Osteoarthritis

Important: This panel contains ANA Screen IFA with Reflex to Titer and Pattern #249 which is a Reflex test. If ANA Screen, IFA is positive, then ANA Titer and Pattern will be performed at an additional charge of $13.00

Important: This panel contains ANA Screen IFA with Reflex to Titer and Pattern #249 which is a Reflex test. If ANA Screen, IFA is positive, then ANA Titer and Pattern will be performed at an additional charge of $13.00

Description: An antinuclear antibody screening is a blood test that is going to look for a positive or negative result. If the result comes back as positive further test will be done to look for ANA Titer and Pattern. Antinuclear antibodies are associated with Lupus.

Also Known As: ANA Test, ANA Screen IFA with Reflex to Titer and pattern IFA Test, ANA with Reflex Test, Antinuclear Antibody Screen Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

IMPORTANT Reflex Information: If ANA Screen, IFA is positive, then ANA Titer and Pattern will be performed at an additional charge of $13.00

When is an ANA Screen test ordered?

When someone exhibits signs and symptoms of a systemic autoimmune illness, the ANA test is requested. Symptoms of autoimmune illnesses can be vague and non-specific, and they can fluctuate over time, steadily deteriorate, or oscillate between periods of flare-ups and remissions.

What does an ANA Screen blood test check for?

Antinuclear antibodies are a type of antibody produced by the immune system when it is unable to differentiate between its own cells and foreign cells. Autoantibodies are antibodies that attack the body's own healthy cells, causing symptoms like tissue and organ inflammation, joint and muscle discomfort, and weariness. The moniker "antinuclear" comes from the fact that ANA specifically targets chemicals located in a cell's nucleus. The presence of these autoantibodies in the blood is detected by the ANA test.

The presence of ANA may be a sign of an autoimmune process, and it has been linked to a variety of autoimmune illnesses, the most common of which being systemic lupus erythematosus.

One of the most common tests used to detect an autoimmune disorder or rule out other conditions with comparable signs and symptoms is the ANA test. As a result, it's frequently followed by other autoantibody tests that can help establish a diagnosis. An ENA panel, anti-dsDNA, anti-centromere, and/or anti-histone test are examples of these.

Lab tests often ordered with an ANA Screen test:

• ENA Panel
• Sed Rate (ESR)
• C-Reactive Protein
• Complement
• AMA
• Centromere antibody
• Histone Antibody

Conditions where an ANA Screen test is recommended:

• Autoimmune Disorders
• Lupus
• Rheumatoid Arthritis
• Sjogren Syndrome
• Scleroderma

How does my health care provider use an ANA Screen test?

One of the most often performed tests to diagnose systemic lupus erythematosus is the antinuclear antibody test. It serves as the first step in the evaluation process for autoimmune diseases that might impact various body tissues and organs.

When a person's immune system fails to discriminate between their own cells and foreign cells, autoantibodies called ANA are created. They attack chemicals found in a cell's nucleus, causing organ and tissue damage.

ANA testing may be utilized in conjunction with or after other autoantibody tests, depending on a person's indications and symptoms and the suspected condition. Antibodies that target specific compounds within cell nuclei, such as anti-dsDNA, anti-centromere, anti-nucleolar, anti-histone, and anti-RNA antibodies, are detected by some of these tests, which are considered subsets of the general ANA test. In addition, an ENA panel can be utilized as a follow-up to an ANA.

These further tests are performed in addition to a person's clinical history to assist diagnose or rule out other autoimmune conditions such Sjögren syndrome, polymyositis, and scleroderma.

To detect ANA, various laboratories may employ different test procedures. Immunoassay and indirect fluorescent antibody are two typical approaches. The IFA is regarded as the gold standard. Some labs will test for ANA using immunoassay and then employ IFA to confirm positive or equivocal results.

