctor can usually tell whether the drug has been effective.   CK-MB test is prescribed, along with total CK, in persons with chest pain in order to determine whether the pain is due to a heart attack. It may also be ordered in a person with a high CK to determine whether damage is to the heart or other muscles.
Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test   To determine if you have had a heart attack and whether certain clot-dissolving drugs are working.
It is prescribed if you have chest pain or other symptoms of a heart attack.
Reference range values <1 – 5 ng/mL
Abnormal findings A high value of CK-MB and a ratio of CK–MB to total CK more than 2.5–3 usually means, it is likely that the heart was damaged.   A high CK with a relative index below this value suggests that other muscles were damaged.   If your doctor suspects injury to both heart muscle and skeletal muscle, troponin is a more accurate test for identifying a heart attack. Trouble breathing leads patient to have to use their chest muscles. Chest muscles have more CK–MB than other muscles, which would raise the amount of CK–MB in the blood. Kidneys failure can also lead to high CK–MB levels without having had a heart attack. Chronic muscle disease, low thyroid hormone levels, and alcohol abuse can also increase CK–MB levels.

Copper, Serum

  Description   Copper testing is primarily ordered to help diagnose Wilson's disease. If a doctor suspects Wilson's, then he would typically order a total and/or free (unbound) blood copper test and a ceruloplasmin level test. If these tests are abnormal, then they may be followed by a 24-hour urine copper test to measure copper excretion and a hepatic (liver) copper test to evaluate copper storage. Genetic testing may also be performed to detect mutations in the ATP7B gene if Wilson's disease is suspected. If a doctor suspects copper toxicity, copper deficiency, or a disorder that is inhibiting copper metabolism, then he may order blood and/or urine copper tests along with ceruloplasmin. One or more copper tests may be ordered to monitor the effectiveness of treatment for Wilson's disease, copper excess, or copper deficiency. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test One or more copper tests are ordered along with ceruloplasmin when someone has signs and symptoms of Wilson's disease, excess copper storage, copper poisoning, or due to a copper deficiency. These may include: -        anemia -        nausea, abdominal pain -        jaundice -        fatigue -        behavioral changes -        tremors -        difficulty walking and/or swallowing -        dystonia A hepatic copper test may be ordered to further investigate copper storage when copper and ceruloplasmin results are abnormal or equivocal. Reference range values Age
Male
Female

0 up to 6 months
0,20-0,70 mg/L
0,20-0,70 mg/L

7 months-18 years
0,90-1,90 mg/L
0,90-1,90 mg/L

Adults
0,70-1,40 mg/L
0,80-1,55 mg/L Abnormal findings Copper serum test results must be evaluated in context and are usually compared to ceruloplasmin levels. Abnormal copper results are not diagnostic of a specific condition; they indicate the need for further investigation. Interpretation can be complicated by the fact that ceruloplasmin is an acute phase reactant - it may be elevated whenever inflammation or severe infections are present. Both ceruloplasmin and copper are also increased during pregnancy and with estrogen and oral contraceptive use. Low blood copper concentrations along with increased urine copper levels, low ceruloplasmin levels, and increased hepatic copper are typically seen with Wilson's disease Increased blood and urine copper concentrations and normal or increased ceruloplasmin levels may indicate exposure to excess copper or may be associated with conditions that decrease copper excretion - such as liver disease. Increased hepatic copper may be present with chronic conditions. Decreased blood and urine copper concentrations and decreased ceruloplasmin may indicate a copper deficiency. A normal hepatic copper test may indicate that copper metabolism is functioning properly or that the distribution of copper in the patient's liver is uneven and the sample is not representative of the person's condition. If a patient is being treated for excess copper storage with chelators, then his 24-hour urine copper levels may be high until body copper stores decrease. Eventually, blood copper and 24-hour urine copper concentrations should normalize. If someone is being treated for a condition related to copper deficiency and his ceruloplasmin and total copper concentrations begin to rise, then the condition is likely responding to the treatment. Total serum copper concentrations are normally low at birth, rise over the next few years, peak, and then decline slightly to a relatively stable level.

Cortisol

Description Cortisol is a hormone produced by the adrenal glands. Production of cortisol is stimulated by ACTH (adrenocorticotropic hormone), a hormone produced by the pituitary gland. Cortisol has a lot of functions in the body. It helps break down protein, glucose, and lipids, maintain blood pressure, and regulate immune system. The hormone is secreted mainly during the early morning and less during the evening. Variations of cortisol can cause symptoms such as weight loss, muscle weakness, fatigue, low blood pressure, and abdominal pain. High cortisol levels cause increased blood pressure, high blood sugar, obesity, fragile skin, purple streaks on the abdomen, muscle weakness, and osteoporosis.  Women can have irregular menstrual periods and increased facial hair.  Children may have delayed development and a short stature. Blood and urine tests for cortisol help diagnose Cushing's syndrome and Addison's disease. Typically, blood will be drawn from a vein in the arm, but sometimes urine or saliva may be tested. Purpose of the test The purpose of the test is to help diagnose Cushing's syndrome or Addison's disease.   It is prescribed when doctor suspects excess or deficient cortisol production. Cortisol test may be prescribed when a patient has symptoms that suggest Cushing's syndrome (obesity, muscle wasting, and muscle weakness) or Addison's disease (weakness, fatigue, increased pigmentation, among others).
Suppression or stimulation testing is ordered after an initial test result is abnormal. Cortisol testing may be also ordered repeatedly when patients are being treated for Cushing's syndrome or Addison's disease to check the effectiveness of treatment.
Reference range values 138– 690nmol/L Abnormal findings Cortisol levels are normally very low at bedtime and very high just after waking. This pattern will change if a person works irregular shifts and sleeps at different times of the day. With Cushing's syndrome, this pattern is typically lost. Increased or normal cortisol concentrations in the morning plus levels that do not drop in the afternoon and evening suggest an overproduction of cortisol. This can be cause by increased pituitary, tumor outside of the pituitary, problem with the adrenal gland, or medication. Pregnancy, physical and emotional stress, hyperthyroidism and obesity can increase cortisol levels. A number of drugs can also increase levels, particularly oral contraceptives, hydrocortisone, and spironolactone. Adults have slightly higher cortisol levels than children. Hypothyroidism may decrease cortisol levels. Drugs that may decrease levels

Creatine Kinase

Description This test measures concentration of creatine kinase in blood. It is used to evaluate tissue damage, particularly muscle tissue. This test may be used when conditions including rhabdomyolysis are suspected. CK–MB levels, as well as total CK levels, are tested in persons who have chest pain to diagnose whether they have had a heart attack. Since a high total CK could indicate damage to the heart but also to other muscles, CK–MB helps to distinguish between both cases. If patient has symptoms of having had a heart attack, doctor usually gives the patient a "clot-dissolving" drug. Then CK–MB test can help the doctor tell if the drug worked. When the clot dissolves, CK–MB tends to rise and fall faster. By measuring CK–MB in blood several times, your doctor can usually tell whether the drug has been effective. CK-MB test is prescribed, along with total CK, in persons with chest pain in order to determine whether the pain is due to a heart attack. It may also be ordered in a person with a high CK to determine whether damage is to the heart or other muscles. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test To measure concentration of creatine kinase in blood. Reference range values Male        52 – 386 U/L Female    38 – 252  U/L
Abnormal findings The following are possible diseases related with abnormal Creatine Kinase tests results:
  • Heat stroke
  • Legionnaire's disease
  • Muscle disorder caused by HIV
  • Muscle tissue death
  • Muscular dystrophy
  • Neuroleptic malignant syndrome
  • Reye's syndrome
  • Rhabdomyolysis
  • SARS - Severe acute respiratory syndrome
  • Statin-induced myopathy

Creatinine

Description This test measures concentration of creatinine in blood and/or urine. Creatinine is a waste product produced in the muscles from the decomposition creatine. Creatine is part of the cycle that produces energy needed to contract the muscles. Almost all creatinine is filtered out by the kidneys.  Consequently blood levels measure of how well the kidneys are working. Also Creatinine levels serve to monitor treatment for kidney disease. It is prescribed when doctor suspects that you are suffering from kidney dysfunction also at intervals to monitor treatment for kidney disease. Creatinine blood test is usually ordered together with a blood urea nitrogen (BUN) test to check kidney function. Creatinine may be ordered routinely as part of a comprehensive or basic metabolic panel, when someone has non-specific health complaints, is acutely ill, and/or when a doctor suspects kidney dysfunction. The creatinine blood test may be ordered, along with the BUN test, at regular intervals when the patient has a known kidney disorder or has a disease that may affect kidney function or be exacerbated by dysfunction. Both may be ordered when a CT scan is planned, prior to and during certain drug therapies, and before and after dialysis to monitor the effectiveness of treatments. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Also you may be asked to collect a complete 24-hour urine sample in addition. Purpose of the test To measure Creatinine concentration in blood in order to know whether the kidneys are functioning correctly.
Reference range values
Female   61.88 – 114.92 mcmol/L
Male  79.56 – 123.76 mcmol/L
eGFR <60 mL/min/1.73sq.m    suggests moderate kidney dysfunction.
Abnormal findings
High creatinine levels in the blood suggest diseases that affect kidney function. These include:
  • damage to blood vessels in the kidneys (glomerulonephritis).
  • bacterial infection of the kidneys (pyelonephritis).
  • death of cells in the kidneys' small tubes (acute tubular necrosis) caused, for example, by drugs or toxins.
  • prostate disease, kidney stone, or other urinary tract obstruction.
  • reduced blood flow to the kidney due to shock, dehydration, congestive heart failure, atherosclerosis, or complications of diabetes.
Creatinine can increase temporarily due to muscle injury
Creatinine levels are slightly lower during pregnancy

Creatinine Clearance

Description Creatinine clearance test is a calculation of the amount of blood that is being filtered by the kidneys in 24 hours. Since the amount of creatinine produced depends on muscle mass, some calculations also use a correction factor in order to take into account the patient's  height and weight. This test helps evaluating kidney dysfunction.   It is prescribed when doctor thinks that there may be a problem affecting the function of the kidneys or another disease, such as congestive heart failure. Purpose of the test This test measures the amount of creatinine in the blood and urine to help evaluate the kidneys' filtering ability. Creatinine is a waste product derived from creatine, a nitrogen-based organic compound used by muscles to store energy. The amount of creatinine produced in the body is dependent on muscle mass and is constant for an individual. It is removed from the body by filtering units called glomeruli as blood passes through the kidneys. The amount of creatinine taken from the blood depends on the filtering ability of the glomeruli and the rate at which blood is carried to the kidneys. If the glomeruli are damaged or diseased, or if blood circulation is slowed, then less creatinine will be removed from the blood and released into the urine.
Reference range values Creatinine Clearance (Corrected) mL/min/1.73m2
(SI: mL/s/m^2= 0.00963 x mL/min/1.73m^2) Male 13Y-150Y      90 – 130
Female 13Y-150Y  80 – 125
Creatinine Clearance (Uncorrected) mL/min
(SI: mL/s = 0.0166 x mL/min)
0Y-1Y      35 – 65
1Y-12Y    60 – 90
>=13Y     90 – 125 In order to correct creatinine clearance for body surface area:
Creatinine clearance in mL/min x 1.73 / patient body surface area. Body surface area:
BSA = (W0.425 x H0.725) / 139.315
W=weight (kg)
H=height (cm)
Abnormal findings High creatinine in blood levels means decreased kidneys' ability to clear creatinine and other wastes out of the blood.   Then creatinine clearance will be decreased in the urine. Low creatinine clearance rate can also occur when there is decreased blood flow to the kidneys: as may occur with congestive heart failure, obstruction within the kidney, or acute or chronic kidney failure. Increased creatinine clearance rates may occasionally be seen during pregnancy, exercise, and with diets high in meat.
Patients with only one functional kidney will usually have normal creatinine clearance rates as the functional kidney will increase its rate of filtration.

Digoxin

Description Digoxin is a drug used to alleviate symptoms of heart failure and arrhythmias. This test measures the concentration of digoxin in the blood. Heart failure makes the heart less effective at circulating blood. This makes blood backs up into the legs, hands, feet, lungs and liver, causing swelling, fatigue and breathing problems. Digoxin strengthens the contractions of the heart, making it work more efficiently. Digoxin also helps control abnormal heart rhythms (arrhythmias). The test to measure digoxin is ordered at the beginning of drug therapy to ensure correct dosage. Digoxin concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test To determine if the concentration of digoxin in your blood is within therapeutic levels. This test is prescribed after the start of digoxin therapy and at regular intervals to ensure that drug levels are within therapeutic levels. Reference range values
Therapeutic Levels:
In case of CHF          1.024 – 1.92 nmol/L
In case of Arrhythmia  1.92 – 2.56 nmol/L
Toxic Levels:       >3.2 nmol/L
Abnormal findings Digoxin effects depends on each patient's response to medications, as well as other factors such as kidney function or concurrent medications.
Some diseases that can affect levels of digoxin in the blood are:
- kidney function
- thyroid problems
- cancer
- stomach or intestinal illness Digoxin levels need to be controlled because of a small variation from the appropriate range has important effects.  With low levels the disease symptoms can return. If the level is too high, toxicity may occur with following possible side effects:
- dizziness
- blurred vision or seeing yellow or green halos
- vomiting
- diarrhea
- irregular heartbeat
- difficulty breathing

Estradiol

Description
Estradiol is a type of hormone called estrogen.
This test can be used for conditions suspected such as amenorrhea, early puberty or hypogonadism. The following are possible reasons why this test may be done:
- Absent or decreased secretion of sex hormones
- Cancer
- Early-onset puberty
- Finding of ovulation
- Hypothalamic amenorrhea
- Polycystic ovaries Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test This test measures the amount of estradiol in blood
If you are a menstruating female, you may be asked to provide the day of your menstrual cycle when this test is performed. Reference range values Estradiol, Serum pg/mL (SI: pmol/L = 3.67 x pg/mL) Male >=16yrs                     <20 – 56 Female: Untreated postmenopausal  <20 – 30 Treated postmenopausal     <20 – 93 Oral Contraceptives             <20 – 102 Follicular Phase                  <20 – 160 Follicular Phase 2-3 days     <20 – 84 Periovulatory phase ±3 days  34 – 400 Luteal phase                          27 – 246
Abnormal findings- Increased results appear with:
- Obesity
- Hyperthyroidism
- Liver disease
- Gynecomastia
- Precocious puberty - Decresed results appear with:
- Vegetarianism
- Turner's Syndrome
- Menopause

Ferritin

Description Ferritin is a protein located inside the cells. It serves to store iron for later use by the body. While the body also stores iron in other forms such as hemosiderin (a complex of iron, proteins, and other materials), by measuring the concentration of ferritin in blood we can have an idea of the total iron reservoir of the body. Ferritin and hemosiderin are stored in the liver, the bone marrow, spleen, and skeletal muscles. Healthy people's bodies store iron mainly as ferritin (around 75% of it) and smaller amounts as hemosiderin. When the bloods iron decreases, iron reserves are used to prevent iron deficiency. Ferritin levels are low in patients with iron deficiency, so when the doctor suspects that you may have too little or too much iron in your system, ferritin test is ordered. The test is done, usually with an iron test and the TIBC. Ferritin is the best test for iron deficiency and it is also a very good test for iron overload. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test This test is prescribed in order to check body's store of iron. Iron deficiency is the most probable cause of anemia if a blood count indicates that your hemoglobin and hematocrit are low, and especially if your red cells are microcytic and hypochromic. Ferritin and other iron tests can be used to confirm the diagnosis. Ferritin is normally found mainly inside of cells, with only a small amount in the blood. When there is damage to organs like liver, spleen and bone narrow, that contain ferritin, ferritin levels can become elevated even though the total amount of iron in the body is normal. Ferritin levels may not be useful to monitor disease in persons with liver disease, chronic infections, cancers, or autoimmune diseases. Reference range values Male      18 – 370 mcg/L Female   9 – 120mcg/L
Abnormal findings
High levels of ferritin can be caused by:
- hemochromatosis, a genetic disease in which too much iron is absorbed
- hemosiderosis
- Inflammation
- liver disease
- some types of cancer
- multiple transfusions

Folate, Serum

Description Folic acid is one of many B vitamins. The body needs folic acid to make red blood cells (RBC), white blood cells (WBC), platelets, genetic material (DNA), and for growth. Folic acid also is important for the normal development of a baby (fetus). Folic acid concentration can be measured in the liquid portion of blood (serum). This reflects a person's recent intake of folic acid in the diet. Folic acid is found in foods such as liver, citrus fruits, leafy vegetables, whole grains, cereals with B vitamins, beans, milk, kidney, and yeast. Folic acid may also be measured in the red blood cells. This test better serves to measure the amount of folic acid stored in the body. Pregnant women need extra folic acid. Women who do not get enough folic acid before and during pregnancy are more likely to have a child born with a birth defect, such as spina bifida. Folic acid concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test A folic acid test measures the amount of folic acid in the blood. Folic acid deficiency can produce a type of anemia called megaloblastic anemia. Severe folic acid deficiency cause a sore tongue, diarrhea, headaches, weakness, forgetfulness, and fatigue. Reference range values 20.61 – 70 nmol/L
Abnormal findings High levels of B12 and folate are not usual. They can be seen in conditions such as leukemia or liver dysfunction. High folate levels may be seen with pernicious anemia and with vegetarian diets. . B12 and/or folate deficiencies can be caused by:
- Insufficient intake.   Very rare. Cases appear among vegetarians.
- Malabsorption, due to:
- Celiac disease
- Bacterial overgrowth in the stomach and intestines
- Reduced stomach acid production
- Pernicious anemia. This is the most common cause of B12 deficiency.
- Surgery that removes part of the stomach or the intestines may greatly decrease absorption.
- Increased loss, due to:
- Liver and kidney disease
- Alcoholism
- Anti-seizure medications such as phenytoin, metformin and methotrexate
- Increased need due to pregnancy. Some drugs can decrease B12 and folic acid levels including oral contraceptives, estrogens, alcohol, and some antibiotics

Folate RBC, Vitamin B12

Description Also known as: Vitamin B12 or Cobalamin, Folic Acid, RBC folate. B12 and folate belong to the B complex of vitamins. The body needs folic acid to make red blood cells (RBC), white blood cells (WBC), platelets, new genetic material (DNA) in cells, and for normal growth. Folic acid also is important for the normal development of a baby (fetus). Folate is found in green vegetables, citrus fruits, dry beans and peas, liver, and yeast B12 is found red meat, fish, poultry, milk, and eggs. Both B12 and folate are needed for RBC formation, cellular reparation, and DNA synthesis. A deficiency in either B12 or folate can lead to megaloblastic anemia.   This disease is characterized by the production of fewer, but larger, RBCs called macrocytes. Macrocytes have a shorter life  than normal RBCs and lead to fatigue, weakness, and other symptoms of anemia. A lack of B12 can also lead to neuropathy and nerve damage afecting hands and feet. Folate deficiency during early pregnancy can increase the risk of neural tube defects such as spina bifida in the fetus. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test To measure the Folate level in blood to help diagnose the cause of anemia or neuropathy. Also to evaluate nutritional status in some patients or to check effectiveness of treatment for B12 or folate deficiency.

