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Low levels of fibrinogen are associated with bleeding most commonly secondary to liver disease or Disseminated Intravascular Coagulation (DIC). Fibrinogen is an acute phase reactant and thus elevated levels may be associated with inflammation. Increased concentrations are also associated with increased risk of atherosclerosis.

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BNP is used to aid in the diagnosis of left ventricular dysfunction in heart failure. In contrast with BNP, a drug to treat left ventricular dysfunction does not interfere with the measurement of N-terminal pro-BNP.

Dietary supplements containing biotin may interfere in assays and may skew results to be either falsely high or falsely low. For patients receiving the recommended daily doses of biotin, draw samples at least 8 hours following the last biotin supplementation. For patients on mega-doses of biotin supplements, draw samples at least 72 hours following the last biotin supplementation.


Description: A Prothrombin Time test will measure the speed of which your blood clots. This test can be used to detect a bleeding or clotting disorder or to determine in your blood is clotting too fast or too slow.

Also Known As: Pro Time with INR Test, Prothrombin Time and International Normalized Ratio test, Prothrombin Time PT with INR Test, Prothrombin Time with INR Test, Prothrombin with INR, Protime with INR, PT Test

Collection Method: Blood draw

Specimen Type: Whole Blood

Test Preparation: No preparation required

When is a Prothrombin Time with INR test ordered?

When a person takes the anticoagulant medicine warfarin, a PT and INR are ordered on a regular basis to confirm that the prescription is working effectively and that the PT/INR is adequately extended. A doctor will prescribe them frequently enough to ensure that the treatment is having the desired effect, namely, boosting the person's clotting time to a therapeutic level while minimizing the danger of excessive bleeding or bruising.

When a person who isn't taking anticoagulants exhibits signs or symptoms of excessive bleeding or clotting, a PT may be ordered when they are experiencing:

  • Bleeding that isn't explained or bruises that isn't easy to get rid of
  • Nosebleeds
  • Gums that are bleeding
  • A blood clot in an artery or vein
  • Disseminated intravascular coagulation
  • A persistent disorder that affects hemostasis, such as severe liver disease

PT and PTT may be prescribed prior to surgery when there is a high risk of blood loss associated with the procedure and/or when the patient has a clinical history of bleeding, such as frequent or severe nosebleeds and easy bruising, which may indicate the presence of a bleeding problem.

What does a Prothrombin Time with INR blood test check for?

The prothrombin time is a test that determines a person's capacity to make blood clots properly. The international normalized ratio, or INR, is a calculation based on the results of a PT that is used to track people who are taking the blood thinner warfarin.

After chemicals are added to a person's blood sample, a PT measures how long it takes for a clot to develop. The PT is frequently used with a partial thromboplastin time to measure the number and function of proteins known as coagulation factors, which are essential for optimal blood clot formation.

When an injury develops in the body and bleeding ensues, the clotting process known as hemostasis begins. This process is aided by a series of chemical events known as the coagulation cascade, in which coagulation or "clotting" components are activated one by one, leading to the development of a clot. In order for normal clotting to occur, each coagulation factor must be present in appropriate quantities and operate effectively. Excessive bleeding can result from too little, while excessive clotting can result from too much.

There are two "pathways" that can trigger clotting in a test tube during a laboratory test, the extrinsic and intrinsic pathways. Both of these pathways subsequently converge to finish the clotting process. The PT test assesses how well all coagulation factors in the extrinsic and common routes of the coagulation cascade cooperate. Factors I, II, V, VII, and X are included. The PTT test examines the protein factors XII, XI, IX, VIII, X, V, II, and I, as well as prekallikrein and high molecular weight kininogen, which are all part of the intrinsic and common pathways. The PT and PTT examine the overall ability to generate a clot in a fair period of time, and the test results will be delayed if any of these elements are insufficient in quantity or are not operating effectively.

The PT test is normally done in seconds and the results are compared to a normal range that represents PT levels in healthy people. Because the reagents used to conduct the PT test vary from one laboratory to the next and even within the same laboratory over time, the normal ranges will change. The Internationalized Normalized Ratio, which is computed based on the PT test result, was developed and recommended for use by a World Health Organization committee to standardize results across various laboratories in the United States and around the globe for people taking the anticoagulant warfarin.

The INR is a formula that accounts for variations in PT reagents and enables for comparison of findings from different laboratories. When a PT test is performed, most laboratories report both PT and INR readings. However, the INR should only be used by people who are taking the blood thinner warfarin.

Lab tests often ordered with a Prothrombin Time with INR test:

  • Partial Thromboplastin Time
  • Fibrinogen Activity
  • Platelet Count
  • Complete Blood Count (CBC)
  • Coagulation Factors
  • Warfarin Sensitivity testing

Conditions where a Prothrombin Time with INR test is recommended:

  • Bleeding Disorders
  • Excessive Clotting Disorders
  • Vitamin K Deficiency
  • Liver Disease
  • DIC

How does my health care provider use a Prothrombin Time with INR test?

The prothrombin time is used to diagnose the origin of unexplained bleeding or abnormal blood clots, generally in conjunction with a partial thromboplastin time. The international normalized ratio is a calculation based on the results of a PT that is used to monitor people on the blood thinner warfarin.

Coagulation factors are proteins that are involved in the body's process of forming blood clots to assist stop bleeding. When an injury occurs and bleeding begins, coagulation factors are triggered in a series of events that finally assist in the formation of a clot. In order for normal clotting to occur, each coagulation factor must be present in appropriate quantities and operate effectively. Excessive bleeding can result from too little, while excessive clotting can result from too much.

The PT and INR are used to monitor the anticoagulant warfarin's efficacy. This medication influences the coagulation cascade's function and aids in the prevention of blood clots. It is given to those who have a history of recurrent abnormal blood clotting on a long-term basis. Warfarin therapy's purpose is to strike a balance between preventing blood clots and causing excessive bleeding. This equilibrium must be carefully monitored. The INR can be used to change a person's medication dosage in order to get their PT into the ideal range for them and their condition.

What do my PT and INR test results mean?

Most laboratories report PT findings that have been corrected to the INR for persons taking warfarin. For basic "blood-thinning" needs, these persons should have an INR of 2.0 to 3.0. Some people with a high risk of blood clot require a higher INR, about 2.5 to 3.5.

The outcome of a PT test is determined by the method utilized, with results measured in seconds and compared to a normal range defined and maintained by the laboratory that administers the test. This normal range is based on the average value of healthy persons in the area, and it will differ somewhat from test to lab. Someone who isn't on warfarin would compare their PT test result to the usual range provided by the laboratory that conducted the test.

A prolonged PT indicates that the blood is taking an excessive amount of time to clot. This can be caused by liver illness, vitamin K inadequacy, or a coagulation factor shortage, among other things. The PT result is frequently combined with the PTT result to determine what condition is present.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.


Description: A Gamma Glutamyl Transferase or GGT test is a test that measures that level of GGT in your blood’s serum to check for a variety of conditions related to liver health such as hepatitis or cirrhosis along with diabetes and heart health.

Also Known As: Gamma Glutamyltransferase GGT test, Gamma-Glutamyl Transferase Test, Gamma-Glutamyl Transpeptidase Test, Gamma-GT Test, GGTP Test, GTP Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a GGT test ordered?

When someone has an increased ALP level, a GGT test may be ordered. Even if no symptoms are present, an ALP test may be conducted alone or as part of a standard liver panel to screen for liver disease. When the ALP test results are high but the other tests in the liver panel are not, a GGT test may be ordered.

When a person has indications or symptoms that imply liver disease, GGT may be administered in conjunction with or as a follow-up to other liver function tests. The following are some of the signs and symptoms of liver damage:

  • Weakness and exhaustion
  • Appetite loss.
  • Vomiting and nausea
  • Swelling and/or pain in the abdomen
  • Jaundice
  • Urine that is dark in color and feces that is light in color
  • Pruritus

GGT may also be done after someone with a history of alcohol abuse has finished alcohol treatment to ensure that the treatment program is being followed.

What does a GGT blood test check for?

Glutamyl transferase is an enzyme found throughout the body, with the liver having the highest amount of it. GGT levels in the blood are raised in most disorders that affect the liver or bile ducts. This test determines the amount of GGT present in a blood sample.

GGT is normally present in tiny amounts, however when the liver is harmed, the level of GGT might grow. When any of the bile ducts that convey bile from the liver to the intestines become clogged, GGT levels are usually the first liver enzyme to become elevated in the blood. It's the most sensitive liver enzyme test for diagnosing bile duct issues because of this.

However, because it can be raised with many types of liver disorders, the GGT test is not highly specific and is not effective in differentiating between various causes of liver damage. As a result, the GGT test is not suggested for usage on a regular basis. It can, however, be used in conjunction with other tests to determine the source of a high alkaline phosphatase level, which is another liver enzyme.

In liver disorders, both GGT and ALP are elevated, whereas only ALP is elevated in diseases that impact bone tissue. As a result, GGT can be used as a follow-up test to establish whether an elevated ALP result is related to liver or bone illness.

When even small amounts of alcohol are consumed, GGT levels can sometimes rise. Chronic heavy drinkers have higher levels than persons who drink less than 2 to 3 drinks per day or who only drink heavily on rare occasions. The GGT test can be used to determine whether someone is suffering from acute or chronic alcoholism.

Lab tests often ordered with a GGT test:

  • AST
  • ALT
  • ALP
  • Bilirubin
  • Hepatic Function Panel
  • Ethanol
  • Comprehensive Metabolic Panel

Conditions where a GGT test is recommended:

  • Liver Disease
  • Alcoholism
  • Hepatitis
  • Cirrhosis

Commonly Asked Questions:

How does my health care provider us a GGT test?

The gamma-glutamyl transferase test can be used to figure out why your alkaline phosphatase is high. In bile duct illness and several liver diseases, both ALP and GGT are increased, while only ALP is elevated in bone disease. As a result, if a person's GGT level is normal but their ALP is high, the culprit is most likely bone disease.

The GGT test can be used to diagnose liver disease and bile duct blockages. Other liver tests such as ALT, AST, ALP, and bilirubin are frequently ordered in conjunction with or as a follow-up to this test. An elevated GGT level shows that a person's liver is being damaged in general, but it does not particularly point to a condition that could be causing the damage.

GGT can be used to test for chronic alcohol abuse and to monitor for alcohol use in patients undergoing alcoholism or alcoholic hepatitis therapy.

What do my GGT test results mean?

An high GGT level indicates that the liver is being harmed by a condition or disease, but it does not specify what that ailment or disease is. In general, the higher the level, the worse the liver damage. Elevated levels can be caused by liver illnesses like cirrhosis or hepatitis, but they can also be caused by other conditions like congestive heart failure, diabetes, or pancreatitis. They can also be caused by alcohol misuse or the use of liver-toxic medications.

A GGT test result that is low or normal suggests that a person does not have liver disease or has not recently consumed alcohol.