An indirect fluorescent antibody is created by mixing a person's blood sample with cells attached to a slide. Autoantibodies in the blood bind to the cells and cause them to react. A fluorescent antibody reagent is used to treat the slide, which is then inspected under a microscope. The existence of fluorescence is observed, as well as the pattern of fluorescence.

Immunoassays—these procedures are frequently carried out using automated equipment, however they are less sensitive than IFA in identifying ANA.

Other laboratory tests linked to inflammation, such as the erythrocyte sedimentation rate and/or C-reactive protein, can be used to assess a person's risk of SLE or another autoimmune disease.

What do my ANA test results mean?

A positive ANA test indicates the presence of autoantibodies. This shows the presence of an autoimmune disease in someone who has signs and symptoms, but more testing is needed to make a definitive diagnosis.

Because ANA test results can be positive in persons who have no known autoimmune disease, they must be carefully assessed in conjunction with a person's indications and symptoms.

Because an ANA test can become positive before signs and symptoms of an autoimmune disease appear, determining the meaning of a positive ANA in a person who has no symptoms can take some time.

SLE is unlikely to be diagnosed with a negative ANA result. It is normally not required to repeat a negative ANA test right away; however, because autoimmune illnesses are episodic, it may be desirable to repeat the ANA test at a later date if symptoms persist.

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

Description: The CRP test is used to identify and/or monitor inflammation in patients.

Also Known As: CRP Test, Inflammation test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a C-Reactive Protein test ordered?

When a person's medical history and signs and symptoms indicate that they may have a significant bacterial infection, a CRP test may be recommended. When a newborn displays signs of infection or when a person has sepsis symptoms including fever, chills, and rapid breathing and heart rate, it may be ordered.

It's also commonly requested on a regular basis to check illnesses like rheumatoid arthritis and lupus, and it's routinely repeated to see if medication is working. This is especially effective for inflammation issues because CRP levels decrease as inflammation decreases.

What does a C-Reactive Protein blood test check for?

C-reactive protein is a protein produced by the liver and released into the bloodstream within a few hours following tissue injury, infection, or other inflammatory event. After trauma or a heart attack, with active or uncontrolled autoimmune illnesses, and with acute bacterial infections like sepsis, markedly higher levels are reported. CRP levels can rise by a thousand-fold in response to inflammatory diseases, and their elevation in the blood can occur before pain, fever, or other clinical signs. The test detects inflammation caused by acute situations or monitors disease activity in chronic diseases by measuring the level of CRP in the blood.

The CRP test is not a diagnostic tool, although it can tell a doctor if inflammation is occurring. This information can be combined with other indicators like signs and symptoms, a physical exam, and other tests to establish whether someone has an acute inflammatory disorder or is having a flare-up of a chronic inflammatory disease. The health care provider may next do additional tests and treatment.

This CRP test should not be confused with the hs-CRP test. These are two separate CRP tests, each of which measures a different range of CRP levels in the blood for different purposes.

Lab tests often ordered with a C-Reactive Protein test:

• Sed Rate (ESR)
• Procalcitonin
• ANA
• Rheumatoid Factor
• Complement

Conditions where a C-Reactive Protein test is recommended:

• Arthritis
• Autoimmune Disorders
• Pelvic Inflammatory Disease
• Inflammatory Bowel Disease
• Sepsis
• Vasculitis
• Systemic Lupus Erythematosus
• Meningitis and Encephalitis

Commonly Asked Questions:

How does my health care provider use a C-Reactive Protein test?

A health practitioner uses the C-reactive protein test to diagnose inflammation. CRP is an acute phase reactant, a protein produced by the liver and released into the bloodstream within a few hours following tissue injury, infection, or other inflammatory event. The CRP test is not a diagnostic test for any ailment, but it can be used in conjunction with other tests to determine whether a person has an acute or chronic inflammatory disorder.