These tests measure the concentration of folate and vitamin B12 in the liquid portion of the blood (serum) or inside the red blood cell (RBC).  It will normally be at a higher concentration inside the cells than in the serum Either a serum or RBC folate test may be used to help detect a deficiency. B12 and folate tests are done when a CBC, done routinely or as part of an evaluation of anemia symptoms, indicates the presence of large RBCs. When a person shows mental or behavioral changes such as irritability, confusion, depression, and/or paranoia, B12 and folate may be done to help diagnose the underlying cause. These tests are also be ordered when a patient has physical symptoms that suggest a B12 or folate deficiency, including dizziness, weakness, fatigue, or a sore mouth or tongue. When a patient has symptoms suggesting nerve damage such as, tingling, burning, or numbness in their hands, arms, legs, and or/feet, a B12 test may be requested.
In patients with known B12 and folate deficiencies, these tests may be ordered occasionally to help monitor the effectiveness of treatment with supplements (or with B12 injections). Normal or elevated results indicate a response to treatment. Reference range values 1123 – 3345 nmol/L Abnormal findings High levels of B12 and folate are not usual. They can be seen in conditions such as leukemia or liver dysfunction. High folate levels may be seen with pernicious anemia and with vegetarian diets.
B12 and/or folate deficiencies can be caused by:
- Insufficient intake.   Very rare. Cases appear among vegetarians. • Malabsorption, due to:
- Celiac disease
- Bacterial overgrowth in the stomach and intestines
- Reduced stomach acid production
- Pernicious anemia. This is the most common cause of B12 deficiency.
- Surgery that removes part of the stomach or the intestines may greatly decrease absorption.
- Increased loss, due to:
- Liver and kidney disease
- Alcoholism
- Anti-seizure medications such as phenytoin, metformin and methotrexate
- Increased need due to pregnancy. Some drugs can decrease B12 and folic acid levels including oral contraceptives, estrogens, alcohol, and some antibiotics.

Follicle Stimulating Hormone

Description Follicle-stimulating hormone (FSH) is made by the pituitary gland. FSH controls the growth and maturation of women`s ovarian follicles (eggs). At the time of menopause, the ovaries stop functioning and FSH levels rise. In men, FSH stimulates the testes to produce mature sperm and it level is relatively constant in males after puberty. FSH levels rise shortly after birth and then fall  between 6 months and 2 years. Levels rise again before puberty.
This test is prescribed when a woman is having difficulty getting pregnant or is having irregular menstrual periods.   Also the doctor thinks that there are symptoms of a pituitary or hypothalamic disorder or symptoms of ovarian (or testicular) disease.   In children, if a there is delayed or earlier than expected sexual maturation.
Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm.   Sometimes urine test is also prescribed. Purpose of the test To evaluate pituitary function. Both in women and men, FSH and LH tests are ordered as part of the workup of pituitary or gonadal disorders. FSH may be ordered to determine if a woman has reached menopause. In children, FSH and LH may be ordered when a boy or girl has puberty at an appropriate age (either too late or too soon) Reference range values
Females: Follicular      3 – 11 U/L
Mid-Cycle    6 - 21 U/L
Luteal           1 – 9 U/L
Postmenopausal     22 – 153 U/L Males:          1 – 11 U/L
Abnormal findings In women, FSH and LH levels can help to differentiate between primary ovarian failure (failure of the ovaries themselves) and secondary ovarian failure (failure of the ovaries due to disorders of either the pituitary or the hypothalamus). Increased levels of FSH and LH are consistent with primary ovarian failure. Some causes of primary ovarian failure are listed below. High livels of FSH and LH can indicate ovarian failure such as :
- Ovarian agenesis (failure to develop ovaries) 
- Chromosomal abnormality, such as Turner's syndrome
- Ovarian steroidogenesis defect, such as 17 alpha hydroxylase deficiency
These could be due to:
- Radiation 
- Chemotherapy 
- Autoimmune disease
On the other hand chronic anovulation (failure to ovulate) can be due to:
- Polycystic ovary syndrome (PCOS)
- Adrenal disease 
- Thyroid disease 
- Ovarian tumor
FSH levesl rise when a woman enters menopause.   Low levels of FSH and LH are can indicate a pituitary or hypothalamic problem both in women and men.
In men, high FSH levels are due to testicular failure due to developmental defects in testicular growth or to testicular injury due to:
- Gonadal agenesis 
- Chromosomal abnormality, such as Klinefelters syndrome
- Viral infection (mumps) 
- Trauma 
- Radiation 
- Chemotherapy 
- Autoimmune disease 
- Germ cell tumor Some of the causes for High FSH levels in children are:
- Central nervous system lesions
- Hormone-secreting tumors
- Ovarian tumors or cysts
- Testicular tumors

Gamma Glutamyl Transferase GGT

Description Alternative name: Gamma-glutamyl transpeptidase, GGTP
GGT is an enzyme found in the liver and in low levels in the blood. When the liver is injured or obstructed, the GGT blood level rises. It is the most sensitive liver enzyme in detecting bile duct problems. GGT test is used to detect liver and bile duct problems. Both ALP and GGT are elevated in disease of the bile ducts, but only ALP will be elevated in bone disease. GGT can also be used to look for chronic alcohol abuse. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm.
Purpose of the test
To meassure GGTP level in blood in order to investigate possible  liver disease and/or alcohol abuse or to differentiate between liver and bone disease. A doctor usually orders GGT in order to detect liver disease which symptoms can include : jaundice, nausea, vomiting, abdominal swelling, abdominal pain, pruritus (severe itching), and fatigue. GGT is usually not helpful in distinguishing between different causes of liver damage. Because of that, GGT is not advised in some cases. In persons with a past history of alcohol abuse, GGT may be used to monitor compliance with the treatment program. Reference range values
5 – 85 U/L Abnormal findings Low level only indicate that it is unlikely that a patient has liver disease. Oral contraceptives can also decrease GGT levels. High GGT levels ussually indicate a liver problem, but also can be due to congestive heart failure, alcohol consumption, and use of many prescription and non-prescription drugs including nonsteroidal anti-inflammatory drugs (NSAIDs), lipid-lowering drugs, antibiotics, histamine blockers, antifungal agents, seizure control medications, antidepressants, and hormones such as testosterone. Smoking can also increase GGT. GGT levels increase normaly with age in women (not in men), and are always somewhat higher in men than in women. GGT is normally double in persons with African ancestry than in those of European ancestry.

Estimated GFR (eGFR)

Description The eGFR is a calculated estimation of the glomerular filtration rate and is based on the serum creatinine level. Calculation also takes into account the age, gender, height, and weight, even sometimes the race. Glomerular filtration rate (GFR) is a measure of the function of the kidneys. Glomeruli are small filters in your kidney that allow waste products to be removed from the blood. GFR indicates the amount of blood filtered per minute. Measuring GFR directly is difficult, so it is used an estimation (eGFR). Compared to serum creatinine, eGFR detects more reliably the kidney disease in its early stages.   Measured clearance rather than calculated (eGFR) is recommended for:
- Patients with known kidney damage 
- Patients very old
- Patients very young
- Patients with high overweight problems
- Patients with unusual dietary intakes such as vegetarians
- Patients taking drugs that can affect renal function. The most commonly used equation for calculating the eGFR is called the MDRD (Modification of Diet in Renal Disease study) equation. The simple version of this equation requires only the creatinine test result, your age and gender. It may be modified depending on your racial origin.   Purpose of the test To evaluate kidney function when the doctor thinks that there may be kidney damage. GFR is considered the most accurate way to detect changes in kidney status. When kidney damage is detected early, it may be possible to prevent worsening damage. Reference range values eGFR 90-120 mL/min/1.73 sq.m normal range.
eGFR <60 mL/min/1.73 sq.m suggests moderate kidney problem.
eGFR <15 mL/min/1.73 sq.m means severe kidney failure.
Abnormal findings Low GFR values can be caused by any kidney disease and also high blood pressure and diabetes.

Glucose serum

Description
Glucose is a sugar which serves as the main source of energy for the body. The carbohydrates we eat are broken down into glucose. Most of the body's cells require glucose for energy production. Blood glucose levels rise after a meal, and insulin is secreted to lower them. If blood glucose levels drop too low, the liver will turn some glycogen back into glucose, raising the blood glucose levels. Severe hyperglycemia or hypoglycemia can cause organ failure, brain damage, coma, and, even death. Chronically high blood glucose levels will cause progressive damage to body organs such as the kidneys, eyes, heart and blood vessels, and nerves. Chronic hypoglycemia lead to brain and nerve damage. Some women may develop hyperglycemia during pregnancy (gestational diabetes). Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm.  Also for a self check, a drop of blood from a skin prick. Sometimes a random urine sample is used. Purpose of the test To determine blood glucose level to diagnose or monitor hyperglycemia, hypoglycemia.   Also to monitor glucose levels in persons with diabetes.  A diabetic person has to check blood glucose level several times a day. This test is prescribed, when you have symptoms suggesting hyperglycemia or hypoglycemia, and during pregnancy. Blood glucose testing can be used to regularly screen healthy, asymptomatic individuals for diabetes and pre-diabetes because diabetes is a common disease that begins with few symptoms.
Reference range values 3.88 – 6.38 mmol/L
Abnormal findings High levels of glucose frequently indicate diabetes or prediabetes.
Some other possible diseases that can result in elevated glucose levels include:
- Acromegaly
- Acute stress
- Chronic renal failure
- Cushing syndrome
- Drugs such as: corticosteroids, tricyclic antidepressants, diuretics, epinephrine, estrogens, lithium, phenytoin, salicylates,
- Excessive food intake
- Hyperthyroidism
- Pancreatic cancer
- Pancreatitis Increased urine glucose levels can be due to medications, such as estrogens and chloral hydrate, and to some forms of renal disease. Low blood glucose levels (hypoglycemia) can be cause by:
- Adrenal insufficiency
- Drinking alcohol
- Drugs, such as acetaminophen and anabolic steroids
- Extensive liver disease
- Hypopituitarism
- Hypothyroidism
- Insulin overdose
- Insulinomas
- Starvation

Glycohemoglobin GHB

Description Glycohemoglobin is a blood test that checks the amount of sugar (glucose) bound to hemoglobin. Only a small percentage of hemoglobin in the blood (4% to 6%) has glucose bound to it. People with diabetes or other conditions that increase the blood glucose levels have more glycohemoglobin. The glycohemoglobin A1c test checks the long-term control of blood glucose levels in people with diabetes. Most doctors think the glycohemoglobin A1c level is the best way to check how well a person is controlling diabetes. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test This test is done to check evolution of diabetes treatment. A home blood glucose test measures the level of blood glucose only at the moment. Blood glucose levels change during the day: diet, exercise, and the level of insulin in blood. Glucose binds to hemoglobin in red blood cells at a steady rate. Since red blood cells last 3 to 4 months, glycohemoglobin A1c test shows how much glucose is in the plasma part of blood. This test shows how well diabetes has been controlled in the last 2 to 3 months and whether diabetes medicine needs to be changed. Reference range values
Glycohemoglobin A1c: - Adults: 4.5%-5.7%
- Children below 6 years old 7.5-8.5%
- Children ages 6-12 years old < 8%
- Teens ages 13-19 years old <7.5%
Total glycohemoglobin: 5.3%-7.5%
Abnormal findings A glycohemoglobin A1c level above 8% means that your diabetes has been poorly controlled over the last 2 to 3 months. Some medical conditions can increase A1c levels. These conditions include Cushing's syndrome, pheochromocytoma, and polycystic ovary syndrome.

Hemoglobin A1c

Description Glycohemoglobin is a blood test that checks the amount of sugar (glucose) bound to hemoglobin. Only a small percentage of hemoglobin in the blood (4% to 6%) has glucose bound to it. People with diabetes or other conditions that increase the blood glucose levels have more glycohemoglobin. The glycohemoglobin A1c test checks the long-term control of blood glucose levels in people with diabetes. Most doctors think the glycohemoglobin A1c level is the best way to check how well a person is controlling diabetes. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test This test is done to check evolution of treatment for diabetes. A home blood glucose test measures the level of blood glucose only at that moment. Blood glucose levels change during the day due to diet, exercise, and the level of insulin in the blood. It is useful for a diabetic to have information about the long-term control of sugar levels. The glycohemoglobin test is one blood sample every 3 to 4 months, and the test does not change with any recent changes in medicines, diet or exercise. Glucose binds to hemoglobin in red blood cells at steady rate. Since red blood cells last 3 to 4 months, the glycohemoglobin A1c test shows how much glucose is in plasma part of blood. This test shows how well diabetes has been controlled in the last 2 to 3 months and whether diabetes medicine needs to be changed. A1c level can also helps to see how big your risk is of developing problems from diabetes, such as kidney failure, vision problems, and leg or foot numbness. The lower A1c level, the lower chance for problems.
Reference range values
Glycohemoglobin A1c: - Adults: 4.5%-5.7%
- Children below 6 years old 7.5-8.5%
- Children ages 6-12 years old < 8%
- Teens ages 13-19 years old <7.5%
Total glycohemoglobin: 5.3%-7.5% Abnormal findings A glycohemoglobin A1c level above 8% means that diabetes has been poorly controlled over the last 2 to 3 months. Some medical conditions can increase A1c levels, but the results may still be within normal level. Conditions include Cushing's syndrome, pheochromocytoma, and polycystic ovary syndrome (PCOS).

Homocysteine

Description Homocysteine is an amino acid present in very small amounts in the cells of the body. Homocysteine is a product of methionine metabolism. Methionine is one essential amino acids that must be got from food since the body cannot produce them. Vitamins B6, B12, and folate are necessary to metabolize homocysteine. Patients who are deficient in these vitamins can have increased levels of homocysteine. Increased concentrations of homocysteine have been associated with an increased tendency to form inappropriate blood clots. This can lead to heart attack, strokes, and blood vessel blockages. This test is used as a screen for people at high risk for heart attack or stroke. It may be useful in patients who have a family history of coronary artery disease. It can be also prescribed if a patient has B12 or folate deficiency. The homocysteine concentration may be elevated in patients before B12 and folate tests are abnormal. Some doctors may recommend homocysteine testing in malnourished patients, such as the elderly  and those with drug or alcohol problems. Greatly increased concentrations of homocysteine in the urine and blood mean that it is likely that an infant has homocystinuria and indicate the need for further testing to confirm the cause of the increase. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm.   Also a urine test is sometimes prescribed. Purpose of the test To meassure the level of homocysteine in blood in order to determine if there is an increased risk of a heart attack or stroke.   Also to determine if you are folate-deficient or B12-deficient.  Finally ,  to help diagnose a rare inherited disorder called homocystinurina. It is prescribed when the patient has had a heart attack or stroke, or as part of a cardiac risk assessment.   Also when a doctor suspects a vitamin B12 or folate deficiency or suspects that an infant or young person may have homocystinuria. Reference range values
0 – 13  mcmol/L Abnormal findings High levels of homocysteine in blood are indicative of cardiac risk, vitamin B12 or folate deficiency, or  homocystinuria.
Homocysteine levels can increase with age, when a patient smokes, and with the use of drugs such as carbamazepine, methotrexate, and phenytoin.

Human Chorionic Gonadotropin (HCG) Serum

Description
hCG is a protein produced in the placenta of a pregnant woman. A pregnancy test is a specific blood or urine test that can detect hCG and confirm pregnancy. This hormone can be detected 10 days after a missed menstrual period, the time period when the fertilized egg is implanted in the woman's uterus. At pregnancy, production of hCG increases steadily during the first 10 weeks, peaking around the 10th week after the last menstrual cycle.   Then  level fall slowly during the rest of the pregnancy. hCG is also produced by some germ cell tumors and increased levels are seen in trophoblastic disease. Qualitative hCG testing is routinely used to confirm pregnancy. It measures the actual amount of hCG present in the blood.
Its concentration is measured by means of a urine sample collected first thing in the morning or a blood sample drawn from a vein in the arm. Purpose of the test To confirm and monitor pregnancy or to help diagnose and monitor trophoblastic disease or germ cell tumors.
It is prescribed as early as 10 days after a missed menstrual period or if a doctor thinks that your symptoms suggest ectopic pregnancy, trophoblastic disease, or germ cell tumors.
Reference range values Negative        < 6 IU/L
Indeterminate    6-29 IU/L Positive           >=30 IU/L
Abnormal findings During early pregnancy, the hCG level in the blood doubles every two to three days. Ectopic pregnancies usually have a longer doubling time.
hCG is also used to check eficiency of  treatment in patients with trophoblastic disease and to detect recurrent disease after treatment is complete. Certain drugs such as diuretics and promethazine can also cause false-negative urine results. Other drugs such as anti-convulsants, anti-parkinson drugs, hypnotics, and tranquilizers may cause false-positive results. There are reports of false positive serum hCG results due to several different compounds (not drugs) that may interfere with the test. These include certain types of antibodies that may be present in some individuals and fragments of the hCG molecule. Generally, if results are questionable, they may be confirmed by testing with a different method.

