All Bone and Joint Tests

Bone and Joint Lab Tests and health information

Aside from your medical history, bone and joint lab tests can help your doctor to diagnose if you have any bone or joint conditions. Here are some of the laboratory tests that you can undergo:


Name Matches
The Bone-Specific Alkaline Phosphatase (BSAP) assay provides a general index of bone formation and a specific index of total osteoblast activity. BSAP and osteocalcin are the most effective markers of bone formation and are particularly useful for monitoring bone formation therapies and antiresorptive therapies.

DC - Bone Health Panel

This panel contains both Cortisol, A.M. #4212 and Cortisol, P.M. #4213, which will require the patient to visit the patient service center twice in one day.

  • First visit between 7 a.m. - 9 a.m. to have Cortisol, A.M. #4212 drawn along with most of the panel
  • Second visit between 3 p.m. – 5 p.m. to have Cortisol, P.M. #4213 drawn.

Dr. Weatherby’s  Additional biomarkers for Bone Health Evaluation -  Use with Blood Chemistry Analysis Standard Panel.


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

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

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: Fasting preferred, but not required.

When is a Vitamin D test ordered?

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

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

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

What does a Vitamin D blood test check for?

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

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

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

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

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

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

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

This test has 3 Biomarkers

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

Lab tests often ordered with a Vitamin D test:

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

Conditions where a Vitamin D test is recommended:

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

Commonly Asked Questions:

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

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

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

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

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

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

What do my Vitamin D results result mean?

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

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

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

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

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


Description: Vitamin D, 1,25-Dihydroxy, LC/MS/MS is a blood test that measures calcitriol (1,25-Dihydroxyvitamin) in your blood's serum.

Also Known As: Calcitriol Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a Vitamin D 1,25-Dihydroxy test ordered?

When renal illness or problems of the enzyme that converts 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D are suspected, 1,25-dihydroxyvitamin D tests may be requested. This test is only performed in rare cases when calcium levels are high or a person has an illness that produces excessive amounts of vitamin D, such as sarcoidosis or some types of lymphoma.

Vitamin D levels are sometimes evaluated to check therapy success when vitamin D, phosphorus, calcium or magnesium supplementation is required.

What does a Vitamin D 1,25-Dihydroxy blood test check for?

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

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

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

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

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

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

Lab tests often ordered with a Vitamin D 1,25-Dihydroxy test:

  • Vitamin D 25-Hydroxy (D2 and D3)
  • Calcium
  • Phosphorus
  • PTH
  • Magnesium
  • Bone Markers
  • Trace Minerals

Conditions where a Vitamin D 1,25-Dihydroxy test is recommended:

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

How does my health care provider use a Vitamin D 1,25-Dihydroxy test?

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

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

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

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

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

What do my Vitamin D, 1,25-Dihydroxy test results mean?

In kidney illness, a low level of 1,25-dihydroxyvitamin D is one of the first alterations to appear in people with early renal failure.

A high amount of 1,25-dihydroxyvitamin D can arise when there is an excess of parathyroid hormone or when there are disorders that can produce 1,25-dihydroxyvitamin D outside of the kidneys, such as sarcoidosis or some lymphomas.

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.


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Serum calcium is involved in the regulation of neuromuscular and enzyme activity, bone metabolism and blood coagulation. Calcium blood levels are controlled by a complex interaction of parathyroid hormone, vitamin D, calcitonin and adrenal cortical steroids. Calcium measurements are useful in the diagnosis of parathyroid disease, some bone disorders and chronic renal disease. A low level of calcium may result in tetany.

Urinary calcium reflects dietary intake, rate of calcium absorption by the intestine and bone resorption. Urinary calcium is used primarily to evaluate parathyroid function and the effects of vitamin D. A significant number of patients with primary hyperparathyroidism will have elevated urinary calcium. However, there are other clinical entities that may be associated with increased urine calcium: Sarcoidosis, Paget's disease of bone, vitamin D intoxication, hyperthyroidism and glucocorticoid excess. Decreased urine calcium is seen with thiazide diuretics, vitamin D deficiency and familial hypocalciuric hypercalcemia.


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. 