CRP, for example, can be used to detect or track substantial inflammation in someone who is suspected of having an acute ailment like:

• Sepsis is a dangerous bacterial infection.
• An infection caused by a fungus
• Inflammation of the pelvis

People with chronic inflammatory diseases can use the CRP test to detect flare-ups and/or see if their medication is working. Here are a few examples:

• Inflammatory bowel disease
• Arthritis, which can take many forms.
• Autoimmune disorders, examples include lupus and vasculitis

CRP is occasionally requested in conjunction with an erythrocyte sedimentation rate, another inflammatory test. While the CRP test is not specific enough to diagnose an illness, it does serve as a broad marker for infection and inflammation, alerting doctors to the need for more testing and treatment. A variety of additional tests may be used to determine the source of inflammation, depending on the probable cause.

What do my C-Reactive Protein test results mean?

CRP levels in the blood are usually low.

CRP levels in the blood that are high or rising indicate the existence of inflammation, but they don't tell you where it is or what's causing it. A high CRP level can establish the presence of a severe bacterial infection in people who are suspected of having one. High levels of CRP in persons with chronic inflammatory disorders indicate a flare-up or that treatment isn't working.

When the CRP level rises and then falls, it indicates that the inflammation or infection is diminishing and/or responding to treatment.

Is there anything else I should know about C-Reactive Protein?

CRP levels can rise during pregnancy, as well as with the use of birth control tablets or hormone replacement therapy. Obese people have also been found to have higher CRP levels.

In the presence of inflammation, the erythrocyte sedimentation rate test will also rise; however, CRP rises first and then falls faster than the ESR.

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 

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: 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: 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. 

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. 

Description: Anti-CCP is a test that measure the amount of cyclic citrullinated peptide in the blood. Anti-CCP is an autobody and it can be used to determine the if a person has Rheumatoid Arthritis.

Also Known As: ACPA, Anti-CCP, Anti-citrulline Antibody, Anti-cyclic Citrullinated Peptide, Anti-Cyclic Citrullinated Peptide (CCP) Antibody IgG, CCP, CCP Antibody, Citrullinated Peptide (CCP) IgG, Cyclic Citrullinated Peptide Antibody, Cyclic Citrullinated Peptide CCP Antibody IgG.

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a Cyclic Citrullinated Peptide IgG Antibody test ordered?

When someone displays indications and symptoms that could be attributable to previously undiagnosed inflammatory arthritis or has been diagnosed with undifferentiated arthritis, a CCP antibody test is usually ordered along with an RF test. When clinical indications and symptoms lead a health practitioner to suspect RA, it may be ordered as a follow-up test following a negative RF test. In most cases, RA affects many joints in a symmetrical pattern. The following are possible signs and symptoms:

• Painful, heated, swollen joints in the hands and wrists.
• Pain that affects the neck, shoulds, elbows, hips, knees, and/or feet.
• In the morning, affected joints are stiff, although this improves over the day.
• Fatigue
• Fatigue
• Underneath the skin, nodules form, especially at the elbows
• An overall sensation of unwellness

What does a Cyclic Citrullinated Peptide IgG Antibody blood test check for?

Cyclic citrullinated peptide antibodies are autoantibodies directed against cyclic citrullinated peptides produced by the immune system. Anti-CCP antibodies are detected and measured in the blood with this test.

Citrulline is created in the body as a byproduct of the amino acid arginine metabolism. This conversion may occur at a faster rate in joints with rheumatoid arthritis. Citrulline alters the structure of proteins, triggering an immunological response that results in the production of autoantibodies against joint proteins. The CCP antibody test aids in the diagnosis of RA and can help identify persons with the disease's more quickly erosive type.

RA is a chronic, systemic autoimmune disease that affects the hands, foot, and other joints throughout the body, causing inflammation, discomfort, stiffness, and degenerative changes. It can strike anyone at any age, but it commonly strikes between the ages of 40 and 60, with women accounting for roughly 75 percent of those affected. The prognosis and course of RA are both unpredictable. It could take a long time to develop and progress, or it could happen quickly. In some people, it may go into remission, and in others, it may completely disappear. If left untreated, RA can impair a person's life expectancy and render many people unable to work within a few years.