Insulin

Description Insulin may be used, often along with glucose and C-peptide levels, to help diagnose insulinomas and to help diagnose documented chronic (fasting) hypoglycemia. Insulin and C-peptide levels may also be used to monitor endogenous insulin, check for insulin resistance, and to help determine when a type 2 diabetic might need to start taking insulin injections to supplement oral medications. Insulin levels are used in conjunction with the glucose tolerance test (GTT). In this situation, blood glucose and insulin levels are measured at pre-established time intervals to evaluate insulin resistance. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test Insulin levels are most frequently ordered following an abnormal glucose test and/or when a patient has acute or chronic symptoms of hypoglycemia, such as sweating, palpitations, hunger, confusion, blurred vision, dizziness, fainting, and seizures. Insulin and C-peptide are produced by the body at similar rate as part of the activation and division of proinsulin in the pancreas. Both may be ordered to evaluate how much insulin in the blood is due to endogenous production and how much is from exogenous sources. Insulin tests will reflect the total, while C-peptide will reflect only the endogenous insulin. Doctor may order both tests to verify that an insulinoma has been successfully removed.
Reference range values
3-19 mIU/L Abnormal findings
High insulin levels are seen with:
- Acromegaly
- Cushing's syndrome
- Drugs such as corticosteroids, levodopa, oral contraceptives
- Fructose or galactose intolerance
- Insulinomas
- Obesity
- Insulin resistance, such as in type 2 diabetes and metabolic syndrome Low insulin levels are seen with:
- Diabetes
- Hypopituitarism
- Pancreatic diseases such as chronic and pancreatic cancer

Insulin and C peptide

Description When a patient has newly diagnosed type 1 or type 2 diabetes, C-peptide can be used to help determine how much insulin the patient's pancreas is still producing. Type 1 diabetes is an autoimmune process that often starts in early childhood and involves the almost complete destruction of the beta cells over time. Eventually, little or no insulin (and C-peptide) is produced, leading to a complete dependence on exogenous insulin. In type 2 diabetes, there is insulin resistance and a compensatory increase in insulin production and release that can also lead to beta cell damage. Type 2 diabetics usually are treated with oral drugs to stimulate their body to make more insulin and/or to cause their cells to be more sensitive to the insulin that is already being made. Eventually, because of the beta cell damage, type 2 diabetics may make very little insulin and require injections. Any insulin that the body does make will be reflected in their C-peptide level; therefore, the C-peptide test can be used to monitor beta cell activity and capability over time and to help your doctor determine when to begin insulin treatment. C-peptide measurements also can be used in conjunction with insulin and glucose levels to help diagnose the cause of documented hypoglycemia and to monitor its treatment. Symptoms of hypoglycemia may be caused by excessive supplementation of insulin, alcohol consumption, inherited liver enzyme deficiencies, liver or kidney disease, or insulinomas (tumors of the islet cells in the pancreas that can produce uncontrolled amounts of insulin and C-peptide). Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test C-peptide levels may be ordered if you have newly diagnosed type 1 diabetes, as part of an evaluation of your "residual beta cell function" (how much insulin your beta cells are making). With type 2 diabetes, the test may be ordered if your doctor wants to monitor the status of your beta cells and insulin production over time and to determine if/when insulin injections may be required. C-peptide levels may be done when there is documented acute or recurring hypoglycemia. Symptoms include sweating, palpitations, hunger, confusion, blurred vision, fainting, seizures, and even loss of consiousness, although these symptoms also can occur with other conditions. The C-peptide test may be used to help separate excessive insulin production from excessive administration and to help diagnose insulinomas. If you have had your pancreas removed or are one of the few patients to have had pancreas islet cell transplants (in order to restore your ability to make insulin), your C-peptide levels may be monitored to verify the effectiveness of treatment and continued success of the procedure. Reference range values
0.78-1.89 microg/L (0.26-0.62 nmol/L) Abnormal findings
High levels of C-peptide generally indicate high levels of endogenous insulin production. This may be a response to high levels of blood glucose caused by glucose intake and/or insulin resistance. (With insulin resistance, the body's cells do not use insulin normally to transport glucose inside the cell. The cells become "starved for glucose," interpret that as a lack of insulin, and signal the body to make more.) High levels of C-peptide also are seen with insulinomas (insulin-producing tumors) and may be seen with hypokalemia, pregnancy, Cushing's syndrome, and renal failure. Low levels of C-peptide are associated with low levels of insulin production. This can occur when insufficient insulin is being produced by the beta cells or when production is suppressed by exogenous insulin or with suppression tests that involve substances such as somatostatin.

Insulin-Like Growth Factor-1

Description Also known as: Somatomedin C The insulin-like growth factor-1 (IGF-1) test is an indirect measure of the average amount of growth hormone (GH). IGF-1 and GH are peptide hormones vital for normal bone and tissue growth and development. GH is produced by the pituitary gland, a grape-sized gland located at the base of the brain behind the bridge of your nose. IGF-1 is produced by the liver and to a lesser degree by skeletal muscles, primarily in response to GH stimulation. Excess GH and IGF-1 can cause abnormal growth of the skeleton and other signs and symptoms characteristic of gigantism and acromegaly. Both conditions can lead to enlarged organs, such as the heart, and to other complications such as type 2 diabetes, increased cardiovascular disease risk, high blood pressure, arthritis, and a decreased life span.
IGF-1 testing may be ordered, along with a GH stimulation test, when a child has symptoms of GH deficiency, such as a slowed growth rate and short stature. They also may be ordered when adults have symptoms that the doctor suspects may be due to a GH deficiency. An IGF-1 also may be ordered when a doctor suspects that a person has an underactive pituitary gland and at intervals to monitor patients on GH therapy.
IGF-1 testing may be ordered, along with a GH suppression test, when a child has symptoms of gigantism, an adult shows signs of acromegaly, and/or when a doctor suspects that a patient has hyperpituitarism. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test To identify diseases caused by deficiencies and overproduction of growth hormone (GH), also to evaluate pituitary function. and to monitor the effectiveness of GH treatment.
This test is prescribed as part of an evaluation of pituitary function, when you have symptoms of slow growth, short stature, and delayed development or decreased bone density, reduced muscle strength, and increased lipids that suggest insufficient GH and IGF-1 production.   Also when you have symptoms of gigantism (in children) or acromegaly (in adults) that suggest excess GH and IGF-1 production.
IGF-1 may be ordered with other pituitary hormone tests, such as adrenocorticotropic hormone (ACTH), to help diagnose hypopituitarism. It may be used to monitor the effectiveness of treatment for growth hormone deficiencies and growth hormone insensitivity. Reference range values
Units: mcg/L
1Y         55 – 327
2Y         51 – 303
3Y         49 – 289
4Y         49 – 283
5Y         50 – 286
6Y         52 – 297
7Y         57 – 316
8Y         64 – 345  
9Y         74 – 388
10Y       88 – 452
11Y      111 – 551
12Y      143 – 693
13Y      183 – 850
14Y      220 – 972
15Y      237 – 996
16Y      226 – 903
17Y      193 – 731
18Y      163 – 584
19Y      141 – 483
20Y      127 – 424
21-25Y  116 – 358
26-30Y  117 – 329
31-35Y  115 – 307
36-40Y  109 – 284
41-45Y  101 – 267
46-50Y    94 – 252
51-55Y    87 – 238
56-60Y    81 – 225
61-65Y    75 – 212
66-70Y    69 – 200
71-75Y    64 – 188
76-80Y    59 – 177
81-85Y    55 – 166
Tanner Stages Males:
I:     63 – 279 II:    75 – 420 III     94 – 765 IV:   192 – 861 V:    171 – 814
Females
I:     49 – 342 II:    115 – 428 III    145 – 760 IV:   244 – 787 V:   143 – 859 Abnormal findings
Low  IGF-1 concentrations can appear due to  a deficiency of GH or an insensitivity to GH.
If a decrease in IGF-1 is due to a more general decrease in pituitary function (hypopituitarism), this may be due to inherited defects.
On the other hand, it can rise as a result of pituitary damage following conditions such as trauma, infections, and inflammation.
Low levels of IGF-1 also may be seen with nutritional deficiencies, chronic kidney or liver disease, inactive/ineffective forms of GH, and with high doses of estrogen.
High  IGF-1 concentrations can appear due to puberty and pregnancy but are most frequently due to pituitary tumors. If other pituitary hormones are also abnormal, then the patient may have hyperpituitarism.

Ketones Urine

Description Ketones are substances that are made when the body breaks down fat for energy. Normally, the body gets the energy it needs from carbohydrate. However, stored fat is broken down and ketones are made if the diet does not contain enough carbohydrate to supply the body with glucose for energy or if your body cannot use it properly. Newer home blood sugar meters can also measure ketones. Home urine tests to measure ketones are available also. It is recommended for all people with diabetes symptoms such as nausea, vomiting, or abdominal pain. These symptoms are similar to symptoms of high blood sugar and may mean you have diabetic ketoacidosis, a potentially life-threatening problem. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm, but  An urine test is the most commonly used method. Purpose of the test The purpose of this test is to detect the presence of ketones in blood or urine.
This test may be done to:
- Monitor a person on a very low-carbohydrate diet.
- Monitor a pregnant woman with diabetes or who has developed gestational diabetes. Reference range values Negative
Abnormal findings If the result of the test is positive this means that the body is breaking down fat for energy instead of  carbohydrate. This can be due to:
- Having diabetes or diabetic ketoacidosis.
- Being on a very low-carbohydrate diet.
- Being starving or having an eating disorder, such as anorexia nervosa or bulimia, alcoholism, or poisoning from drinking rubbing alcohol.
- Having not eaten for 18 hours or longer.
- Being pregnant. Reasons why the results may not be helpful include:
- Taking medicines, such as:
- Levodopa, such as Sinemet or Larodopa.
- Phenazopyridine, such as Pyridium, Geridium, Pyridiate, or Urogesic.
- Valproic acid, such as Depakote, Depacon, or Depakene.
- Vitamin C in large amounts.
- Dehydration.
- A high-fat diet.
- Pregnancy.

Lactate Dehydrogenase  Serum

Description Also known as: LD, Lactate dehydrogenase, Lactic dehydrogenase, Total LDH, and LDH isoenzymes. Lactate dehydrogenase (LDH or LD) is an enzyme found in almost all body tissues, but only in a small amount in the blood. LDH is found in the bloodstream when cells are damaged. Because of this, LDH test can be used as a general marker of cells damage. Level of LDH may be measured either as a total LDH or as LDH isoenzymes. A total LDH level is an overall measurement of five different LDH isoenzymes (slightly different molecular versions of the LDH enzyme). Each of the five LDH isoenzymes tends to be concentrated in specific body tissues. Then, measurements of the individual LDH isoenzyme levels can help determine the disease or by  identifying the organs and tissues involved. The five isoensymes and they common location are:
• LDH-1, heart, red cells, kidney, germ cells
• LDH-2, heart, red blood cells, kidney
• LDH-3, lungs and other tissues
• LDH-4, white blood cells, lymph nodes, muscle, liver
• LDH-5, liver, skeletal muscle LDH-2 usually is present on a bigger pertentage on the total LDH test. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test This test helps identifying the cause and location of tissue damage in the body and to monitor its progress. It is prescribed, along with other tests, when the doctor suspects an acute or chronic condition that is causing tissue or cellular destruction, in order to identify the source of the damage. Reference range values
113 – 226  U/L Abnormal findings High levels of LDH and changes in the ratio of the LDH isoenzymes usually indicate some type of tissue damage.
Elevated levels of LDH may be seen with:
• Cerebrovascular accident (CVA, stroke)
• Drugs: anesthetics, aspirin, narcotics, procainamides, alcohol
• Hemolytic anemias
• Pernicious anemias (megaloblastic anemais)
• Infectious mononucleosis (Mono)
• Intestinal and pulmonary infarction
• Kidney disease
• Liver disease
• Muscular dystrophy
• Pancreatitis
• Lymphoma or other cancers
Low and normal levels of LDH do not usually indicate a problem. Low levels can be seen when a patient ingests large amounts of vitamin C).

Lipase  Serum

Description Lipase is an enzyme produced by the pancreas to help digest fats, proteins, and carbohydrates. Lipase is usually present in the blood in small quantities. When cells in the pancreas are injured or the pancreatic duct is blocked the increased amounts of lipase leak into the bloodstream, increasing blood concentrations. This test is ordered when a patient has symptoms of a pancreatic problem, such as severe abdominal pain, fever, loss of appetite, or nausea. It also helps,  ordered at intervals, when a doctor wants to monitor a patient with a pancreas condition to evaluate the effectiveness of treatment and to determine whether the lipase levels are increasing or decreasing over time. Lipase testing is also occasionally used in the diagnosis and follow-up of cystic fibrosis, celiac disease, and Crohn's disease. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test To meassure the concentration of Lipase enzyme in blood in order to diagnose and monitor pancreatitis or other pancreatic diseases. It is ordered when the patient has symptoms of a pancreatic disorder, such as severe abdominal pain, fever, loss of appetite, or nausea. Reference range values 52 – 336 U/L Abnormal findings Very high levels of Lipase in blood can be due to acute pancreatitis. High levels are also found with pancreatic duct obstruction, pancreatic cancer, and other pancreatic diseases.
Moderately increased lipase values may occur with kidney disease, salivary gland inflammation, a bowel obstruction, or peptic ulcer disease. Low  lipase levels may indicate permanent damage to the lipase-producing cells in the pancreas.

Lipoprotein a

Description Lipoprotein(a) (Lp(a)) is a lipoprotein subclass. Lp(a) is a risk factor for atherosclerotic diseases such as coronary heart disease and stroke. The physiological function of Lp(a) is still unknown. A function within the coagulation system seems plausible. Other functions have been related to recruitment of inflammatory cells through interaction with Mac-1 integrin, angiogenesis, and wound healing. Studies whown that high Lp(a) in blood is a risk factor for coronary heart disease (CHD), cerebrovascular disease (CVD), atherosclerosis, thrombosis, and stroke. Commonly prescribed lipid-reducing drugs have little or no effect on Lp(a) concentration. Niacin and aspirin are two safe, easily available and inexpensive drugs known to significantly reduce the levels of Lp(a) in some individuals with high Lp(a). Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test High Lp(a) predicts risk of early atherosclerosis similar to high LDL, but in advanced atherosclerosis, Lp(a) is an independent risk factor not dependent on LDL. Lp(a) then indicates a coagulant risk of plaque thrombosis. Apo(a) contains domains that are very similar to plasminogen (PLG). Lp(a) accumulates in the vessel wall and inhibits binding of PLG to the cell surface, reducing plasmin generation which increases clotting. This inhibition of PLG by Lp(a) also promotes proliferation of smooth muscle cells. These unique features of Lp(a) suggest Lp(a) causes generation of clots and atherosclerosis. Reference range values
Lp(a) concentrations widely vary between individuals, from 2000 mg/L. This range of concentrations is observed in all populations studied so far. The mean and median concentrations between different world populations show distinct particularities, the main being the two- to threefold higher Lp(a) plasma concentration of populations of African descent compared to Asian, Oceanic, or European populations. Thus the threshold below values are applicable only to individuals of European descent, if at all. Desirable: < 14 mg/dL (< 35 nmol/l)
Borderline risk: 14 - 30 mg/dL (35 - 75 nmol/l)
High risk: 31 - 50 mg/dL (75 - 125 nmol/l)
Very high risk: > 50 mg/dL (> 125 nmol/l) Abnormal findings Fish oil supplements may be helpful to lower the levels of Lp-a. Fibrates such as benzafibrate or gemfibrozil have significantly lowered Lp-a in some individuals. Regular consumption of alcohol leads to significant decline in plasma levels of Lp-a. High levels of Apo AI HDL cholesterol are protective against atherogenic potential of Lp-a.

Luteinizing Hormone

Description Luteinizing hormone (LH) is produced by the pituitary gland. Control of LH production is a complex system involving hormones produced by the gonads (ovaries or testes), the pituitary, and the hypothalamus. Women's menstrual cycles are divided into 2 phases, the follicular and luteal, by a mid-cycle surge of follicle-stimulating hormone (FSH) and LH. The high level of LH (and FSH) at mid-cycle triggers ovulation. In men, LH stimulates the Leydig cells in the testes to produce testosterone. In children, LH levels rise shortly after birth and then fall to very low. At about 6-8 years, levels again rise before the beginning of puberty. LH is used together with other tests (FSH, testosterone, estradiol and progesterone) in the study  of infertility in both men and women. LH levels are also useful in the investigation of menstrual irregularities, diagnosis of pituitary disorders or diseases involving the ovaries or testes. In children, FSH and LH are used to diagnose delayed and precocious (early) puberty. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test
To meassure the level of Luteinizing Hormone in order to evaluate pituitary function, especially in terms of fertility issues.
It is prescribed when the patient is having difficulty getting pregnant or is having irregular menstrual periods.   Also if doctor sees symptoms of a pituitary or hypothalamic disorder or symptoms of ovarian or testicular disease. Also when a doctor suspects that a child has delayed or earlier than expected sexual maturation. In women and men, LH (along with FSH) is ordered as part of the workup of infertility and pituitary or gonadal disorders. Reference range values Male Adult             1 – 8 U/L
Female
Follicular               1 – 12 U/L
Mid-Cycle Peak    17 - 77 U/L
Luteal                    0 - 15 U/L
Post menopausal  11 - 40 U/L
Abnormal findings High levels of LH and FSH are seen in primary ovarian failure whose causes can be :
• Ovarian agenesis (failure to develop ovaries) 
• Chromosomal abnormality, such as Turner's syndrome
• Ovarian steroidogenesis defect such as 17 alpha hydroxylase deficiency
• Radiation
• Chemotherapy
• Autoimmune disease
• Polycystic ovary syndrome (PCOS)
• Adrenal disease 
• Thyroid disease 
• Ovarian tumor
When a woman enters menopause , LH levels will rise. Low levels of LH and FSH are seen in secondary ovarian failure and indicate a problem in the pituitary or hypothalamus.
In men, high LH levels indicate primary testicular failure. This can be due to:
• Gonadal agenesis 
• Chromosomal abnormality, such as Klinefelters syndrome
• Viral infection (mumps) 
• Trauma 
• Radiation 
• Chemotherapy 
• Autoimmune disease 
• Germ cell tumor
Low levels are consistent with pituitary or hypothalamic disorders. In young children, high levels of LH and FSH are indication of precocious puberty. Some of the causes may be:
• Central nervous system lesions
• Hormone-secreting tumors
• Ovarian tumors or cysts
• Testicular tumors
On the contrary, low levels of LH and FSH indicate delayed puberty, cause by:
• Gonadal (ovary or testes) failure
• Hormone deficiency
• Turner's syndrome (chromosomal abnormality in girls)
• Klinefelter's syndrome (chromosomal abnormality in boys)
• Chronic infections
• Cancer
• Eating disorder (anorexia nervosa)

Lyme Disease (Borrelia burgdorferi), PCR

Description A Lyme disease test detects antibodies to the Lyme disease bacteria Borrelia burgdorferi in blood. Lyme disease bacteria are spread by certain kinds of ticks. Lyme disease can be hard to diagnose because its symptoms are similar to those of many other illnesses. It may take up to 2 months after becoming infected before antibodies can be detected in a normal blood test. Once formed, antibodies usually stay in the body for many years, even after successful treatment of the disease. There are three types of antibody Lyme disease test:
- Enzyme-linked immunosorbent assay (ELISA). Common and rapid test to identify Lyme disease antibodies.
- Indirect fluorescent antibody (IFA).
- Western blot test. This test also identifies Lyme disease antibodies and can confirm the results of an ELISA or IFA test. Antibody testing should be done in a two-step process, using either the ELISA or IFA followed by the Western blot test. ELISA is considered a more reliable and accurate test than IFA, but IFA may be used if ELISA is not available. The Western blot test (which is a more specific test) should be done in all people who have tested positive or borderline positive in an ELISA or IFA test. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Antibody testing may also be done on fluid from the spine or from a joint.
Purpose of the test A Lyme disease test is done to diagnose Lyme disease in people who have symptoms that include:
- Expanding red rash with a pale center.
- Extreme tiredness.
- Fever.
- Headache and stiff neck.
- Muscle and joint pain. Symptoms of chronic Lyme disease include joint pain, stiffness, and problems with the heart, brain, or nerves. Reference range values The results of a Lyme disease test (ELISA, IFA, Western blot) may be reported in titers. A titer is a measure of how much the sample can be diluted before the antibodies to the Lyme disease bacteria can no longer be detected. A titer of 1 to 8 (1:8) means that antibodies can be detected when 1 part of the blood sample is diluted by up to 8 parts of a salt solution (saline).
Normal (negative):
- For the IFA test, the titer is less than 1:256.
- Polymerase chain reaction (PCR) test does not find any Lyme disease bacteria DNA. Abnormal (positive):
- For the IFA test, the titer is equal to or greater than 1:256.
- Polymerase chain reaction (PCR) test detects Lyme disease bacteria DNA.
Abnormal findings An abnormal, or positive, test for Lyme disease can mean: - If antibodies are found, Lyme disease is present now or was in the past. Antibodies to the bacteria will usually stay in the body for the rest of life.
- If Lyme disease bacteria DNA is found, active Lyme disease infection is present.
- Sometimes an antibody test for Lyme disease finds antibodies to other bacteria, such as syphilis, or viruses, such as the Epstein-Barr virus or the human immunodeficiency virus (HIV). The PCR test must be done to confirm an infection in case of a positive antibody test result.

