Hemolytic Anemia Test

Brief Description: A Hemoglobinopathy Evaluation test is used to detect hemoglobin abnormalities and forms that may be causing problems with hemoglobin production.

Also Known As: Hemoglobin Evaluation Test, Hb ELP Test, Hb IEF, Sickle Cell Screen Test, Hemoglobin Fraction Test, Hemoglobinopathies Test

Collection Method: Blood Draw

Specimen Type: Whole Blood

Test Preparation: No preparation required

When is a Hemoglobinopathy Evaluation test ordered?

Hemoglobinopathies must be tested for as part of the state-mandated newborn screening program. Additionally, when a parent is at high risk or when parents have a kid with hemoglobinopathy, it is frequently utilized for prenatal screening.

When a complete blood count and/or blood smear reveal that a person may have an atypical form of hemoglobin, an assessment is typically requested.

It might be prescribed if a medical professional believes that a patient's signs and symptoms are brought on by irregular hemoglobin production. Hemolytic anemia is frequently brought on by abnormal types of hemoglobin and is characterized by symptoms like:

• weakness, exhaustion
• Not enough energy
• Jaundice
• light skin

A few severe hemoglobinopathies can cause episodes of excruciating pain, shortness of breath, an enlarged spleen, and issues with a child's growth.

What does a Hemoglobinopathy Evaluation blood test check for?

An individual with a hemoglobinopathy has an inherited blood ailment in which their hemoglobin is produced at a reduced rate or in an aberrant form. The goal of a hemoglobinopathy evaluation is to screen for and/or diagnose a hemoglobin disease by identifying aberrant forms of or indicating issues with hemoglobin production.

All red blood cells include hemoglobin, an iron-containing protein that binds to oxygen in the lungs and enables RBCs to transport the oxygen throughout the body, supplying it to the body's cells and tissues. Heme, the molecule with iron at its center, makes up one portion of hemoglobin. The other portion is made up of four globin chains. The globin chains are referred to as alpha, beta, gamma, and delta depending on their structural makeup. The functions of hemoglobin and its capacity to carry oxygen depend on the kinds of globin chains that are present.

Types of normal hemoglobin include:

• About 95%–98% of the hemoglobin (Hb) found in adults is hemoglobin A, which has two alpha and two beta protein chains.
• About 2%–3% of adult hemoglobin is hemoglobin A2, which has two alpha and two delta protein chains.
• In adults, hemoglobin F, which contains two alpha and two gamma protein chains, accounts for 1% to 2% of all hemoglobin. The fetus produces the majority of this hemoglobin during pregnancy; production typically declines after birth and approaches adult levels in 1-2 years.

When the genes that produce the globin chains mutate, it results in hemoglobinopathies, which modify the proteins. One of the typical globin chains may produce less as a result of these genetic modifications, or they may produce globin chains with different structural characteristics. The behavior, stability, production rate, and/or structure of hemoglobin can all be impacted by genetic changes. Red blood cells' appearance and functionality can be changed by the presence of aberrant hemoglobin within them.

Hemolytic anemia is caused by red blood cells with defective hemoglobin, which may not transport oxygen effectively and may be broken down by the body earlier than usual. The three most prevalent hemoglobin variants are hemoglobin C, which can cause a slight amount of hemolytic anemia, hemoglobin E, which may or may not cause any symptoms, and hemoglobin S, which is the primary hemoglobin in people with sickle cell disease and causes the RBC to become misshapen and reduce the cell's survival.

A gene mutation causes diminished synthesis of one of the globin chains, which leads in the disorder known as thalassemia. This may throw off the ratio of alpha to beta chains, leading to the formation of aberrant hemoglobin or an increase in minor hemoglobin components like Hb A2 or Hb F.

There are many more uncommon variations of hemoglobin. Some have no visible signs or symptoms, while others have an impact on the stability and/or performance of the hemoglobin molecule. The types and levels of hemoglobin present in a person's sample of blood are often assessed during an assessment of a hemoglobin problem. Several instances include:

• Tests for hemoglobin S, the primary hemoglobin associated with sickle cell disease, are performed using the hemoglobin solubility method.
• Blood-hematology electrophoresis
• High performance liquid chromatography for isoelectric focusing of hemoglobin

Lab tests often ordered with Hemoglobinopathy Evaluation test:

• Complete Blood Count (CBC)
• Hemoglobin
• Hematocrit
• Sickle Cell Tests
• Iron Tests

Conditions where a Hemoglobinopathy Evaluation test is recommended:

• Hemolytic Anemia
• Sickle Cell Anemia
• Thalassemia
• Hemoglobin Abnormalities
• Pregnancy

How does my health care provider use a Hemoglobinopathy Evaluation test?

The protein found in all red blood cells that carries oxygen is called hemoglobin, and a hemoglobinopathy examination is used to find aberrant types and/or relative levels of it. Tests might be conducted for:

Screening

Newborns must be checked in every state for specific hemoglobin variations.

High-risk parents with an ethnic origin linked to a higher prevalence of hemoglobin abnormalities and those with affected family members frequently undergo prenatal screening. Prior to becoming pregnant, screening may be done in addition to genetic counseling to ascertain whether the parents are carriers.

To find variations among asymptomatic parents with an ill child

Diagnosis

To find and/or identify hemoglobinopathy in those who have unexplained anemic symptoms or abnormal complete blood count results

A person's hemoglobin type can be determined using a variety of laboratory techniques. A few of these are:

• Tests for hemoglobin S, the primary hemoglobin associated with sickle cell disease, are performed using the hemoglobin solubility method.
• Blood-hematology electrophoresis
• Isoelectric focusing of hemoglobin
• High performance liquid chromatography of hemoglobin

Based on the physical and chemical characteristics of the various hemoglobin molecules, these approaches assess the various hemoglobin subtypes.

One of these tests, or a combination of them, can be used to diagnose the majority of common hemoglobin variations or thalassemias. Any observed variant hemoglobin's relative concentrations can help with a diagnosis. However, it is typically insufficient to diagnose hemoglobinopathy with a single test. Instead, the outcomes of numerous tests are taken into account. Other possible laboratory examinations include, for instance:

• CBC Reticulocyte count Blood smear
• Studies on iron using transferrin, TIBC, and serum iron

Genetic testing: can be used to find changes in the genes that produce the chains of proteins that make up hemoglobin. This is not a common test, but it can be used to determine if a person has one or two copies of a mutant gene.

What do my Hemoglobinopathy Evaluation test results mean?

When evaluating the findings of an assessment for hemoglobinopathy, care must be exercised. The laboratory report typically comes with an interpretation from a pathologist with knowledge in hematology.

The types and relative amounts of hemoglobin present are often reported in the evaluation's findings. The percentages of adults' normal hemoglobins are as follows:

• Hemoglobin A: between 95% and 98%
• Hemoglobin A2: between 2% and 3%
• 2% or less for hemoglobin F

Testing may be used to identify a disorder that results in the production of hemoglobin with structural changes or a condition known as thalassemia, where a gene mutation reduces the production of one of the globin chains. This may throw off the ratio of alpha to beta chains, leading to the formation of aberrant hemoglobin or an increase in minor hemoglobin components like Hb A2 or Hb F.

These tests can measure and detect some of the most prevalent types of aberrant hemoglobin, including:

The main hemoglobin in persons with sickle cell disease is hemoglobin S. According to the Centers for Disease Control and Prevention, around 1 in 500 African American infants are born with this ailment, and more than 70,000 Americans currently have it. The proportion of Hb S in sickle cell disease patients is high. In spite of having a modest amount of Hb S, people with sickle cell trait nonetheless have the regular type of Hb A. When exposed to low oxygen levels, Hb S makes red blood cells distorted. Red blood cells with scleroderma can obstruct small blood vessels, resulting in discomfort, poor circulation, decreased oxygen delivery to tissues and cells, and reduced cell survival. High levels of hemoglobin A or F can keep red blood cells well-oxygenated and prevent sickling.

Hemoglobin C: Approximately 2 to 3 percent of people of African origin have the hemoglobin C trait. Hemoglobin C disease is uncommon and often not severe. It typically results in a mild to moderate spleen enlargement and a little amount of hemolytic anemia.

One of the most prevalent beta chain hemoglobin variants in the world is hemoglobin E. It is especially common among people with Southeast Asian ancestry. Homozygous carriers of Hb E typically have mild hemolytic anemia, microcytic red blood cells, and a minor splenic enlargement. Unless another mutation is present, a single copy of the hemoglobin E gene does not cause symptoms.

The main hemoglobin that a growing fetus produces is hemoglobin F. Normal Hb F production starts to decline after birth and reaches adult levels between the ages of 1-2. In many diseases, including beta thalassemia and sickle cell anemia, Hb F may be high.

In a few instances of alpha thalassemia, hemoglobin H is present. It is created because there is a severe lack of alpha chains and is made up of four beta globin chains. The four beta chains do not function appropriately even though each beta globin chain is healthy.

Babies with alpha thalassemia develop hemoglobin Barts, a particular type. When there are not enough alpha chains, it is made of four gamma protein chains, much as how Hb H is made. Due to declining gamma chain synthesis, Hb Barts vanishes quickly after delivery.

Additional types that could be found include:

• hematoxylin D
• Blood globin G
• hematoxylin J
• hematoxylin M

Spring Constant Hemoglobin

Additionally, a person can receive two distinct defective genes from each parent. Compound heterozygosity or doubly heterozygosity are terms used to describe this. Hemoglobin SC illness, sickle cell - hemoglobin D disease, hemoglobin E - beta thalassemia, and hemoglobin S - beta thalassemia are a few examples of clinically relevant combos. See the articles on Thalassemia and Hemoglobin Abnormalities for more information on this.

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

Description: A CBC or Complete Blood Count with Differential and Platelets test is a blood test that measures many important features of your blood’s red and white blood cells and platelets. A Complete Blood Count can be used to evaluate your overall health and detect a wide variety of conditions such as infection, anemia, and leukemia. It also looks at other important aspects of your blood health such as hemoglobin, which carries oxygen. 

Also Known As: CBC test, Complete Blood Count Test, Total Blood Count Test, CBC with Differential and Platelets test, Hemogram test  

Collection Method: Blood Draw 

Specimen Type: Whole Blood 

Test Preparation: No preparation required 

Average Processing Time: 1 to 2 days

When is a Complete Blood Count test ordered?  