A high GGT level can help rule out bone disease as the source of an elevated ALP level, but if GGT is low or normal, bone disease is the most likely explanation.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.


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Description: A Glucose test is a blood test used to screen for, diagnose, and monitor conditions that affect glucose levels such as prediabetes, diabetes, hyperglycemia, and hypoglycemia.

Also Known As: Fasting Blood Glucose Test, FBG Test, Fasting Blood Sugar Test, FBS Test, Fasting Glucose Test, FG Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: Fasting required

When is a Glucose test ordered?

Diabetes screening is recommended by several health groups, including the American Diabetes Association and the United States Preventive Services Task Force, when a person is 45 years old or has risk factors.

The ADA recommends retesting within three years if the screening test result is within normal limits, but the USPSTF recommends testing once a year. Annual testing may be used to monitor people with prediabetes.

When someone exhibits signs and symptoms of high blood glucose, a blood glucose test may be conducted.

Diabetics are frequently asked to self-check their glucose levels multiple times a day in order to monitor glucose levels and choose treatment alternatives as suggested by their doctor. Blood glucose levels may be ordered on a regular basis, along with other tests such as A1c, to track glucose control over time.

Unless they show early symptoms or have had gestational diabetes in a prior pregnancy, pregnant women are routinely screened for gestational diabetes between the 24th and 28th week of pregnancy. If a woman is at risk of type 2 diabetes, she may be tested early in her pregnancy, according to the American Diabetes Association. When a woman has type 1, type 2, or gestational diabetes, her health care provider will normally order glucose levels to monitor her condition throughout the duration of her pregnancy and after delivery.

What does a Glucose blood test check for?

A fasting glucose test measures glucose. Glucose is the major energy source for the body's cells and the brain and nervous system's only source of energy. A consistent supply must be provided, and a somewhat constant level of glucose in the blood must be maintained. The glucose level in the blood can be measured using a variety of methods. 

Fruits, vegetables, breads, and other carbohydrate-rich foods are broken down into glucose during digestion, which is absorbed by the small intestine and circulated throughout the body. Insulin, a hormone generated by the pancreas, is required for the use of glucose for energy production. Insulin promotes glucose transport into cells and instructs the liver to store surplus energy as glycogen for short-term storage or triglycerides in adipose cells.

Normally, blood glucose rises slightly after you eat or drink, and the pancreas responds by releasing insulin into the blood, the amount of which is proportional to the size and substance of the meal. The level of glucose in the blood declines as glucose enters the cells and is digested, and the pancreas responds by delaying, then ceasing the secretion of insulin.

When blood glucose levels fall too low, such as between meals or after a strong activity, glucagon is released, which causes the liver to convert some glycogen back into glucose, so boosting blood glucose levels. The level of glucose in the blood remains pretty steady if the glucose/insulin feedback loop is working appropriately. When the balance is upset and the blood glucose level rises, the body strives to restore it by boosting insulin production and removing excess glucose through the urine.

Several diseases can cause the equilibrium between glucose and pancreatic hormones to be disrupted, resulting in high or low blood glucose. Diabetes is the most common cause. Diabetes is a collection of illnesses characterized by inadequate insulin production and/or insulin resistance. Untreated diabetes impairs a person's ability to digest and utilize glucose normally. Type 1 diabetes is diagnosed when the body is unable to produce any or enough insulin. People with prediabetes or type 2 diabetes are insulin resistant and may or may not be able to produce enough of the hormone.

Organ failure, brain damage, coma, and, in extreme situations, death can result from severe, sudden fluctuations in blood glucose, either high or low. Chronically high blood glucose levels can harm body organs like the kidneys, eyes, heart, blood vessels, and nerves over time. Hypoglycemia can harm the brain and nerves over time.

Gestational diabetes, or hyperglycemia that exclusively arises during pregnancy, can affect some women. If left untreated, this can result in large babies with low glucose levels being born to these mothers. Women with gestational diabetes may or may not acquire diabetes later in life.

Lab tests often ordered with a Glucose test:

  • Complete Blood Count
  • Iron Total and Total Iron binding capacity
  • Hemoglobin A1c
  • Lipid Panel
  • Urinalysis Complete
  • TSH
  • CMP
  • Insulin
  • Microalbumin
  • Fructosamine
  • C-Peptide

Conditions where a Glucose test is recommended:

  • Diabetes
  • Kidney Disease
  • Insulin Resistance
  • Pancreatic Diseases
  • Hyperglycemia
  • Hypoglycemia

Commonly Asked Questions:

How does my health care provider use a Glucose test?

The blood glucose test can be used for a variety of purposes, including:

  • Detect hyperglycemia and hypoglycemia
  • Screen for diabetes in those who are at risk before symptoms appear; there may be no early indications or symptoms of diabetes in some circumstances. As a result, screening can aid in detecting it and allowing treatment to begin before the illness worsens or complications emerge.
  • Aid in the detection of diabetes, prediabetes, and gestational diabetes.
  • Monitor your blood sugar levels and manage your diabetes

Glucose levels should be monitored in those who have been diagnosed with diabetes.

Between the 24th and 28th week of pregnancy, glucose blood tests are performed to assess pregnant women for gestational diabetes. Pregnant women who have never been diagnosed with diabetes should be screened and diagnosed using either a one-step or two-step strategy, according to the American Diabetes Association and the US Preventive Services Task Force.

Other tests, including diabetic autoantibodies, insulin, and C-peptide, may be used in conjunction with glucose to assist in detecting the reason of elevated glucose levels, differentiate between type 1 and type 2 diabetes, and assess insulin production.

What does my glucose test result mean?

High blood glucose levels are most commonly associated with diabetes, but they can also be caused by a variety of other diseases and ailments.

Hypoglycemia is defined by a drop in blood glucose to a level that triggers nervous system symptoms before affecting the brain. The Whipple triad is a set of three criteria for diagnosing hypoglycemia.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.


Description: Hemoglobin A1c is the protein Hemoglobin found in red blood cells, but with glucose attached to it. Hemoglobin A1c is used to check for and monitor diabetes as it shows average blood glucose levels over the past 2 to 3 months.

Also Known As: A1c Test, HbA1c Test, Glycohemoglobin Test, Glycated Hemoglobin Test, Glycosylated Hemoglobin Test, HbA1c Test

Collection Method: Blood Draw

Specimen Type: Whole Blood

Test Preparation: No preparation required

When is a Hemoglobin A1c test ordered?

A1c may be requested as part of a routine physical examination or when a practitioner suspects a patient of having diabetes due to characteristic signs or symptoms of high blood sugar, such as:

  • Increased thirst and fluid intake
  • Increased urination
  • Increase in hunger
  • Fatigue
  • Vision is hazy
  • Infections that take a long time to heal

Adults who are overweight and have the following additional risk factors may consider doing the A1c test:

  • Physically inactive
  • Diabetes in a first-degree relative
  • Race/ethnicity that is at high risk such as African Americans, Latinos, Native Americans, Asian Americans, and Pacific Islanders
  • Blood pressure that is high
  • A lipid profile that is abnormal.
  • Polycystic ovarian syndrome 
  • Cardiovascular disease 
  • Insulin resistance and other conditions links to insulin resistance

People who have not been diagnosed with diabetes but have been assessed to be at an increased risk of developing diabetes should have their A1c levels tested at least once a year.

Monitoring

The A1c test may be performed 2 to 4 times a year, depending on the type of diabetes a person has, how well their diabetes is controlled, and the healthcare provider's recommendations. If diabetics are fulfilling treatment goals and have stable glycemic control, the American Diabetes Association advises A1c testing at least twice a year. A1c may be ordered quarterly when someone is first diagnosed with diabetes or if control isn't good.

What does a Hemoglobin A1c blood test check for?

Hemoglobin A1c, often known as A1c or glycated hemoglobin, is hemoglobin that has been attached to glucose. By assessing the proportion of glycated hemoglobin, the A1c test determines the average quantity of glucose in the blood during the previous 2 to 3 months.

Hemoglobin is a protein present inside red blood cells that transports oxygen.

Glycated hemoglobin is generated in proportion to the amount of glucose in the blood. Once glucose attaches to hemoglobin, it stays there for the duration of the red blood cell's life, which is usually about 120 days. The most common kind of glycated hemoglobin is known as A1c. A1c is created on a daily basis and is gradually removed from the bloodstream as older RBCs die and younger RBCs replace them.

This test can be used to detect and diagnose diabetes, as well as the risk of developing it. According to the American Diabetes Association's standards of medical care in diabetes, diabetes can be diagnosed using either A1c or glucose.

This test can also be used to track the progress of a diabetic patient's treatment. It aids in determining how well a person's glucose levels have been controlled over time by medication. An A1c of less than 7% suggests good glucose control and a lower risk of diabetic complications for the majority of diabetics for monitoring reasons.

Lab tests often ordered with a Hemoglobin A1c test:

  • Complete Blood Count
  • Glucose
  • Frucstosamine
  • Albumin
  • Comprehensive Metabolic Panel
  • Microalbumin w/creatinine
  • Lipid panel

Conditions where a Hemoglobin A1c test is recommended:

  • Type 1 Diabetes
  • Type 2 Diabetes

How does my health care provider use a Hemoglobin A1c test?

Adults can use the hemoglobin A1c test to screen for and diagnose diabetes and prediabetes.

A fasting glucose or oral glucose tolerance test should be done to screen or diagnose diabetes in these instances.

The A1c test is also used to track diabetics' glucose control over time. Diabetics strive to maintain blood glucose levels that are as close to normal as feasible. This helps to reduce the risks of consequences associated with chronically high blood sugar levels, such as progressive damage to body organs such as the kidneys, eyes, cardiovascular system, and nerves. The result of the A1c test depicts the average quantity of glucose in the blood over the previous 2-3 months. This can help diabetics and their healthcare professionals determine whether the steps they're taking to control their diabetes are working or if they need to be tweaked.

A1c is a blood test that is usually used to help newly diagnosed diabetics identify how high their uncontrolled blood glucose levels have been in the previous 2-3 months. The test may be ordered multiple times throughout the control period, and then at least twice a year after that to ensure that good control is maintained.

What does my Hemoglobin A1c test result mean?

HbA1c levels is currently reported as a percentage for monitoring glucose control, and it is suggested that most diabetics try to keep their hemoglobin A1c below 7%. The closer diabetics can keep their A1c to the therapeutic objective of less than 7% without experiencing abnormally low blood glucose, the better their diabetes is controlled. The risk of problems rises as the A1c rises.

However, a person with type 2 diabetes may have an A1c goal set by their healthcare professional. The length of time since diagnosis, the presence of other diseases as well as diabetes complications, the risk of hypoglycemia complications, life expectancy, and whether or not the person has a support system and healthcare resources readily available are all factors that may influence the goal.

For example, a person with heart disease who has had type 2 diabetes for many years without diabetic complications may have a higher A1c target set by their healthcare provider, whereas someone who is otherwise healthy and newly diagnosed may have a lower target set by their healthcare provider as long as low blood sugar is not a significant risk.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.