Magnesium

Description Alternative Names : Mg+2 About half of the body's magnesium is found in the bones. The other half is found inside cells. Magnesium is necessary for nearly all biochemical processes in the body. It helps maintain muscle and nerve function, keeps the bones strong, controls the heart beat, and helps regulate blood pressure. Magnesium also controls blood sugar levels and helps support the body's immune system. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test A serum magnesium test is done to see how much magnesium is there in the blood. It is prescribed, in order to help detect a wide range of abnormal body circunstancies. Abnormal levels of magnesium are most frequently seen in conditions or diseases that cause abnormal excretion of magnesium by the kidneys or that cause impaired absorption in the intestines. Magnesium levels may be checked as part of an evaluation of the severity of kidney problems or of uncontrolled diabetes and may help in the diagnosis of gastrointestinal disorders. Since a low magnesium level can, cause persistently low calcium and potassium levels, it may be checked to help diagnose problems with calcium, potassium, phosphorus, and parathyroid hormone. Magnesium levels may be checked frequently to monitor the response to oral or intravenous magnesium supplements and may be used, along with calcium and phosphorus testing, to monitor calcium supplementation. Magnesium testing may be ordered to check chronically low levels of calcium and potassium. It also may be ordered if you have symptoms of an abnormally low magnesium level such as muscle weakness, twitching, cramping, confusion, cardiac arrhythmias. Reference range values
18 to 30 mg/L Abnormal findings High magnesium levels are seen in persons who have:
- Addison's disease
- Chronic renal failure
- Dehydration
- Diabetic acidosis
- Oliguria Low magnesium levels are seen in persons who have:
- Alcoholism
- Chronic diarrhea
- Delirium tremens
- Hemodialysis
- Hepatic cirrhosis
- Hyperaldosteronism
- Hypoparathyroidism
- Pancreatitis
- Too much insulin
- Toxemia of pregnancy
- Ulcerative colitis

Methemoglobin

Description
Red Blood Cells (RBC) contain a protein called hemoglobin.   The function of hemoglobin is very important, since this protein adds oxigen when the RBC goes through the lumbs and after that it carries this oxigen to the entire body so body cells can work.  Afterwards it takes the CO2 that is a waste of the normal cellular function back to the lumps where it is expulsed by the respiration. Methemoglobin is a type of hemoglobin that is unable to transport oxygen to tissues in blood. When the production of this protein is big enough leads to important health problems so this condition is called methemoglobinemia. Purpose of the test This test is used to evaluate and manage a condition called methemoglobinemia.
The following are possible reasons why this test may be done:
• Acquired methemoglobinemia
• Congenital methemoglobinemia Reference range values Normal   <2%
Abnormal findings High concentration of Methemoglobin in blood is caused by both acquired or congenital methemoglobinemia

Microalbumin Creatinine Ratio

Description Albumin is a protein that produced in the liver. It is present in high levels in the blood, but when the kidneys are functioning properly, virtually no albumin is present in the urine. If the kidneys become damaged they begin to lose their ability to filter proteins out of the urine. This is frequently seen in chronic diseases, such as diabetes and hypertension, with increasing amounts of protein in the urine reflecting increasing kidney failure. Albumin molecule is small.  For this reason it is one of the first proteins to be detected in the urine with kidney damage. Patients who have consistently detectible amounts of albumin in their urine (microalbuminuria) have risk of developing progressive kidney failure and cardiovascular disease. When a creatinine measurement is performed together with a random microalbumin, the resulting microalbumin/creatinine ratio approaches the accuracy of the 24-hour microalbumin test without the extended collection hassle. This test is ordered as a screening test on patients with chronic conditions, such as diabetes and hypertension, that put them at an increased risk of developing kidney failure. Patients with chronic hypertension may be tested at regular intervals.
Its concentration is measured by means of a random urine analysis, along with a creatinine test. Purpose of the test To obtain albumin concentration in order to screen a possible kidney disorder in the very first stage.
Microalbumin test is an early indicator of kidney failure. It measures the small amounts of albumin that the body begins to release into the urine years before significant kidney damage.
Reference range values 0.0 – 16.9  mg/g Abnormal findings High microalbumin levels in urine indicate that a person is in an early phase of developing kidney disease. Very high levels are an indication of severe kidney disease.

Osteocalcin

Description Alternative name: Bone g1a protein measurement.
Osteocalcin is a major protein found in bone. Small amounts of this protein are found in the bloodstream. By analysing the Osteocalcin level in the blood, we can have an estimation of the presence of the protein in the bones. This analysis is normally used to help evaluate bone formation disorders. Also it is used when a secondary malignant neoplasm of the bone is suspected. Finally it may also be used to monitor postmenopausal women who are at risk for osteoporosis. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test This test measures the level of osteocalcin in blood.   It is presecribed when a bone formation problem is foreseen.  Also to check for bone tumor metastasis and to monitor osteoporosis. Reference range values The following are considered normal results for this test:
• Adult male: 3-13 mcg/L
• Adult premenopausal female: 0.4-8.2 mcg/L
• Adult postmenopausal female: 1.5-11 mcg/L
• Children, 2 to 17 years: 2.8-41 mcg/L
• Neonates: 20-40 mcg/L
In adult males, levels vary over a 24h period  in a 5- to 10-mc/L. Circulating levels are lowest in late afternoon and peak at night.   Abnormal findings High Osteocalcin levels in blood are found with:
o Adolescent growth spurts (40-80 mcg/L in boys)
o Chronic renal failure
o Hyperthyroidism
Low Osteocalcin levels in blood are found with:
o Pregnancy
o Cirrhosis

Parathyroid Hormone

Description A parathyroid hormone (PTH) blood test measures the level of parathyroid hormone in blood. This test is used to help identify hyperparathyroidism or to find the cause of abnormal calcium blood levels. PTH controls calcium and phosphorus levels in the blood. PTH is made by the parathyroid glands. If the blood calcium level is too low, the parathyroid glands release more PTH . Then bones release more calcium into the blood and reduces the amount of calcium released by the kidneys into the urine. Then, vitamin D is converted to a more active form, causing the intestines to absorb more calcium and phosphorus. If the calcium level is too high, the parathyroid glands release less PTH, and the whole process runs opposite direction. PTH levels that are too high or too low can cause problems with the kidneys and bones and cause changes in calcium and vitamin D. Tests for calcium and phosphorus levels in the blood are normally done at the same time as a PTH test. PTH concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test This test is done in order to:
- Help identify hyperparathyroidism.
- Find the cause of abnormal blood calcium level.
- Check whether a problem with the parathyroid glands is causing the abnormal calcium level.
- Check problems in people with chronic kidney disease.
Reference range values 10-65 ng/L
Abnormal findings High PTH levels can be caused by:
- Parathyroid gland growth (hyperplasia) or Parathyroid tumor.
- Low level of calcium in the blood, caused by kidney disease, kidney failure, severe vitamin D deficiency, or an inability of the intestines to absorb calcium from food.
- Some types of cancer, such as of the lung, kidney, pancreatic, or ovarian cancer. Low PTH levels can be caused by:
- Damage to the parathyroid gland, which can by caused by neck surgery or radiation treatments.
- Rare disease, such as sarcoidosis or histiocytosis X.
- Overdose of vitamin D or calcium.
- Cancer, such as lymphoma or multiple myeloma.
- Low magnesium level.

pH Urine

Description pH means Potential of Hidrogen.  It measures how acid or alkaline a substance is.   Body fluids are a mixture of different substances, some of them being electrically active, positive or negative.   The reults of both types of substances is a net acid or alkaline character. This test measures the pH of urine. This test is used to evaluate and manage disorders that affect urine acidity, such as kidney stones or a urinary tract infection. This test can be prescribed when the doctors suspects:
• Kidney stone
• UTI - Urinary tract infection Purpose of the test This test measures the pH of urine.
It is used to evaluate and manage disorders that affect urine acidity, such as kidney stones or a urinary tract infection. Reference range values
• Adults: 5-9
• Newborns: 5-7 Abnormal findings Appart from kidney stones and Urinary tract infection, there are other circunstatencies that can influence the Urine ph.
High ph results are obtained with:
o Diet high in citrus fruits and vegetables
o Gastric losses from vomiting or nasogastric suction
o Prolonged time from sample collection
Low ph results are obtained with:
o Diet high in meat protein or cranberries
o Potassium depletion

Phosphorus Serum

Description Also known as: P, PO4, Phosphate Phosphorus is a mineral.  Combined with oxygen form a variety of phosphates (PO4). Phosphates are vital for energy production, muscle and nerve function, and bone growth. Also play an important role as a buffer, helping to maintain the body's acid-base balance. Around 70% to 80% of the phosphates are combined with calcium to form bones and teeth, around 10% are found in muscle, and around 1% in nerve tissue. Around 1% of total body phosphorus is found in the blood. Phosphorus comes from diet. A variety of foods, such as beans, peas and nuts, cereals, eggs, beef, chicken, and fish contain significant amounts of phosphorus. Phosphorus is absoved from the intestines and excreted by the kidneys. This way the body regulates the phosphorus/phosphate levels in the blood. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Timed urine phosphorus measurements also may be used to monitor phosphorus elimination by the kidneys. Purpose of the test To evaluate the level of phosphorus in the blood in order to monitor some bone and kidney disorders.   It is prescribed as a follow-up to an abnormal calcium level, also if there is a kidney disorder or uncontrolled diabetes, and if the patient is taking calcium or phosphate supplements. A phosphorus test may help in the diagnosis of problems with hormones, such as parathyroid hormone (PTH), and Vitamin D, which functions as a hormone, that regulate the body's calcium level and, to a lesser degree, phosphorus levels. Phosphorus testing often is performed as a follow-up to an abnormal calcium level and/or related symptoms, such as fatigue, muscle weakness, cramping, or bone problems.
Reference range values
mg/dL (SI: mmol/L = 0.323 x mg/dL)
>=18Y      2.5 - 4.8
Abnormal findings Low levels of phosphorus are rare but may be seen with alcoholism and malnutrition. Low levels of phosphorus (hypophosphatemia) may also be due to: 
• Hypercalcemia, especially due to hyperparathyroidism 
• Overuse of diuretics 
• Severe burns 
• Diabetic ketoacidosis
• Hypothyroidism 
• Hypokalemia 
• Chronic antacid use 
• Rickets and osteomalacia
High levels of phosphorus (hyperphosphatemia) may be due to:
• Kidney failure 
• Hypoparathyroidism
• Diabetic ketoacidosis 
• Phosphate supplementation

Plasminogen

Description
This test measures plasminogen enzyme in blood. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test This test is used to evaluate thromboembolic disorders, including ligneous conjuctivitis (a type of mucous membrane abnormality). This test is normally prescribed when searching for the following diseases:
• Disorder involving the fibrinolytic system
• Ligneous conjunctivitis Reference range values
Adults:
o Functional assay: 80%-130%
o Antigenic assay: 84-140 mg/L Neonates: 60% of adult value
Abnormal findings Apart from ligneous conjunctivitis and problems involving fibrinolytic system, there are another circumstances on which abnormal levels can result from this test: High levels of plasminogen can be seen in:
o Pregnancy (peak of 165% of normal in third trimester)
o Increased triglyceride and/or cholesterol levels
Low levels of plasminogen can be seen in:
o Liver disease
o Consumptive coagulopathies
o Fibrinolytic therapy
o DIC
o Advanced age

Platelet Aggregation

Description Platelets are components of the blood.   They have the property to react in the presence of atmospheric oxygen, forming clumps.  This property is essential when a damage is caused to arteries and veins.   Platelets aggregate quickly enough to prevent important lack of blood and also to prevent exogenous agents to enter the blood stream. This test evaluates the ability of platelets to clump together in blood. This test is used to assess how well platelets function. This test is used when an inherited or drug-caused platelet dysfunction is suspected. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test To evaluate the level of platelet aggregation of the blood in order to check that platelet aggregation function correctly. Possible reasons why this test may be done:
• Hereditary platelet function disorder
• Platelet dysfunction due to drugs
Patients with history of thrombosis or similar problems of clots in the blood have to get medication to keep this parameter within a narrow band, and get monitored its platelet aggregation levels frequently.   If the level of platelet aggregation in their blood is low, this leads to risk of hemorrhage and edema. If level is too high the risk of heart attack, thrombosis or emboli will be increased. Reference range values Adults: >65% aggregation in response to adenosine diphosphate (ADP), arachidonic acid, collagen, epinephrine and ristocetin. Abnormal findings Abnormal aggregation levels are normally due to an inherited disease or the effect of drugs. Also platelet aggregation can be increased by:
o Hemolysis
o Lipemia
o Nicotine

Potassium  Serum

Description Potassium is an electrolyte, a positively charged molecule.   It works with other electrolytes, such as sodium, chloride, and bicarbonate (total CO2) in order to regulate the amount of fluid in the body, stimulate muscle contraction, and maintain a stable acid-base balance. Only a very small part of the body`s potassium is present in the blood.   Because of this, minor changes can have significant consequences.  Abnormal concentration can alter the function of neuromuscular tissue. Potassium testing is used to detect concentrations that are too high (hyperkalemia) or too low (hypokalemia). Typical cause of hyperkalemia is kidney disease.   Also many drugs can decrease potassium excretion from the body and result in this condition. Hypokalemia can occur with diarrhea and vomiting or with excessively sweating. Potassium test may be ordered at regular intervals to monitor drugs that can cause  kidneys to lose potassium, particularly diuretics, resulting in hypokalemia. Also if you have a condition or disease, such as acute or chronic kidney failure, that can be associated with abnormal potassium levels. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test To meassure potassium levels in order to determine whether potassium concentration is within normal limits and to help evaluate an electrolyte imbalance.   Also to monitor chronic or acute hyperkalemia or hypokalemia.