  • 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: 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
  Less than  Greater Than 
WBC  1.5 x 10^3  30.0 x 10^3 
Hemoglobin  7.0 g/dL  19.0 g/dL 
Hematocrit  None  75%
Platelet  100 x 10^3  800 x 10^3 
MCV  70 fL  115 fL 
MCH  22 pg  37 pg 
MCHC  29 g/dL  36.5 g/dL 
RBC  None  8.00 x 10^6 
RDW  None  21.5
Relative Neutrophil %  1% or ABNC <500  None 
Relative Lymphocyte %  1% 70%
Relative Monocyte %  None  25%
Eosinophil  None  35%
Basophil  None  3.50%
     
Platelet  <75 with no flags,
>100 and <130 with platelet clump flag present,
>1000 
Instrument Flags Variant lymphs, blasts,
immature neutrophils,  nRBC’s, abnormal platelets,
giant platelets, potential interference
     
The automated differential averages 6000+ cells. If none of the above parameters are met, the results are released without manual 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

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Description: RF is a blood test that is measuring 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.


NTx is useful to assess bone resorption in patients with metabolic bone disease and monitor therapy to slow or halt osteoporotic bone loss. A decline of 30% or more of NTx over a six-month period suggests effective therapy.

NTx is useful to assess bone resorption in patients with metabolic bone disease. The test is also useful in monitoring therapy to slow or halt osteoporotic bone loss. A decline of 30% or more of NTx over a six-month period suggests effective therapy.

CTx is useful to assess bone resorption in patients with metabolic bone disease. The test is also useful in monitoring therapy to slow or halt osteoporotic bone loss.

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Description: Estradiol is a blood test that is used to measure the levels of Estradiol in the blood's serum. Estradiol is one of the Estrogen hormones in the body.  Estradiol, Ultrasensitive LC/MS/MS #30289 is a more appropriate test for children that have not yet started a menstrual cycle.

Also Known As: E2 Test, Estrogen 2 Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is an Estradiol test ordered?

Tests for estradiol for women may be ordered if:

  • After menopause, a woman may experience symptoms such as abnormal vaginal bleeding or irregular or absent menstrual cycles.
  • When a woman is unable to conceive, a series of estradiol readings taken over the course of her menstrual cycle may be used to track follicle development before using in vitro fertilization procedures
  • A woman is experiencing menopause symptoms such as hot flashes, night sweats, sleeplessness, and/or irregular or absent menstrual cycles.
  • If a menopausal woman is on hormone replacement therapy, her doctor may order estrone levels on a regular basis to check her progress.

Men and young boys may be subjected to estradiol testing if:

  • A boy's puberty is delayed, as evidenced by slow or delayed growth of testicles and penis, as well as a lack of deepening of voice or growth of body hair.
  • Signs of feminization, such as larger breasts.

What does an Estradiol blood test check for?

Estradiol, or E2, is a component of Estrogen that is present in the blood. For women, Estradiol is something that should be produced naturally, and the body produces larger amounts of Estradiol during puberty and it fluctuates throughout the menstrual cycle. Estradiol is most prominent in women of reproductive age. Low levels are common in girls who have not yet had their first menstrual cycle and in women after their reproductive age.

Lab tests often ordered with an Estradiol test:

  • Estrogen, Total, Serum
  • Estriol
  • Estrone
  • Testosterone Free and Total
  • Sex Hormone Binding Globulin
  • FSH
  • LH
  • Progesterone

Conditions where an Estradiol test is recommended:

  • Infertility
  • Menopause
  • Polycystic Ovarian Syndrome
  • Hormone Imbalance
  • Premature, delayed, or abnormal development of sex organs

Commonly Asked Questions:

How does my health care provider use an Estradiol test?

Estrogen tests are used to detect a deficit or excess of estrogen in a woman, as well as to aid in the diagnosis of a range of illnesses linked to this imbalance. They may also be ordered to monitor the health of the growing fetus and placenta during pregnancy, as well as to help predict the timing of a woman's ovulation. Estrogen testing can be used to detect a hormone excess and its origin in men.

In the case of girls and women

Estradiol testing may be requested for the following reasons:

  • Diagnose early-onset puberty, which occurs when a girl develops secondary sex traits much earlier than anticipated, or late puberty, which occurs when a female develops secondary sex characteristics or begins menstruation later than predicted.
  • Examine menstrual irregularities such as the absence of menstrual periods, infertility, and unusual vaginal bleeding.
  • Evaluate ovary function and look for signs of ovarian failure.
  • Serial measurements of estradiol can be used to track follicle development in the ovary in the days leading up to in vitro fertilization.
  • Keep track of any hormone replacement therapy you're getting to help with your fertility.
  • Keep track of menopausal hormone replacement medication, which is used to treat symptoms caused by estrogen insufficiency.
  • Identify cancers that produce estrogen.
  • As with breast cancer, keep an eye on anti-estrogen therapy.