There are a number of treatments available to help reduce the difficulties of RA, but they all hinge on getting a proper diagnosis and starting treatment before severe joint damage occurs. The basic blood test for detecting RA and distinguishing it from other types of arthritis and other inflammatory processes has been rheumatoid factor. However, RF's sensitivity and specificity aren't optimal; it can be negative in persons with RA symptoms but positive in those who don't. According to studies, the CCP antibody test has a sensitivity and specificity that is comparable to or better than RF, and it is more likely to be positive in patients with early RA.

CCP antibody testing, along with RF, is included in the American College of Rheumatology's (ACR) 2010 Rheumatoid Arthritis Classification Criteria for diagnosing rheumatoid arthritis. CCP antibodies can be found in roughly 50-60% of persons with early RA, as early as 3-6 months following the onset of symptoms, according to the ACR. Early detection and diagnosis of RA allows healthcare practitioners to start aggressive treatment early on, reducing complications and tissue damage.

Lab tests often ordered with a Cyclic Citrullinated Peptide IgG Antibody test:

• Rheumatoid Factor
• Sed Rate (ESR)
• C-Reactive Protein
• ANA

Conditions where a Cyclic Citrullinated Peptide IgG Antibody test is recommended:

• Rheumatoid Arthritis
• Autoimmune Disorders

How does my health care provider use a Cyclic Citrullinated Peptide IgG Antibody test?

To help diagnose rheumatoid arthritis and assess the severity and likely course of the disease, a cyclic citrullinated peptide antibody test may be ordered in conjunction with or after a rheumatoid factor test. Inflammatory indicators such as ESR and C-reactive protein may also be tested at this time.

Cyclic citrullinated peptide antibodies are autoantibodies directed against cyclic citrullinated peptides produced by the immune system.

CCP antibody testing may also be conducted to assess the likelihood of RA developing in persons with undifferentiated arthritis, or those who have symptoms that imply RA but do not yet fulfill the American College of Rheumatology's criteria. According to the American College of Rheumatology, roughly 95% of persons with a positive CCP antibody will develop RA in the future. It is critical to discover RA early in order to make informed treatment recommendations.

What do my CCP Antibody test results mean?

When persons with arthritis symptoms test positive for both CCP antibody and RF, they almost certainly have RA and are at risk of developing a more rapidly progressing and severe version of the illness. When patients show clinical indications of RA and are positive for CCP antibody but not RF, or have low levels of both, it is likely that they have early RA or will develop RA in the future.

When people have a positive RF but no CCP antibody, clinical signs and symptoms are more important in evaluating whether they have RA or another inflammatory illness. It is less likely that someone gets RA if they are negative for both CCP antibody and RF. However, it should be noted that RA is a clinical diagnosis that can be made even if autoantibody testing are negative.

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

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

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

Collection Method: Blood Draw

Specimen Type: Serum

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

When is a Lipid Panel with Ratios test ordered?

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

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

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

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

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

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

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

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

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

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

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

A lipid profile consists of the following elements:

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

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

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

Conditions where a Lipid Panel with Ratios test is recommended:

• Hypertension
• Cardiovascular Disease
• Heart Disease
• Stroke

Commonly Asked Questions:

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

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

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

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

A normal lipid profile test measures the following elements:

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

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

What do my Lipid Panel test results mean?

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

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

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

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

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

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

Is there anything else I should know?

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

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

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

Description: RF is a blood test that is measures the amount of rheumatoid factor that is present in the blood’s serum. It is used along with other tests to diagnose rheumatoid arthritis.

Also Known As: RF Test, Rheumatoid Arthritis Factor Test

Collection Method: Blood Draws

Specimen Type: Serum

Test Preparation: No preparation required

When is a Rheumatoid Factor test ordered?