This test is prescribed as part of a routine medical exam, with symptoms such as weakness and/or cardiac arrhythmia, or when an electrolyte imbalance is suspected; at regular intervals when you medication is being taken.   Also when there is high blood pressure (hypertension) or kidney disease. Reference range values 3.3 - 5.1 mmol/L Abnormal findings High potassium levels (hyperkalemia) can be due to :
• acute or chronic kidney failure
• Addison's disease
• hypoaldosteronism 
• injury to tissue
• infection
• diabetes
• dehydration
• excessive dietary potassium intake
• excessive intravenous potassium intake
Low potassium levels (hypokalemia) can be due to :
• dehydration
• vomiting
• diarrhea
• Hyperaldosteronism 
• deficient potassium intake
• as a complication of acetaminophen overdose

Progesterone

Description Progesterone is a steroid hormone that helps prepare a woman's body for pregnancy. Progesterone stops endometrial growth and readies the uterus for the possible implantation of a fertilized egg. If fertilization does not occur, progesterone levels drop, and menstrual bleeding begins. If a fertilized egg is implanted in the uterus, the corpus luteum continues to produce progesterone. After several weeks, the placenta replaces the corpus luteum as the main source of progesterone, creating relatively large amounts of the hormone throughout the rest of a normal pregnancy.
This test is used to help recognize and manage some causes of infertility. Progesterone can be measured to determine whether or not a woman has ovulated, to determine when ovulation occurred, and to monitor the success of induced ovulation. Also, progesterone measurements may be used, along with human chorionic gonadotropin (hCG) testing, to help diagnose an ectopic or failing pregnancy. Progesterone levels also may be measured to monitor placenta and fetal health. These progesterone levels may be monitored in women who have trouble maintaining a pregnancy, as low levels of the hormone can lead to miscarriage. If a woman is receiving progesterone injections to help support her early pregnancy, her progesterone levels may be monitored on a regular basis to help determine the effectiveness of that treatment. Progesterone levels may be used, along with other tests, to help determine the cause of abnormal uterine bleeding. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test
Progeterone levels in the blood help determine the cause of infertility, track ovulation, help diagnose an ectopic or failing pregnancy, monitor the health of a pregnancy, and help diagnose the cause of abnormal uterine bleeding. It can be presecribed at specific times during a woman's menstrual cycle to determine whether/when the woman is ovulating; during early pregnancy if symptoms suggest an ectopic or failing pregnancy; throughout pregnancy to help determine placenta and fetal health; and in cases of abnormal uterine bleeding.
Reference range values ng/mL (SI: nmol/L = 3.18 x ng/mL) Males >=16Y          0.27 – 0.9 Females: Follicular                   0.33 – 1.20
Luteal                       0.72 – 17.8
Postmenopausal        <0.2 – 1
Oral Contraceptives      0.34 – 0.92 Males & Females:
Cord                          350 – 750
1D-3M                        0.25 – 17
4M-12M                      <0.2 – 2
1Y-9Y                        <0.2 – 1.3
Abnormal findings
Low leves during an early pregnancy can mean ectopic pregnancy.
High levels of progesterone can mean more than one fetus (twins, triplets, etc.).
High progesterone levels also are seen occasionally with luteal ovarian cysts, molar pregnancies, and with a rare form of ovarian cancer

Prolactin

Description Prolactin level tests may be ordered when a patient has symptoms such as: unexplained headaches, visual impairment, and/or galactorrhea. They can also be ordered, along with other tests, when a woman is experiencing infertility or irregular menses; or when a man has symptoms such as: a decreased sex drive, galactorrhea, or infertility. Prolactin levels are also often ordered in men as a follow-up to a low testosterone level. When a patient has a prolactinoma, prolactin levels may be ordered to monitor the progress of the tumor and its response to the treatment. They may also be used at regular intervals to monitor for recurrence. Prolactin levels may be ordered, along with other hormone levels such as growth hormone, when doctor suspects that a more general hypopituitarism (low levels of pituitary function that result in lowered levels of thyroid or adrenal hormones) exist. Purpose of the test Prolactin levels are used, along with other tests, to help:
- Determine the cause of galactorrhea
- Determine the cause of headaches and visual disturbances
- Diagnose infertility and erectile dysfunction in males
- Diagnose infertility in females
- Diagnose prolactinomas
- Evaluate anterior pituitary function (along with other hormones)
- Monitor treatment of prolactinomas and detect recurrences Reference range values
Male
2.1-17.7 ng/mL Female
1-9 years: 2.1-17.7 ng/mL
10 years and older: 2.8-26.0 ng/mL Abnormal findings Prolactin levels will vary over a 24-hour period, rising during sleep and peaking in the morning. High Levels: High levels of prolactin (hyperprolactinemia) are normal during pregnancy and after childbirth while nursing. High levels are also seen with:
- Anorexia nervosa
- Drugs: Estrogen, tricyclic antidepressants, and drugs that block the effect of dopamine such as: tranquilizers, some hypertension drugs, and some drugs that are used to treat gastroesophageal reflux
- Hypothalamic diseases
- Hypothyroidism
- Kidney disease
- Nipple stimulation
- Other pituitary tumors and diseases
- Polycystic ovary syndrome
- Prolactinomas Low levels: Levels of prolactin that are below normal are not usually treated but may be indicative of a more general hypopituitarism. Low levels may also be caused by drugs such as: dopamine, levodopa, and ergot alkaloid derivatives.

Prostate Specific Antigen or PSA

Description
PSA is a protein produced  by the prostate. Most of the PSA that the prostate produces is released into the semen, but small amounts are also released into the bloodstream.
Patients with prostate cancer frequently have altered ratios of the two forms of PSA: low leves of free PSA and high levels of cPSA (PSA bound to a protein).
PSA test and digital rectal exam (DRE) are ordered to screen for prostate cancer. If either the PSA or the DRE are found to be abnormal, then the doctor may choose to follow this testing with a prostate biopsy and perhaps imaging tests, such as an ultrasound. If the DRE is normal but the PSA is moderately elevated, the doctor may order a free PSA test to look at the ratio of free to total PSA. This can help to distinguish between prostate cancer and other non-cancer causes of elevated PSA. The PSA test may be ordered during treatment of patients who have been diagnosed with prostate cancer to verify the effectiveness of treatment and at regular intervals after treatment to monitor for cancer recurrence. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test To meassure the Prostate Specific Antigen (PSA) level in blood in order to screen asymptomatic and symptomatic men for prostate cancer in order to help determine the necessity for a biopsy of the prostate and also in order to monitor the effectiveness of treatment for prostate cancer, or to detect recurrence of prostate cancer. It was developed as a tumor marker to screen for and to monitor prostate cancer. It is a good tool, but not a perfect one. PSA levels are higher in those of African American heritage, and levels tend to increase in all men as they age. Reference range values
<=4 mcg/L Abnormal findings Patients with PSA level greater than 10mcg/L are at an increased risk for prostate cancer.
Levels between 4 and 10 may indicate prostate cancer BPH, or prostatitis. These conditions are more common in the elderly, as is a general increase in PSA levels.

Protein C

Description Formal name: Protein C Functional or Antigen; Protein S Free (Functional) or Antigen (Total). Proteins C and S are present in small quantities in the blood. They work together to inhibit excessive blood clotting. When a blood vessel or tissue is injured, the body initiates the coagulation cascade, a step-by-step process involving the activation of up to 20 protein factors, which results in the formation of a stable blood clot. This clot prevents additional blood loss and protects the injury until it heals. Once it is no longer needed, other factors break the clot down so that it can be removed. Problems with Protein C and Protein S can be inherited or acquired. There are two types of Protein C deficiencies: type 1 is related to quantity and type 2 to abnormal function. Tests for Protein C and Protein S are usually ordered to help diagnose the cause of a venous thromboembolism (VTE).
Functional tests for Protein C and free Protein S are usually ordered, along with other tests for hypercoagulability, to screen for sufficient, normal, factor activity.
Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test To evaluate level of protein C in blood in order to help evaluate a thrombotic episode.   Also to determine whether there is an inherited or acquired Protein C or Protein S deficiency.
It is prescribed when there is an unexplained thromboembolism.  Also when a newborn has a severe clotting disorder, such as disseminated intravascular coagulation (DIC) or purpura fulminans. Sometimes it is prescribed when a close relative has an inherited Protein C or Protein S deficiency Protein C and Protein S tests are ordered when a person has had a thrombotic episode or thromboembolism, especially when the affected patient is relatively young (less than 50 years old). Reference range values 59% - 144% Abnormal findings High Protein C and Protein S levels are not usually associated with medical problems. Low levels of Protein C or Protein S can result in excessive formation of blood clots.
Low concentrations of Protein C and Protein S may be seen with vitamin K deficiency, liver disease, severe infections (inflammatory conditions), renal disease, cancers, disseminated intravascular coagulation (DIC), HIV, during pregnancy, immediately following a thrombotic episode, and with warfarin or heparin anticoagulant therapy.

Protein Total Serum

Description Total protein in serum test measures the amount of total protein in blood. It is used to help evaluate disorders affecting albumin or immunoglobulin levels. Some of the possible reason why this test may be done are:
- Decreased blood sodium
- Henoch-Schِnlein purpura
- Monoclonal gammopathy Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test To evaluate the total protein levels in blood in order to check for an albumin or inmunoglobulin disorder.
Reference range values
64 – 82 g/L Abnormal findings Some of the possible abnormal results can be related with:
- Decreased blood sodium
- Henoch-Schِnlein purpura
- Monoclonal gammopathy
High levels can be also due to :
- Upright position for several hours after rising (highest level at mid-morning)
- Venous stasis
- Short-term high-protein diet
- Strenuous exercise
- Male sex
- Hyperglycemia
- Severe hyperlipidemia
- Marked dehydration Low levels can be also due to :
- Overnight recumbent position
- Elderly during summer months
o Advanced age in nonsmokers (0.5-1 g/L per decade)
o Prolonged bed rest

Prothrombin Time

Description This test measures how long it takes for blood to clot. It is used to evaluate and manage bleeding and blood clotting disorders.
Thrombin is a clotting factor that accelerates or decelerates blood clot formation by promoting or inhibiting its own activation. Thrombin first combines with a protein called thrombomodulin, then activates Protein C. This activated Protein C (APC) then combines with Protein S (a cofactor) and together they work to degrade coagulation factors VIIIa and Va. 
Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test The purpose of this test is to measure the time necessary for the blood to clot.
This test is prescribed when a coagulation problem is suspected such in:
- Abnormal liver function
- Anticoagulant drug monitoring
- Blood clotting disorder
- Heat stroke
- Hemophilia
- HUS - Hemolytic uremic syndrome
- Obstruction of biliary tree
- Systemic infection
- Vitamin K deficiency
Reference range values
- Adults: 11.1-13.1 seconds
- Neonates: Prolonged by 2-3 seconds
- Premature neonates, 1-3 days old: Prolonged by 3-5 seconds INR PT   ratio 2.5-3.5  mechanical heart valves
2.0-3.0  Prophylaxis and treatment of venous thrombosis, pulmonary embolism, tissue heart valves, acute myocardial infarction, atrail fibrillation, valvular heart disease, and systemic embolization.
Abnormal findings Abnormal results can be found due to the following subjacent problems:
- Abnormal liver function
- Anticoagulant drug monitoring
- Blood clotting disorder
- Heat stroke
- Hemophilia
- HUS - Hemolytic uremic syndrome
- Obstruction of biliary tree
- Systemic infection
- Vitamin K deficiency

RA Factor Rheumatoid Arthritis

RA Factor (Rheumatoid Arthritis) Description Rheumatoid factor is used to help diagnose Rheumatoid Arthritis. It is eventually present in significant concentrations in about 80% of patients with RA but also present in other conditions and in a small percentage of healthy people. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test The goals with testing are to help diagnose rheumatoid arthritis, to distinguish it from other forms of arthritis and conditions with similar symptoms, and to evaluate its severity. Testing can be used to monitor the condition, its potential complications, response to treatment, and to monitor for potential side effects associated with some treatments. There is no single test that can be used to diagnose rheumatoid arthritis; it is a diagnosis that is made through clinical evaluation with the assistance of laboratory and non-laboratory testing. Laboratory Tests
- Rheumatoid factor - used to help diagnose RA.
- Erythrocyte sedimentation rate - this test (sed rate or ESR) shows the presence of inflammation in the body and the activity of the disease
- Cyclic Citrullinated Peptide Antibody (CCP) - a relatively new test that may be used to help diagnose RA, especially early in the disease and in patients who are RF negative.
- Erythrocyte sedimentation rate (ESR) - this test shows the presence of inflammation in the body and the activity of the disease. It is used to help diagnose RA and to evaluate and monitor the condition. ESR will be increased in RA but not in osteoarthritis.
- C-reactive protein test (CRP) - this test also indicates inflammation and tests for the activity of the disease. It may be used to help diagnose RA and to evaluate and monitor the condition. An increased level of CRP occurs in RA but not in osteoarthritis.
- Complete Blood Count (CBC) - this is a group of tests that are used to help evaluate the patient's red and white blood cells and hemoglobin to help evaluate and monitor the condition and complications such as anemia and/or a decreased white blood cell count.
- Comprehensive Metabolic Panel (CMP) - this is a group of tests that may be used to help evaluate and monitor the patient's kidney and liver function. Non-Laboratory Tests
- American Rheumatism Association criteria, including: morning stiffness, arthritis in at least 3 joint areas, arthritis in hand joints, symmetric arthritis, rheumatoid nodules, rheumatoid factor, and radiographic changes are used to help diagnose RA. (A diagnosis of RA is considered in a person who has had at least four of these criteria for several weeks).
- X-ray - used to help diagnose RA and monitor joint damage but will not usually show significant changes early in the disease.
- Ultrasound and MRI - being used primarily as research tools to attempt to detect changes in the joints earlier in the disease. Reference range values
0-14 IU/mL Abnormal findings RA Factor above the reference ranges are normally related with Rheumatoid Arthritis process, but it is also significantly present in other conditions and in a small percentage of healthy people.

Sedimentation Rate Westergren

Category: All Lab Tests Sedimentation Rate, Westergren Description The sedimentation rate blood test measures how quickly red blood cells (erythrocytes) settle in a test tube in one hour. The more red cells that fall to the bottom of the test tube in one hour, the higher the sedimentation rate. When inflammation is present in the body, certain proteins cause red blood cells to stick together and fall more quickly to the bottom of the tube. These proteins are produced by the liver and the immune system under many abnormal conditions, such as an infection, autoimmune disease, or cancer. There are many possible causes of a high sedimentation rate. For this reason, a sed rate is done with other tests to confirm. After a diagnosis has been made, a sed rate can be done to check on the disease or see how well treatment is working. Sedimentatuion rate is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test The sedimentation rate blood test measures how quickly red blood cells settle in a test tube. A sedimentation rate test is done to:
- Find out if inflammation is present.
- Check on the progress of a disease.
- See how well a treatment is working. Reference range values Men : <15 mm/hr
Women : <20 mm/hr
Children : <10 mm/hr
Newborns : <2 mm/hr
Abnormal findings
High sedimentation rates may be caused by:
- Autoimmune diseases, such as systemic lupus erythematosus or rheumatoid arthritis.
- Cancer, such as lymphoma or multiple myeloma.
- Chronic kidney disease.
- Infection, such as pneumonia, pelvic inflammatory disease, or appendicitis.
- Inflammation of joints (such as polymyalgia rheumatica) and blood vessels (such as giant cell arteritis).
- Inflammation of the thyroid gland (Graves' disease).
- Kidney, bone, joint, skin, or heart valve infections.
- Pregnancy and preeclampsia (toxemia of pregnancy).
- Viral infections. Low values of sedimentation rate may be caused by:
- High blood sugar levels.
- Polycythemia.
- Sickle cell disease.
- Severe liver disease.

Sedimentation Rate Westergren

Sedimentation Rate, Westergren Description The sedimentation rate blood test measures how quickly red blood cells (erythrocytes) settle in a test tube in one hour. The more red cells that fall to the bottom of the test tube in one hour, the higher the sedimentation rate. When inflammation is present in the body, certain proteins cause red blood cells to stick together and fall more quickly to the bottom of the tube. These proteins are produced by the liver and the immune system under many abnormal conditions, such as an infection, autoimmune disease, or cancer. There are many possible causes of a high sedimentation rate. For this reason, a sed rate is done with other tests to confirm. After a diagnosis has been made, a sed rate can be done to check on the disease or see how well treatment is working. Sedimentatuion rate is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test The sedimentation rate blood test measures how quickly red blood cells settle in a test tube. A sedimentation rate test is done to:
- Find out if inflammation is present.
- Check on the progress of a disease.
- See how well a treatment is working. Reference range values Men : <15 mm/hr
Women : <20 mm/hr
Children : <10 mm/hr
Newborns : <2 mm/hr
Abnormal findings
High sedimentation rates may be caused by:
- Autoimmune diseases, such as systemic lupus erythematosus or rheumatoid arthritis.
- Cancer, such as lymphoma or multiple myeloma.
- Chronic kidney disease.
- Infection, such as pneumonia, pelvic inflammatory disease, or appendicitis.
- Inflammation of joints (such as polymyalgia rheumatica) and blood vessels (such as giant cell arteritis).
- Inflammation of the thyroid gland (Graves' disease).
- Kidney, bone, joint, skin, or heart valve infections.
- Pregnancy and preeclampsia (toxemia of pregnancy).
- Viral infections. Low values of sedimentation rate may be caused by:
- High blood sugar levels.
- Polycythemia.
- Sickle cell disease.
- Severe liver disease.

Sex Hormone Binding Globulin SHBG

Description Also known as: Testosterone-estrogen Binding Globulin (TeBG). SHBG is a protein produced by the liver. It transports testosterone, dihydrotestosterone (DHT), and estradiol in the blood. SHBG level is affected by age and sex, by decreased or increased testosterone or estrogen production, and can be affected by certain diseases and conditions such as liver disease, hyperthyroidism or hypothyroidism, and obesity. SHBG test is prescribed in order to evaluate the status of a patient's androgens - the male hormones. With men, the concern is testosterone deficiency, while with women the concern is excess testosterone production.
SHBG and testosterone levels may be ordered on an adult male to help determine the cause of infertility.
In women, small amounts of testosterone can disrupt the balance of hormones and cause symptoms such as amenorrhea, infertility, acne, and hirsutism.
Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test The purpose of this test is to evaluate the level of SHBG in blood in order to evaluate whether the concentration of SHBG is affecting the amount of testosterone available to the body's tissues. Reference range values nmol/L Male       13 – 71
Female   18 – 114  (non-pregnant) Children
Males
Tanner Stages:     Age, mean         nmol/L
Stage I:              7.1(pre-pubertal)  28-150
Stage II:              11.5                    44-160
Stage III:             13.6                     5.5-163
Stage IV:             15.1                    13-88
Stage V:              18.0                    10-60 Females 
Tanner Stages:     Age, mean         nmol/L
Stage I*:              7.1(pre-pubertal)  39-176
Stage II:              10.5                    7.2-107
Stage III:             11.6                    28-171
Stage IV:             12.3                   28-149
Stage V:              14.5                   20-130 Abnormal findings
High levels of SHBG in blood ussually means that it is likely to be less free testosterone available to the tissues than is indicated by the total testosterone. If SHBG concentrations are decreased, more of the total testosterone is "bioavailable"  - not bound to SHBG.

Sjogren Antibodies

Category: All Lab Tests Sjِgren Antibodies (Anti-SS-A/Anti-SS-B) Description Sjِgren's syndrome is an autoimmune disorder in which the body's immune system mistakenly reacts to the tissue in glands such as tear and salivary glands. It is a chronic, inflammatory disease that often progresses to a more complex, systemic disorder (affecting other organs in the body such as joints, kidneys, and intestinal tract). It is characterized by infiltration of these glands that are responsible for fluid production by lymphocytes, thus causing decreased saliva (dry mouth), decreased tear production (dry eyes), and drying of other mucous membranes. In addition this syndrome includes swollen salivary glands, feeling of sand or grit in the eyes, difficulty swallowing, joint pain, and decreased sense of taste. Sjِgren's syndrome can affect at any age, but about 90% of those affected are women older than 40. Presence of Sjِgren Antibodies is detected by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test This test helps determining the presence of Sjِgren Antibodies in the blood stream. It is prescribed in people with different symthoms that can vary from person to person, change over time, may include non-specific symptoms such as chronic fatigue and fever, and may involve other body organs such as the kidneys and the gastrointestinal tract. Recognizing and diagnosing Sjِgren's syndrome can sometimes be challenging. May be present as the Primary Sjِgren's Syndrome or as Secondary Sjِgren's Syndrome, a condition that coexists with other autoimmune disorders, such as Systemic Lupus Erythematosus, polymyositis, scleroderma, or rheumatoid arthritis. It has also been associated with an increased incidence of lymphoma.
Reference range values Negative Result: <29AU/mL
Equivocal: 30-40AU/mL
Positive Result: >41AU/mL Abnormal findings SSA (Ro) antibody is seen in 70-75% of Sjِgren syndrome cases, 30-40% of systemic lupus erythematosus (SLE) cases, and 5-10% of progressive systemic sclerosis (PSS) cases.
SSB (La) antibody is seen in 50%-60% of Sjِgren syndrome cases and is specific if it is the only ENA antibody detected. 15%-25% of patients with systemic lupus erythematosus (SLE) and 5-10% of patients with progressive systemic sclerosis (PSS) also have this antibody.