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Description: Homocysteine is an amino acid that is present in every cell. There is a small amount present as it is an amino acid that changes quickly into other needed products in the body.

Also Known As: Homocysteine Cardiac Risk Test, Homocysteine Blood Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: Fasting for at least 8 hours is preferred

When is a Homocysteine test ordered?

When a doctor feels a person may be deficient in vitamin B12 or folate, he or she may request this test. At first, the signs and symptoms are vague and ambiguous. People who have an early deficit may be diagnosed before they show any visible symptoms. Other persons who are impacted may experience a range of moderate to severe symptoms, including:

  • Diarrhea
  • Dizziness
  • Weakness and exhaustion
  • Appetite loss
  • Paleness
  • Heart rate that is quite fast
  • Breathing problems
  • Tongue and mouth ache
  • In the feet, hands, arms, and legs, there is tingling, numbness, and/or burning

Depending on an individual's age and other risk factors, homocysteine may be requested as part of determining a person's risk of developing cardiovascular disease. It may also be ordered after a heart attack or stroke to aid in treatment planning.

When newborn screening identifies an increased level of methionine or if an infant or kid shows signs and symptoms of homocystinuria, this test may be ordered. Babies with this illness will appear normal at birth, but if left untreated, they will develop symptoms such as a displaced lens in the eye, a long slender build, long thin fingers, and skeletal abnormalities within a few years.

What does a Homocysteine blood test check for?

Homocysteine is an amino acid that is found in trace amounts in all of the body's cells. The body generally converts homocysteine to other compounds fast. Because vitamins B6, B12, and folate are required for homocysteine metabolism, elevated levels of the amino acid could indicate a vitamin deficit. The level of homocysteine in the blood is determined by this test.

Increased homocysteine levels have also been linked to an increased risk of coronary heart disease, stroke, peripheral vascular disease, and artery hardening. Homocysteine has been linked to cardiovascular disease risk through a variety of processes, including damage to blood vessel walls and support for the production of abnormal blood clots, but no direct linkages have been established. Several studies have also found no benefit or reduction in CVD risk with folic acid and B vitamin supplementation. The American Heart Association does not believe it to be a significant risk factor for heart disease at this time.

Homocysteine levels in the blood can also be dramatically increased by a rare genetic disorder known as homocystinuria. In homocystinuria, one of multiple genes is mutated, resulting in a defective enzyme that prevents the normal breakdown of methionine, the precursor of homocysteine. Methionine is one of the eleven necessary amino acids that the body cannot make and must therefore be obtained from food.

Homocysteine and methionine build up in the body without the necessary enzyme to break them down. Babies born with this condition appear normal at birth, but develop symptoms such as a long slender build, a dislocated lens in the eye, long thin fingers, osteoporosis, skeletal abnormalities, and a significantly increased risk of thromboembolism and atherosclerosis, which can lead to premature CVD within a few years.

In addition to intellectual disability, mental illness, a little low IQ, behavioral issues, and seizures, artery blockages can induce intellectual disability, mental illness, and seizures. Some of them can be avoided if homocystinuria is diagnosed early, which is why all states screen neonates for the disease.

Lab tests often ordered with a Homocysteine test:

  • Vitamin B12
  • Folate
  • MTHFR Mutation
  • Intrinsic Factor Antibody

Conditions where a Homocysteine test is recommended:

  • Vitamin B12 and Folate Deficiency
  • Heart Attack
  • Heart Disease
  • Stroke

How does my health care provider use a Homocysteine test?

The homocysteine test can be used in a variety of ways, including:

A homocysteine test may be ordered by a doctor to see if a person is deficient in vitamin B12 or folate. Before B12 and folate tests are abnormal, the homocysteine level may be raised. Homocysteine testing may be recommended by some health professionals in malnourished people, the elderly, who absorb less vitamin B12 from their diet, and people who have poor nutrition, such as drug or alcohol addicts.

For those at high risk of a stroke or heart attack, homocysteine testing may be requested as part of a health screening. It could be beneficial for someone who has a family history of coronary artery disease but no other recognized risk factors like smoking, high blood pressure, or obesity. However, because the specific role of homocysteine in the course of cardiovascular disease is unknown, the screening test's efficacy continues to be questioned.

If a health professional believes that an infant or kid has homocystinuria, tests for both urine and blood homocysteine can be utilized to assist diagnose the genetic condition. As part of their newborn screening in the United States, all babies are regularly tested for excess methionine, a symptom of homocystinuria. If a baby's test results are positive, urine and blood homocysteine tests are frequently used to confirm the results.

What do my homocysteine test results mean?

Homocysteine levels may be high in cases of suspected malnutrition, vitamin B12, or folate insufficiency. If a person does not consume enough B vitamins and/or folate through diet or supplements, the body may be unable to convert homocysteine into forms that the body can use. The level of homocysteine in the blood may rise in this scenario.

According to studies conducted in the mid- to late-1990s, those with high homocysteine levels have a substantially higher risk of heart attack or stroke than those with normal levels. The study of the relationship between excessive homocysteine levels and heart disease is still ongoing. However, considering that multiple trials studying folic acid and B vitamin supplementation have found no benefit or reduction in CVD risk, the use of homocysteine levels for risk assessment of cardiovascular disease, peripheral vascular disease, and stroke is now questionable.

A 2012 research study using various datasets, including 50,000 persons with coronary heart disease, called into question the possibility of a cause-and-effect relationship between homocysteine levels and heart disease. Although the American Heart Association recognizes a link between homocysteine levels and heart attack/stroke survival rates, it does not consider high homocysteine to be a major CVD risk factor.

While the AHA does not advocate for widespread use of folic acid and B vitamins to reduce the risk of heart attack and stroke, it does advocate for a balanced, nutritious diet and advises doctors to consider total risk factors as well as nutrition when treating cardiovascular disease.

Significantly elevated homocysteine concentrations in the urine and blood indicate that an infant is likely to have homocystinuria and need additional testing to confirm the reason of the increase.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.


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Brief Description: An Insulin test is a blood test that measures the insulin levels in the blood's serum. It is a measurement that is heavily used in patients with diabetes.

Also Known As: Fasting Insulin Test, Insulin Assay Test, Insulin Serum Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: 9 Hours Fasting Required

When is an Insulin test ordered?

Insulin levels are most commonly ordered after a low glucose result or when someone has acute or chronic symptoms of hypoglycemia.  Hypoglycemia can cause the following symptoms:

  • Sweating
  • Palpitations
  • Hunger
  • Brain fox
  • Hazy vision
  • Dizziness
  • Fainting

Seizures and loss of consciousness are common in severe instances.

While low blood glucose can cause these symptoms, they can also be caused by other illnesses.

When a person has or is suspected of having insulin resistance, an insulin test may be performed. People with type 2 diabetes, polycystic ovary syndrome, prediabetes or cardiac disease, or metabolic syndrome may fall into this category.

After an insulinoma has been effectively removed, a health practitioner may arrange insulin and C-peptide testing to verify the effectiveness of treatment and subsequently order the tests on a regular basis to monitor for recurrence.

Periodic testing can also be performed to track the success of an islet cell transplant by determining the graft's insulin-producing capacity.

What does an Insulin blood test check for?

Insulin is a hormone produced in the pancreas' beta cells and stored there. It is necessary for the transfer and storage of glucose, the body's primary energy source. Insulin aids in the delivery of glucose from the bloodstream to cells, as well as the regulation of blood glucose levels and lipid metabolism. This test determines how much insulin is present in the blood.

The levels of insulin and glucose in the blood must be balanced. Carbohydrates are frequently broken down into glucose and other simple sugars after a meal. The blood glucose level rises, prompting the pancreas to produce insulin into the bloodstream. The amount of glucose in the blood reduces as it enters cells, and the amount of insulin released by the pancreas decreases.

If an individual is unable to produce enough insulin, or if the body's cells become resistant to its effects, glucose is unable to reach the majority of the body's cells, causing the cells to starve as blood glucose climbs to harmful levels. This can disrupt normal metabolic processes, leading to a variety of illnesses and difficulties, such as kidney disease, cardiovascular disease, and eyesight and neurological issues.

Diabetes is a life-threatening illness characterized by excessive glucose levels and diminished insulin action. People with type 1 diabetes produce relatively little insulin, necessitating the use of insulin supplements. Insulin resistance is a common cause of type 2 diabetes, which worsens over time.

Insulin resistance occurs when the body is unable to respond to insulin's effects. The body makes up for this by manufacturing more of the hormone. Hyperinsulinemia and overstimulation of some insulin-sensitive tissues happen as a result of this. This process generates an imbalance in the connection between glucose and insulin over time, which, if left untreated, can lead to health problems affecting numerous regions of the body.

Insulin resistance can be present in people with polycystic ovary syndrome, prediabetes or cardiac disease, metabolic syndrome, and diseases of the pituitary or adrenal glands, in addition to type 2 diabetes.

Hyperinsulinemia is most commonly seen in persons with tumors of the pancreatic islet cells or an excess of injected insulin, aside from insulin resistance. Low blood sugar is caused by hyperinsulinemia, which can cause sweating, hunger, palpitations, confusion, dizziness, blurred vision, seizures, and fainting. Because the brain relies on blood glucose for energy, severe glucose deprivation caused by hyperinsulinemia can swiftly result in insulin shock and death.

Lab tests often ordered with an Insulin test:

  • Glucose
  • Hemoglobin A1c
  • C-Peptide
  • Comprehensive Metabolic Panel

Conditions where an Insulin test is recommended:

  • Diabetes
  • Insulin Resistance
  • PCOS
  • Metabolic Syndrome

Commonly Asked Questions:

How does my health care provider use an insulin test?

Insulin testing can be used for a variety of purposes. Insulin is a hormone produced in the pancreas' beta cells and stored there. Insulin is a hormone that aids in the movement of glucose, the body's primary source of energy, from the bloodstream to the cells. Cells starve if a person produces too little insulin or is resistant to its effects. When someone produces too much insulin, such as when they have an insulin-producing tumor, symptoms of low blood glucose appear.

Insulin testing may be used to assist with the following:

  • Diagnose an insulinoma, confirm that the tumor was successfully removed, and/or keep an eye out for recurrence.
  • Determine the source of hypoglycemia in a person who has signs and symptoms.
  • Recognize insulin resistance.
  • In this instance, a C-peptide test may be used to monitor the quantity of insulin produced by the beta cells in the pancreas. As part of the conversion of proinsulin to insulin in the pancreas, the body produces both insulin and C-peptide at the same time. When a doctor wishes to know how much insulin is created by the body and how much comes from outside sources like insulin injections, both tests may be ordered. The C-peptide test indicates insulin produced by the pancreas, but the insulin test analyzes insulin from both sources.
  • Determine when a type 2 diabetic may need to supplement oral medications with insulin.

Insulin tests can be ordered in conjunction with glucose and C-peptide tests. In addition to the glucose tolerance test, insulin levels are sometimes employed. To assess insulin resistance, blood glucose and insulin levels are tested at pre-determined time intervals in this circumstance.