Boys and men may be subjected to estradiol testing in order to:

  • Assist in the diagnosis of delayed puberty
  • Assist in determining the cause of larger breasts or other feminization indications.
  • Detect an excess of relative estrogen due to a testosterone or androgen deficit.
  • Identify cancers that produce estrogen.

What do my Estradiol test results mean?

Estradiol is one of the three Estrogens that have a large impact on the women's body throughout the menstrual cycle. When these hormones are too high or too low, it could cause irregular bleeding, infertility, complications with menopause, and delayed or premature puberty. Out of range levels can also be indicative of an ovarian condition such as PCOS. It is important to note that these values will fluctuate throughout a woman's cycle. The Estrogen hormones work together and if one is out of range, the others may also be out of range. It is recommended to follow up with a licensed healthcare professional to determine the best treatment if need.

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

IMPORTANT - Note this Estradiol test is not for children that have yet to start their menstrual cycle.  If this test is ordered for a child that has yet to begin their menstrual cycle Quest Diagnostics labs will substitute in Estradiol, Ultrasensitive LC/MS/MS - #30289 at an additional charge of $34


Brief Description: Testosterone, Free (Dialysis) and Total, MS is a blood test used to detect abnormal levels of testosterone in both male and female patients, and diagnose causes of erectile dysfunction, infertility, virilization, polycystic ovary syndrome, and delayed or early puberty in children.

Also Known As: Total Testosterone, Free Testosterone, Testosterone Free and Total

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a Free and Total Testosterone test ordered?

When infertility is suspected, or when a man has decreased sex drive or erectile difficulties, a testosterone test may be ordered. Other signs include a lack of beard and body hair, a loss of muscle mass, and the formation of breast tissue. Low total and bioavailable testosterone levels have also been linked to, or caused by, increased visceral fat, insulin resistance, and an increased risk of coronary artery disease.

The test is frequently ordered in conjunction with the FSH and LH tests in males who are experiencing delayed or slow puberty. Although the age at which puberty begins varies from person to person, it usually begins around the age of ten. The following are some of the signs and symptoms of delayed puberty:

  • Muscle mass development is delayed.
  • Voice not getting lower or a lack of body hair growth
  • Growth of the testicles and penis is slowed or delayed.

When a young boy appears to be going through an early puberty with clear secondary sex traits, the test can be ordered. Various malignancies and congenital adrenal hyperplasia can cause early puberty in boys due to elevated testosterone.

When a woman has irregular or no menstrual cycles, is having trouble getting pregnant, or displays masculine traits such as abundant facial and body hair, male pattern baldness, and/or a low voice, testosterone testing may be done. Testosterone levels can rise as a result of malignancies in the ovary or adrenal gland, as well as other illnesses including polycystic ovarian syndrome.

What does a Testosterone Total and Free blood test check for?

In men, testosterone is the primary sex hormone. It's in charge of a man's physical appearance. Although it is thought to be a "masculine" sex hormone, it is found in both men and women's blood. This test determines the amount of testosterone in a person's blood.

Testosterone is primarily produced in the male testicles by unique endocrine tissue called Leydig cells. It's also made by the adrenal glands in both males and females, as well as the ovaries in females in modest amounts.

In males, testosterone promotes the formation of secondary sex characteristics such as penis size, body hair growth, muscle development, and a deeper voice. It is abundant in males during adolescence and adulthood in order to regulate sex drive and preserve muscle mass. Estradiol is the major sex hormone in females, and testosterone is converted to it in women.

The pituitary gland produces luteinizing hormone, which stimulates and regulates testosterone synthesis. Testosterone functions in a negative feedback loop: when testosterone levels rise, LH production falls, slowing testosterone production; lower testosterone levels cause higher LH production, which promotes testosterone production.

Testosterone levels fluctuate throughout the day, increasing in the early morning hours and dropping in the evening. Levels rise after activity and fall as people get older.