Sodium

Category: All Lab Tests Sodium Category: Chemistry Sodium analysis measures the Sodium concentration in a blood sample (normally) or urine sample. Sodium is a mineral needed on body processes such as nerve and muscle functioning. Purpose of the test The main purpose of the test is to check whether sodium concentration is within normal range. Also this test helps evaluating electrolyte balance and kidney function. Edema and dehydration led to abnormal Sodium in blood concentrations. High or low blood pressure is also surveyed through Sodium Test. Urine sodium is normally checked when Sodium in blood concentration has abnormal value in order to determine whether the value reported comes from an excessive intake (typically by eating too much salt) or an excessive loss of Sodium. Reference range values Normal range for blood sodium levels: Adult : 135-145 mEq/L Children and teenagers have a wide range of variability of this value. Normal range for urine sodium levels: From 20 mEq/L to 40 mEq/L Abnormal findings Hypernatremia means Sodium levels in blood higher than normal. Commonly this is due to loss of Sodium that can be related with excessive sweating, diarrhea, diuretics intake, kidney disease, or Addison´s disease. Hyponatremia means Sodium levels in blood lower than normal. This can be due to excessive water intake or fluid retention and typically due to edema.

Sodium Serum

Sodium  Serum Description Sodium Test measures the Sodium concentration in a blood sample (normally) or urine  sample. Sodium is a mineral needed on body processes such as nerve and muscle functioning.  It is electrically charged same as potassium, chloride and others and regulates the cells functioning and also the fluid retention on the body.   However, excessive concentration of Sodium increase blood pressure. Sodium is lost with sweating.   It is present on all the body's fluids and its concentration is higher in blood stream and extracellular fluids.   Its concentration is regulated by kidney's regulation of body water. Purpose of the test The main purpose of the test is to check whether sodium concentration is within normal range. Also this test helps evaluating electrolyte balance and kidney function. Edema and dehydration led to abnormal Sodium in blood concentrations. High or low blood pressure is also surveyed through Sodium Test. Urine sodium is normally checked when Sodium in blood concentration has abnormal value in order to determine whether the value reported comes from an excessive intake (typically by eating too much salt) or an excessive loss of Sodium.
Reference range values (North America) Normal range for blood sodium levels: Adult : 135-145 mEq/L
Children and teenagers have a wide range of variability of this value. Normal range for urine sodium levels: From 20 mEq/L to 40 mEq/L Abnormal findings Hypernatremia means Sodium levels in blood higher than normal.   Commonly  this is due to loss of Sodium  that can be related with excessive sweating, diarrhea, diuretics intake, kidney disease, or Addison´s disease. Hyponatremia means Sodium levels in blood lower than normal. This can be due to excessive water intake or fluid retention and typically due to edema. Low urinary sodium levels can be indicative of dehydration, congestive heart failure, liver disease, or nephrotic syndrome. High urinary sodium levels can be indicative of use of diuretics or Addison's disease.

Specific Gravity Urine

Description A urine test checks different components of urine, a waste product made by the kidneys.
The kidneys take out waste material, minerals, fluids, and other substances from the blood to be passed in the urine. Urine has hundreds of different body wastes.  Consequently more than 100 different tests can be done on urine., Among then, Specific Gravity.
This test measures the amount of solid substances in the urine.
Its concentration is measured by means of analysis of a urine sample.
Purpose of the test
The purpose of a specific gravity urine test is to analyse the solid content in the urine.   This is, the amount of substances.  It ishows how well the kidneys balance the amount of water in urine.
A higher specific gravity means the urine is more solid.  This is, the concept in susbtances is higher.
On the contrary, a low specific gravity test result means the urine is too liquid, with low concentration of substances.
When the patient drinks a lot of fluid, the kidneys make urine with a high amount of water in it which has a low specific gravity.
When the patient  do not drinks fluids, the kidneys make urine with a small amount of water in it which has a high specific gravity.
Reference range values
1.002 - 1.035 Abnormal findings Very high specific gravity test result means very concentrated urine, which may be caused by not drinking enough fluid, loss of too much fluid (excessive vomiting, sweating, or diarrhea), or substances (such as sugar or protein) in the urine.
Very low specific gravity test result means dilute urine, which may be caused by drinking too much fluid, severe kidney disease, or the use of diuretics

Syphilis Test RPR

Syphilis Test (RPR) Description Syphilis test detects antibodies of the bacteria that causes syphillis (Treponema pallidum) in blood, body fluid, or tissue. The tests are used to screen for or to confirm a syphilis infection. Syphilis is a sexually transmitted disease (STD) that is usually spread during sexual contact, including kissing or oral sex. A syphilis infection can spread through the bloodstream to all parts of the body. If not treated, syphilis can cause severe heart disease, brain damage, spinal cord damage, blindness, and death. Tests used to screen for syphilis include: Venereal disease research laboratory (VDRL) test. The VDRL test checks for an antibody that can be produced in people who have syphilis. This antibody is not produced as a reaction to the syphilis bacteria specifically, so this test is sometimes not accurate. The VDRL test may be done on a sample of blood or spinal fluid. The VDRL test is not very useful for detecting syphilis in very early or advanced stages.
Rapid plasma reagin (RPR) test. The RPR test also detects syphilis antibodies by means of analysis of a blood sample drawn from the vein in the arm.
Enzyme immunoassay (EIA) test. This is a newer blood test that check for antibodies to the bacteria that cause syphilis. A positive EIA test should be confirmed with either the VDRL or RPR tests.
Tests used to diagnose syphilis include: Fluorescent treponemal antibody absorption (FTA-ABS) test. The FTA-ABS test detects antibodies to the bacteria that cause syphilis and can be used to detect syphilis except during the first 3 to 4 weeks after exposure to syphilis bacteria. It is more difficult to do and may be used to confirm a syphilis infection after another method tests positive for the syphilis bacteria. The test can be done on a sample of blood or spinal fluid.
Treponema pallidum particle agglutination assay (TPPA). The TPPA test is used to confirm a syphilis infection after another method tests positive for the syphilis bacteria. This test detects antibodies to the bacteria that cause syphilis and can be used to detect syphilis in all stages, except during the first 3 to 4 weeks. This test is not done on spinal fluid.
Darkfield microscopy. This test uses a special microscope to examine a sample of fluid or tissue from an open sore (chancre) for the syphilis bacteria. If syphilis is present, it can be seen as corkscrew-shaped objects on the microscope slide. This test is used mainly to diagnose syphilis in an early stage.
Microhemagglutination assay (MHA-TP). The MHA-TP is used to confirm a syphilis infection after another method tests positive for the syphilis bacteria. The MHA-TP test detects antibodies to the bacteria that cause syphilis and can be used to detect syphilis in all stages, except during the first 3 to 4 weeks. This test is not done on spinal fluid. The MHA-TP test is rarely used any more.
Purpose of the test A test for syphilis is done to Screen for syphilis or monitor treatment for a syphilis infection.
Test Results Syphilis tests of blood and spinal fluid - Normal: No antibodies to syphilis are present. This is called a nonreactive or negative result.
- Abnormal:
o Antibodies to syphilis bacteria are present. This is called a reactive or positive test.
o A result that is not clearly normal or abnormal is called inconclusive or equivocal.
Venereal disease research laboratory (VDRL) and rapid plasma reagin (RPR) tests - Normal: The antibody to the syphilis bacteria (reagin) is not present. This is called a nonreactive or negative result.
- Abnormal: The antibody reagin is present. This is called a reactive or positive test.

T3  Free

Description
Formal name: Triiodothyronine T3 and T4 hormones are by the thyroid gland. Thyroid gland is a small butterfly-shaped organ that lies flat across your windpipe. T3 and T4 control the rate at which the body uses energy. When blood levels of thyroid hormones decline, the hypothalamus releases thyrotropin releasing hormone, which stimulates the pituitary to produce thyroid-stimulating hormone (TSH). TSH then stimulates the thyroid gland to produce hormones. Most of the thyroid hormone produced is T4. This hormone is relatively inactive, but it is converted into the much more active T3 in the liver.
If the thyroid gland produces a lot of T4 and T3, then the patient may have symptoms associated with hyperthyroidism, such as nervousness, tremors of the hands, weight loss, insomnia, and puffiness around dry, irritated eyes.
If the thyroid gland produces insufficient hormones, then the patient may have symptoms associated with hypothyroidism and a slowed metabolism, such as weight gain, dry skin, fatigue, and constipation.
About 99.7% of the T3 found in the blood is attached to a protein and the rest is free. 
Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test To meassure the level of free T3 hormone in blood in order to detect problems of hyperthyroidism or hypothyroidism.
A T3 test helps to see whether the thyroid is functioning properly. Mainly to help diagnose hyperthyroidism. The T3 test is usually following an abnormal TSH and T4 test.  T3 testing may be ordered along with thyroid antibodies to help diagnose Graves' disease, an autoimmune disorder that is the most common cause of hyperthyroidism. A T3 test may be ordered at intervals to monitor a known thyroid condition and to help monitor the effectiveness of treatment for hyperthyroidism.
Reference range values 2.77 – 6.47pmol Abnormal findings If after a TSH test result high and a T4 test result normal, a T3 test result is normal, it can indicate a mild form of hypothyroidism. If after a TSH test result high and a T4 test result low, a T3 test result is normal or low, it can indicate hypothyroidism. If after a TSH test result low and a T4 test result normal, a T3 test result is normal, it can indicate a mild form of hyperthyroidism. If after a TSH test result low and a T4 test result normal or high, a T3 test result is normal or high, it can indicate hyperthyroidism. If after a TSH test result low and a T4 test result normal or low, a T3 test result is normal or low, it can indicate a nonthyroidal illness, for example a rare pituitary hypothyroidism.

Testosterone  Total

Description Testosterone is a steroid hormone.  It is made by the testes in males. Its production is controlled by luteinizing hormone (LH), which is manufactured in the pituitary gland. In males, testosterone stimulates development of secondary sex characteristics. Testosterone is also produced by the adrenal glands in both males and females and by the ovaries in females. In women, testosterone is converted to estradiol, the main sex hormone in females.
Testosterone testing is used to diagnose various conditions, including :
- delayed or precocious puberty in boys 
- decreased sex drive in men
- erectile dysfunction
- infertility in bohth men and women
- testicular tumors 
- hirsutism and masculinization, also called virilization in women
Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test To meassure the testosterone levels in blood in order to help explain symptoms such difficulty getting an erection in men, inability of women to get pregnant, premature or delayed puberty in men, or the appearance of masculine physical features in female.

In boys, the test is ordered, often along with the FSH and LH tests, if puberty is delayed or slow in developing. In men, the test can be ordered when infertility is suspected or if the patient has a decreased erectile dysfunction. In women, testosterone testing may be done if a patient has irregular or no menstrual periods, is having difficulty getting pregnant, or appears to have masculine features, such as facial and body hair, male pattern baldness, and a low voice. Testosterone levels can rise because of tumors that develop in either the ovary or adrenal gland or because of other conditions, such as polycystic ovarian syndrome (PCOS).
Reference range values ng/dL (SI: nmol/L = 0.0347 x ng/dL) Male:
20Y-49Y                262-1593
>=50Y                    181-758 Female:
Ovulating                   <20-80
Postmenopausal        <20-62 Abnormal findings
In males, a low testosterone level can indicate :
- hypothalamic disease
- pituitary disease
- damage to the testes
- Genetic diseases such as :
- Klinefelter's syndrom
- Kallman's syndrom
- Prader-Willi syndrom
- testicular failure and infertility
- acquired damage to the testes, such as
- alcoholism
- physical injury
- mumps In males, a high testosterone level can indicate :
- testicular tumors
- adrenal tumors
- use of androgens
Increased testosterone in boys is usually the cause of early puberty. In women, increased testosterone levels can indicate PCOS or an ovarian or adrenal gland tumor.

Thyroglobulin

Description Thyroglobulin is a protein produced in the thyroid gland. The thyroid gland is a small butterfly-shaped organ that helps to regulate body uses of energy. Cells in the thyroid produce and store thyroglobulin, breaking it down as needed into the thyroid hormones T4 (thyroxine) and T3 (triiodothyronine).

The thyroglobulin test is used as a tumor marker to evaluate the effectiveness of treatment for thyroid cancer. Most common cancers (papillary and follicular thyroid cancer) that arise from the thyroid gland produce thyroglobulin.
A thyroglobulin antibody (TgAb) test may be ordered together with the thyroglobulin test. Thyroglobulin antibodies are proteins that the body's immune system develops to attack thyroglobulin.
Also thyroglobulin testing is ordered to help determine the cause of hyperthyroidism and to monitor the effectiveness of treatment for conditions such as Grave's disease or thyroiditis.
Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test To meassure the level of thyroglobulin in order to monitor treatment of some types of thyroid cancer and to detect recurrence; less commonly, may be used to help determine the cause of hyperthyroidism. At regular intervals this test can be prescribed prior to and after the completion of treatment for thyroid cancer, before and after radioactive iodine therapy in order to monitor evolution.
Reference range values
Thyroglobulin   1.6 - 59.9 mcg/L Anti-Thyroglobulin 0 - 40  IU/mL Abnormal findings High levels can be due to : • goiter
- thyroiditis
- hyperthyroidism
- thyroid cancer
Decreasing levels of thyroglobulin in patients treated for Grave's disease are indicative of a response to treatment.

Thyroid Stimulating Hormone  TSH

Description Also known as: Thyrotropin. TSH is produced by the pituitary gland. It stimulates the production and release of T4 and T3 by the thyroid gland.
When TSH concentrations are high, the thyroid will make and release excessive amounts of T4 and T3 and the patient may experience hyperthyroidism, with symptoms such as rapid heart rate, weight loss, nervousness, hand tremors, irritated eyes, and difficulty sleeping.
With decreased production of thyroid hormones (hypothyroidism), the patient can experience symptoms such as weight gain, dry skin, constipation, cold intolerance, and fatigue.
Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test To meassure the level of TSH in blood in order to diagnose thyroid disorders and to monitor treatment of hypothyroidism and hyperthyroidism. The TSH test is often chosen for evaluating thyroid function and/or symptoms of hyper- or hypothyroidism.
TSH testing helps in :
- diagnose a thyroid disorder in a person with symptoms
- screen newborns for an underactive thyroid
- monitor thyroid replacement therapy in people with hypothyroidism
- diagnose and monitor female infertility problems
- help evaluate the function of the pituitary gland
- screen adults for thyroid disorders Reference range values
0.40 – 4.00 mU/L
Abnormal findings If after a TSH test result high and a T4 test result normal, a T3 test result is normal, it can indicate a mild form of hypothyroidism. If after a TSH test result high and a T4 test result low, a T3 test result is normal or low, it can indicate hypothyroidism. If after a TSH test result low and a T4 test result normal, a T3 test result is normal, it can indicate a mild form of hyperthyroidism. If after a TSH test result low and a T4 test result normal or high, a T3 test result is normal or high, it can indicate hyperthyroidism. If after a TSH test result low and a T4 test result normal or low, a T3 test result is normal or low, it can indicate a nonthyroidal illness, for example a rare pituitary hypothyroidism.

Thyroxine  Free  T4

Also know as T4.
Thyroid hormone test check how well the thyroid gland is working. Thyroid gland makes hormones that regulate the way the body uses energy.
The thyroid gland makes two thyroid hormones, thyroxine (T4) and triiodothyronine (T3).
These hormones can be found in two forms in the blood stream: free, or attached to a protein (Thyroxine Binding Globulin). The greatest percentage of thyroid hormones are  attached to TBG, while only a small part of them are free on the blood.
Thyroid hormones are important for normal development of the brain, especially during the first 3 years of life.  Older children also need thyroid hormones to develop normally, and adults need the hormones to regulate the way the body uses energy (metabolism). Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Description Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test Thyroxine (T4) test is done in order to check the levels of this hormone in blood in order to help diagnose thyroid disorders such as hyperthyroidism and hypothyroidism.
Also this test is done in order to check how well treatment for thyroid disease is working.
Finally newborns are screened with test in order to detect congenite diseases such an underactive thyroid. Reference range values
ng/dL (SI: pmol/L = 12.9 x ng/dL) 18-150Y    0.8 – 1.9 Abnormal findings If after a TSH test result high and a T4 test result normal, a T3 test result is normal, it can indicate a mild form of hypothyroidism. If after a TSH test result high and a T4 test result low, a T3 test result is normal or low, it can indicate hypothyroidism. If after a TSH test result low and a T4 test result normal, a T3 test result is normal, it can indicate a mild form of hyperthyroidism. If after a TSH test result low and a T4 test result normal or high, a T3 test result is normal or high, it can indicate hyperthyroidism. If after a TSH test result low and a T4 test result normal or low, a T3 test result is normal or low, it can indicate a nonthyroidal illness, for example a rare pituitary hypothyroidism.