The complete blood count (CBC) is an extremely common test. When people go to the doctor for a standard checkup or blood work, they often get a CBC. Suppose a person is healthy and their results are within normal ranges. In that case, they may not need another CBC unless their health condition changes, or their healthcare professional believes it is necessary. 

When a person exhibits a variety of signs and symptoms that could be connected to blood cell abnormalities, a CBC may be done. A health practitioner may request a CBC to help diagnose and determine the severity of lethargy or weakness, as well as infection, inflammation, bruises, or bleeding. 

When a person is diagnosed with a disease that affects blood cells, a CBC is frequently done regularly to keep track of their progress. Similarly, if someone is being treated for a blood condition, a CBC may be performed on a regular basis to see if the treatment is working. 

Chemotherapy, for example, can influence the generation of cells in the bone marrow. Some drugs can lower WBC counts in the long run. To monitor various medication regimens, a CBC may be required on a regular basis. 

What does a Complete Blood Count test check for? 

The complete blood count (CBC) is a blood test that determines the number of cells in circulation. White blood cells (WBCs), red blood cells (RBCs), and platelets (PLTs) are three types of cells suspended in a fluid called plasma. They are largely created and matured in the bone marrow and are released into the bloodstream when needed under normal circumstances. 

A CBC is mainly performed with an automated machine that measures a variety of factors, including the number of cells present in a person's blood sample. The findings of a CBC can reveal not only the quantity of different cell types but also the physical properties of some of the cells. 

Significant differences in one or more blood cell populations may suggest the presence of one or more diseases. Other tests are frequently performed to assist in determining the reason for aberrant results. This frequently necessitates visual confirmation via a microscope examination of a blood smear. A skilled laboratory technician can assess the appearance and physical features of blood cells, such as size, shape, and color, and note any anomalies. Any extra information is taken note of and communicated to the healthcare provider. This information provides the health care provider with further information about the cause of abnormal CBC results. 

The CBC focuses on three different types of cells: 

WBCs (White Blood Cells) 

The body uses five different types of WBCs, also known as leukocytes, to keep itself healthy and battle infections and other types of harm. The five different leukocytes are eosinophiles, lymphocytes, neutrophiles, basophils, and monocytes. They are found in relatively steady numbers in the blood. Depending on what is going on in the body, these values may momentarily rise or fall. An infection, for example, can cause the body to manufacture more neutrophils in order to combat bacterial infection. The amount of eosinophils in the body may increase as a result of allergies. A viral infection may cause an increase in lymphocyte production. Abnormal (immature or mature) white cells multiply fast in certain illness situations, such as leukemia, raising the WBC count. 

RBCs (Red Blood Cells) 

The bone marrow produces red blood cells, also known as erythrocytes, which are transferred into the bloodstream after maturing. Hemoglobin, a protein that distributes oxygen throughout the body, is found in these cells. Because RBCs have a 120-day lifespan, the bone marrow must constantly manufacture new RBCs to replace those that have aged and disintegrated or have been lost due to hemorrhage. A variety of diseases, including those that cause severe bleeding, can alter the creation of new RBCs and their longevity. 

The CBC measures the number of RBCs and hemoglobin in the blood, as well as the proportion of RBCs in the blood (hematocrit), and if the RBC population appears to be normal. RBCs are generally homogeneous in size and shape, with only minor differences; however, considerable variances can arise in illnesses including vitamin B12 and folate inadequacy, iron deficiency, and a range of other ailments. Anemia occurs when the concentration of red blood cells and/or the amount of hemoglobin in the blood falls below normal, resulting in symptoms such as weariness and weakness. In a far smaller percentage of cases, there may be an excess of RBCs in the blood (erythrocytosis or polycythemia). This might obstruct the flow of blood through the tiny veins and arteries in extreme circumstances. 

Platelets 

Platelets, also known as thrombocytes, are small cell fragments that aid in the regular clotting of blood. A person with insufficient platelets is more likely to experience excessive bleeding and bruises. Excess platelets can induce excessive clotting or excessive bleeding if the platelets are not operating properly. The platelet count and size are determined by the CBC. 

Lab tests often ordered with a Complete Blood Count test: 

• Reticulocytes
• Iron and Total Iron Binding Capacity
• Basic Metabolic Panel
• Comprehensive Metabolic Panel
• Lipid Panel
• Vitamin B12 and Folate
• Prothrombin with INR and Partial Thromboplastin Times
• Sed Rate (ESR)
• C-Reactive Protein
• Epstein-Barr Virus
• Von Willebrand Factor Antigen

Conditions where a Complete Blood Count test is recommended: 

• Anemia
• Aplastic Anemia
• Iron Deficiency Anemia
• Vitamin B12 and Folate Deficiency
• Sickle Cell Anemia
• Heart Disease
• Thalassemia
• Leukemia
• Autoimmune Disorders
• Cancer
• Bleeding Disorders
• Inflammation
• Epstein-Barr Virus
• Mononucleosis

Commonly Asked Questions: 

How does my health care provider use a Complete Blood Count test? 

The complete blood count (CBC) is a common, comprehensive screening test used to measure a person's overall health status.  

What do my Complete Blood Count results mean? 

A low Red Blood Cell Count, also known as anemia, could be due many different causes such as chronic bleeding, a bone marrow disorder, and nutritional deficiency just to name a few. A high Red Blood Cell Count, also known as polycythemia, could be due to several conditions including lung disease, dehydration, and smoking. Both Hemoglobin and Hematocrit tend to reflect Red Blood Cell Count results, so if your Red Blood Cell Count is low, your Hematocrit and Hemoglobin will likely also be low. Results should be discussed with your health care provider who can provide interpretation of your results and determine the appropriate next steps or lab tests to further investigate your health. 

What do my Differential results mean? 

A low White Blood Cell count or low WBC count, also known as leukopenia, could be due to a number of different disorders including autoimmune issues, severe infection, and lymphoma. A high White Blood Cell count, or high WBC count, also known as leukocytosis, can also be due to many different disorders including infection, leukemia, and inflammation. Abnormal levels in your White Blood Cell Count will be reflected in one or more of your different white blood cells. Knowing which white blood cell types are affected will help your healthcare provider narrow down the issue. Results should be discussed with your health care provider who can provide interpretation of your results and determine the appropriate next steps or lab tests to further investigate your health. 

What do my Platelet results mean? 

A low Platelet Count, also known as thrombocytopenia, could be due to a number of different disorders including autoimmune issues, viral infection, and leukemia. A high Platelet Count, also known as Thrombocytosis, can also be due to many different disorders including cancer, iron deficiency, and rheumatoid arthritis. Results should be discussed with your health care provider who can provide interpretation of your results and determine the appropriate next steps or lab tests to further investigate your health. 

NOTE: Ulta Lab Tests provides CBC test results from Quest Diagnostics as they are reported. Often, different biomarker results are made available at different time intervals. When reporting the results, Ulta Lab Tests denotes those biomarkers not yet reported as 'pending' for every biomarker the test might report. Only biomarkers Quest Diagnostics observes are incorporated and represented in the final CBC test results provided by Ulta Lab Tests. 

NOTE: Only measurable biomarkers will be reported. Certain biomarkers do not appear in healthy individuals. 

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

Reflex Parameters for Manual Slide Review

CBC Reflex Pathway

Step 1 - The slide review is performed by qualified Laboratory staff and includes:

• Confirmation of differential percentages
• WBC and platelet estimates, when needed
• Full review of RBC morphology
• Comments for toxic changes, RBC inclusions, abnormal lymphs, and other
• significant findings
• If the differential percentages agree with the automated counts and no abnormal cells are seen, the automated differential is reported with appropriate comments

Step 2 - The slide review is performed by qualified Laboratory staff and includes: If any of the following are seen on the slide review, Laboratory staff will perform a manual differential:

• Immature, abnormal, or toxic cells
• nRBC’s
• Disagreement with automated differential
• Atypical/abnormal RBC morphology
• Any RBC inclusions

Step 3 - If any of the following are seen on the manual differential, a Pathologist will review the slide:

• WBC<1,500 with abnormal cells noted
• Blasts/immature cells, hairy cell lymphs, or megakaryocytes
• New abnormal lymphocytes or monocytes
• Variant or atypical lymphs >15%
• Blood parasites
• RBC morphology with 3+ spherocytes, RBC inclusions, suspect Hgb-C,
• crystals, Pappenheimer bodies or bizarre morphology
• nRBC’s

Description: ABO Group and Rh type is a blood test that is used to determine which blood group and Rh type you are.

Also Known As: Blood group test, blood type test, blood group and Rh type test

Collection Method: Blood Draw

Specimen Type: Whole Blood

Test Preparation: No preparation required

Average Processing Time: 1 to 2 days

When is an ABO Group and Rh Type test ordered?

All donated blood undergoes ABO grouping and Rh typing. They're also used when someone needs a blood transfusion. The following conditions or circumstances may necessitate a transfusion:

• Anemia that is severe, as well as anemia-causing illnesses such as sickle cell disease and thalassemia
• During or after surgery when you have bleeding
• Trauma or injury
• Excessive blood loss 
• Chemotherapy and  cancer
• Hemophilia and similar bleeding disorders

When a woman becomes pregnant, she is tested to see if she is Rh negative or positive. Soon after birth, all newborn babies of Rh-negative mothers are tested for ABO and Rh to see if the mother need Rh immune globulin.

When an individual becomes a candidate to receive an organ, tissue, or bone marrow transplant, or when a person decides to become a donor, blood typing may be required. It's one of the first of several tests used to see if a possible donor and recipient are a good match.

Blood type is sometimes used as part of the process of determining whether or not someone is a blood relative.

What does an ABO Group and Rh Type blood test check for?

The markers or antigens on the surface of red blood cells are used to determine blood types. The A and B antigens are two primary antigens or surface identifiers on human RBCs. Rh is another essential surface antigen. Blood typing determines a person's ABO blood group and Rh type by detecting the presence or absence of these antigens.

Blood group A is made up of people who have A antigens in their red blood cells, blood group B is made up of people who have B antigens in their red blood cells, blood group AB is made up of people who have both A and B antigens in their red blood cells, and blood group O is made up of people who don't have either of these markers.