About two-thirds of testosterone is attached to sex-hormone binding globulin in the bloodstream, with the remaining one-third bound to albumin. Only a small percentage of testosterone is released into the bloodstream as free testosterone. The bioavailable fraction is the free plus albumin-bound testosterone, which can act on target tissues.

Lab tests often ordered with a Testosterone Free and Total test:

  • Estradiol
  • Dihydrotestosterone
  • FSH
  • LH
  • Estrogens
  • Estriol
  • Estrone
  • Albumin
  • Prolactin
  • Anti-mullerian Hormone
  • Androstenedione
  • Sex Hormone Binding Globulin

Conditions where a Testosterone Free and Total test is recommended:

  • Polycystic Ovary Syndrome
  • Alcoholism
  • Mumps
  • Hypothalamic disease
  • Pituitary disease
  • Infertility
  • Liver disease
  • Hyperthyroidism
  • Eating disorders
  • Pregnancy
  • Cushing Syndrome
  • Hypothyroidism
  • Testicular cancer
  • Adrenal insufficiency
  • Congenital Adrenal Hyperplasia

Commonly Asked Questions:

How does my health care provider use a Testosterone Free and Total test?

In men, women, girls, and boys, testosterone testing is used to identify a variety of problems. Testosterone is the major sex hormone in males, and it is responsible for masculine physical traits. It is produced mostly by the testicles. Although it is thought to be a "male" sex hormone, it is found in both males and females.

The testosterone test can be used to determine whether or not you're experiencing:

  • Delayed or early puberty in boys
  • In both men and women, sex drive has decreased.
  • Men's erectile dysfunction
  • Male and female infertility
  • Tumors of the testicles in men
  • Disorders of the hypothalamus or pituitary gland
  • Virilization and hirsutism in girls and women

A testosterone total test is usually used to diagnose a condition. The free and total testosterone test distinguishes between testosterone that is bound to proteins in the blood and testosterone that is not attached to proteins.

About two-thirds of testosterone is tied to SHBG in the blood, with the remaining one-third attached to albumin. Free testosterone circulates in a tiny percentage. Bioavailable testosterone is made up of free testosterone and testosterone bound to albumin, and it can operate on target tissues.

A test for free or bioavailable testosterone may be performed in some circumstances, such as when the level of SHBG is abnormal, as it may more accurately indicate the presence of a medical issue.

Other tests and hormone levels may be performed in conjunction with testosterone testing, depending on the reason for testing. Here are a few examples:

  • FSH
  • LH
  • Estrogen
  • Estradiol
  • SHBG
  • DHEA-S
  • Prolactin
  • Androstenedione
  • 17-Hydroxyprogesterone

What does my testosterone test result mean?

Males: 

Testosterone levels often begin to fall after the age of 30. Testosterone levels may drop more in obese or chronically unwell men, as well as with the use of certain drugs.

Hypogonadism can be caused by a variety of factors, including:

  • Pituitary or hypothalamic illness
  • Reduced testosterone production in young males can be caused by genetic disorders
  • Possible infertility or testicular failure
  • Acquired damage to the testes, such as from drinking, physical injury, or viral infections like mumps, reduces testosterone production.
  • Diabetes

Healthcare practitioners may recommend testosterone replacement therapy to men who have consistently low testosterone levels and associated signs and symptoms. The Food and Drug Administration has not approved testosterone supplements to improve strength, sports performance, or avoid aging disorders. It's possible that using it for these purposes is dangerous.

Increased testosterone levels in men can mean one of several things:

  • Tumors of the testicles
  • Testosterone-producing tumors in the adrenal glands
  • Use of anabolic steroids
  • Early puberty in males due to an unknown cause
  • Adrenal hyperplasia in toddlers and babies

Females:

Testosterone levels in women are typically low. Increased testosterone levels can mean one of the following things:

  • Ovarian or adrenal gland tumor
  • PCOS
  • Adrenal hyperplasia that occurs at birth.

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


Helpful in assessing testicular function in males and managing hirsutism, virilization in females.

Description: Testosterone Free and Total with Sex Hormone Binding Globulin is a blood test used to detect abnormal levels of testosterone in both male and female patients, and diagnose causes of erectile dysfunction, infertility, virilization, polycystic ovary syndrome, and delayed or early puberty in children.