Thyroxine  T4

Description Also know as T4.
Thyroid hormone test check how well the thyroid gland is working. Thyroid gland makes hormones that regulate the way the body uses energy.
The thyroid gland makes two thyroid hormones, thyroxine (T4) and triiodothyronine (T3
Thyroid hormones are important for normal development of the brain, especially during the first 3 years of life.  Older children also need thyroid hormones to develop normally, and adults need the hormones to regulate the way the body uses energy (metabolism). Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test Thyroxine (T4) test is done in order to check the levels of this hormone in blood in order to help diagnose thyroid disorders such as hyperthyroidism and hypothyroidism.
Also this test is done in order to check how well treatment for thyroid disease is working.
Finally newborns are screened with test in order to detect congenite diseases such an underactive thyroid. Reference range values
mcg/dL   (SI: nmol/L = 12.9 x mcg/dL)
4.5 – 12.5 Abnormal findings If after a TSH test result high and a T4 test result normal, a T3 test result is normal, it can indicate a mild form of hypothyroidism. If after a TSH test result high and a T4 test result low, a T3 test result is normal or low, it can indicate hypothyroidism. If after a TSH test result low and a T4 test result normal, a T3 test result is normal, it can indicate a mild form of hyperthyroidism. If after a TSH test result low and a T4 test result normal or high, a T3 test result is normal or high, it can indicate hyperthyroidism. If after a TSH test result low and a T4 test result normal or low, a T3 test result is normal or low, it can indicate a nonthyroidal illness, for example a rare pituitary hypothyroidism.

Thyroxine Binding Globulin

Description The thyroid gland makes two thyroid hormones, thyroxine (T4) and triiodothyronine (T3).   These hormones regulate the way the body uses energy.
These hormones can be found in two forms in the blood stream: free, or attached to a protein (Thyroxine Binding Globulin). The greatest percentage of thyroid hormones are attached to TBG, while only a small part of them are free on the blood.
Thyroid hormones are important for normal development of the brain, especially during the first 3 years of life.  Older children also need thyroid hormones to develop normally, and adults need the hormones to regulate the way the body uses energy (metabolism). Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test To meassure the amount of Thyroxine Binding Globulin in blood in order to check the amount of thyroid hormones. This test helps in :
- diagnose a thyroid disorder in a person with symptoms
- screen newborns for an underactive thyroid
- monitor thyroid replacement therapy in people with hypothyroidism
- diagnose and monitor female infertility problems
- help evaluate the function of the pituitary gland
- screen adults for thyroid disorders
Reference range values mcg/mL (SI: nmol/L = 18.5 x mcg/mL)
13 – 39
Abnormal findings If after a TSH test result high and a T4 test result normal, a T3 test result is normal, it can indicate a mild form of hypothyroidism. If after a TSH test result high and a T4 test result low, a T3 test result is normal or low, it can indicate hypothyroidism. If after a TSH test result low and a T4 test result normal, a T3 test result is normal, it can indicate a mild form of hyperthyroidism. If after a TSH test result low and a T4 test result normal or high, a T3 test result is normal or high, it can indicate hyperthyroidism. If after a TSH test result low and a T4 test result normal or low, a T3 test result is normal or low, it can indicate a nonthyroidal illness, for example a rare pituitary hypothyroidism.

Tobramycin

Description
Tobramycin sulfate is an aminoglycoside antibiotic.  It is used to treat various types of bacterial infections, particularly Gram-negative infections.
Tobramycin works by attaching itself to a certain location in the ribosome of the bacterial 30S and 50S.  As a result, mRNA cannot be translated into protein and cell dyies. Tobramycin is preferred over gentamicin for Pseudomonas aeruginosa pneumonia due to better lung penetration and bactericidal activity.
Tobramycin does not pass the gastro-intestinal tract, so for systemic use it can only be given intravenously or intramuscularly. This formulation for injection is branded Nebcin.
Patients with cystic fibrosis will often take an inhalational form (Tobi) for suppression of Pseudomonas aeruginosa infections. Tobramycin is also combined with dexamethasone as an ophthalmic solution (TobraDex).
Bausch & Lomb Pharmaceuticals, Inc. makes a sterile Tobramycin Ophthalmic Solution (eye-drops) with a tobramycin concentration of 0.3% (In some countries, such as Italy, it is available over the counter.). It is mixed with 0.01% benzalkonium chloride as a preservative. These concentrations result in 3 mg per ml and 0.1 mg per ml, respectively.
Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test To meassure the concentration of antibiotic tobarmycin in blood in order to monitor treatment with this medicament, and prevent possible side effects due to inadecuate amount. Reference range values mg/L (SI: mcmol/L = 2.14 x mg/L) Therapeutic:
Pre     <2
Post   5 – 10 Toxic:
Post   >10 mg/L
Abnormal findings
Tobramycin can cause deafness or a loss of equilibrioception (vertigo) in certain individuals with a harmless mutation in their DNA, that allows the tobramycin to affect their cells. The cells of the ear are particularly sensitive to this.
If multiple doses accumulate, tobramycin can also be highly toxic to the kidneys.

Total Iron Binding Capacity TIBC

Description Alternative names: IBC - Iron binding capacity, transferrin. Transferrin is a protein that carries iron through the entyre body by means of the blood stream. This test is ain indicative of how much iron is available for tissues of the body to use. This test can be prescribed when the doctor suspects: • Excess-iron disease
- Iron deficiency anemia
- Liver function tests abnormal
- Protein-deficient diet Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test To meassure the Iron binding capacity in order to check the level of Iron on the body, due to any disease causing excess or lack of iron on the body. Reference range values 45-66 micromol/L
Abnormal findings High concentrations in blood can be due to :
- Excess-iron disease
- Liver disease Low concentrations in blood can be due to : • Iron deficiency anemia
- Liver function disease
- Protein-deficient diet

Magnesium, Serum

Description
Magnesium is a vital to energy production, muscle contraction, nerve function, and maintenance of strong bones. Half of the body's magnesium is combined with calcium and phosphorus to form bone.
Abnormal levels of magnesium are normally due to a problem of regulation of magnesium absortion in the intestines or excesseve excretion by the kidneys. A constant low magnesium level can cause persistently low calcium and potassium levels. For thies resason, it may be checked to help diagnose problems with calcium, potassium, phosphorus, and/or parathyroid hormone. Magnesium levels may be measured frequently to monitor the response to oral or intravenous magnesium and calcium supplements. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test To evaluate the level of magnesium in the blood and to help determine the cause of abnormal calcium and/or potassium levels. Doctor will prescribe ths test if you have symptoms such as weakness, irritability, cardiac arrhythmia, nausea, and/or diarrhea that may be due to too much or too little magnesium or if you have abnormal calcium or potassium levels. It can be ordered to a monitor chronically low levels of calcium and potassium. If magnesium and/or calcium supplementation is necessary, then this test will be done at intervals to monitor the effectiveness of treatment. If you have a kidney disorder or uncontrolled diabetes, your doctor may order this test to help monitor kidney function and to make sure that you are not excreting or retaining excessive amounts of magnesium.
Reference range values 0.75 – 1.00 mmol/L Abnormal findings Low magnesium levels in blood are called hypomagnesemia, and can be due to :
- not getting enough magnesium in the diet
- intestines are not absorbing enough magnesium
- kidneys are excreting too much magnesium These deficiencies may be due to:
- Low dietary intake, typically seen in the elderly, malnourished, and with alcoholism
- Gastrointestinal disorders
- Uncontrolled diabetes 
- Hypoparathyroidism
- Long-term diuretic use 
- Prolonged diarrhea 
- Post surgery 
- Severe burns 
- Toxemia of pregnancy
High magnesium levels are rarely due to dietary sources but are usually the result of an excretion problem or excessive supplementation. Increased levels are seen in: 
- Kidney failure 
- Hyperparathyroidism 
- Hypothyroidism 
- Dehydration 
- Diabetic acidosis 
- Addison's disease
- Use of magnesium-containing antacids or laxatives

Triglycerides  Serum

Description
Triglycerides are the body's storage form for fat. Most triglycerides are found in tissue. Some of them circulate in the blood to provide fuel for muscles to work. Extra triglycerides are found in the blood after eating a meal. This test for triglycerides are usually part of a lipid profile used to identify the risk of developing heart disease. In case of a diabetic patient, it is especially important to have triglycerides measured as part of any lipid testing since triglycerides increase significantly when blood sugar is out of control. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test
To meassure the concentration of triglycerides in blood in order to evaluate the risk of developing heart disease. This test is prescribed as part of a lipid profile during a regular medical exam or if you are being treated for high triglycerides. Lipid profiles, including triglycerides test, are recommended as routine tests to evaluate risk of heart disease in healthy adults. This test is not often ordered alone since risk of heart disease is based on cholesterol levels (see cholesterol, HDL, LDL), not triglycerides. Also if you have been found to have high triglycerides and are being treated for it, a triglyceride test may be ordered to see if treatment is working.
Reference range values mg/dL (SI: mmol/L = 0.0113 x mg/dL) Normal                         <150
Borderline high risk   150 – 199
High risk                  200 – 499
Very high risk              >=500
Abnormal findings Even when it is unusual to have high triglycerides without also having high cholesterol. Most treatments for heart disease risk will be aimed at lowering LDL cholesterol. However, the type of treatment used to lower LDL cholesterol may differ depending on whether triglycerides are high or normal.
Very high triglycerides levels lead to risk of developing pancreatitis.

Triiodothyronine  T3

Also know as T3. T3 and T4 hormones are by the thyroid gland. Thyroid gland is a small butterfly-shaped organ that lies flat across your windpipe. T3 and T4 control the rate at which the body uses energy. When blood levels of thyroid hormones decline, the hypothalamus releases thyrotropin releasing hormone, which stimulates the pituitary to produce thyroid-stimulating hormone (TSH). TSH then stimulates the thyroid gland to produce hormones. Most of the thyroid hormone produced is T4. This hormone is relatively inactive, but it is converted into the much more active T3 in the liver.
If the thyroid gland produces a lot of T4 and T3, then the patient may have symptoms associated with hyperthyroidism, such as nervousness, tremors of the hands, weight loss, insomnia, and puffiness around dry, irritated eyes.
If the thyroid gland produces insufficient hormones, then the patient may have symptoms associated with hypothyroidism and a slowed metabolism, such as weight gain, dry skin, fatigue, and constipation.
About 99.7% of the T3 found in the blood is attached to a protein and the rest is free. 
Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test To meassure the level of free T3 hormone in blood in order to detect problems of hyperthyroidism or hypothyroidism.
A T3 test helps to see whether the thyroid is functioning properly. Mainly to help diagnose hyperthyroidism. The T3 test is usually following an abnormal TSH and T4 test.  T3 testing may be ordered along with thyroid antibodies to help diagnose Graves' disease, an autoimmune disorder that is the most common cause of hyperthyroidism. A T3 test may be ordered at intervals to monitor a known thyroid condition and to help monitor the effectiveness of treatment for hyperthyroidism. Reference range values 2.77 – 6.47pmol Abnormal findings If after a TSH test result high and a T4 test result normal, a T3 test result is normal, it can indicate a mild form of hypothyroidism. If after a TSH test result high and a T4 test result low, a T3 test result is normal or low, it can indicate hypothyroidism. If after a TSH test result low and a T4 test result normal, a T3 test result is normal, it can indicate a mild form of hyperthyroidism. If after a TSH test result low and a T4 test result normal or high, a T3 test result is normal or high, it can indicate hyperthyroidism. If after a TSH test result low and a T4 test result normal or low, a T3 test result is normal or low, it can indicate a nonthyroidal illness, for example a rare pituitary hypothyroidism.

Urea Nitrogen or BUN

Description
Also know as BUN measurement.
The following are possible reasons why this test may be done:
- Acute kidney failure
- Acute post-streptococcal glomerulonephritis
- Community acquired pneumonia
- Dehydration
- Diabetes with ketoacidosis
- Diabetic hyperosmolar non-ketotic state
- Kidney failure
- Systemic infection Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test
This test measures the amount of blood urea nitrogen (BUN) in blood. It is used to evaluate and manage kidney disorders, and medical conditions involving too little or too much body fluid. Reference range values mg/dL  (SI: mmol/L = 0.357 x mg/dL) Adults: 8 – 22
Children: 5-18
Abnormal findings Appart from kidney disorders, this test can be influenced by other conditions such as:
- Results increased in:
- Febrile illness
- High protein diet • Results decreased in:
- Low protein diet
- High carbohydrate diet

Uric Acid

Description
Uric acid is produced by the breakdown of purines, chemicals that come from nucleic acids (DNA). They enter the circulation from digestion of foods or from normal metabolism in the body cells.  Uric acid is removed by the kidneys and expulsed in the urine and also excreted in the feces.
The excesive presence of uric acid in blood can cause the condition called gout – an inflammation that occurs in joints when crystals derived from uric acid form in the joint fluid.
Common reasons for accumulation of uric acid are an inherited tendency to overproduce uric acid or inapropiated kidney function that results in low ability to excrete uric acid.
Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test To detect high levels of uric acid in bllod, which could be a sign of the condition gout, or to monitor uric acid levels when undergoing chemotherapy or radiation treatment.

It is prescribed when monitoring certain chemotherapy or radiation therapies for cancer or when there are symptoms of gout such as joint pain. The uric acid test is used to learn whether the body might be breaking down cells too quickly or not getting rid of uric acid quickly enough. The test also is used to monitor levels of uric acid when a patient has had chemotherapy or radiation treatments.
Reference range values mg/dL (SI: mmol/L = 0.059 x mg/dL)
Male     3.7 – 8.6 Female 2.4 – 5.8
Abnormal findings Higher than normal uric acid levels can be due to over production of uric acid or due to the body being unable to clear away it. In any case this lead to formation of uric acid crystals in the joints, which leads to the joint inflammation and pain characteristic of gout. Uric acid can also form crystals or kidney stones that can damage the kidneys.
Low values can be associated with some kinds of liver or kidney diseases, exposure to toxic compounds, and rarely as the result of an inherited metabolic defect.

Urinalysis

Description
A urinalysis is a test that detect various compounds that are eliminated in the urine, as well as cells, including bacteria, and cellular fragments. Urine is produced by the kidneys as product of filtering wastes and metabolic byproducts out of the blood. Anything that is not needed is excreted in the urine. Urine is generally yellow and relatively clear, but color, quantity, concentration, and content of the urine can be slightly different because of varying constituents.
Many disorders can be diagnosed in their early stages by detecting abnormalities in the urine.
A complete urinalysis consists of:
1. physical examination : urine's color, clarity, and concentration
2. chemical examination, which tests chemically for 9 substances that provide valuable information about health and disease
3. microscopic examination, which searches and counts the type of cells, casts, crystals, and other components (bacteria, mucus ) that can be present
Its concentration is measured by means of analysis of a urine sample. Purpose of the test To detect the presence of some possible substances in the blood in order to give a first alert for many possible problems.  For example to screen for metabolic and kidney disorders and for urinary tract infections.
This test is done during a routine physical or when there are symptoms of a urinary tract infection, such as abdominal pain, back pain, frequent or painful urination, or blood in the urine.   Also as part of a pregnancy checkup, a hospital admission, or a pre-surgical work-up.
Reference range values Urinalysis Protein =                     Negative Glucose =                   Negative

Ketones =                   Negative Hemoglobin =               Negative Urobilinogen =              Negative Leukocyte Esterase =   Negative Nitrite =                       Negative pH =                            5-8 (fasting) Specific Gravity =         1.002-1.035 RBC's                          0 - 15/mcL WBC's                         0 - 25/mcL Abnormal findings
Abnormal results can mean that something is wrong and need to be further evaluation. But the results do not tell exactly what the problem can be. Also a normal result does not mean that there is no illness.

Valproic Acid

Description Alternative names: Depakote, Depakene Valproic acid is a drug used primarily to treat epilepsy.   It is also prescribed to treat bipolar disease and to prevent migraine headaches. I t can be prescribed in combination with other antiepileptic drugs such as phenytoin or phenobarbital.
Epilepsy affects the brain's ability to transmit electrical impulses and to regulate nerve activity. During a seizure, a patient may experience changes in consciousness, alterations in sight, smell, and taste, and may experience convulsions.
Bipolar disorder is a mental condition characterized by alternative depression and euphoria that may last from days to years.
Valproic acid is also given to some patients with recurrent migraine headaches, not so much as to treat migraines but to help prevent their occurrence.
Valproic acid levels must be maintained within a narrow therapeutic range. Too little and the patient may experience a recurrence of symptoms.  Too much and the patient may experience increased side effects.
Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test
To measure the concentration of valproic acid in blood in order to maintain it within a therapeutic level. It is prescribed at regular intervals to monitor the drug's level when a patient begins valproic acid treatment and if a patient's medications. When stable blood concentrations in the therapeutic range have been achieved, valproic acid levels may then be monitored at regular intervals to ensure that it remains within this range.
The test may be ordered when a patient's condition does not appear to be responding to valproic acid to determine whether concentrations are too low, the medication is ineffective, and/or to determine if the patient is complying with therapy (taking the valproic acid regularly). It may also be ordered when a patient experiences a troublesome level of side effects and/or develops complications. Reference range values mg/L  (SI: mcmol/L = 6.93 x mg/L)
Therapeutic   50 – 100
Toxic             >100
Abnormal findings If the level of valproic acid is low, the patient could continue having symptoms such as recurrent seizures, mood swings, or migraines.
High levels can lead to secondary effects.
Some drugs affect the effect of valproic acid, such as carbamazepine, phenytoin, lamotrigine, and phenobarbital, increasing the rate of valproic acid metabolism, thus decreasing its concentration in the blood.

Vancomycin

Description Vancomycin is an antimicrobial medicament used to treat serious infections caused by gram-positive bacteria. Vancomycin is used when organisms proved resistant to penicillin or to methicillin  or when the patient is allergic to penicillin.
Intravenous vancomycin may be given to treat infections such as septicemia, endocarditis, osteomyelitis, some pneumonias, and meningitis. It is often used for methicillin-resistant Staphylococcus epidermidis and Staphylococcus aureus infections, especially when they are associated with implanted prosthetic devices such as heart valves, artificial hips, and indwelling catheters.
Excessive concentrations of vancomycin must be avoided because high levels can result in toxicities - specifically ototoxicity (damage to hearing) and nephrotoxicity (kidney damage).
The amount of vancomycin given per dose depends on a variety of factors, including kidney function, other nephrotoxic drugs the patient may be taking, age, and weight.
If the patient has a decreased kidney function may not be able to clear the drug out of his system efficiently, resulting in increased concentration in the blood. If a patient is given too little drug and is unable to maintain a sufficient minimum dose in the blood, then it is unlikely that treatment will be effective.
The vancomycin test can be used to monitor the amount of drug in the blood to ensure that it is adequate but not excessive.
Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test
To monitor the concentration of vancomycin in the blood, at intervals during vancomycin treatment. After taken a vancomycin dose, its concentration rises in the blood, peaks, and then falls. The next dose is timed to anticipate the falling level in order to maintain always a minimum concentration in the blood. Measurement of blood levels are ordered at times to reflect the lowest concentration and the highest concentration to evaluate the adequacy of dosing.
Reference range values
mg/L (SI: mcmol/L = 0.69 x mg/L
Therapeutic
Pre      5 – 10
Post    20 – 40 Toxic
Pre        >15
Post      >80-100 Abnormal findings Very high concentrations can lead to nephrotoxicity and/or ototoxicity because of other medications, decreased kidney function, etc.