What do my Insulin test result mean?

Insulin levels must be reviewed in the context of other diagnostic tests and symptoms.

Insulin levels can be elevated with:

  • Acromegaly
  • Cushing's syndrome
  • Use of medications such as corticosteroids, levodopa, and oral contraceptives
  • Intolerance to fructose or galactose
  • Insulinomas
  • Obesity
  • Insulin resistance, as seen in type 2 diabetes and metabolic syndrome

Insulin levels can be low with:

  • Diabetes 
  • Hypopituitarism
  • Chronic pancreatitis 
  • Pancreatic cancer

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.


Description: Iron and Total Iron Binding Capacity is a blood panel used to determine iron levels in your blood, your body’s ability to transport iron, and help diagnose iron-deficiency and iron overload.

Also Known As: Serum Iron Test, Serum Fe Test, Iron Binding Capacity Test, IBC Test, Serum Iron-Binding Capacity Siderophilin Test, TIBC Test, UIBC Test, Iron Lab Test, TIBC Blood test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a Iron and Total Iron Binding Capacity test ordered?

When a doctor feels that a person's symptoms are caused by iron overload or poisoning, an iron and TIBC test, as well ferritin assays, may be done. These may include the following:

  • Joint discomfort
  • Weakness and exhaustion
  • Energy deficiency
  • Pain in the abdomen
  • Suffering from a lack of sexual desire
  • Problems with the heart

When a child is suspected of ingesting too many iron tablets, a serum iron test is required to detect the poisoning and to determine its severity.

A doctor may also request iron and TIBC when the results of a standard CBC test are abnormal, such as a low hematocrit or hemoglobin, or when a doctor suspects iron deficiency based on signs and symptoms such as:

  • Chronic tiredness/fatigue
  • Dizziness
  • Weakness
  • Headaches
  • Skin that is pale

What does a Iron and Total Iron Binding Capacity blood test check for?

Iron is a necessary ingredient for survival. It is a vital component of hemoglobin, the protein in red blood cells that binds and releases oxygen in the lungs and throughout the body. It is required in small amounts to help form normal red blood cells and is a critical part of hemoglobin, the protein in RBCs that binds oxygen in the lungs and releases it as blood circulates to other parts of the body.

By detecting numerous components in the blood, iron tests are ordered to determine the quantity of iron in the body. These tests are frequently ordered at the same time, and the data are analyzed together to determine the diagnosis and/or monitor iron deficiency or overload.

The level of iron in the liquid component of the blood is measured by serum iron.

Total iron-binding capacity is a measurement of all the proteins in the blood that may bind to iron, including transferrin.

The percentage of transferrin that has not yet been saturated is measured by the UIBC. Transferrin levels are also reflected in the UIBC.

Low iron levels can cause anemia, resulting in a decrease in the production of microcytic and hypochromic RBCs. Large amounts of iron, on the other hand, might be hazardous to the body. When too much iron is absorbed over time, iron compounds build up in tissues, particularly the liver, heart, and pancreas.

Normally, iron is absorbed from food and distributed throughout the body by binding to transferrin, a liver protein. About 70% of the iron delivered is used in the synthesis of hemoglobin in red blood cells. The rest is stored as ferritin or hemosiderin in the tissues, with minor amounts being utilized to make other proteins like myoglobin and enzymes.

Insufficient intake, limited absorption, or increased dietary requirements, as observed during pregnancy or with acute or chronic blood loss, are all signs of iron deficiency. Excessive intake of iron pills can cause acute iron overload, especially in children. Excessive iron intake, genetic hemochromatosis, multiple blood transfusions, and a few other disorders can cause chronic iron overload.

Lab tests often ordered with a Iron and Total Iron Binding Capacity test:

  • Complete Blood Count
  • Ferritin
  • Transferrin
  • Zinc Protoporphyrin

Conditions where a Iron and Total Iron Binding Capacity test is recommended:

  • Anemia
  • Hemochromatosis

How does my health care provider use a Iron and Total Iron Binding Capacity test?

The amount of circulating iron in the blood, the capacity of the blood to carry iron, and the amount of stored iron in tissues can all be determined by ordering one or more tests. Testing can also assist distinguish between different types of anemia

The level of iron in the blood is measured by serum iron.

Total iron-binding capacity is a measurement of all the proteins in the blood that may bind to iron, including transferrin. The TIBC test is a useful indirect assessment of transferrin because it is the predominant iron-binding protein. In response to the requirement for iron, the body generates transferrin. Transferrin levels rise when iron levels are low, and vice versa. About one-third of the binding sites on transferrin are used to transport iron in healthy humans.

The reserve capacity of transferrin, or the part of transferrin that has not yet been saturated, is measured by UIBC. Transferrin levels are also reflected in the UIBC.

The iron test result, as well as TIBC or UIBC, are used to calculate transferrin saturation. It represents the proportion of transferrin that is iron-saturated.

Ferritin is the major storage protein for iron inside cells, and serum ferritin represents the quantity of stored iron in the body.

These tests are frequently ordered together, and the results can assist the doctor figure out what's causing the iron deficit or overload.

Additional information about iron

A balance between the quantity of iron received into the body and the amount of iron lost is required to maintain normal iron levels. Because a tiny quantity of iron is lost each day, a deficiency will develop if too little iron is consumed. In healthy persons, there is usually enough iron to prevent iron deficiency and/or iron deficiency anemia, unless they eat a bad diet. There is a greater need for iron in some circumstances. People who have persistent gut bleeding or women who have heavy menstrual periods lose more iron than they should and can develop iron deficiency. Females who are pregnant or breastfeeding lose iron to their babies and may develop an iron shortage if they do not consume enough supplemental iron. Children may require additional iron, especially during periods of rapid growth, and may suffer iron shortage.

Low serum iron can also arise when the body is unable to adequately utilize iron. The body cannot correctly utilize iron to generate additional red cells in many chronic disorders, particularly malignancies, autoimmune diseases, and chronic infections. As a result, transferrin production slows, serum iron levels drop because little iron is absorbed from the stomach, and ferritin levels rise. Malabsorption illnesses like sprue syndrome can cause iron deficiency.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.


Description: A Lipid Panel is a blood test that measures your cholesterol levels to evaluate your risk of cardiovascular disease.

Also Known As: Lipid Profile Test, Lipid Test, Cholesterol Profile Test, Cholesterol Panel Test, Cholesterol Test, Coronary Risk Panel Test, lipid blood test, Lipid w/Ratios Test, Cholesterol Ratio test, blood cholesterol Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: Patient should be fasting 9-12 hours prior to collection.

When is a Lipid Panel with Ratios test ordered?

A fasting lipid profile should be done about every five years in healthy persons who have no additional risk factors for heart disease. A single total cholesterol test, rather than a complete lipid profile, may be used for initial screening. If the screening cholesterol test result is high, a lipid profile will almost certainly be performed.

More regular testing with a full lipid profile is indicated if other risk factors are present or if earlier testing revealed a high cholesterol level.

Other risk factors, in addition to high LDL cholesterol, include:

  • Smoking
  • Obesity or being overweight
  • Unhealthy eating habits
  • Not getting enough exercise and being physically inactive
  • Older age
  • Having hypertension
  • Premature heart disease in the family
  • Having experienced a heart attack or having pre-existing heart disease

Diabetes or pre-diabetes is a condition in which a person has High HDL is a "negative risk factor," and its existence permits one risk factor to be removed from the total.

The American Academy of Pediatrics recommends routine lipid testing for children and young adults. Children and teenagers who are at a higher risk of developing heart disease as adults should be screened with a lipid profile earlier and more frequently. A family history of heart disease or health problems such as diabetes, high blood pressure, or being overweight are some of the risk factors, which are comparable to those in adults. According to the American Academy of Pediatrics, high-risk children should be examined with a fasting lipid profile between the ages of 2 and 8.

A lipid profile can also be done at regular intervals to assess the effectiveness of cholesterol-lowering lifestyle changes like diet and exercise, as well as pharmacological therapy like statins.

What does a Lipid Panel with Ratios blood test check for?

Lipids are a class of fats and fat-like compounds that are essential components of cells and energy sources. The level of certain lipids in the blood is measured by a lipid profile.

Lipoprotein particles transport two key lipids, cholesterol and triglycerides, through the bloodstream. Protein, cholesterol, triglyceride, and phospholipid molecules are all present in each particle. High-density lipoproteins, low-density lipoproteins, and very low-density lipoproteins are the three types of particles assessed with a lipid profile.

It's critical to keep track of and maintain optimal levels of these lipids in order to stay healthy. While the body creates the cholesterol required for normal function, some cholesterol is obtained from the diet. A high amount of cholesterol in the blood can be caused by eating too many foods high in saturated fats and trans fats or having a hereditary tendency. The excess cholesterol may form plaques on the inside walls of blood vessels. Plaques can constrict or block blood channel openings, causing artery hardening and raising the risk of a variety of health problems, including heart disease and stroke. Although the explanation for this is unknown, a high level of triglycerides in the blood is linked to an increased risk of developing cardiovascular disease.

A lipid profile consists of the following elements:

  • Cholesterol total
  • HDL Cholesterol - commonly referred to as "good cholesterol" since it eliminates excess cholesterol from the body and transports it to the liver for elimination.
  • LDL Cholesterol - commonly referred to as "bad cholesterol" because it deposits excess cholesterol in the walls of blood arteries, contributing to atherosclerosis.
  • Triglycerides
  • Ratio of LDL to HDL cholesterol

Lab tests often ordered with a Lipid Panel with Ratios test:

  • CBC (Blood Count Test) with Smear Review
  • Comprehensive Metabolic Panel
  • Direct LDL
  • VLDL
  • Lp-PLA2
  • Apolipoprotein A1
  • Apolipoprotein B
  • Lipoprotein (a)
  • Lipoprotein Fractionation Ion Mobility (LDL Particle Testing)

Conditions where a Lipid Panel with Ratios test is recommended:

  • Hypertension
  • Cardiovascular Disease
  • Heart Disease
  • Stroke

Commonly Asked Questions:

How does my health care provider use a Lipid Panel with Ratios test?

The lipid profile is used as part of a cardiac risk assessment to help determine an individual's risk of heart disease and, if there is a borderline or high risk, to help make treatment options.

Lipids are a class of fats and fat-like compounds that are essential components of cells and energy sources. It's critical to keep track of and maintain optimal levels of these lipids in order to stay healthy.

To design a therapy and follow-up strategy, the results of the lipid profile are combined with other recognized risk factors for heart disease. Treatment options may include lifestyle changes such as diet and exercise, as well as lipid-lowering drugs such as statins, depending on the results and other risk factors.