When a person has RA signs and symptoms, an RF test may be ordered. Pain, warmth, swelling, and morning stiffness in the joints are common symptoms, as are nodules under the skin and, if the disease has progressed, signs of enlarged joint capsules and cartilage and bone loss on X-rays. When the first RF test is negative but the symptoms persist, the RF test may be repeated.

A cyclic citrullinated peptide antibody test may be ordered along with RF or if the RF result is negative to help diagnose RA in someone who has joint inflammation but does not yet fit the criteria for RA.

Additional autoimmune-related tests, such as an ANA, as well as other markers of inflammation, such as a CRP and Sed Rate, as well as a CBC to examine blood cells, may be ordered in addition to the RF test.

What does a Rheumatoid Factor blood test check for?

The autoantibody rheumatoid factor is an immunoglobulin M protein produced by the body's immune system. Autoantibodies attack a person's own tissues, mistaking them for "foreign" tissue. While the biological role of RF is unknown, its presence can be used to detect inflammatory and autoimmune activities. This test identifies and quantifies radiofrequency in the bloodstream.

The RF test is an important tool in the diagnosis of rheumatoid arthritis. A RF test will be positive in about 80% of people with RA. RF, on the other hand, can be found in persons with a range of different illnesses, including as Sjögren syndrome, as well as persistent bacterial, viral, and parasite infections, and some malignancies. It can be noticed in patients who have lung, liver, or kidney disease, and it can also be detected in a tiny percentage of healthy persons.

Lab tests often ordered with a Rheumatoid Factor test:

• Cyclic Citrullinated Peptide Antibody
• ANA
• Sed Rate
• C-Reactive Protein
• Immunoglobulins

Conditions where a Rheumatoid Factor test is recommended:

• Rheumatoid Arthritis
• Autoimmune Disorders

How does my health care provider use a Rheumatoid Factor test?

The rheumatoid factor test is used to diagnose rheumatoid arthritis and to distinguish it from other types of arthritis or diseases that generate similar symptoms.

While the clinical picture is critical in the diagnosis of RA, some signs and symptoms, particularly in the early stages of the disease, may not be present or follow a predictable pattern. Additionally, the signs and symptoms may not always be easy to distinguish because people with RA may also have other connective tissue disorders such Raynaud phenomenon, scleroderma, autoimmune thyroid problems, and systemic lupus erythematosus and present symptoms of these disorders. When RA is suspected, the RF test is one of several tools that can be used to aid determine a diagnosis.

What do my Rheumatoid Factor test results mean?

The results of the RF test must be interpreted in the context of a person's symptoms and medical history.

The presence of large amounts of RF in persons with symptoms and clinical indications of rheumatoid arthritis indicates that they are likely to develop RA. Higher RF levels are associated with a worse prognosis and more severe illness.

A negative RF test does not rule out the possibility of RA. Around 20% of persons with RA will have very low levels of RF or none at all. In these circumstances, a positive CCP antibody test can be utilized to confirm RA.

Sjögren syndrome, systemic lupus erythematosus, sarcoidosis tuberculosis, syphilis, HIV/AIDS, hepatitis, scleroderma, infectious mononucleosis, cancers such as leukemia and multiple myeloma, or disease of the liver, lung, or kidney may all produce positive RF test These other disorders are neither diagnosed or monitored with the RF test.

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

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

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

Collection Method: Blood Draw

Specimen Type: Whole Blood

Test Preparation: No preparation required

When is a Sed Rate test ordered?

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

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

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

What does a Sed Rate blood test check for?

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

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

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

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

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

Lab tests often ordered with a Sed Rate test:

• C-Reactive Protein
• ANA
• Rheumatoid Factor

Conditions where a Sed Rate test is recommended:

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

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

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

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

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

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

What do my Sed Rate test results mean?

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

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

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

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

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

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