A person's blood type is Rh+ if the Rh protein is present on red blood cells; if it is not, the person's blood type is Rh-.

Our bodies develop antibodies against antigens A and B that aren't found on our red blood cells. Anti-B antibodies are directed against the B antigens on red blood cells in people with blood type A, while anti-A antibodies are directed against the A antigens in people with blood type B. People with type AB blood do not have either of these antibodies, whereas people with type O blood do.

These antibodies are helpful in detecting a person's blood type and determining which blood kinds he or she can safely receive. If a person with antibodies directed against the B antigen, for example, is transfused with type B blood, his or her own antibodies will attack and kill the transfused red blood cells, resulting in serious and perhaps fatal consequences. As a result, matching a person's blood type to the blood that will be transfused is crucial.

Antibodies to Rh are not created spontaneously, unlike antibodies to A and B antigens. That is, Rh antibodies form only when a person without Rh factor on their red blood cells is exposed to Rh positive red blood cells. When a Rh-negative mother is pregnant with a Rh-positive kid, or when a Rh-negative individual is transfused with Rh-positive blood, this might happen during pregnancy or birth. In either instance, the first encounter to the Rh antigen may not trigger a robust immune response to Rh positive cells, but subsequent exposures may result in severe reactions.

Lab tests often ordered with an ABO Group and Rh Type test:

• Direct Antiglobulin Test
• RBC Antibody Screen
• HLA Testing
• Compatibility Testing

Conditions where an ABO Group and Rh Type test is recommended:

• Anemia
• Bleeding Disorders
• Pregnancy

How does my health care provider use an ABO Group and Rh Type test?

Blood typing is used to determine a person's blood group, including whether they are blood group A, B, AB, or O, as well as whether they are Rh positive or negative.

Blood typing can be used for a variety of purposes, including:

• Ensure that the blood type of a person who needs a blood transfusion or blood components is compatible with the ABO and Rh types of the unit of blood that will be transfused. Blood typing is usually used in conjunction with other tests, such as an RBC antibody screen and a crossmatch, to determine what type of blood or blood components a person can safely receive. A potentially fatal transfusion reaction may occur if a unit of blood harboring an ABO antigen to which the blood recipient has an antibody is transfused to the recipient. Anti-A and anti-B antibodies, for instance, are present in the blood of people with blood group O. The antibodies in the recipient's blood will react with the red blood cells in this individual if they get a unit of blood from group A, B, or AB, destroying them and possibly having serious effects.
• In the same way, if a Rh-negative person is transfused with Rh-positive blood, the person is likely to develop antibodies against Rh-positive blood. Although the recipient is unaffected by this scenario during the current transfusion, a future transfusion with Rh-positive blood could produce a significant transfusion reaction.
• Determine the compatibility of a pregnant lady and her unborn child. Because a mother and her fetus may be incompatible, Rh type is especially significant during pregnancy. If the mother is Rh negative but the father is Rh positive, the fetus may test positive for the Rh antigen. As a result, the mother's body may produce antibodies against the Rh antigen. Hemolytic sickness of the fetus and infant could arise from the antibodies penetrating the placenta and destroying the baby's red blood cells. If the infant is Rh-positive, an injection of Rh immune globulin is given to the Rh-negative mother both during pregnancy and again after delivery to stop the production of Rh antibodies. The Rh immune globulin binds to and "masks" the fetus's Rh antigen during pregnancy and delivery to stop the mother from producing antibodies against it.
• Determine the blood type of potential blood donors at a collection facility. Blood units from donors are blood typed and properly labeled so they can be utilized for patients who need a certain ABO group and Rh type.
• The blood type of potential donors and recipients of organs, tissues, or bone marrow should be ascertained as part of the preparation for a transplant surgery. To identify and match organ and tissue donors with recipients who have the same or a sufficient number of matching HLA genes and antigens, ABO blood type is utilized in conjunction with HLA testing.

What do my ABO Group and Rh Type test results mean?

Blood typing determines if a person is type A, B, AB, or O, as well as whether he or she is Rh negative or positive. The results will inform the healthcare provider about whether blood or blood components are safe to provide to the patient.

The results of blood typing will reveal if a pregnant woman is Rh positive or negative. This information will help determine whether she is a candidate for Rh immune globulin, which prevents antibodies from forming against her fetus' blood cells.

Donated blood typing is significant because it allows health care providers to determine whether patients are compatible with the blood and may safely receive it.

When a donated organ, tissue, or bone marrow is compatible with the intended recipient, it is less likely to be rejected immediately after transplantation.

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

The Different Blood Types

There are four major blood groups and eight different blood types. Doctors call this the ABO Blood Group System.

The groups are based on whether or not you have two specific antigens -- A and B:

• Group A has the A antigen and B antibody.
• Group B has the B antigen and the A antibody.
• Group AB has A and B antigens but neither A nor B antibodies.
• Group O doesn’t have A or B antigens but has both A and B antibodies.

There’s also a third kind of antigen called the Rh factor. You either have this antigen (meaning your blood type is “Rh+” or “positive”), or you don’t (meaning your blood type is “Rh-” or “negative”). So, from the four blood groups, there are eight blood types:

• A positive or A negative
• B positive or B negative
• AB positive or AB negative
• O positive or O negative

Description: The Glucose 6 Phosphate Dehydrogenase, or G6PD, test is used to determine if you inherited a G6PD deficiency.

Also Known As: G6PD Test, G6PD Enzyme Test, RBC G6PD test, G-6-P-D Test

Collection Method: Blood Draw

Specimen Type: Whole Blood

Test Preparation: No preparation required

Average Processing Time: 4 to 5 days

When is a Glucose-6-Phosphate Dehydrogenase test ordered?

When a person develops signs and symptoms of hemolytic anemia, G6PD enzyme testing is done. When someone has experienced an episode of elevated RBC destruction but the crisis has passed, testing may be done.

When other lab test findings point to hemolytic anemia, testing may be performed. 

When alternative causes of anemia and jaundice have been eliminated and several weeks have passed since an acute episode, G6PD activity testing is usually recommended.

If available, newborn screening can be done in the first day or two after birth.

What does a Glucose-6-Phosphate Dehydrogenase blood test check for?

The enzyme glucose-6-phosphate dehydrogenase is involved in the creation of energy. It is found in all cells, including red blood cells, and aids in the protection of these cells against some hazardous by-products of cellular metabolism. RBCs with a G6PD deficit are more susceptible to splitting apart under specific situations. To assist diagnose a deficit, this test analyzes the quantity of G6PD in RBCs.

G6PD insufficiency is a hereditary condition. When people who have inherited this illness are exposed to a trigger like stress, infection, certain medicines, or another substance, the structure of their red blood cells changes significantly. Heinz bodies are deposits formed by hemoglobin, the life-sustaining, oxygen-transporting protein found in RBCs. When exposed to fava beans, some people have these symptoms, which is known as "favism." RBCs might break apart more easily as a result of these alterations, resulting in a reduction in the quantity of RBCs. Hemolytic anemia occurs when the body is unable to manufacture enough RBCs to replace those that have been destroyed. Symptoms include jaundice, weakness, exhaustion, and/or shortness of breath.

G6PD insufficiency is the most common enzyme deficiency, affecting over 400 million individuals worldwide. It can be found in as many as 10% of African-American men and 20% of African men. People from the Mediterranean and Southeast Asia are also susceptible.

Due to mutations or alterations in the G6PD gene that produce lower enzyme activity, G6PD deficiency is inherited and handed down from parent to kid. G6PD insufficiency has approximately 440 different forms. The G6PD gene is found on the X chromosome, which is inherited from both parents. Because men have only one X and one Y chromosome, the G6PD gene is only found on the X chromosome. If a guy gets the single X chromosome with a mutated gene, he may have G6PD deficiency.

Women inherit two copies of the G6PD gene since they have two X chromosomes. Women with only one mutant gene produce enough G6PD to show no symptoms most of the time, although they may show a minor version of the deficit in stressful settings. A mother can also carry the single altered gene to any male children she has. Women with two defective gene copies, which could lead to G6PD deficiency, are uncommon.

In infants, G6PD deficiency is a prevalent cause of chronic jaundice. This can result in substantial brain damage and mental impairment if left untreated.

The majority of persons with G6PD deficiency can live relatively normal lives, however there is no specific treatment for it other than prevention. They must be cautious and avoid pharmaceuticals like aspirin, phenazopyridine, and rasburicase, as well as antibiotics with "sulf" in the name and dapsone, anti-malarial treatments with "quine" in the name, foods like fava beans, and chemical chemicals like naphthalene. Fava beans, often known as broad beans, are widely farmed in the Mediterranean region. Acute viral and bacterial infections can cause hemolytic anemia and blood acid levels to rise. Individuals should seek a thorough list of these triggers from their healthcare provider. The list on the G6PD Deficiency Favism Association website is a nice place to start.

RBCs are destroyed at a faster rate in hemolytic anemia, and the person affected feels pale and tired as their ability to provide oxygen to their body decreases. Jaundice can be observed in severe cases of RBC breakdown. The majority of these episodes are self-limiting, but if a substantial number of RBCs are lost and the body is unable to replenish them quickly enough, the affected person may require a blood transfusion. If not addressed, this illness can be fatal. Chronic anemia can afflict a small number of people with G6PD deficiency.

Lab tests often ordered with a Glucose-6-Phosphate Dehydrogenase test:

• Complete Blood Count (CBC)
• Reticulocyte Count
• Bilirubin
• Hemoglobin
• Red Blood Cell Count
• Lactate Dehydrogenase (LD)
• Haptoglobin

Conditions where a Glucose-6-Phosphate Dehydrogenase test is recommended:

• Hemolytic Anemia

How does my health care provider use a Glucose-6-Phosphate Dehydrogenase test?

The enzyme assay for glucose-6-phosphate dehydrogenase is used to screen for and diagnose G6PD deficiency. It could be used to screen children who were born with unexplained chronic jaundice. Currently, babies are not routinely tested for G6PD deficiency; however, this depends on the state that offers the service. According to the National Newborn Screening and Genetics Resource Center, two states, Pennsylvania and the District of Columbia, offer G6PD testing as part of their newborn screening panel as of November 2014.

G6PD is an enzyme present in all cells, including red blood cells, that protects them against hazardous by-products of cellular metabolism. RBCs with a G6PD deficit are more susceptible to splitting apart under specific situations.