Also Known As: Total Testosterone Test, Free Testosterone Test, Testosterone Free and Total Test, Sex Hormone Binding Globulin Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a Testosterone Free and Total with Sex Hormone Binding Globulin test ordered?

When infertility is suspected, or when a man has decreased sex drive or erectile difficulties, a testosterone test may be ordered. Other signs include a lack of beard and body hair, a loss of muscle mass, and the formation of breast tissue. Low total and bioavailable testosterone levels have also been linked to, or caused by, increased visceral fat, insulin resistance, and an increased risk of coronary artery disease.

The test is frequently ordered in conjunction with the FSH and LH tests in males who are experiencing delayed or slow puberty. Although the age at which puberty begins varies from person to person, it usually begins around the age of ten. The following are some of the signs and symptoms of delayed puberty:

  • Muscle mass development is delayed.
  • Voice not getting lower or a lack of body hair growth
  • Growth of the testicles and penis is slowed or delayed.

When a young boy appears to be going through an early puberty with clear secondary sex traits, the test can be ordered. Various malignancies and congenital adrenal hyperplasia can cause early puberty in boys due to elevated testosterone.

When a woman has irregular or no menstrual cycles, is having trouble getting pregnant, or displays masculine traits such as abundant facial and body hair, male pattern baldness, and/or a low voice, testosterone testing may be done. Testosterone levels can rise as a result of malignancies in the ovary or adrenal gland, as well as other illnesses including polycystic ovarian syndrome.

What does a Testosterone Total and Free with Sex Hormone Binding Globulin blood test check for?

In men, testosterone is the primary sex hormone. It's in charge of a man's physical appearance. Although it is thought to be a "masculine" sex hormone, it is found in both men and women's blood. This test determines the amount of testosterone in a person's blood.

Testosterone is primarily produced in the male testicles by unique endocrine tissue called Leydig cells. It's also made by the adrenal glands in both males and females, as well as the ovaries in females in modest amounts.

In males, testosterone promotes the formation of secondary sex characteristics such as penis size, body hair growth, muscle development, and a deeper voice. It is abundant in males during adolescence and adulthood in order to regulate sex drive and preserve muscle mass. Estradiol is the major sex hormone in females, and testosterone is converted to it in women.

The pituitary gland produces luteinizing hormone, which stimulates and regulates testosterone synthesis. Testosterone functions in a negative feedback loop: when testosterone levels rise, LH production falls, slowing testosterone production; lower testosterone levels cause higher LH production, which promotes testosterone production.

Testosterone levels fluctuate throughout the day, increasing in the early morning hours and dropping in the evening. Levels rise after activity and fall as people get older.

About two-thirds of testosterone is attached to sex-hormone binding globulin in the bloodstream, with the remaining one-third bound to albumin. Only a small percentage of testosterone is released into the bloodstream as free testosterone. The bioavailable fraction is the free plus albumin-bound testosterone, which can act on target tissues.

In many circumstances, measuring total testosterone is sufficient information for a healthcare provider. A test for free or bioavailable testosterone may be performed in some circumstances, such as when the level of SHBG is abnormal, as it may more accurately indicate the presence of a medical issue.

SHBG is a liver-produced protein that strongly binds to the hormones testosterone, dihydrotestosterone, and estradiol. SHBG distributes these hormones in the blood as physiologically inactive versions when they are bound. This test examines the amount of SHBG in the blood and is most commonly used to determine whether a person has too much or too little testosterone.

In men, SHBG binds roughly 45 percent to 65 percent of testosterone in the blood, with the rest weakly and reversibly linked to albumin. Only around 2% to 3% of testosterone is accessible to tissues as free testosterone, but testosterone that is weakly linked to albumin is also bioavailable and can be rapidly absorbed by the body's tissues.

In women, a somewhat higher percentage of testosterone is bound to SHBG in the blood than in men. SHBG is important in controlling the quantities of bioavailable male sex hormones and estrogens circulating throughout the body in women. Because SHBG has a stronger affinity for the androgens testosterone and DHT, women with low SHBG may experience signs and symptoms of androgen excess.

A total testosterone test does not differentiate between bound and unbound testosterone; instead, it determines the total amount of testosterone present. In many circumstances, this is sufficient to determine if testosterone production is excessive or inadequate. However, if a person's SHBG level is abnormal, the total testosterone level may not accurately reflect the amount of testosterone available to the person's tissues. When a person's indications and symptoms do not match the results of a total testosterone test, a SHBG test may be conducted.