A normal lipid profile test measures the following elements:

  • Total cholesterol is a test that determines how much cholesterol is present in all lipoprotein particles.
  • HDL Cholesterol — measures hdl cholesterol in particles, sometimes referred to as "good cholesterol" since it eliminates excess cholesterol and transports it to the liver for elimination.
  • LDL Cholesterol – estimates the cholesterol in LDL particles; sometimes known as "bad cholesterol" since it deposits excess cholesterol in blood vessel walls, contributing to atherosclerosis. The amount of LDL Cholesterol is usually estimated using the total cholesterol, HDL Cholesterol, and triglycerides readings.
  • Triglycerides – triglycerides are measured in all lipoprotein particles, with the highest concentration in very-low-density lipoproteins.
  • As part of the lipid profile, several extra information may be presented. The results of the above-mentioned tests are used to determine these parameters.
  • VLDL Cholesterol — derived using triglycerides/5; this calculation is based on the typical VLDL particle composition.
  • Non-HDL Cholesterol - the result of subtracting total cholesterol from HDL Cholesterol.
  • Cholesterol/HDL ratio — total cholesterol to HDL Cholesterol ratio computed.

An expanded profile may include the amount and concentration of low-density lipoprotein particles. Rather than assessing the amount of LDL cholesterol, this test counts the number of LDL particles. This figure is thought to more accurately reflect the risk of heart disease in some persons.

What do my Lipid Panel test results mean?

Healthy lipid levels, in general, aid in the maintenance of a healthy heart and reduce the risk of heart attack or stroke. A health practitioner would analyze the results of each component of a lipid profile, as well as other risk factors, to assess a person's total risk of coronary heart disease, if therapy is required, and, if so, which treatment will best serve to reduce the person's risk of heart disease.

The Adult Treatment Panel III of the National Cholesterol Education Program published guidelines for measuring lipid levels and selecting treatment in 2002. The American College of Cardiology and the American Heart Association announced updated cholesterol therapy guidelines in 2013 to minimize the risk of cardiovascular disease in adults. These guidelines suggest a different treatment method than the NCEP guidelines. Cholesterol-lowering medications are now chosen based on the 10-year risk of atherosclerotic cardiovascular disease and other criteria, rather than on LDL-C or non-HDL-C objectives.

The revised guidelines include an evidence-based risk calculator for ASCVD that may be used to identify people who are most likely to benefit from treatment. It's for adults between the ages of 40 and 79 who don't have a heart condition. The computation takes into account a number of characteristics, including age, gender, race, total cholesterol, HDL-C, blood pressure, diabetes, and smoking habits. The new guidelines also suggest comparing therapeutic response to LDL-C baseline readings, with decrease criteria varying depending on the degree of lipid-lowering medication therapy.

Unhealthy lipid levels, as well as the presence of additional risk factors like age, family history, cigarette smoking, diabetes, and high blood pressure, may indicate that the person being examined needs to be treated.

The NCEP Adult Treatment Panel III guidelines specify target LDL cholesterol levels based on the findings of lipid testing and these other main risk factors. Individuals with LDL-C levels over the target limits will be treated, according to the guidelines.

According to the American Academy of Pediatrics, screening youths with risk factors for heart disease with a full, fasting lipid panel is advised. Fasting is not required prior to lipid screening in children who do not have any risk factors. For non-fasting lipid screening, non-high-density lipoprotein cholesterol is the preferred test. Non-HDL-C is computed by subtracting total cholesterol and HDL-C from total cholesterol and HDL-C.

Is there anything else I should know?

The measurement of triglycerides in people who haven't fasted is gaining popularity. Because most of the day, blood lipid levels reflect post-meal levels rather than fasting levels, a non-fasting sample may be more representative of the "usual" circulating level of triglyceride. However, because it is still unclear how to interpret non-fasting levels for assessing risk, the current recommendations for fasting before lipid tests remain unchanged.

A fasting lipid profile is usually included in a routine cardiac risk assessment. In addition, research into the utility of additional non-traditional cardiac risk markers, such as Lp-PLA2, is ongoing. A health care provider may use one or more of these markers to help determine a person's risk, but there is no consensus on how to use them and they are not widely available.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.


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Description: Lp(a) is a test that is measuring for the levels of Lipoprotein in the blood’s serum. This test can be used to evaluate the risk for cardiovascular disease.

Also Known As: Lipoprotein A Test, lipoprotein little a Test, lpa test, lp(a) test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a Lipoprotein (a) test ordered?

Lp(a) is not a lipid profile that is commonly ordered. When an individual has a family history of heart disease at a young age that is not caused by high LDL or low HDL, it may be done along with other lipid testing.

This test may also be ordered by some doctors when:

  • A person has a history of heart or vascular disease, particularly if their lipid levels are normal or very slightly raised.
  • Someone is born with a genetic susceptibility to high cholesterol.
  • A individual who has had a stroke or a heart attack but whose lipids are normal or only slightly increased.

What does a Lipoprotein (a) blood test check for?

Lipoprotein (a), often known as Lp(a), is a lipoprotein that transports cholesterol through the bloodstream. It has a single apolipoprotein B protein, as well as cholesterol and other lipids, and is similar to low-density lipoprotein. This test evaluates a person's risk of getting cardiovascular disease by measuring the amount of Lp(a) in their blood.

Lp(a) is a risk factor for CVD, same as LDL. A person's level of Lp(a) is genetically determined and remains generally stable throughout their lives. Because a high level of Lp(a) is expected to contribute to a person's overall risk of CVD, this test could be useful as a CVD risk marker.

The protein portion of Lipoprotein (a) is made up of the following components:

  • Apolipoprotein B, a lipid-metabolizing protein that is the major protein ingredient of lipoproteins like LDL and VLDL
  • Apo (a), a second protein that is connected to Apo B. Apolipoprotein(a) is a protein with a unique structure that is considered to prevent clots from breaking down naturally. The apolipoprotein(a) portion of Lp(a) varies in size from person to person, with Caucasians having a smaller apolipoprotein(a) portion than those of African heritage. Although the importance of size variation in contributing to CVD risk is debatable, there is some evidence that smaller size increases risk. However, most Lipoprotein(a) assays don’t assess the size of Apo(a). Only Lipoprotein(a) levels in the blood are measured and reported.

Because roughly half of those who have heart attacks have normal cholesterol levels, scientists have looked for additional factors that may impact heart disease. Lp(a) is assumed to be one of these factors. Lp(a) has two possible contributions. For starters, because Lp(a) can stimulate the uptake of LDL into blood channel walls, it may aid in the formation of atherosclerotic plaque on blood vessel walls. Second, because apo(a) has a structure that inhibits clot-dissolving enzymes, Lp(a) may enhance clot buildup in the arteries. Lp(a) may be more atherogenic than LDL for these reasons.

Lab tests often ordered with a Lipoprotein (a) test:

  • Lipid Panel
  • Homocysteine
  • Hs-CRP
  • Apolipoprotein A1
  • Apolipoprotein B

Conditions where a Lipoprotein (a) test is recommended:

  • Heart Disease
  • Cardiovascular Disease
  • Heart Attack
  • Stroke

How does my health care provider use a Lipoprotein (a) test?

The Lp(a) test is used to determine whether an elevated level of lipoprotein (a) is a risk factor for cardiovascular disease. The test can be used in conjunction with a standard lipid profile to provide you further information about your CVD risk.

The Lp(a) level is determined by genetics and remains largely stable throughout a person's life. It is not the objective of therapy because it is usually unaffected by lifestyle modifications or most medicines. Instead, when Lp(a) is high, the presence of this additional risk factor may indicate that other, more manageable risk factors, such as an elevated low-density lipoprotein, require more urgent treatment.

What does my Lipoprotein (a) test result mean?

A high Lp(a) level raises the risk of cardiovascular disease and cerebral vascular disease. People with a normal lipid profile can develop high Lp(a). Lp(a) levels that are high are thought to increase the risk of heart disease independently of other lipids.

Lp(a) levels are genetically set and are difficult to adjust with lifestyle modifications or medicines. However, some non-genetic diseases can result in an increase in Lp (a). Estrogen depletion, hypercholesterolemia, hypothyroidism, diabetes, chronic renal failure, and nephrotic syndrome are examples of these conditions.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.


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Clinical Significance

Lipoprotein-associated phospholipase A2 (Lp-PLA2), also known as platelet activating factor Acetylhydrolase, is an inflammatory enzyme that circulates bound mainly to low density lipoproteins and has been found to be localized and enriched in atherosclerotic plaques. In multiple clinical trials, Lp-PLA2 activity has been shown to be an independent predictor of coronary heart disease and stroke in the general population. Measurement of Lp-PLA2 may be used along with traditional cardiovascular risk factor measures for identifying individuals at higher risk of cardiovascular disease events. Clinical management may include beginning or intensifying risk reduction strategies. The activity assay is an enzyme assay run on an automated chemistry platform.


Lupus anticoagulants (LA) are members of a family of antibodies with phospholipid specificity. LA may be defined as an immunoglobulin, IgG or IgM or a mixture of both, that interferes with one or more of the in vitro phospholipid (PL) dependent tests of coagulation. These antibodies are not associated with a hemorrhagic diathesis, but rather have been linked to thrombotic events. In addition to thrombosis other clinical complications have been associated with the presence of LA. These include strokes, nonbacterial thrombotic endocarditis, livedo reticularis and a variety of obstetrical complications such as intrauterine fetal death, recurrent spontaneous abortion, fetal growth retardation, early onset preeclampsia and chorea gravidarum.

Description: The MTHFR gene is responsible for making Methylenetetrahydrofolate reductase, which is an enzyme that plays an important role in processing amino acids. This test will be used to determine if there is a DNA gene mutation with the MTHFR gene.

Also Known As: MTHFR Factor Test, MTHFR Mutation Test, MTHFR Gene Mutation Test, Methylenetetrahydrofolate Reductase Gene Test, MTHFR Disease Test

Collection Method: Blood Draw

Specimen Type: Whole Blood

Test Preparation: No preparation required

When is a Methylenetetrahydrofolate Reductase DNA Mutation Analysis test ordered?

When a person has excessive homocysteine levels, the MTHFR mutation test may be conducted, especially if the person has a personal or family history of early cardiovascular disease or thrombosis. When a close family has MTHFR gene mutations, it may be ordered, but it isn't always effective if that family member has normal homocysteine levels, and some labs and organizations advise against using it for thrombophilia screening.

What does a Methylenetetrahydrofolate Reductase DNA Mutation Analysis blood test check for?

The DNA code for the MTHFR enzyme is found in the methylenetetrahydrofolate reductase gene. Two of the most common mutations are detected by this test.

Homocystinuria, anencephaly, spina bifida, and other significant genetic illnesses can result from mutations or polymorphisms in the MTHFR gene. The MTHFR enzyme is required for the conversion of one type of B vitamin, folate, into another. It's also involved in the conversion of homocysteine to methionine, a crucial component of many proteins.

Homocysteine levels over normal indicate that the body is not digesting it adequately. A homocystinuria-causing mutation in the MTHFR gene could be one explanation. While there are at least seven different MTHFR mutations seen in persons with homocystinuria, only two DNA sequence variants known as single nucleotide polymorphisms are analyzed. Individuals can inherit one or both of the MTHFR variations, which are C677T and A1298C. These SNPs cause DNA changes that are linked to elevated homocysteine levels in the blood, which may raise the risk of early cardiovascular disease, abnormal blood clot formation, and stroke.