People of any age who have experienced unexplained episodes of hemolytic anemia, jaundice, or dark urine may benefit from G6PD testing to assist establish a diagnosis. G6PD deficiency may be suspected if the person had a recent viral or bacterial illness or was exposed to a recognized trigger, followed by a hemolytic event.

G6PD testing may be repeated on occasion to validate initial findings. A simple qualitative test is usually used in screening tests to determine if a person has a high amount of G6PD in his or her cells. A quantitative test will be used to determine the actual quantity of enzyme activity during confirmation testing.

G6PD levels are normal in newly generated cells in the most prevalent form of G6PD deficiency seen in people of African heritage, but decline by up to 75% as RBCs age. As a result, testing should be delayed for several weeks after a hemolytic episode has passed. The older, more fragile G6PD-deficient RBCs are often killed during the episode, leaving the newer, less deficient cells to be tested, potentially hiding a G6PD deficiency.

Although genetic testing is not commonly performed, it can be requested as a follow-up to an enzyme test that suggests a deficiency in order to discover which G6PD mutations are present. There are currently around 440 G6PD gene variants that can produce varied degrees of deficiency based on the mutation and the specific person. Some mutations have no effect on the activity of the G6PD enzyme. The G6PD mutations have been divided into five groups by the World Health Organization, depending on the enzyme levels and their influence on the affected person's health. During testing, however, only the most prevalent G6PD mutations are discovered. If a certain mutation is known to exist in a family line, tests to detect that mutation can be performed.

What do my Glucose-6-Phosphate Dehydrogenase test results mean?

A deficit is indicated by a low level of G6PD enzyme. When exposed to a trigger, an affected person is more likely to develop symptoms. However, the findings cannot be utilized to forecast how an affected individual will react in a specific situation. Symptom severity varies from person to person and from episode to episode.

If a male has a normal G6PD enzyme level, he is unlikely to have a deficit, and if anemia is present, it is most likely due to another cause. If the test was done during a bout of hemolytic anemia, it should be redone several weeks later once the RBC population has replenished and matured.

Carriers, who have one mutant and one normal gene copy, will have some G6PD-deficient RBCs and others that are not. G6PD levels in these women are normally normal or near normal, and they rarely exhibit symptoms. A carrier will have a normal or low normal G6PD level, therefore they may not be discovered by G6PD screening, but they will be detected by a G6PD confirmation test, which measures the overall quantity of enzyme present in the cells. It's worth noting that a rare female with two defective gene copies will almost certainly have a large drop in G6PD levels.

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

Description: A Hemoglobin (Hgb) test is a blood test that measures the amount of hemoglobin your red blood cells contain.

Also Known As: Hb Test, Hgb Test

Collection Method: Blood Draw

Specimen Type: Whole Blood

Test Preparation: No preparation required

Average Processing Time: 1 to 2 days

When is a Hemoglobin test ordered?

The hemoglobin test may be requested as part of a general health assessment or when a person exhibits signs and symptoms of a red blood cell disorder such as anemia or polycythemia.

When someone has been diagnosed with recurrent bleeding difficulties, chronic anemias, or polycythemia, this test may be done numerous times or on a regular basis to check the effectiveness of treatment. It's also possible that it'll be ordered on a regular basis for those having therapy for cancers that are known to harm the bone marrow.

What does a Hemoglobin blood test check for?

Hemoglobin is an iron-containing protein found in all red blood cells, which gives them their distinctive red color. RBCs use hemoglobin to bind to oxygen in the lungs and transport it to tissues and organs all over the body. It also aids in the movement of a little amount of carbon dioxide, which is a byproduct of cell metabolism, from tissues and organs to the lungs, where it is exhaled.

The hemoglobin test determines how much hemoglobin is present in a person's blood sample. To swiftly assess an individual's red blood cells, a hemoglobin level can be used alone or in conjunction with a hematocrit, a test that assesses the fraction of blood made up of RBCs. Red blood cells, which account for roughly 40% of the amount of blood, are created in the bone marrow and released into the bloodstream when they are mature, or nearly so. RBCs have a 120-day lifespan, and the bone marrow must constantly manufacture new RBCs to replace those that have aged and degraded or have been lost due to hemorrhage.

RBCs, and thus the level of hemoglobin in the blood, can be affected by a variety of diseases and situations. When the quantity of red blood cells grows, the hemoglobin level and hematocrit both rise. When the synthesis of RBCs by the bone marrow decreases, RBC destruction increases, or blood is lost owing to hemorrhage, the hemoglobin level and hematocrit fall below normal. Anemia is a disorder in which the body's tissues and organs do not acquire enough oxygen, causing exhaustion and weakness. It is caused by a decline in RBC count, hemoglobin, and hematocrit. Polycythemia occurs when the body produces too many RBCs, causing the blood to thicken, resulting in sluggish blood flow and other complications.

Lab tests often ordered with a Hemoglobin test:

• Complete Blood Count (CBC)
• Hematocrit
• Red Blood Cell Count (RBC Count)
• Blood Smear
• Iron Total
• Ferritin
• Reticulocyte Count
• Vitamin B12
• Folate
• Red Cell Indices
• G6PD
• Erythropoietin
• Hemoglobinopathy Evaluation

Conditions where a Hemoglobin test is recommended:

• Anemia
• Sickle Cell Anemia
• Thalassemia
• Myeloproliferative Neoplasms
• Hemoglobin Abnormalities
• Bone Marrow Disorders

How does my health care provider use a Hemoglobin test?

Anemia is commonly detected with a hemoglobin test in conjunction with a hematocrit or as part of a complete blood count. The test can be used to detect, diagnose, or track a variety of illnesses and disorders that impact red blood cells and/or hemoglobin levels in the blood. All red blood cells include hemoglobin, an iron-containing protein that allows RBCs to bind to oxygen in the lungs and transport it to tissues and organs throughout the body.

A hemoglobin test can be used for a variety of purposes, including:

• Anemia and polycythemia are diagnosed, diagnosed, and measured.
• Assess the patient's reaction to anemia or polycythemia treatment.
• If the anemia is severe, you can help make decisions about blood transfusions or other therapies.

Some factors influence RBC production in the bone marrow, resulting in an increase or decrease in the quantity of mature RBCs discharged into the bloodstream. The longevity of RBCs in the circulation can be influenced by a variety of factors. The overall amount of RBCs and hemoglobin will diminish if there is greater destruction of RBCs or loss of RBCs through bleeding, and/or the bone marrow is unable to make new ones quickly enough, leading in anemia.

This test can tell you if you have an issue with red blood cell production or longevity, but it can't tell you what's causing it. A blood smear, reticulocyte count, iron studies, vitamin B12 and folate levels, and, in more severe cases, a bone marrow examination are some of the other tests that may be conducted at the same time or as follow-up to establish a reason.

What do my Hemoglobin test results mean?

Because hemoglobin levels are frequently measured as part of a complete blood count, the results of other components are taken into account. Hemoglobin levels must be interpreted in conjunction with other indicators such as RBC count, hematocrit, reticulocyte count, and/or red blood cell indices when they rise or fall. Other characteristics to consider are age, gender, and race. Hemoglobin reflects the RBC count and hematocrit results in general.

Anemia is defined as a low hemoglobin level combined with a low RBC count and a low hematocrit. Among the causes are:

• Excessive blood loss-as a result of severe trauma or continuous bleeding from the digestive tract, bladder, or uterus.
• Iron, folate, or B12 deficiency are examples of nutritional inadequacies.
• Toxins, radiation, chemotherapy, infection, and medicines can all cause damage to the bone marrow.
• Myelodysplastic syndrome, aplastic anemia, or tumors of the bone marrow, such as lymphoma, leukemia, multiple myeloma, or other cancers of the bone marrow
• Renal failure—severe and chronic kidney illnesses cause the kidneys to produce less erythropoietin, a hormone that drives RBC synthesis in the bone marrow.
• Inflammatory diseases or disorders that last a long time
• Hemoglobin production is reduced.
• Excessive destruction of red blood cells, such as hemolytic anemia caused by autoimmunity or faults in the red blood cell itself, such as hemoglobinopathy, RBC membrane abnormalities, or RBC enzyme.

Polycythemia is defined as a high hemoglobin level combined with a high RBC count and hematocrit. Among the causes are:

• Lung disease-when a person's body is unable to breathe in and absorb enough oxygen. As a result, the body produces more red blood cells to compensate.
• Congenital heart disease—in some cases, an improper connection between the two sides of the heart occurs, resulting in lower blood oxygen levels. The body responds by creating extra red blood cells in an attempt to compensate.
• Excess erythropoietin-producing kidney tumors
• Hemoglobin levels in heavy smokers are higher than in nonsmokers.
• Genetic factors
• Having to live at a high altitude
• Dehydration causes hemoglobin to rise unnaturally when the volume of liquid in the blood declines.
• Polycythemia vera-a rare condition in which the body creates too many RBCs.

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

Description: Reticulocytes are red blood cells that are not fully developed yet. The reticulocyte test is used to measure the amount of underdeveloped red blood cells.

Also Known As: Retic Count Reticulocyte Percent Test, Reticulocyte Index Test, Corrected Reticulocyte Test, Reticulocyte Production Index Test, RPI Test

Collection Method: Blood Draw

Specimen Type: Whole Blood

Test Preparation: No preparation required

Average Processing Time: 2 to 3 days

When is a Reticulocyte Count test ordered?

A reticulocyte count may be requested in the following situations:

• A low RBC count, as well as a low hemoglobin and hematocrit, are found on a complete blood count.
• A doctor wants to check the function of the bone marrow.
• Paleness, loss of energy, exhaustion, weakness, shortness of breath, and/or blood in the stool are signs and symptoms of anemia or persistent bleeding.
• A disorder known to impact RBC production, such as iron deficiency anemia, vitamin B12 or folate deficiency, or renal illness, has been recognized and is being treated.
• A person is receiving radiation or chemotherapy.
• A bone marrow transplant has been performed.

When a person has an increased quantity of RBCs and an elevated hemoglobin and hematocrit, a blood test is performed to evaluate the degree and pace of RBC overproduction.

What does a Reticulocyte Count blood test check for?

Reticulocytes are young red blood cells that have just been created. The number and/or percentage of reticulocytes in the blood is determined by a reticulocyte test, which is a reflection of recent bone marrow function or activity.