Lab tests often ordered with a Testosterone Free and Total with Sex Hormone Binding Globulin test:

  • Estradiol
  • Dihydrotestosterone
  • FSH
  • LH
  • Estrogens
  • Estriol
  • Estrone
  • Albumin
  • Prolactin
  • Anti-mullerian Hormone
  • Androstenedione

Conditions where a Testosterone Free and Total with Sex Hormone Binding Globulin test is recommended:

  • Polycystic Ovary Syndrome
  • Alcoholism
  • Mumps
  • Hypothalamic disease
  • Pituitary disease
  • Infertility
  • Liver disease
  • Hyperthyroidism
  • Eating disorders
  • Pregnancy
  • Cushing Syndrome
  • Hypothyroidism
  • Testicular cancer
  • Adrenal insufficiency
  • Congenital Adrenal Hyperplasia

Commonly Asked Questions:

How does my health care provider use a Testosterone Free and Total with Sex Hormone Binding Globulin test?

In men, women, girls, and boys, testosterone testing is used to identify a variety of problems. Testosterone is the major sex hormone in males, and it is responsible for masculine physical traits. It is produced mostly by the testicles. Although it is thought to be a "male" sex hormone, it is found in both males and females.

The testosterone test can be used to determine whether or not you're experiencing:

  • Delayed or early puberty in boys
  • In both men and women, sex drive has decreased.
  • Men's erectile dysfunction
  • Male and female infertility
  • Tumors of the testicles in men
  • Disorders of the hypothalamus or pituitary gland
  • Virilization and hirsutism in girls and women

A testosterone total test is usually used to diagnose a condition. The free and total testosterone test distinguishes between testosterone that is bound to proteins in the blood and testosterone that is not attached to proteins.

About two-thirds of testosterone is tied to SHBG in the blood, with the remaining one-third attached to albumin. Free testosterone circulates in a tiny percentage. Bioavailable testosterone is made up of free testosterone and testosterone bound to albumin, and it can operate on target tissues.

A test for free or bioavailable testosterone may be performed in some circumstances, such as when the level of SHBG is abnormal, as it may more accurately indicate the presence of a medical issue.

Other tests and hormone levels may be performed in conjunction with testosterone testing, depending on the reason for testing. Here are a few examples:

  • FSH
  • LH
  • Estrogen
  • Estradiol
  • SHBG
  • DHEA-S
  • Prolactin
  • Androstenedione
  • 17-Hydroxyprogesterone
  • The sex hormone binding globulin test can be performed to determine whether a man has low testosterone or if a woman has too much testosterone. It can be used in conjunction with other tests to assess a person's sex hormone status.

SHBG is a protein that binds to testosterone, dihydrotestosterone, and estradiol, among other hormones. SHBG distributes these hormones in the blood as physiologically inactive versions when they are bound. Changes in SHBG levels can have an impact on the amount of hormone accessible to the body's tissues.

To assess a person's current hormonal balance, tests for albumin and one or more additional sex hormones, such as prolactin, estradiol, and LH may be conducted.

In men

In order to diagnose the cause of infertility, diminished sex drive, or erectile dysfunction in an adult male, SHBG and total testosterone levels may be ordered. When total testosterone findings are contradictory with clinical symptoms, measuring SHBG in addition to testosterone is extremely beneficial.

Total testosterone in the blood is measured without distinguishing between bound and unbound testosterone; rather, it determines the total amount of testosterone in the blood. In many circumstances, this is sufficient to determine if testosterone production is excessive or inadequate. However, if a person's SHBG level is abnormal, the total testosterone level may not accurately reflect the amount of testosterone available to the body's tissues.

With a simple total testosterone assessment, health practitioners can estimate bioavailable testosterone by measuring SHBG. Because less testosterone is accessible to the body's tissues, increased SHBG in males may be linked to symptoms of low testosterone levels.

Total testosterone should be measured in the initial screening for testosterone deficiency, according to the Endocrine Society's professional standards. If the results are abnormal, the test is repeated the next day. They propose one of the following if repeat readings are low-normal and/or SHBG is abnormal:

In women

The ovaries and adrenal glands produce modest amounts of testosterone in women. Even little increases in testosterone production can throw off the hormone balance, resulting in symptoms including irregular or missed periods, infertility, acne, and excessive face and body hair. These and other signs and symptoms are common in polycystic ovarian syndrome, a disorder marked by an overproduction of male sex hormones. SHBG and testosterone testing may be helpful in detecting and evaluating excess testosterone production and/or decreasing SHBG concentrations, as well as in evaluating women with PCOS.