About 5-14 percent of the population in the United States is homozygous for C677T, which means they have two copies of the gene. The frequency varies with ethnicity, with individuals of Mediterranean descent having the highest frequency and those of African ancestry having the lowest.

The C677T variation causes the MTHFR enzyme to be less active and has a lower ability to handle folate and homocysteine. Reduced MTHFR enzyme activity slows down the homocysteine-to-methionine conversion process and can lead to a buildup of homocysteine in the blood when a person has two copies of the MTHFR C677T gene mutation or one copy of MTHFR C677T and one copy of A1298C.

The increase in homocysteine is usually mild to moderate, but the level of MTHFR enzyme activity varies from person to person. Even if a person has two copies of the MTHFR gene, proper folate consumption can "balance out" the effect of the MTHFR mutation, preventing elevated homocysteine levels.

According to some research, excessive levels of homocysteine in the blood may increase the risk of CVD by weakening blood vessel walls and encouraging plaque development and abnormal blood clotting. However, no direct link has been discovered between homocysteine levels and cardiovascular disease or thrombotic risk. See the Homocysteine article for further information.

Lab tests often ordered with a Methylenetetrahydrofolate Reductase DNA Mutation Analysis test:

  • Homocysteine
  • Vitamin B12
  • Folate
  • Lipoprotein Fractionation Ion Mobility
  • Apolipoprotein Evaluation
  • Lipid Panel
  • Factor V Leiden Mutation

Conditions where a Methylenetetrahydrofolate Reductase DNA Mutation Analysis test is recommended:

  • Heart disease
  • Cardiovascular Disease
  • Excessive Clotting Disorders
  • Stroke
  • Neural Tube Defects

How does my health care provider use a Methylenetetrahydrofolate Reductase DNA Mutation Analysis test?

The methylenetetrahydrofolate reductase mutation test is used to discover two mutations in the MTHFR gene that are linked to high homocysteine levels in the blood. It is not a common request.

If a person has a personal or family history of early cardiovascular disease or improper blood clots, this test may be done as a follow-up to a high homocysteine test. It may also be ordered in conjunction with other cardiac risk tests. However, its value in measuring CVD risk has yet to be proven, and some expert guidelines advise against using it for thrombosis screening.

If a person has a close family with known MTHFR genetic mutations, it may be ordered, especially if that person also has high homocysteine levels. The MTHFR C677T and A1298C gene variants are the most common and often tested. If someone in their family has a different mutation, that mutation should be checked.

An MTHFR test may be ordered in conjunction with other hereditary clotting risk tests, such as Factor V Leiden or prothrombin 20210 mutation tests, to assess a person's overall risk of developing dangerous blood clots.

Although the MTHFR mutation test can help establish the reason of high homocysteine levels, the utility of monitoring homocysteine levels is unclear. While some research suggests that high homocysteine levels increase the risk of cardiovascular disease and/or thrombosis, no direct correlation has been demonstrated. The American Heart Association does not suggest routine homocysteine testing as a cardiac risk measure. The American College of Medical Genetics and the College of American Pathologists both advise against testing for the C677T variation, citing its limited value in individuals with blood clots. Furthermore, the use of homocysteine levels to determine the risk of CVD, peripheral vascular disease, and stroke is controversial at this time, as multiple studies have found no benefit or reduction in risk in persons who took folic acid and vitamin B supplements to lower their homocysteine levels.

What do my MTHFR test results mean?

The results are usually reported as negative or positive, with the positive results naming the mutation. Frequently, the results are accompanied by an interpretation.

Only a small fraction of cases of high homocysteine are caused by genetic factors. MTHFR mutations C677T and A1298C are among the most frequent.

If a person has two copies of MTHFR C677T, or one copy of C677T and one copy of A1298C, it's likely that these hereditary mutations are causing or contributing to increased homocysteine levels.

Increased homocysteine levels are not usually linked to two copies of A1298C.

If the MTHFR mutation test results are negative, the C677T and A1298C mutations were not found, and the elevated homocysteine level is most likely attributable to something else. Other, more uncommon MTHFR genetic variants will be missed by standard testing.

MTHFR mutations, as well as other clotting risk factors like Factor V Leiden or PT 20210 mutations, may increase the risk of thrombosis.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.


Description: A microalbumin test is a urine test for albumin, which is used to screen for and diagnose kidney disease, liver disorders, and evaluate a patient’s nutritional status.

Also Known As: ALB Test, Albumin Test, Urine Albumin Test, Microalbumin test, Random Microalbumin Test

Collection Method: Urine Collection

Specimen Type: Urine

Test Preparation: No preparation required

When is a Microalbumin Random Urine with Creatinine test ordered?

According to the American Diabetes Association and the National Kidney Foundation, everyone with type 1 diabetes should be tested annually beginning five years after diagnosis, and everyone with type 2 diabetes should be tested annually beginning from the time of diagnosis. If albumin is found in the urine, it should be confirmed by repeating the test two more times within a 3-6 month period. People with hypertension may be examined at regular intervals, with their healthcare professional determining the frequency.

What does a Microalbumin Random Urine with Creatinine test check for?

Albumin is a significant protein found in the blood. The urine albumin test identifies and quantifies albumin levels in the urine. The presence of a little amount of albumin in the urine could be a sign of renal disease early on. Urine microalbumin or microalbuminuria refers to the presence of a little amount of albumin in the urine. The term "microalbuminuria" is gradually being replaced by "albuminuria," which refers to any increase in albumin in the urine.

The liquid element of blood, plasma, contains a variety of proteins, including albumin. One of the kidneys' many roles is to conserve plasma proteins so that they do not mix with waste materials when urine is generated. Protein does not generally enter into urine due to two mechanisms: the glomeruli form a barrier that keeps most big plasma proteins inside the blood arteries, and the tubules almost totally resorb the smaller proteins that do get through.

Protein in the urine is most common when the kidney's glomeruli or tubules are damaged. The glomeruli can become inflamed and/or scarred, allowing more protein to seep into the urine. Protein can't be reabsorbed if the tubules are damaged.

Albumin is a plasma protein seen in high concentrations in the blood and virtually no albumin in the urine when the kidneys are functioning normally. However, when a person's kidneys are damaged or sick, they lose their ability to store albumin and other proteins. This is common in chronic conditions including diabetes and hypertension, when increased protein levels in the urine indicate worsening kidney function.

Albumin is one of the first proteins found in the urine of people who have kidney disease. People who have tiny amounts of albumin in their urine on a regular basis have a higher chance of developing renal failure and cardiovascular disease in the future.

In persons with chronic illnesses including diabetes and high blood pressure, a urine albumin test is used to check for kidney damage. Small levels of albumin that escape from the bloodstream through the kidneys and into the urine can be detected several years before serious kidney impairment manifests. Albumin and creatinine tests are usually performed on a urine sample obtained at random, and an albumin-to-creatinine ratio is calculated. This is done to give a more precise estimate of how much albumin is discharged into the urine.

Lab tests often ordered with a Microalbumin Random Urine with Creatinine test:

  • Hepatic Function Panel
  • Comprehensive Metabolic Panel
  • Albumin Serum
  • Urinalysis
  • Glucose
  • Hemoglobin A1c
  • Urine Protein

Conditions where a Microalbumin Random Urine with Creatinine test is recommended:

  • Diabetes
  • Kidney Disease
  • Hypertension
  • Proteinuria

How does my health care provider use a Microalbumin Random Urine with Creatinine test?

The urine albumin test, also known as the albumin/creatinine ratio, is used to assess persons who have chronic illnesses like diabetes or high blood pressure, which put them at risk of renal disease. People and healthcare providers can change treatment if they are identified in the early stages of kidney disease, according to studies. Controlling diabetes and hypertension by maintaining tight glycemic control and lowering blood pressure can slow or stop renal disease from progressing.

Albumin is a protein found in large amounts in the bloodstream. When the kidneys are working normally, there is almost no albumin in the urine. Even in the early stages of renal illness, albumin can be identified in the urine.

If albumin is found in a urine sample taken at random, over 4 hours, or overnight, the test can be repeated and/or validated using urine taken over a 24-hour period.

In most cases, an albumin/creatinine ratio is calculated by measuring both albumin and creatinine in a random urine sample. This might be done to detect how much albumin is escaping from the kidneys into the urine more precisely. The amount of liquid secreted in addition to the body's waste products varies throughout the day, with more or less liquid being discharged. As a result, albumin content in the urine may vary.

Creatinine, a byproduct of muscle metabolism, is generally released into the urine at a consistent rate, and its content in the urine is a measure of urine concentration. Because of this trait, creatinine can be used to compensate for urine concentration in a random urine sample. The ACR is preferred by the American Diabetes Association for screening for albuminuria, which indicates early kidney impairment. A high ACR should be done twice within 3 to 6 months to confirm the diagnosis because the amount of albumin in the urine might vary significantly.

What do my microalbumin test results mean?

The presence of moderately elevated albumin levels in both initial and repeat urine tests indicates the presence of early renal disease. Extremely high levels indicate that renal disease has progressed to a more serious stage. Normal renal function is indicated by undetectable levels.

A positive test result may be caused by the presence of blood in the urine, a urinary tract infection, strenuous activity, or other acute illnesses that are not connected to kidney disease. Following the resolution of these situations, testing should be redone.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.


Patients with vascular diseases will generally have either a C-ANCA pattern or P-ANCA pattern, and give positive results in specific tests for PR-3 or MPO. Patients with bowel disease have been shown to have antibodies that give a P-ANCA or C-ANCA pattern. These antibodies, however, may not be directed toward MPO. Patients with drug induced lupus, etc., often present with a P-ANCA pattern that is associated with antibodies against MPO.

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Assessment of skeletal muscle breakdown (rhabdomyolysis).


Screening test for deficiencies of plasma coagulation factors other than Factors VII and XIII. The test is also used to monitor patients on heparin therapy.

Description: Sed Rate is a blood test that is used to measure the rate that red blood cells fall to the bottom of a test tube. The measurement is based how many cells fall within one hour. This test can be used to determine infection or inflammation.

Also Known As: Erythrocyte Sedimentation Rate Test, ESR Test, Sed Rate Test, Sedimentation Rate Test, Westergren Sedimentation Rate Test

Collection Method: Blood Draw

Specimen Type: Whole Blood

Test Preparation: No preparation required

When is a Sed Rate test ordered?

When a condition or disease is believed to be causing inflammation in the body, an ESR may be ordered. Several inflammatory illnesses can be identified using this test. It may be requested, for example, if arthritis is suspected of producing joint inflammation and pain, or if inflammatory bowel disease is suspected of causing digestive symptoms.