Red blood cells are made in the bone marrow, where blood-forming stem cells differentiate and grow into reticulocytes, which then mature into mature RBCs. When compared to mature RBCs, reticulocytes have a volume of about 24 percent more. Although adult RBCs do not have a nucleus like most other cells in the body, reticulocytes still contain some genetic material. Reticulocytes lose the last traces of RNA as they mature, and most of them are fully matured within a day of being released from the bone marrow into the bloodstream. The reticulocyte count or percentage is an excellent measure of a person's ability to manufacture enough red blood cells in their bone marrow.

RBCs last around 120 days in circulation, and the bone marrow must constantly manufacture new RBCs to replace those that have aged and degraded or have been lost due to hemorrhage. Normally, a steady number of RBCs is maintained in the blood by replacing deteriorated or lost RBCs on a regular basis.

A range of diseases and conditions, including those that cause severe bleeding, can impair the creation of new RBCs and/or their survival. These situations can cause an increase or decrease in the number of RBCs, as well as a change in the reticulocyte count.

Reticulocyte % higher than normal: Anemia is caused by a lack of RBCs in the blood due to acute or chronic bleeding or enhanced RBC breakdown (hemolysis). The body adjusts for this loss or responds to deficiency anemia treatment by increasing RBC production and releasing RBCs into the bloodstream before they mature. When this happens, the number and percentage of reticulocytes in the blood grows until the bone marrow's production capacity is reached or until a sufficient number of RBCs replaces those that were lost.

A lower-than-normal percentage of reticulocytes: When the bone marrow isn't working properly, RBC production can suffer. A bone marrow condition, such as aplastic anemia, can cause this. Other causes that might cause decreased production include liver cirrhosis, kidney disease, cancer treatments such as radiation or chemotherapy, a low amount of the hormone erythropoietin, or dietary shortages such as iron, vitamin B12, or folate. As old RBCs are eliminated from the blood but not entirely replaced, there are fewer RBCs in circulation, poorer hemoglobin and oxygen-carrying capacity, a lower hematocrit, and a lower number of reticulocytes.

Due to excessive RBC production by the bone marrow, both the reticulocyte and RBC counts might occasionally rise. This could be caused by increased erythropoietin production, diseases that cause chronic RBC overproduction (polycythemia vera), or cigarette smoking.

Some medications can increase or reduce the number of reticulocytes in the body.

Lab tests often ordered with a Reticulocyte Count test:

• Complete Blood Count (CBC)
• Red Blood Cell Count
• Hemoglobin
• Hematocrit
• Blood Smear
• Erythropoietin
• Vitamin B12
• Folate
• Haptoglobin
• G6PD
• Iron Total
• Iron and Total Iron Binding Capacity
• Ferritin

Conditions where a Reticulocyte Count test is recommended:

• Anemia
• Bone Marrow Disorders
• Myeloproliferative Neoplasms

How does my health care provider use a Reticulocyte Count test?

A reticulocyte test is used to assess the number and/or percentage of reticulocytes in the blood to aid in the diagnosis of red blood cell abnormalities such as anemia and bone marrow illnesses. Reticulocytes are young red blood cells that have just been created. Before being released into the circulation, they develop and mature in the bone marrow.

The reticulocyte test can be used in the following situations:

• To help determine the reason of aberrant results on a complete blood count, RBC count, hemoglobin, or hematocrit.
• To see if the bone marrow is appropriately functioning and reacting to the body's need for red blood cells.
• To aid in the detection and differentiation of various kinds of anemia
• To track how well people are responding to treatments, such as those for iron deficiency anemia.
• To track the activity of the bone marrow after therapies like chemotherapy.
• To keep track of how well you're doing after a bone marrow transplant.

A reticulocyte count is usually done using an automated device and can be done in conjunction with a complete blood count, which includes an RBC count, hemoglobin, and hematocrit. It is possible to report either an absolute number of reticulocytes or a percentage of reticulocytes. The number of reticulocytes is compared to the total number of red blood cells as a percentage:

[ Number of Reticulocytes / Total Red Blood Cells ] X 100 = Reticulocyte Percentage

Several more tests, in addition to a reticulocyte count, can be done to further screen someone for a disorder that affects RBC production. Here are a few examples:

• Iron testing
• Haptoglobin
• G6PD
• Erythropoietin
• Vitamin B12 and Folate

Following up on abnormal results from early tests, a bone marrow aspiration and biopsy may be performed. This is an invasive operation that is not performed on everyone. If necessary, it can, however, supply extra information.

What do my reticulocyte count test results mean?

The results must be carefully evaluated in conjunction with the results of other tests, such as a red blood cell count, hemoglobin, hematocrit, or a complete blood count. The reticulocyte count, in general, reflects recent bone marrow activity. The results could reveal whether a disease or condition is present that is causing an elevated need for new RBCs, as well as whether the bone marrow is capable of meeting that demand. Overproduction of RBCs may be detected in some cases.

When anemia is present and the bone marrow responds adequately to the demand for more RBCs, the bone marrow will create more and allow for the early release of more immature RBCs, resulting in an increase in the number of reticulocytes in the blood.

A high reticulocyte count along with low RBCs, hemoglobin, and hematocrit may indicate the following conditions:

• When a person bleeds, the number of reticulocytes increases after a few days to make up for the loss of red blood cells. If someone has chronic blood loss, the marrow will try to keep up with the need for new RBCs by increasing the number of reticulocytes.
• Anemia is caused by an increase in the breakdown of RBCs in hemolytic anemia. To compensate, the bone marrow boosts RBC production, resulting in a high reticulocyte count.
• Hemolytic illness of the newborn: Similar to hemolytic anemia, this syndrome causes an increase in RBC destruction.

For example, a low reticulocyte count with low hemoglobin, low red blood cells, and low hematocrit can be detected when:

• Anemia due to a lack of iron
• Folic acid deficiency or pernicious anemia
• Aplastic anemia is a kind of anemia that occurs when the
• Radiation therapy is a type of treatment that uses a
• Infection or malignancy can induce bone marrow failure.
• A low level of erythropoietin can be caused by severe kidney disease.
• Alcoholism
• Endocrine illness

When a person has anemia, the percentage of reticulocytes in their blood may appear to be higher than the total number of RBCs. A calculation known as a corrected reticulocyte count or reticulocyte index may be reported to get a more accurate estimate of bone marrow function. When a person's hematocrit is compared to a normal hematocrit reading, the RI is computed. The reticulocyte production index and an immature reticulocyte fraction are two more estimates that may be presented. The IRF was once known as the reticulocyte maturity index, but it is currently the most widely used phrase to describe the younger percentage of reticulocytes.

The existence of a disease or condition is indicated by the reticulocyte test, however it is not specifically diagnostic of any disease. It's a warning that more research is needed, as well as a method for monitoring therapy effectiveness.

When reticulocyte numbers increase after chemotherapy, a bone marrow transplant, or treatment for an iron, vitamin B12, or folate shortage, bone marrow RBC production is on the mend.

A high reticulocyte count can indicate an overproduction of RBCs in people who do not have anemia or have a high RBC count. This can be caused by a variety of factors, including:

• Polycythemia vera
• Excess erythropoietin-producing tumor

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

Description: The Erythropoietin test measures levels of the hormone erythropoietin in your blood’s serum and is generally used to identify the cause of anemia.

Also Known As: EPO Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: Due to diurnal variation, it is recommended that specimens be collected between 7: 30am and noon

Average Processing Time: 3 to 4 days

When is an Erythropoietin test ordered?

When a person develops anemia that does not seem to be due to iron deficiency, vitamin B12 or folate deficiency, shortened red blood cell lifespan, or heavy bleeding, a test for erythropoietin may be prescribed. It may be requested when the reticulocyte count is either improperly normal or lowered and the RBC count, hemoglobin, and hematocrit are all decreasing.

When a medical professional has reason to believe that renal dysfunction could be connected to a decline in erythropoietin production in a patient with chronic kidney disease, erythropoietin levels may be requested.

When a complete blood count test reveals that a person has an elevated RBC count along with a high hematocrit and hemoglobin, an EPO test may be required.

When a medical professional has a suspicion that a patient has a bone marrow condition such myeloproliferative neoplasms or myelodysplastic syndrome, they may prescribe an EPO test.

What does an Erythropoietin blood test check for?

The hormone called erythropoietin is largely produced by the kidneys. It is essential for the development of red blood cells, which transport oxygen from the lungs to the body's tissues. Erythropoietin levels in the blood are determined by this test.

When blood oxygen levels are low, the kidneys generate and release erythropoietin into the blood. The transport of EPO to the bone marrow increases the formation of red blood cells. The hormone only lasts a little time before being removed from the body in the urine.

The kidneys' capacity to manufacture erythropoietin and the oxygen saturation level determine how much of it is released. Erythropoietin is produced and released at higher rates until blood oxygen levels return to normal or close to normal levels, at which point production of the hormone declines. This dynamic feedback system is used by the body to maintain a constant blood RBC count and adequate oxygen levels.

However, if a person has damaged kidneys and does not produce enough erythropoietin, too few RBCs are created and the person usually becomes anemic. Similar to this, a person may develop anemia if their bone marrow is unable to respond to the stimulation provided by EPO. Some bone marrow problems and chronic illnesses like rheumatoid arthritis might cause this.

People with illnesses like lung ailments that affect how much oxygen they breathe in may manufacture more EPO to try and make up for the low oxygen level. Both persistent smokers of tobacco and people who reside at high altitudes may have greater levels of EPO.

Too many RBCs may be created if erythropoietin is produced in excess, as is the case with a number of different malignancies as well as some benign or malignant kidney tumors. This can cause the blood to become thicker and occasionally cause high blood pressure, blood clots, heart attacks, or strokes. Rarely, polycythemia is brought on by the bone marrow condition polycythemia vera rather than by an excess of erythropoietin.

Lab tests often ordered with an Erythropoietin test:

• Red Blood Cell Count
• Hemoglobin
• Hematocrit
• Complete Blood Count (CBC)
• Reticulocyte Count
• JAK2 Mutation

Conditions where an Erythropoietin test is recommended:

• Anemia
• Kidney Disease
• Bone Marrow Disorders

How does my health care provider use an Erythropoietin test?