What does my testosterone test result mean?

Males: 

Testosterone levels often begin to fall after the age of 30. Testosterone levels may drop more in obese or chronically unwell men, as well as with the use of certain drugs.

Hypogonadism can be caused by a variety of factors, including:

  • Pituitary or hypothalamic illness
  • Reduced testosterone production in young males can be caused by genetic disorders
  • Possible infertility or testicular failure
  • Acquired damage to the testes, such as from drinking, physical injury, or viral infections like mumps, reduces testosterone production.
  • Diabetes

Healthcare practitioners may recommend testosterone replacement therapy to men who have consistently low testosterone levels and associated signs and symptoms. The Food and Drug Administration has not approved testosterone supplements to improve strength, sports performance, or avoid aging disorders. It's possible that using it for these purposes is dangerous.

Increased testosterone levels in men can mean one of several things:

  • Tumors of the testicles
  • Testosterone-producing tumors in the adrenal glands
  • Use of anabolic steroids
  • Early puberty in males due to an unknown cause
  • Adrenal hyperplasia in toddlers and babies

Females:

Testosterone levels in women are typically low. Increased testosterone levels can mean one of the following things:

  • Ovarian or adrenal gland tumor
  • PCOS
  • Adrenal hyperplasia that occurs at birth.

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


Please note: If Testosterone, Total, Males (Adult) Only #873 is ordered for a pediatric or female patient, the lab will automatically change the test to and charge for Testosterone, Total, MS #15983.

Description: Testosterone, Total, Male is a blood test used to detect abnormal levels of testosterone in male patients, diagnose causes of erectile dysfunction and infertility.

Also Known As: Total Testosterone Test, Testosterone Total Test, Male Testosterone Test, Testosterone Male Test, Testosterone Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

This test is for male patients 18 years of age and older only. Pediatric and Female patients will need to order Testosterone, Total, MS #15983.

Due to changes in testosterone levels throughout the day, two morning (8:00-10:00 a.m.) specimens obtained on different days are recommended by The Endocrine Society for screening.

This test can report a value up to 3000 ng/dL. any number >3000 will be stated as >3000.

When is a Testosterone Total Male test ordered?

When infertility is suspected, or when a man has decreased sex drive or erectile difficulties, a testosterone test may be ordered. Other signs include a lack of beard and body hair, a loss of muscle mass, and the formation of breast tissue. Low total and bioavailable testosterone levels have also been linked to, or caused by, increased visceral fat, insulin resistance, and an increased risk of coronary artery disease.

What does a Testosterone Total Male blood test check for?

In men, testosterone is the primary sex hormone. It's in charge of a man's physical appearance. This test determines the amount of testosterone in a person's blood.

Testosterone is primarily produced in the male testicles by unique endocrine tissue called Leydig cells. It's made by the adrenal glands in males.

In males, testosterone promotes the formation of secondary sex characteristics such as penis size, body hair growth, muscle development, and a deeper voice. It is abundant in males during adolescence and adulthood in order to regulate sex drive and preserve muscle mass.

The pituitary gland produces luteinizing hormone, which stimulates and regulates testosterone synthesis. Testosterone functions in a negative feedback loop: when testosterone levels rise, LH production falls, slowing testosterone production; lower testosterone levels cause higher LH production, which promotes testosterone production.

Testosterone levels fluctuate throughout the day, increasing in the early morning hours and dropping in the evening. Levels rise after activity and fall as people get older.

About two-thirds of testosterone is attached to sex-hormone binding globulin in the bloodstream, with the remaining one-third bound to albumin. Only a small percentage of testosterone is released into the bloodstream as free testosterone. The bioavailable fraction is the free plus albumin-bound testosterone, which can act on target tissues.

In many circumstances, measuring total testosterone is sufficient information for a healthcare provider. A test for free or bioavailable testosterone may be performed in some circumstances, such as when the level of SHBG is abnormal, as it may more accurately indicate the presence of a medical issue.