When a person develops symptoms of polymyalgia rheumatica, systemic vasculitis, or temporal arteritis, such as headaches, neck or shoulder discomfort, anemia, pelvic pain, poor appetite, joint stiffness, and unexplained weight loss, a doctor may recommend an ESR. To follow the development of specific illnesses, the sed rate test can also be routinely ordered.

A health practitioner may wish to repeat the ESR before undertaking a full workup to look for disease.

What does a Sed Rate blood test check for?

The erythrocyte sedimentation rate is a test that evaluates the degree of inflammation in the body indirectly. The test evaluates the rate at which erythrocytes fall in a blood sample that has been placed in a tall, thin, vertical tube. The millimeters of clear fluid present at the upper portion of the tube after one hour are reported as the results.

When a drop of blood is inserted in a tube, the red blood cells settle out slowly, leaving just a small amount of transparent plasma. In the presence of an increased number of proteins, particularly proteins known as acute phase reactants, red cells settle at a faster pace. Inflammation raises the levels of acute phase reactants such as C-reactive protein and fibrinogen in the blood.

An inherent component of the immune system's response is inflammation. It could be chronic, showing symptoms over time with conditions like autoimmune illnesses or cancer, or acute, showing symptoms right away after a shock, injury, or infection.

The ESR is a non-specific indication that can rise in a number of disorders; it is not a diagnostic test. It provides you with a fundamental understanding of whether you have an inflammatory condition or not.

Given the availability of more recent, specialized tests, there have been reservations about the ESR's utility. The ESR test, on the other hand, is commonly used to diagnose and monitor temporal arteritis, systemic vasculitis, and polymyalgia rheumatica. Extremely high ESR values can aid in differentiating between rheumatic diseases. Furthermore, ESR may still be a viable alternative in some cases, such as when newer tests are unavailable in resource-constrained places or while monitoring the progression of a disease.

Lab tests often ordered with a Sed Rate test:

  • C-Reactive Protein
  • ANA
  • Rheumatoid Factor

Conditions where a Sed Rate test is recommended:

  • Vasculitis
  • Autoimmune Disorders
  • Rheumatoid Arthritis
  • Osteoarthritis
  • Celiac Disease
  • Lupus
  • Chronic Fatigue Syndrome
  • Juvenile Rheumatoid Arthritis
  • Inflammatory Bowel Disease

How does my health care provider use a Sed Rate test?

The erythrocyte sedimentation rate is a non-specific, very straightforward test that has been used for many years to detect inflammation associated with infections, malignancies, and autoimmune illnesses.

Because an elevated ESR often indicates the presence of inflammation, but does not tell the health practitioner where the inflammation is in the body or what is causing it, it is referred to as a non-specific test. Other illnesses besides inflammation may have an impact on an ESR. As a result, other tests, such C-reactive protein, are routinely paired with the ESR.

ESR is used to identify temporal arteritis, systemic vasculitis, and polymyalgia rheumatica, among other inflammatory illnesses. A notably elevated ESR is one of the crucial test results used to support the diagnosis.

This test can be used to track disease activity and treatment response in both of the disorders mentioned above, as well as several others including systemic lupus erythematosus.

What do my Sed Rate test results mean?

Because ESR is a non-specific inflammatory measure that is influenced by a variety of circumstances, it must be used in conjunction with other clinical findings, the individual's medical history, and the results of other laboratory tests. The health practitioner may be able to confirm or rule out a suspected illness if the ESR and clinical data match.

Without any signs of a specific condition, a single elevated ESR is usually insufficient to make a medical conclusion. A normal result does not, however, rule out inflammation or illness.

Inflammation, as well as anemia, infection, pregnancy, and aging, can cause a moderately raised ESR.

A severe infection with a rise in globulins, polymyalgia rheumatica, or temporal arteritis are common causes of an extremely high ESR. Depending on the person's symptoms, a health practitioner may employ various follow-up tests, such as blood cultures. Even if there is no inflammation, people with multiple myeloma or Waldenstrom's macroglobulinemia have extraordinarily high ESRs.

Rising ESRs may suggest increased inflammation or a poor response to therapy when monitoring a condition over time; normal or falling ESRs may indicate an adequate response to treatment.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.


Includes

  • Hemoglobin A, Hemoglobin F, Hemoglobin A2 (Quant), Hemoglobin A2 Prime, Hemoglobin S, Hemoglobin C, Hemoglobin D, Hemoglobin G, Hemoglobin Lepore, Hemoglobin E, Hemoglobin Barts, Variant Hemoglobin, HPLC, Hemogram (Red Blood Cell Count, Hemoglobin, Hematocrit, MCV, MCH, MCHC, RDW), Ferritin and Interpretation
  •  
  • This is a reflexive profile. Additional testing, such as molecular tests, will be added at an additional charge, if indicated.
  •  
  • If results suggest sickling hemoglobin, Sickle Cell Screen will be performed at an additional charge (CPT code(s): 85660). 
  •  
  • If results suggest an unstable hemoglobin based on % of the variant and pattern seen on HPLC and Electrophoresis , Unstable Hemoglobin (Isopropanol) will be performed at an additional charge (CPT code(s): 83068).
  •  
  • If the hemogram shows microcytosis or decreased MCH or both and, there is no evidence of beta thalassemia (i.e., normal A2 and HbF), Alpha Globin common mutation analysis will be performed at an additional charge (CPT code(s): 81257). In consultation with the client, this test may also be performed (at an additional charge) in an individual with a normal hemogram for genetic counseling purposes as individuals with mild alpha thalassemia commonly have a normal hemogram and normal fractions.
  •  
  • If HPLC or CZE, point to an unidentified alpha globin variant, the sample will be sent for DNA sequencing and Alpha Globin Complete will be performed at an additional charge (CPT code(s): 81259).
  •  
  • If the genotyping results for the common deletions do not match the phenotype, Alpha Globin Gene Deletion or Duplication will be performed at an additional charge (CPT code(s): 81269) and Alpha Globin Complete will be performed at an additional charge (CPT code(s): 81259).
  •  
  • If a rare beta globin variant cannot be definitively identified by HPLC or CZE, Beta Globin Complete will be performed at an additional charge (CPT code(s): 81364).
  •  
  • If result suggests Hereditary persistence of fetal hemoglobin or Delta beta thalassemia or a beta thalassemia with negative beta globin sequencing, Beta globin gene dosage assay will be performed at an additional charge (CPT code(s) 81363).
  •  
  • Gamma globin gene sequencing or delta globin gene sequencing may be added at an additional charge, if clinically indicated. These tests are performed at an outside reference lab. Not applicable to CA and FL clients.
  • If a reflex test is added, Genotype/phenotype review will be added at an additional charge (CPT code(s) 80500).

 

Clinical Significance

Thalassemia and Hemoglobinopathy Comprehensive Evaluation - Thalassemia and hemoglobinopathies are disorders related to hemoglobin pathophysiology. Although hemoglobinopathies and thalassemias are two genetically distinct disease groups, the clinical manifestations of both include anemia of variable severity and variable pathophysiology.
Thalassemias are group of autosomal recessive disorder of hemoglobin synthesis characterized by the reduction in the rate of synthesis of globin chain of one or more globin chain. The decreased synthesis of globin chain may result from gene deletion, non-sense mutation or mutation that affects the transcription or stability of mRNA products. Thalassemias are classified by the type and magnitude of decreased synthesis of the globin chain and severity of the clinical symptoms. The clinical manifestation ranges from mild anemia with microcytosis to fatal severe anemia.
In the alpha-thalassemias, there is absence or decreased production of beta-globin subunits, whereas in the beta- thalassemias, there is absent or reduced production of beta globin subunits. Rare thalassemias affecting the production of delta or gamma globin subunits have also been described but are not clinically significant disorders.
The beta-thalassemias can be sub-classified into those in which there is total absence of normal beta globin subunit synthesis or accumulation, the beta-zero thalassemias, and those in which some structurally normal beta globin subunits are synthesized, but in markedly decreased amounts, the beta-plus thalassemias. The alpha-thalassemia syndromes however, are usually caused by the deletion of one or more alpha globin genes and are sub-classified according to the number of alpha globin genes that are deleted (or mutated): one gene deleted (alpha-plus thalassemia); two genes deleted on the same chromosome or in cis (alpha-zero thalassemia); three genes deleted (HbH disease); or four genes deleted (hydrops fetalis with Hb Bart's).
Hemoglobinopathies results from the abnormal structure of One of the globin chains of the hemoglobin molecule (mutation of alpha and/or beta globin chain resulting in a variant form of Hemoglobin A). They are inherited single- gene disorders and in most cases, they are inherited as autosomal co-dominant traits. A large number (>800) of variants of hemoglobin (Hb) have been recognized. They are identified by capital letters (eg, Hb A or Hb S), or by the city in which the variant was first discovered (eg, Hb Koln).
Alpha chain variants usually form less than 25% of the total hemoglobin because the mutation typically occurs in one of the four genes that codes for alpha globin chain. For beta globin variants in the heterozygous state the variant forms more than 25% but less than 50% of the total hemoglobin. Ranked in order of relative frequency, these are: Hb S (sickle cell disease and trait), C, E, Lepore, G-Philadelphia, D-Los Angeles, Koln, Constant Spring, O-Arab, and others.
Most common beta globin variants include HbS, HbC, HbD, HbE and HbG. A mutation in one beta globin subunit results in a combination of variant and normal hemoglobin and denotes carrier or trait status, also known as the heterozygote state. Mutations in both beta globin subunits result in disease based on a homozygous expression such as sickle cell anemia (HbSS). Other diseases under sickle cell disease (SCD) are HbSE, HbSC and HbS beta-thalassemia.


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Description: A TSH test is a blood test that measures thyroid stimulating hormone levels in your blood’s serum and is used to screen for and monitor treatment of thyroid disorders such as hypothyroidism and hyperthyroidism.

Also Known As: Thyroid Stimulating Hormone Test, Thyrotropin Test, TSH test, Thyroid Test, TSH Screen Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a TSH test ordered?

When a person has symptoms of hyperthyroidism or hypothyroidism, or an enlarged thyroid gland, a doctor may order a TSH test.

Hyperthyroidism can cause the following signs and symptoms:

  • Heart rate has increased.
  • Anxiety
  • Loss of weight
  • Sleeping problems
  • Hand tremors.
  • Weakness
  • Diarrhea
  • Visual disturbances, light sensitivity
  • Puffiness around the eyes, dryness, discomfort, and, in some cases, bulging of the eyes are all possible side effects.

Hypothyroidism can cause the following signs and symptoms:

  • gaining weight
  • Skin that is dry
  • Constipation
  • Intolerance to the cold
  • Skin that is puffy
  • Hair loss is a common problem.
  • Fatigue
  • Women's menstrual irregularities

When a person is being treated for a thyroid disease, TSH may be ordered at regular intervals. The American Thyroid Association suggests waiting 6-8 weeks after changing a person's thyroid medication dose before testing their TSH level again.

In the United States, TSH screening is routinely performed on newborns shortly after birth as part of each state's newborn screening program.

What does a TSH blood test check for?