The main purpose of an erythropoietin test is to identify the root of anemia. Candidates for erythropoietin replacement therapy can be found with its aid. It may also be used to assess a bone marrow problem or to assist in determining the origin of an excess of red blood cells.

An EPO test is typically requested as a follow-up to aberrant CBC results, such as low RBC count, hemoglobin, or hematocrit levels. These tests identify the existence and degree of anemia and provide the doctor with information about the anemia's most likely cause. To assist identify whether low EPO may be contributing to or escalating the anemia, erythropoietin testing is prescribed.

The test may be prescribed in cases of chronic renal disease to determine whether the kidneys are still capable of producing enough erythropoietin. Erythropoietin replacement therapy may help boost red blood cell synthesis in the bone marrow if the amount of erythropoietin is low.

To help identify whether the extra production of RBCs is caused by an overproduction of erythropoietin or some other cause, an erythropoietin test may occasionally be requested as a follow-up to CBC findings that reveal an increased number of RBCs.

What do my Erythropoietin test results mean?

A person may not be producing enough erythropoietin if they are anemic and their erythropoietin levels are low or normal.

When erythropoietin levels are elevated in an anemic individual, the anemia may be brought on by a vitamin or iron shortage, a bone marrow condition, or both.

It is likely that extra erythropoietin is being created by the kidneys or by other body tissues if a person has too many red blood cells and their erythropoietin levels are elevated. The name for this disorder is secondary polycythemia.

The reason of the polycythemia is probably unrelated to the synthesis of erythropoietin if there is excessive RBC production and erythropoietin levels are normal or low. The name for this disorder is primary polycythemia.

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

Description: A Comprehensive Metabolic Panel or CMP is a blood test that is a combination of a Basic Metabolic Panel, a Liver Panel, and electrolyte panel, and is used to screen for, diagnose, and monitor a variety of conditions and diseases such as liver disease, diabetes, and kidney disease. 

Also Known As: CMP, Chem, Chem-14, Chem-12, Chem-21, Chemistry Panel, Chem Panel, Chem Screen, Chemistry Screen, SMA 12, SMA 20, SMA 21, SMAC, Chem test

Collection Method: Blood Draw 

Specimen Type: Serum 

Test Preparation: 9-12 hours fasting is preferred.

Average Processing Time: 1 to 2 days 

When is a Comprehensive Metabolic Panel test ordered:  

A CMP is frequently requested as part of a lab test for a medical evaluation or yearly physical. A CMP test consists of many different tests that give healthcare providers a range of information about your health, including liver and kidney function, electrolyte balance, and blood sugar levels. To confirm or rule out a suspected diagnosis, abnormal test results are frequently followed up with other tests that provide a more in depth or targeted analysis of key areas that need investigating. 

What does a Comprehensive Metabolic Panel blood test check for? 

The complete metabolic panel (CMP) is a set of 20 tests that provides critical information to a healthcare professional about a person's current metabolic status, check for liver or kidney disease, electrolyte and acid/base balance, and blood glucose and blood protein levels. Abnormal results, particularly when they are combined, can suggest a problem that needs to be addressed. 

The following tests are included in the CMP: 

• Albumin: this is a measure of Albumin levels in your blood. Albumin is a protein made by the liver that is responsible for many vital roles including transporting nutrients throughout the body and preventing fluid from leaking out of blood vessels. 

• Albumin/Globulin Ratio: this is a ratio between your total Albumin and Globulin  

• Alkaline Phosphatase: this is a measure of Alkaline phosphatase or ALP in your blood. Alkaline phosphatase is a protein found in all body tissues, however the ALP found in blood comes from the liver and bones. Elevated levels are often associated with liver damage, gallbladder disease, or bone disorder. 

• Alt: this is a measure of Alanine transaminase or ALT in your blood. Alanine Aminotransferase is an enzyme found in the highest amounts in the liver with small amounts in the heart and muscles. Elevated levels are often associated with liver damage. 

• AST: this is a measure of Aspartate Aminotransferase or AST. Aspartate Aminotransferase is an enzyme found mostly in the heart and liver, with smaller amounts in the kidney and muscles. Elevated levels are often associated with liver damage. 

• Bilirubin, Total: this is a measure of bilirubin in your blood. Bilirubin is an orange-yellowish waste product produced from the breakdown of heme which is a component of hemoglobin found in red blood cells. The liver is responsible for removal of bilirubin from the body. 

• Bun/Creatinine Ratio: this is a ratio between your Urea Nitrogen (BUN) result and Creatinine result.  

• Calcium: this is a measurement of calcium in your blood. Calcium is the most abundant and one of the most important minerals in the body as it essential for proper nerve, muscle, and heart function. 

• Calcium: is used for blood clot formation and the formation and maintenance of bones and teeth. 

• Carbon Dioxide: this is a measure of carbon dioxide in your blood. Carbon dioxide is a negatively charged electrolyte that works with other electrolytes such as chloride, potassium, and sodium to regulate the body’s acid-base balance and fluid levels.  

• Chloride: this is a measure of Chloride in your blood. Chloride is a negatively charged electrolyte that works with other electrolytes such as potassium and sodium to regulate the body’s acid-base balance and fluid levels. 

• Creatinine: this is a measure of Creatinine levels in your blood. Creatinine is created from the breakdown of creatine in your muscles and is removed from your body by the kidneys. Elevated creatinine levels are often associated with kidney damage. 

• Egfr African American: this is a measure of how well your kidneys are functioning. Glomeruli are tiny filters in your kidneys that filter out waste products from your blood for removal while retaining important substances such as nutrients and blood cells. 

• Egfr Non-Afr. American: this is a measure of how well your kidneys are functioning. Glomeruli are tiny filters in your kidneys that filter out waste products from your blood for removal while retaining important substances such as nutrients and blood cells. 

• Globulin: this is a measure of all blood proteins in your blood that are not albumin. 

• Glucose: this is a measure of glucose in your blood. Glucose is created from the breakdown of carbohydrates during digestion and is the body’s primary source of energy. 

• Potassium: this is a measure of Potassium in your blood. Potassium is an electrolyte that plays a vital role in cell metabolism, nerve and muscle function, and transport of nutrients into cells and removal of wastes products out of cells. 

• Protein, Total: this is a measure of total protein levels in your blood. 
  Sodium: this is a measure of Sodium in your blood. Sodium is an electrolyte that plays a vital role in nerve and muscle function. 

• Sodium: this is a measure of sodium in your blood's serum. Sodium is a vital mineral for nerve and muscle cell function.

• Urea Nitrogen (Bun): this is a measure of Urea Nitrogen in your blood, also known as Blood UreaNitrogen (BUN). Urea is a waste product created in the liver when proteins are broken down into amino acids. Elevated levels are often associated with kidney damage. 

Lab tests often ordered with a Comprehensive Metabolic Panel test: 

• Complete Blood Count with Differential and Platelets
• Iron and Total Iron Binding Capacity
• Lipid Panel
• Vitamin B12 and Folate
• Prothrombin with INR and Partial Thromboplastin Times
• Sed Rate (ESR)
• C-Reactive Protein

Conditions where a Comprehensive Metabolic Panel test is recommended: 

• Diabetes
• Kidney Disease
• Liver Disease
• Hypertension

Commonly Asked Questions: 

How does my health care provider use a Comprehensive Metabolic Panel test? 

The comprehensive metabolic panel (CMP) is a broad screening tool for assessing organ function and detecting diseases like diabetes, liver disease, and kidney disease. The CMP test may also be requested to monitor known disorders such as hypertension and to check for any renal or liver-related side effects in persons taking specific drugs. If a health practitioner wants to follow two or more separate CMP components, the full CMP might be ordered because it contains more information. 

What do my Comprehensive Metabolic Panel test results mean? 

The results of the tests included in the CMP are usually analyzed together to look for patterns. A single abnormal test result may indicate something different than a series of abnormal test findings. A high result on one of the liver enzyme tests, for example, is not the same as a high result on several liver enzyme tests. 

Several sets of CMPs, frequently performed on various days, may be examined to gain insights into the underlying disease and response to treatment, especially in hospitalized patients. 

Out-of-range findings for any of the CMP tests can be caused by a variety of illnesses, including kidney failure, breathing issues, and diabetes-related complications, to name a few. If any of the results are abnormal, one or more follow-up tests are usually ordered to help determine the reason and/or establish a diagnosis. 

Is there anything else I should know? 

A wide range of prescription and over-the-counter medications can have an impact on the results of the CMP's components. Any medications you're taking should be disclosed to your healthcare professional. Similarly, it is critical to provide a thorough history because many other circumstances can influence how your results are interpreted. 

What's the difference between the CMP and the BMP tests, and why would my doctor choose one over the other? 

The CMP consists of 14 tests, while the basic metabolic panel (BMP) is a subset of those with eight tests. The liver (ALP, ALT, AST, and bilirubin) and protein (albumin and total protein) tests are not included. If a healthcare provider wants a more thorough picture of a person's organ function or to check for specific illnesses like diabetes or liver or kidney disease, he or she may prescribe a CMP rather than a BMP. 

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

Please note the following regarding BUN/Creatinine ratio: 

The lab does not report the calculation for the BUN/Creatinine Ratio unless one or both biomarkers’ results fall out of the published range. 

If you still wish to see the value, it's easy to calculate. Simply take your Urea Nitrogen (BUN) result and divide it by your Creatinine result.  

As an example, if your Urea Nitrogen result is 11 and your Creatinine result is 0.86, then you would divide 11 by 0.86 and get a BUN/Creatinine Ratio result of 12.79. 

Babesia serological testing is used to diagnose infection by the Babesia tick-borne protozoan. Infection may cause hemolytic anemia.

Description: Bilirubin Fractionated is a blood test that is used to screen for or monitor liver disorders, hemolytic anemia, and neonatal jaundice.

Also Known As: Total Bilirubin Test, TBIL Test, Neonatal Bilirubin Test, Direct Bilirubin Test, Conjugated Bilirubin Test, Indirect Bilirubin Test, Unconjugated Bilirubin Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

Average Processing Time: 1 to 2 days

When is a Bilirubin, Fractionated test ordered?