Varicella Zoster Virus (VZV) Antibodies, IgG

Description Varicella zoster virus (VZV) causes the illness known as chicken pox.
Although most (85% to 90%) of pregnant women have already been exposed to the virus and therefore are immune, some may not have had the infection. Since the virus can cause birth defects or illness in the baby (depending on when during the pregnancy an infection occurs), testing is available before or in early pregnancy to determine if the woman has antibodies to VZV. If she doesn't and is therefore not immune, a vaccine can be given before the woman gets pregnant. If she is already pregnant and may have been exposed to the virus, treatment is available that can prevent or weaken the severity of the illness.
VZV antibodies are detected by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test To detect the presence of Varicella Zoster Virus Antibodies in a blood sample, in order to detect whether the patient has been exposed to the Varicella Zoster Virus. Test Results : Reference Interval:
0.89 IV or less: Negative - No significant level of detectable varicella-zoster IgG antibody is found. 0.90-1.09 IV: Equivocal - Repeat testing in 10-14 days may be helpful. 1.10 IV or greater: Positive - IgG antibody to varicella-zoster are detected, which may indicate a current or past varicella-zoster infection. Positive IgG antibody levels in the absence of current clinical symptoms may indicate immunity (98% correlation with IFA).
Interpretive Data:
The best evidence for current infection is a significant change on two appropriately timed specimens, where both tests are done in the same laboratory at the same time.

Vitamin B1

Vitamin B1, Plasma Description Thiamine, or thiamin, sometimes called aneurin, is a water-soluble vitamin of the B complex (vitamin B1), whose phosphate derivatives are involved in many cellular processes. The best characterized form is thiamine diphosphate (ThDP), a coenzyme in the catabolism of sugars and amino acids.
Animals must cover all their needs from their food and insufficient intake results in a disease called beriberi affecting the peripheral nervous system (polyneuritis) and/or the cardiovascular system, with fatal outcome if not cured by thiamine administration. In less severe deficiency, nonspecific signs include malaise, weight loss, irritability and confusion.
Majority of thiamine in serum is bound to proteins, mainly albumin. Approximately 90% of total thiamine in blood is in erythrocytes. A specific binding protein called thiamine-binding protein (TBP) has been identified in rat serum and is believed to be a hormonally regulated carrier protein that is important for tissue distribution of thiamine.
Concentration of vitamin B1 is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test The purpose of this test is to meassure the concentration of Vitamin B1 by means of analisys of a blood sample.
Thiamine derivatives and thiamine-dependent enzymes are present in all cells of the body, thus, a thiamine deficiency would seem to adversely affect all of the organ systems. However, the nervous system and the heart are particularly sensitive to thiamine deficiency, because of their high oxydative metabolism.
Total thiamine, measured as thiamine (vitamin B1) and thiamine monophosphate, is reported. However, the biologically active form of the vitamin, thiamine diphosphate (TDP), is best measured in whole blood, and is not found in measurable concentration in plasma. Plasma thiamine concentration reflects recent intake rather than body stores.
Whole blood is the preferred specimen for thiamine assessment. Approximately 80% of thiamine present in whole blood is found in red blood cells.
Reference range values
8-30 nmol/L Abnormal findings Thiamine deficiency can lead to myriad problems including neurodegeneration, wasting and death. A lack of thiamine can be caused by malnutrition, a diet high in thiaminase-rich foods (raw freshwater fish, raw shellfish, ferns) and/or foods high in anti-thiamine factors (tea, coffee, betel nuts) and by grossly impaired nutritional status associated with chronic diseases, such as alcoholism, gastrointestinal diseases, HIV-AIDS, and persistent vomiting. It is thought that many people with diabetes have a deficiency of thiamine and that this may be linked to some of the complications that can occur.
Well-known syndromes caused by thiamine deficiency include beriberi and Wernicke-Korsakoff syndrome, diseases also common with chronic alcoholism.

Vitamin B12

Vitamin B12 Description Also known as: RBC Folate,or Cobalamin, Folic Acid, RBC folate.
B12 and folate belong to the B complex of vitamins.
The body needs folic acid to make red blood cells (RBC), white blood cells (WBC), platelets, new genetic material (DNA) in cells, and for normal growth. Folic acid also is important for the normal development of a baby (fetus).
Folate is found in green vegetables, citrus fruits, dry beans and peas, liver, and yeast
B12 is found red meat, fish, poultry, milk, and eggs.
Both B12 and folate are needed for RBC formation, cellular reparation, and DNA synthesis.
A deficiency in either B12 or folate can lead to megaloblastic anemia.   This disease is characterized by the production of fewer, but larger, RBCs called macrocytes. Macrocytes have a shorter life  than normal RBCs and lead to fatigue, weakness, and other symptoms of anemia. A lack of B12 can also lead to neuropathy and nerve damage afecting hands and feet. Folate deficiency during early pregnancy can increase the risk of neural tube defects such as spina bifida in the fetus. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test To measure the Folate level in blood to help diagnose the cause of anemia or neuropathy. Also to evaluate nutritional status in some patients or to check effectiveness of treatment for B12 or folate deficiency.

These tests measure the concentration of folate and vitamin B12 in the liquid portion of the blood (serum) or inside the red blood cell (RBC).  It will normally be at a higher concentration inside the cells than in the serum Either a serum or RBC folate test may be used to help detect a deficiency. B12 and folate tests are done when a CBC, done routinely or as part of an evaluation of anemia symptoms, indicates the presence of large RBCs. When a person shows mental or behavioral changes such as irritability, confusion, depression, and/or paranoia, B12 and folate may be done to help diagnose the underlying cause. These tests are also be ordered when a patient has physical symptoms that suggest a B12 or folate deficiency, including dizziness, weakness, fatigue, or a sore mouth or tongue. When a patient has symptoms suggesting nerve damage such as, tingling, burning, or numbness in their hands, arms, legs, and or/feet, a B12 test may be requested.
In patients with known B12 and folate deficiencies, these tests may be ordered occasionally to help monitor the effectiveness of treatment with supplements (or with B12 injections). Normal or elevated results indicate a response to treatment.
Reference range values 1123 – 3345 nmol/L Abnormal findings High levels of B12 and folate are not usual. They can be seen in conditions such as leukemia or liver dysfunction. High folate levels may be seen with pernicious anemia and with vegetarian diets.
Some drugs can decrease B12 and folic acid levels including oral contraceptives, estrogens, alcohol, and some antibiotics.
B12 and/or folate deficiencies can be caused by:
- Insufficient intake.   Very rare. Cases appear among vegetarians. • Malabsorption, due to:
- Celiac disease
- Bacterial overgrowth in the stomach and intestines
- Reduced stomach acid production
- Pernicious anemia. This is the most common cause of B12 deficiency.
- Surgery that removes part of the stomach or the intestines may greatly decrease absorption.
- Increased loss, due to:
- Liver and kidney disease
- Alcoholism
- Anti-seizure medications such as phenytoin, metformin and methotrexate
- Increased need due to pregnancy.

Vitamin B6

Vitamin B6, Plasma Description Vitamin B6 is a water-soluble vitamin and is part of the vitamin B complex group. Pyridoxal phosphate (PLP) is the active form and is a cofactor in many reactions of amino acid metabolism, including transamination, deamination, and decarboxylation. PLP also is necessary for the enzymatic reaction governing the release of glucose from glycogen.
Pyridoxal phosphate, the metabolically active form of vitamin B6, is involved in many aspects of macronutrient metabolism, neurotransmitter synthesis, histamine synthesis, hemoglobin synthesis and function and gene expression. Pyridoxal phosphate generally serves as a coenzyme for many reactions and can help facilitate decarboxylation, transamination, racemization, elimination, replacement and beta-group interconversion reactions.
The liver is the site for vitamin B6 metabolism.
Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test Determining vitamin B(6) statusspecially in persons who present progressive nerve compression disorders, such as carpal tunnel and tarsal tunnel syndromes
Determining the overall success of a vitamin B(6) supplementation program
Diagnosis and evaluation of hypophosphatasia Reference range values
5.0-30.0 ng/mL Abnormal findings The classic clinical syndrome for B6 deficiency is a seborrhoeic dermatitis-like eruption, atrophic glossitis with ulceration, angular cheilitis, conjunctivitis, intertrigo, and neurologic symptoms of somnolence, confusion, and neuropathy.
While severe vitamin B6 deficiency results in dermatologic and neurologic changes, less severe cases present with metabolic lesions associated with insufficient acitivities of the coenzyme pyridoxal phosphate. The most prominent of the lesions is due to impaired tryptophan-niacin conversion. This can be detected based on urinary excretion of xanthurenic acid after an oral tryptophan load. Vitamin B6 deficiency can also result from impaired transsulfuration of methionine to cysteine. The pyridoxal phosphate-dependent transaminases and glycogen phosphorylase provide the vitamin with its role in gluconeogenesis, so deprivation of vitamin B6 results in impaired glucose tolerance.
A deficiency of vitamin B6 alone is relatively uncommon and often occurs in association with other vitamins of the B complex. The elderly and alcoholics have an increased risk of vitamin B6 deficiency, as well as other micronutrient deficiencies. Renal patients undergoing dialysis may experience vitamin B6 deficiency. The availability of vitamin B6 to the body can be affected by certain drugs such as anticonvulsants and corticosteriods.

Vitamin C

Vitamin C Description Vitamin C or ascorbic acid is an essential nutrient for humans, a large number of higher primate species, a small number of other mammalian species (notably guinea pigs and bats), a few species of birds, and some fish. The presence of ascorbate is required for a range of essential metabolic reactions in all animals and plants. It is made internally by almost all organisms, humans being a notable exception. It is widely known that a deficiency in this vitamin causes scurvy in humans. It is also widely used as a food additive. Biological tissues that accumulate over 100 times the level in blood plasma of vitamin C are the adrenal glands, pituitary, thymus, corpus luteum, and retina. Those with 10 to 50 times the concentration present in blood plasma include the brain, spleen, lung, testicle, lymph nodes, liver, thyroid, small intestinal mucosa, leukocytes, pancreas, kidney and salivary glands. The pharmacophore of vitamin C is the ascorbate ion. In living organisms, ascorbate is an anti-oxidant, since it protects the body against oxidative stress, and is a cofactor in several vital enzymatic reactions. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test To evaluate the concentration of Vitamin C in the blood. Reference range values 0.4-2.0 mg/dL
Abnormal findings Scurvy is an avitaminosis resulting from lack of vitamin C, since without this vitamin, the synthesised collagen is too unstable to perform its function. Scurvy leads to the formation of liver spots on the skin, spongy gums, and bleeding from all mucous membranes. Human body can store only a certain amount of vitamin C, and so the body soon depletes itself if fresh supplies are not consumed. Low blood levels of vitamin C or Chronic Scurvy is a cause of atherosclerosis. Relatively large doses of vitamin C may cause indigestion, particularly when taken on an empty stomach. When taken in large doses, vitamin C causes diarrhea in healthy subjects.

Vitamin D 1 25 Dihydroxy

Category: All Lab Tests Vitamin D, 1,25 Dihydroxy Description Also known as: 25-hydroxy-vitamin D (Calcidiol, Calcifidiol) and 1,25 dihydroxy-vitamin D (Calcitriol). 25 OH Vitamin D tests are used to determine if bone weakness, bone malformation, or abnormal metabolism of calcium (reflected by abnormal calcium, phosphorus or PTH tests) is occurring as a result of a deficiency or excess of vitamin D. Since vitamin D is a fat-soluble vitamin and is absorbed from the intestine like a fat, vitamin D tests are sometimes used to monitor individuals with diseases that interfere with fat absorption, such as cystic fibrosis and Crohn's disease, to assure that they have adequate amounts of vitamin D. Vitamin D tests are sometimes used to determine effectiveness of treatment when vitamin D, calcium, phosphorus, and/or magnesium supplementation Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test 25 OH Vitamin D test If calcium is low or the patient has symptoms of vitamin D deficiency, such as bone malformation in children (rickets) and bone weakness, softness, or fracture in adults (osteomalacia), the 25 OH Vitamin D test usually is ordered to identify a possible deficiency in vitamin D. 1,25 di OH Vitamin D test If calcium is high or the patient has a disease that might produce excess amounts of Vitamin D, such as sarcoidosis or some forms of lymphoma, the 1,25 di OH Vitamin D test usually is ordered. Vitamin D tests also may be used to help diagnose or monitor problems with parathyroid gland functioning since parathyroid hormone is essential for vitamin D activation. When vitamin D, calcium, phosphorus, or magnesium supplementation is necessary, vitamin D levels are sometimes measured to monitor treatment effectiveness.
Reference range values
15-75 ng/L Abnormal findings 25 OH Vitamin D test Low blood levels of 25 hydroxy Vitamin D may mean that patient is not getting enough exposure to sunlight or enough dietary vitamin D to meet body's demand or that there is a problem with its absorption from the intestines. Occasionally, drugs used to treat seizures, particularly phenytoin (Dilantin), can interfere with the production of 25 OH Vitamin D in the liver. High levels of 25 hydroxy Vitamin D usually reflect excess supplementation from vitamin pills or other nutritional supplements. 1,25 di OH Vitamin D test Low levels of 1,25 di OH Vitamin D can be seen in kidney disease and are one of the earliest changes to occur in persons with early kidney failure. High levels of 1,25 di OH Vitamin D may occur when there is excess parathryoid hormone or when there are diseases, such as sarcoidosis or some lymphomas, that can make 1,25 di OH Vitamin D outside of the kidneys.

Vitamin D 25-Hydroxy

Description Formal name: 25-hydroxy-vitamin D (Calcidiol, Calcifidiol) and 1,25 dihydroxy-vitamin D (Calcitriol) Vitamin D is found in blood in two forms: 25 hydroxy Vitamin D and 1,25 dihydroxy Vitamin D. 25 hydroxy Vitamin D (25 OH Vitamin D) is the major form of the hormone found in the blood and is the inactive precursor to the active hormone 1,25 dihyroxy Vitamin D. Because of its long half-life and higher concentration, 25 OH Vitamin D is commonly measured to assess and monitor Vitamin D status in individuals.
Vitamin D is produced in the skin (vitamin D3, also called cholecalciferol) on exposure to sunlight and also is ingested in foods and supplements (vitamin D2, also called ergocalciferol).
The main role of Vitamin D is to help regulate the absorption of calcium, phosphorus, magnesium. Vitamin D is vital for the growth and health of bone.
25 OH Vitamin D tests are precribed to check bone weakness, bone malformation, or abnormal metabolism of calcium. Since vitamin D is a fat-soluble this test is sometimes used to monitor individuals with diseases that interfere with fat absorption, such as cystic fibrosis and Crohn's disease. Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test To meassure the level of Vitamin D in blood in order to check for a problem related to bone metabolism or parathyroid function, possible Vitamin D deficiency or malabsorption, and to monitor some patients taking Vitamin D. 25 OH Vitamin D test is normally ordered to identify a possible deficiency in vitamin D, when calcium is low or the patient has symptoms of vitamin D deficiency, such as bone malformation in children (rickets) and bone weakness, softness, or fracture in adults (osteomalacia).
1,25 di OH Vitamin D test usually is ordered when calcium is high or the patient has a disease that might produce excess amounts of Vitamin D, such as sarcoidosis or some forms of lymphoma.
Vitamin D tests can also be used to diagnose problems with parathyroid gland functioning since parathyroid hormone is essential for vitamin D activation. Reference range values
ng/mL  (SI: nmol/L = 2.496 x ng/mL)
optimum levels: 25-80 ng/ mL
toxicity:  >80 ng/mL Abnormal findings
Low blood levels of 25 hydroxy Vitamin D can mean that you are not getting enough exposure to sunlight or enough dietary vitamin D to meet your body's demand or that there is a problem with its absorption from the intestines.
Occasionally, drugs such as phenytoin, can interfere with the production of 25 OH Vitamin D in the liver.
High levels of 25 hydroxy Vitamin D normally means excess supplementation from vitamin pills.
Low levels of 1,25 di OH Vitamin D can be seen in kidney disease.
High levels of 1,25 di OH Vitamin D can be seen when there is excess parathryoid hormone or when there are diseases, such as sarcoidosis or some lymphomas, that can excess 1,25 di OH Vitamin D outside of the kidneys.

Vitamin E

Vitamin E Description Vitamin E is a fat-soluble vitamin.  It has eight different variants, each one has its own biological activity.
Alpha-tocopherol (a-tocopherol) is the most active form of vitamin E in humans. It is a powerful antioxidant. It is sold in supplements as alpha-tocopheryl acetate. The synthetic form is labeled "D, L" while the natural form is labeled "D". The synthetic form is only half as active as the natural form. Antioxidants such as vitamin E act to protect cells against the effects of free radicals, potentially damaging by-products of energy metabolism.
Vegetable oils, nuts, green leafy vegetables, and fortified cereals are common food sources of vitamin E.
Its concentration is measured by means of analysis of a blood sample drawn from the vein in the arm. Purpose of the test To measure the level of vitamin E in blood in order to check whether the patient has a convenient level of this vitamin or there is a defect in diet or a disease related with absorption of vitamin E. Vitamin E deficiency is rare in humans, except in:
1. persons who cannot absorb dietary fat due to an inability to secrete bile or with rare disorders of fat metabolism: Crohn's Disease and Cystic Fibrosis
2. individuals with rare genetic abnormalities in the alpha-tocopherol transfer protein: Ataxia and vitamin E deficiency (AVED) 
3. premature, very low birth weight infants: Necrotizing enterocolitits Reference range values
mg/L (SI: mcmol/L = 2.32 x mg/L) 20-150Y:  5.5-17
1-19Y:     Not established Abnormal findings
Vitamin E deficiency is usually characterized by neurological problems associated with nerve degeneration in hands and feet.  It can be due to:
- Problems related with inability to absorb fat: Crohn's Disease and Cystic Fibrosis
- Metabolic inherited problems Ataxia and vitamin E deficiency
Blood levels of vitamin E may also be decreased with zinc deficiency.

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