The pituitary gland, a small structure beneath the brain and beyond the sinus cavities, produces thyroid-stimulating hormone. TSH causes thyroxine and triiodothyronine to be released into the bloodstream by the thyroid gland. These thyroid hormones aid in the regulation of the body's energy usage. This test determines how much TSH is present in the blood.

The feedback mechanism that the body utilizes to maintain consistent quantities of thyroid hormones in the blood includes TSH and its regulatory hormone, thyrotropin releasing hormone, which comes from the hypothalamus. TSH synthesis by the pituitary gland increases as thyroid hormone concentrations fall. TSH stimulates the thyroid gland, a small butterfly-shaped gland that lays flat against the windpipe at the base of the throat, to produce and release T4 and T3. Thyroid production turns on and off to maintain generally steady levels of thyroid hormones in the blood when all three organs are operating regularly.

When the thyroid produces excessive amounts of T4 and T3, the affected person may have hyperthyroidism symptoms such as high heart rate, weight loss, agitation, hand tremors, itchy eyes, and difficulty sleeping. The most prevalent cause of hyperthyroidism is Graves disease. It is a chronic autoimmune condition in which the immune system creates antibodies that mimic TSH, causing the thyroid hormone to be produced in excessive levels. As a result, the pituitary gland may produce less TSH, resulting in a low blood level.

Weight gain, dry skin, constipation, cold intolerance, and weariness are all symptoms of hypothyroidism, a condition in which the thyroid produces fewer thyroid hormones. In the United States, Hashimoto thyroiditis is the most prevalent cause of hypothyroidism. It's an autoimmune disease in which the immune system attacks the thyroid, causing inflammation and destruction as well as the generation of autoantibodies. The thyroid generates low levels of thyroid hormone in Hashimoto thyroiditis. The pituitary gland may create more TSH, resulting in a high blood level.

TSH values, on the other hand, do not necessarily indicate or predict thyroid hormone levels. TSH is produced abnormally in some persons and does not work properly. Despite having normal or modestly increased TSH values, they frequently develop hypothyroidism. Thyroid hormone levels can be high or low in a variety of thyroid illnesses, regardless of the amount of TSH in the blood.

TSH levels may be elevated or lowered in rare cases due to pituitary dysfunction. In addition to pituitary dysfunction, an issue with the hypothalamus can cause hyperthyroidism or hypothyroidism.

Lab tests often ordered with a TSH test:

  • T3 Free
  • T3 Total
  • T4 Free
  • T4 Total
  • T3 Reverse
  • T3 Uptake
  • Thyroid Peroxidase
  • Thyroglobulin Antibodies
  • Thyroid Panel

Conditions where a test TSH is recommended:

  • Hyperthyroidism
  • Hypothyroidism
  • Hashimotos
  • Graves’ Disease
  • Autoimmune Diseases
  • Thyroid Cancer

Commonly Asked Questions:

How does my health care provider use a TSH test?

Thyroid function and/or symptoms of a thyroid problem, such as hyperthyroidism or hypothyroidism, are frequently assessed with the thyroid-stimulating hormone test.

The pituitary gland, a small structure beneath the brain and beyond the sinus cavities, produces TSH. It's a part of the body's feedback system that keeps the thyroid hormones thyroxine and triiodothyronine in check and helps regulate the pace at which the body burns calories.

TSH tests are typically ordered in conjunction with or before a free T4 test. A free T3 test and thyroid antibodies are two further thyroid tests that can be ordered. TSH, free T4, and free T3 are sometimes ordered as part of a thyroid panel.

TSH is used to:

  • Diagnose a thyroid issue in a patient who is experiencing symptoms.
  • Check newborns for an underactive thyroid.
  • Monitor thyroid replacement therapy.
  • Monitor treatment of hyperthyroidism that involves medication.
  • Assist women in diagnosing and monitoring infertility issues.
  • Assist in determining the pituitary gland's function
  • Screen adults for thyroid issues and diseases.

What does my TSH blood test result mean?

A high TSH level could indicate that:

  • The person being examined has an underactive thyroid gland that isn't responding well to TSH stimulation owing to acute or chronic thyroid dysfunction.
  • If a person has hypothyroidism or has had their thyroid gland removed, the dose of thyroid hormone replacement medicine may need to be changed.
  • A patient with hyperthyroidism is taking too much anti-thyroid medication, and the dosage needs to be reduced.
  • There is a problem with the pituitary gland, such as a tumor that causes TSH levels to be out of control.

A low TSH level could imply the following:

  • An overactive thyroid gland
  • Thyroid hormone prescription taken in excess by patients being treated for an underactive thyroid gland.
  • Inadequate medication in an individual being treated for hyperthyroidism; nevertheless, after successful anti-thyroid treatment, TSH production may take a time to recover. This is why the American Thyroid Association recommends testing for thyroid hormones as well as TSH levels throughout treatment.
  • The pituitary gland has been damaged, preventing it from releasing enough TSH.

An abnormal TSH result, whether high or low, suggests an excess or deficiency in the quantity of thyroid hormone available to the body, but does not pinpoint the cause for the abnormal result. Additional testing is frequently performed after an abnormal TSH test result to determine the reason of the increase or decrease.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.


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The test of choice for accurate, global cardiometabolic riskstratifi cation and management• Provides comprehensive lipid analysis• Simultaneously and accurately measures cholesterol concentrations ofall 5 lipoprotein classes and their subclasses in a non-fasting patient20

Brief Description: A Vitamin D test is a blood test used to determine if you have a Vitamin D deficiency and to monitor Vitamin D levels if you are on supplementation.

Also Known As: Ergocalciferol Test, Vitamin D2 Test, Cholecalciferol Test, Vitamin D3 Test, Calcidiol Test, 25-hydroxyvitamin D Test, Calcifidiol Test, 25-hydroxy-vitamin D Test, Vitamin D Total Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: Fasting preferred, but not required.

When is a Vitamin D test ordered?

When calcium levels are inadequate and/or a person exhibits symptoms of vitamin D deficiency, such as rickets in children and bone weakening, softness, or fracture in adults, 25-hydroxyvitamin D is frequently ordered to rule out a vitamin D deficit.

When a person is suspected of having a vitamin D deficiency, the test may be requested. Vitamin D deficiency is more common in older folks, people who are institutionalized or homebound and/or have minimal sun exposure, people who are obese, have had gastric bypass surgery, and/or have fat malabsorption. People with darker skin and breastfed babies are also included in this category.

Before starting osteoporosis medication, 25-hydroxyvitamin D is frequently requested.

What does a Vitamin D blood test check for?

Vitamin D is a group of chemicals that are necessary for the healthy development and growth of teeth and bones. The level of vitamin D in the blood is determined by this test.

Vitamin D is tested in the blood in two forms: 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D. The primary form of vitamin D found in the blood is 25-hydroxyvitamin D, which is a relatively inactive precursor to the active hormone 1,25-dihydroxyvitamin D. 25-hydroxyvitamin D is routinely evaluated to assess and monitor vitamin D status in humans due to its longer half-life and higher concentration.

Endogenous vitamin D is created in the skin when exposed to sunshine, whereas exogenous vitamin D is taken through foods and supplements. Vitamin D2 and vitamin D3 have somewhat different molecular structures. Fortified foods, as well as most vitamin preparations and supplements, include the D2 form. The type of vitamin D3 produced by the body is also used in some supplements. When the liver and kidneys convert vitamin D2 and D3 into the active form, 1,25-dihydroxyvitamin D, they are equally effective.

Some tests may not differentiate between the D2 and D3 forms of vitamin D and just report the total result. Newer methods, on the other hand, may record D2 and D3 levels separately and then sum them up to get a total level.

Vitamin D's major function is to assist balance calcium, phosphorus, and magnesium levels in the blood. Vitamin D is necessary for bone growth and health; without it, bones become fragile, misshapen, and unable to mend themselves properly, leading to disorders such as rickets in children and osteomalacia in adults. Vitamin D has also been proven to influence the growth and differentiation of a variety of other tissues, as well as to aid in immune system regulation. Other illnesses, such as autoimmune and cancer, have been linked to vitamin D's other roles.

According to the Centers for Disease Control and Prevention, two-thirds of the US population has adequate vitamin D, while one-quarter is at risk of inadequate vitamin D and 8% is at risk of insufficiency, as defined by the Institute of Medicine's Dietary Reference Intake.

The elderly or obese, persons who don't receive enough sun exposure, people with darker skin, and people who take certain drugs for lengthy periods of time are all at risk of insufficiency. Adequate sun exposure is usually defined as two intervals of 5-20 minutes each week. Vitamin D can be obtained through dietary sources or supplements by people who do not get enough sun exposure.

This test has 3 Biomarkers

  • Vitamin D Total which is a combined measurement of Vitamin D, 25-Oh, D2 and Vitamin 25-Oh, D3
  • Vitamin D, 25-Oh, D2 which is a measurement of ergocalciferol Vitamin D, which is Vitamin D obtained through plant sources. 
  • Vitamin D, 25-Oh, D3 which is a measurement of cholecalciferol Vitamin D, which is Vitamin D obtained through animal sources.

Lab tests often ordered with a Vitamin D test:

  • Complete Blood Count
  • CMP
  • Iron and TIBC
  • Calcium
  • Phosphorus
  • PTH
  • Magnesium

Conditions where a Vitamin D test is recommended:

  • Kidney Disease
  • Osteoporosis
  • Lymphoma
  • Cystic Fibrosis
  • Autoimmune Disorders
  • Celiac Disease
  • Malabsorption
  • Malnutrition

Commonly Asked Questions:

How does my health care provider use a Vitamin D test?

Determine whether a deficit or excess of vitamin D is causing bone weakening, deformity, or improper calcium metabolism.

Because PTH is required for vitamin D activation, it can aid in diagnosing or monitoring problems with parathyroid gland function.

Because vitamin D is a fat-soluble vitamin that is absorbed from the intestine like a fat, it can help monitor the health of people with conditions that interfere with fat absorption, such as cystic fibrosis and Crohn's disease.

People who have had gastric bypass surgery and may not be able to absorb adequate vitamin D should be closely monitored.

When vitamin D, calcium, phosphorus, and/or magnesium supplementation is suggested, it can help assess the success of the treatment.

What do my Vitamin D results result mean?

Despite the fact that vitamin D techniques differ, most laboratories use the same reference intervals. Because toxicity is uncommon, researchers have focused on the lower limit and what cut-off for total 25-hydroxyvitamin D shortage implies.

A low blood level of 25-hydroxyvitamin D could indicate that a person isn't getting enough sunlight or dietary vitamin D to meet his or her body's needs, or that there's an issue with absorption from the intestines. Seizure medications, notably phenytoin, might occasionally interfere with the liver's generation of 25-hydroxyvitamin D.

Vitamin D insufficiency has been linked to an increased risk of some malignancies, immunological illnesses, and cardiovascular disease.

Excessive supplementation with vitamin pills or other nutritional supplements frequently results in a high level of 25-hydroxyvitamin D.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.