When someone shows evidence of abnormal liver function, a doctor will usually request a bilirubin test along with other laboratory tests. A bilirubin test may be ordered when a patient:

• Evidence of jaundice is visible.
• Has a history of excessive alcohol consumption
• Has a possible drug toxicity
• Has been exposed to viruses that cause hepatitis

Other signs and symptoms to look out for include:

• Urine with a dark amber tint.
• Nausea/vomiting
• Swelling and/or pain in the abdomen
• Fatigue and malaise which are common symptoms of chronic liver disease.

In babies with jaundice, measuring and monitoring bilirubin is considered routine medical therapy.

When someone is suspected of hemolytic anemia as a cause of anemia, bilirubin tests may be ordered. In this instance, it's frequently ordered in conjunction with other hemolysis-related tests such a complete blood count, reticulocyte count, haptoglobin, and LDH.

What does a Bilirubin, Fractionated blood test check for?

Bilirubin is an orange-yellow pigment that is largely formed as a byproduct of heme degradation. Heme is a component of hemoglobin, a red blood cell protein. Bilirubin is eventually digested by the liver, which allows it to be excreted from the body. This test assesses a person's liver function or aids in the diagnosis of anemias caused by RBC destruction by measuring the quantity of bilirubin in their blood.

After roughly 120 days in circulation, RBCs generally disintegrate. Heme is transformed to bilirubin as it is released from hemoglobin. Unconjugated bilirubin is another name for this type of bilirubin. Proteins transport unconjugated bilirubin to the liver, where sugars are linked to bilirubin to produce conjugated bilirubin. Conjugated bilirubin enters the bile and travels from the liver to the small intestines, where bacteria break it down further before it is excreted in the stool. As a result, bilirubin breakdown products give stool its distinctive brown hue.

A normal, healthy human produces a tiny quantity of bilirubin each day. The majority of bilirubin comes from damaged or degraded RBCs, with the rest coming from bone marrow or the liver. Small amounts of unconjugated bilirubin are normally discharged into the bloodstream, but there is almost no conjugated bilirubin. Laboratory tests can measure or estimate both types, and a total bilirubin result can be presented as well.

A person may appear jaundiced, with yellowing of the skin and/or whites of the eyes, if the bilirubin level in their blood rises. The pattern of bilirubin test results can provide information to the health care provider about the ailment that may be present. When there is an exceptional quantity of RBC destruction or when the liver is unable to handle bilirubin, unconjugated bilirubin levels may rise. Conversely, conjugated bilirubin levels can rise when the liver can process bilirubin but not transmit the conjugated bilirubin to the bile for elimination; this is most commonly caused by acute hepatitis or bile duct blockage.

In the first few days after birth, increased total and unconjugated bilirubin levels are fairly common in infants. This condition is known as "physiologic jaundice of the newborn," and it develops when the liver of a newborn is not yet mature enough to handle bilirubin. Physiologic jaundice in newborns usually goes away after a few days. RBCs may be damaged in newborn hemolytic illness due to blood incompatibility between the infant and the mother; in these circumstances, treatment may be necessary since large amounts of unconjugated bilirubin might harm the newborn's brain.

Increased total and conjugated bilirubin levels in infants can be caused by biliary atresia, an uncommon but life-threatening congenital disease. To avoid catastrophic liver damage that may necessitate liver transplantation during the first few years of life, this problem must be rapidly recognized and treated, usually with surgery. Despite early surgical therapy, some children may require liver transplants.

Lab tests often ordered with a Bilirubin, Fractionated test:

• CMP
• ALT
• ALP
• AST
• Hepatitis A
• Hepatitis B
• Hepatitis C
• Complete Blood Count (CBC)
• Urinalysis
• GGT
• Reticulocyte Count

Conditions where a Bilirubin, Fractionated test is recommended:

• Jaundice
• Liver Disease
• Hepatitis
• Alcoholism
• Hemolytic Anemia

Commonly Asked Questions:

How does my health care provider use a Bilirubin, Fractionated test?

A bilirubin test is used to detect an abnormally high quantity of the substance in the blood. It can be used to figure out what's causing your jaundice and/or diagnose illnesses like liver disease, hemolytic anemia, and bile duct blockage.

Bilirubin is an orange-yellow pigment that is largely formed as a byproduct of heme degradation. Heme is a component of hemoglobin, a red blood cell protein. Bilirubin is eventually digested by the liver, which allows it to be excreted from the body. An increased blood level can be caused by any disorder that speeds up the breakdown of RBCs or impairs the processing and elimination of bilirubin.

Laboratory testing can measure or estimate two types of bilirubin:

Unconjugated bilirubin—unconjugated bilirubin is formed when heme is released from hemoglobin. Proteins transport it to the liver. Small levels of the substance may be found in the blood.

Sugars are attached to bilirubin in the liver, resulting in conjugated bilirubin. It enters the bile and travels from the liver to the small intestines before being excreted in the feces. In normal circumstances, there is no conjugated bilirubin in the blood.

A chemical test is usually done to determine the total bilirubin level first. If the total bilirubin level rises, a second chemical test can be used to detect water-soluble forms of bilirubin, known as "direct" bilirubin. The amount of conjugated bilirubin present can be estimated using the direct bilirubin test. The "indirect" amount of unconjugated bilirubin can be estimated by subtracting the direct bilirubin level from the total bilirubin level. The pattern of bilirubin test results can provide information to the healthcare professional about the ailment that may be present.

Bilirubin is measured in adults and older children to:

• Diagnose and/or monitor liver and bile duct disorders.
• Evaluate patients with hemolytic anemia
• Distinguish between the causes of jaundice in babies.

Only unconjugated bilirubin is raised in both physiologic jaundice and hemolytic illness of the infant.

Damage to the newborn's liver from neonatal hepatitis and biliary atresia will also raise conjugated bilirubin concentrations, which is generally the first indication that one of these less common disorders is present.

Because excessive unconjugated bilirubin harms growing brain cells, it is critical to detect and treat an increased amount of bilirubin in a newborn. Mental retardation, learning and developmental impairments, hearing loss, eye movement disorders, and mortality are all possible outcomes of this damage.

What do my bilirubin test results mean?

In adults and children, increased total bilirubin, primarily unconjugated bilirubin, could be caused by:

• Hemolytic or pernicious anemia are two types of anemia.
• Reaction to a transfusion
• Cirrhosis
• Gilbert syndrome

When conjugated bilirubin levels are higher than unconjugated bilirubin levels, there is usually a problem with bilirubin removal by the liver cells. This can be caused by a variety of factors, including:

• Hepatitis caused by a virus
• Reactions to drugs
• Alcoholic hepatitis

When the bile ducts are blocked, conjugated bilirubin is raised more than unconjugated bilirubin. This can happen, for example, when:

• In the bile ducts, there are gallstones.
• Damaging of the bile ducts due to tumors

Increased bilirubin levels can also be caused by rare hereditary illnesses that involve aberrant bilirubin metabolism, such as Rotor, Dubin-Johnson, and Crigler-Najjar syndromes.

Low bilirubin levels are usually not a cause for worry and are not monitored.

A newborn's high bilirubin level may be transient and diminish within a few days to two weeks. However, if the bilirubin level exceeds a crucial threshold or rises rapidly, the cause must be investigated so that appropriate treatment can be started. Increased bilirubin levels can be caused by the rapid breakdown of red blood cells as a result of:

• Incompatibility of the mother's blood type with that of her child
• Infections that are present at birth
• oxygen deficiency
• Liver disease

Only unconjugated bilirubin is elevated in most of these disorders. In the rare disorders of biliary atresia and newborn hepatitis, increased conjugated bilirubin is found. To avoid liver damage, biliary atresia necessitates surgical surgery.

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

Description: A Cardiolipin Antibody test is a blood test used to detect antibodies to cardiolipin which may be causing a patient issues with forming blood clots.

Also Known As: Anticardiolipin Antibodies Test, aCL Antibody Test, Cardiolipin IgG Antibody Test, Cardiolipin IgA Antibody Test, Cardiolipin IgM Antibody Test

Collection Method: Blood Draw

Specimen Type: Plasma

Test Preparation: No preparation required

When is a Cardiolipin Antibodies test ordered?

Cardiolipin antibody testing is frequently requested as part of an excessive clotting workup when a person exhibits blood clot-related symptoms, especially when such symptoms reoccur. Depending on where the clot is, different signs and symptoms may be present.

As a follow-up to a protracted PTT test, testing may also be mandated when a woman has experienced repeated miscarriages and/or in conjunction with lupus anticoagulant testing. If a cardiolipin antibody is found, the test may be repeated several weeks later to see if it is a transient or persistent antibody.

When a person exhibits the signs and symptoms of an autoimmune condition and/or receives a positive ANA test result, a test for cardiolipin antibodies may also be prescribed since it may give the doctor further details to help make a diagnosis. If cardiolipin antibodies are not found in a patient with a known autoimmune disease like lupus, further testing may be required to check for the emergence of these antibodies.

What does a Cardiolipin Antibodies test check for?

The immune system creates cardiolipin antibodies, which are autoantibodies that wrongly target the body's own cardiolipins, which are located in the cell and platelet membranes. These autoantibodies may have an unidentified impact on the body's capacity to control blood coagulation. Cardiolipin antibodies are discovered with this test in the blood.

Cardiolipins and other phospholipids in their family are lipid molecules that are crucial to the blood clotting process. Cardiolipin antibodies work by attacking cardiolipins and are linked to a higher risk of repeated, unneeded blood clots in arteries and veins, such the deep veins of the legs or the lungs. They could also be linked to preterm labor, pre-eclampsia, recurrent miscarriages, low platelet counts, and low platelet counts.

The most prevalent antiphospholipid antibody is a class of autoantibodies called cardiolipins that are linked to excessive clotting and autoimmune conditions like lupus. They are usually found in conjunction with other antiphospholipid antibodies, including anti-beta-2 glycoprotein 1 and lupus anticoagulant. Additionally, they might be momentarily picked up in older people, those with HIV/AIDS, some malignancies, and acute infections.

An individual may be diagnosed with antiphospholipid syndrome if they have blood clots that aren't supposed to, have repeated miscarriages, have cardiolipin antibodies, or have another antiphospholipid antibody. A primary or secondary APS may be used. While secondary APS is linked to an autoimmune condition, primary APS is not always connected to a related autoimmune disorder.

Lab tests often ordered with a Cardiolipin Antibodies test:

• ANA Screen
• Lupus Anticoagulant Testing
• Beta-2 Glycoprotein 1 Antibodies
• Phosphatidylserine Antibodies

Conditions where a Cardiolipin Antibodies test is recommended:

• Antiphospholipid Syndrome
• Autoimmune Disorders
• Excessive Clotting Disorders

How does my health care provider use a Cardiolipin Antibodies test?

Cardiolipin antibody tests are routinely used to assist identify the underlying cause of:

• An unexplained blood clot
• Multiple miscarriages
• a prolonged coagulation PTT result; in this context, the test is frequently conducted in conjunction with lupus anticoagulant testing

If cardiolipin antibodies are discovered during an initial test, they are typically checked again 12 weeks later to see if their presence is permanent or transient. Cardiolipin antibodies may emerge at any moment in the future, therefore if a person with a known autoimmune condition tests negative for them, they may be retested in the future.

IgG, IgM, and/or IgA are the three kinds of cardiolipin antibodies that may be found in the blood. IgG and IgM are the two most often examined antibodies. IgA cardiolipin antibody testing may be required, nevertheless, if these tests come back negative and clinical suspicions persist.

Along with cardiolipin antibody tests, other tests including anti-beta-2 glycoprotein 1 antibody and lupus anticoagulant testing may also be carried out.

What do my Cardiolipin Antibodies test results mean?

A negative result only indicates that there are no cardiolipin antibodies present or none that are present in the blood at the time of the test.

Of all the antiphospholipid antibodies, cardiolipin antibodies are the most widespread. It is common to find them in a person's blood temporarily as a result of an infection or medication, as well as in old people who don't have any symptoms. Even though the low to moderate levels of antibody present in these circumstances are frequently insignificant, they still need to be assessed along with any signs, symptoms, and/or other clinical data.

When tested again 12 weeks later, moderate to high levels of cardiolipin antibodies that were present the first time are likely still present. This particular antibody may be linked to an increased risk of excessive clotting or recurrent miscarriages.

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

Cardiolipin Antibodies (IgG, IgM)

• Cardiolipin Antibody (IgG) 
• Cardiolipin Antibody (IgM) 

Cardiolipin antibodies (CA) are seen in a subgroup of patients with autoimmune disorders, particularly systemic lupus erythematosus (SLE), who are at risk for vascular thrombosis, thrombocytopenia, cerebral infarct and/or recurrent spontaneous abortion. Elevations of CA associated with increased risk have also been seen in idiopathic thrombocytopenic purpura, rheumatoid and psoriatic arthritis, and primary Sjögren's syndrome.

Direct Antiglobulin Test (DAT) with Reflex to Anti C3 and Anti IgG

IMPORTANT - NOTE THIS IS A REFLEX TEST AND AN ADDITIONAL CHARGE OF $64 WILL OCCUR IF THE QUEST RUNS THE REFLEX TEST.

If DAT (Coombs, Direct) is positive, Anti C3d and Anti IgG will be performed at an additional charge of $64.00

Reference Range(s)

Negative

Clinical Significance

The DAT (Direct Coomb's test) is positive if red cells have been coated, in vivo, with immunoglobulin, complement, or both. A positive result can occur in immune-mediated red cell destruction, autoimmune hemolytic anemia, a transfusion reaction or in patients receiving certain drugs.

Description: The Hepatic Function Panel is a blood test that measures multiple markers to evaluate the health of your liver.

Also Known As: Liver Profile Test, Liver Function Test, LFT, Liver Enzyme Test, Liver Test, Liver Blood Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

Average Processing Time: 1 to 2 days

When is a Hepatic Function Panel test ordered?

When someone is at risk for liver dysfunction, a liver panel, or one or more of its components, may be requested. Here are a few examples:

• People who are taking drugs that could harm their liver
• Those who are alcoholics or who use a lot of alcohol
• Those who have a history of hepatitis virus exposure, either known or suspected
• Individuals with a history of liver illness in their families
• Overweight people, especially those with diabetes and/or high blood pressure

When a person exhibits signs and symptoms of liver disease, a liver panel may be done; however, most people with liver disease do not have any of these symptoms until the disease has been present for years or is very severe. Here are a few examples:

• 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
• Diarrhea

To make a diagnosis, no single collection of liver tests is usually used. Several liver panels are frequently done over the course of a few days or weeks to aid in determining the source of the liver illness and assessing its severity.

When liver illness is discovered, the liver panel or one or more of its components can be used to monitor it on a regular basis over time. A liver panel may be conducted on a regular basis to assess the efficacy of treatment for the liver condition.

What does a Hepatic Function Panel blood test check for?

A liver panel is a collection of tests used to diagnose, evaluate, and track the progression of liver illness or damage. The liver is one of the largest organs in the body, and it is placed behind the lower ribs in the upper right section of the belly. Drugs and substances that are detrimental to the body are metabolized and detoxified by the liver. It makes blood clotting factors, proteins, and enzymes, as well as regulating hormone levels and storing vitamins and minerals. Bile, a fluid produced by the liver, is delivered to the small intestine via ducts to aid in fat digestion or to the gallbladder to be stored and concentrated for later use.

Inflammation, scarring, bile duct blockages, liver tumors, and liver dysfunction can all be caused by a range of disorders and infections that cause acute or chronic liver damage. Toxins, alcohol, narcotics, and some herbal medications can all be dangerous. Before signs like jaundice, dark urine, light-colored feces, itching, nausea, exhaustion, diarrhea, and unexplained weight loss or increase appear, there may be considerable liver damage. To reduce damage and preserve liver function, early identification is critical.

The liver panel assesses the enzymes, proteins, and chemicals generated, processed, or removed by the liver, as well as those that are altered by liver injury. Some are produced by damaged liver cells, while others indicate a reduction in the liver's ability to execute one or more activities. When these tests are performed combined, they provide a picture of a person's liver's health, an indication of the severity of any liver injury, changes in liver status over time, and a starting point for further diagnostic testing.

Lab tests often ordered with a Hepatic Function Panel test:

• GGT
• Prothrombin Time and International Normalized Ratio
• LD
• Hepatitis A Testing
• Hepatitis B Testing
• Hepatitis C Testing
• Emergency and Overdose Drug Testing
• Ethanol
• ANA
• Smooth Muscle Antibody
• Anti-LKM-1
• Drugs of Abuse Testing
• Copper
• Ceruloplasmin
• DCP
• AFP Tumor Markers
• Alpha-1
• Antitrypsin
• Acetaminophen
• Ammonia

Conditions where a Hepatic Function Panel test is recommended:

• Liver Disease
• Jaundice
• Hepatitis
• Hemochromatosis
• Wilson Disease
• Cirrhosis

Commonly Asked Questions:

How does my health care provider use a Hepatic Function Panel test?

A liver panel can be performed to check for damage to the liver, especially if someone has an illness or is taking a medication that could harm the liver. For regular screening, a comprehensive metabolic panel, which is commonly conducted as part of a general health checkup, may be ordered instead of a liver panel. The majority of the liver panel is included in this group of tests, as well as other tests that evaluate other organs and systems in the body.

If a person has signs and symptoms that indicate suspected liver malfunction, a liver panel or one or more of its component tests may be done to assist identify liver disease. If a person has a known illness or liver disease, testing may be done at regular intervals to assess the liver's health and the efficiency of any therapies. To evaluate and monitor a jaundiced newborn, a variety of bilirubin tests may be ordered.

Abnormal tests on a liver panel may necessitate a repeat study of one or more tests, or the entire panel, to evaluate if the elevations or declines continue, and/or additional testing to discover the etiology of the liver dysfunction.

Typically, a panel consists of numerous tests performed simultaneously on a blood sample.

What do my Liver Panel Test results mean?

The findings of a liver panel test are not diagnostic of a specific condition; rather, they show that the liver may be malfunctioning. Abnormal liver test results in a person who has no symptoms or recognized risk factors may signal a transitory liver injury or reflect something going on elsewhere in the body, such as the skeletal muscles, pancreas, or heart. It could potentially signal the presence of early liver disease, necessitating more testing and/or periodic monitoring.

The results of liver panels are generally compared. Several sets of results from tests conducted over several days or weeks are sometimes analyzed together to see if a pattern emerges. Each person's test findings will be unique, and they will most likely alter over time. A healthcare professional examines the combined findings of liver tests to learn more about the underlying disease. Further testing is frequently required to discover the cause of the liver damage and/or illness.

Abnormal test results may signal a need to review a person's dosage or medication choice if they are taking medicines that may impact their liver. When a person with liver disease is being monitored, the healthcare provider will look at the findings of the liver panel together to see if liver function or damage is getting worse or better. Increased abnormalities in bilirubin, albumin, and/or PT, for example, may suggest a decline in liver function, whereas steady or improved findings may indicate liver function preservation or improvement.

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

IMPORTANT NOTIFICATION: Please be aware that this panel includes three Reflex tests. If Reflex Confirmation is triggered, additional charges will apply for any reflex tests conducted.

BY ORDERING THIS PANEL, YOU ACKNOWLEDGE AND ACCEPT THAT YOU WILL BE RESPONSIBLE FOR PAYMENT OF ANY ADDITIONAL REFLEX TESTS PROCESSED.

This panel includes three reflex tests, which Quest will automatically perform additional testing on if specific criteria are met. Below, we have outlined the potential extra tests that may be conducted for each test, along with their respective additional charge.

• CBC (includes Differential and Platelets)
• Rubella Antibody (IgG), Immune Status
• Antibody Screen, RBC with Reflex to Identification, Titer, and Antigen Typing 
• ABO Group and Rh Type
• RPR (Diagnosis) with Reflex to Titer and Confirmatory Testing
• Hepatitis B Surface Antigen with Reflex Confirmation*

This panel includes three reflex tests, which Quest will automatically perform additional testing on if specific criteria are met. Below, we have outlined the potential extra tests that may be conducted for each test, along with their respective additional charges.

• If Antibody Screen is positive, Antibody Identification, Titer, and Antigen Typing will be performed at an additional charge (CPT code(s): 86870, 86886, 86905).
• If the RPR screen is reactive, RPR Titer and FTA Confirmatory testing will be performed at an additional charge (CPT code(s): 86593, 86780).
• If Hepatitis B Surface Antigen is positive, confirmatory testing based on the manufacturer's FDA-approved recommendations will be performed at an additional charge (CPT code(s): 87341).