Lab tests often ordered with a Testosterone Total Male test:

  • Estradiol
  • Dihydrotestosterone
  • FSH
  • LH
  • Estrogens
  • Estriol
  • Estrone
  • Albumin
  • Prolactin
  • Anti-mullerian Hormone
  • Androstenedione
  • Sex Hormone Binding Globulin

Conditions where a Testosterone Total Male test is recommended:

  • Polycystic Ovary Syndrome
  • Alcoholism
  • Mumps
  • Hypothalamic disease
  • Pituitary disease
  • Infertility
  • Liver disease
  • Hyperthyroidism
  • Eating disorders
  • Pregnancy
  • Cushing Syndrome
  • Hypothyroidism
  • Testicular cancer
  • Adrenal insufficiency
  • Congenital Adrenal Hyperplasia

Commonly Asked Questions:

How is this test used by my health care provider?

In men, testosterone testing is used to identify a variety of problems. Testosterone is the major sex hormone in males, and it is responsible for masculine physical traits. It is produced mostly by the testicles.

The testosterone test can be used to determine whether or not you're experiencing:

  • Decreases sex drive
  • Men's erectile dysfunction
  • Male infertility
  • Tumors of the testicles in men
  • Disorders of the hypothalamus or pituitary gland

A testosterone total test is usually used to diagnose a condition. The free and total testosterone test distinguishes between testosterone that is bound to proteins in the blood and testosterone that is not attached to proteins.

About two-thirds of testosterone is tied to SHBG in the blood, with the remaining one-third attached to albumin. Free testosterone circulates in a tiny percentage. Bioavailable testosterone is made up of free testosterone and testosterone bound to albumin, and it can operate on target tissues.

A test for free or bioavailable testosterone may be performed in some circumstances, such as when the level of SHBG is abnormal, as it may more accurately indicate the presence of a medical issue.

Other tests and hormone levels may be performed in conjunction with testosterone testing, depending on the reason for testing. Here are a few examples:

  • FSH
  • LH
  • Estrogen
  • Estradiol
  • SHBG
  • DHEA-S
  • Prolactin
  • Androstenedione
  • 17-Hydroxyprogesterone

What does my testosterone test result mean?

Testosterone levels often begin to fall after the age of 30. Testosterone levels may drop more in obese or chronically unwell men, as well as with the use of certain drugs.

Hypogonadism can be caused by a variety of factors, including:

  • Pituitary or hypothalamic illness
  • Reduced testosterone production in young males can be caused by genetic disorders
  • Possible infertility or testicular failure
  • Acquired damage to the testes, such as from drinking, physical injury, or viral infections like mumps, reduces testosterone production.
  • Diabetes

Healthcare practitioners may recommend testosterone replacement therapy to men who have consistently low testosterone levels and associated signs and symptoms. The Food and Drug Administration has not approved testosterone supplements to improve strength, sports performance, or avoid aging disorders. It's possible that using it for these purposes is dangerous.

Increased testosterone levels in men can mean one of several things:

  • Tumors of the testicles
  • Testosterone-producing tumors in the adrenal glands
  • Use of anabolic steroids

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


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Description: A T4 Total test is a blood test that measures thyroxine free levels in your blood’s serum to evaluate your thyroid’s health and to screen for, diagnose, and monitor thyroid disorders such as hypothyroidism.

Also Known As: Total T4 Test, Total Thyroxine Test, T4 Test, T4, T4 Total Test, Bound T4 Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a T4 Total test ordered?

When a person exhibits symptoms of hyperthyroidism or hypothyroidism, a Total T4 test may be administered, especially if a TSH test result is abnormal.

Hyperthyroidism can cause the following signs and symptoms:

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

Hypothyroidism can cause the following symptoms:

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

When a person is being treated for a thyroid problem, Total T4 testing, along with other thyroid tests, may be requested on a regular basis.

Thyroid testing will most likely be ordered early and late in the pregnancy, as well as for a period after delivery, to monitor the mother and baby in pregnant women with thyroid abnormalities.

In the United States, thyroid hormone screening is routinely performed on babies as part of newborn screening programs.

What does a T4 Total blood test check for?

The thyroid gland, a small butterfly-shaped structure that lays on the windpipe towards the bottom of the throat, produces one of two primary hormones: thyroxine. Triiodothyronine is the other primary thyroid hormone, and together they help govern the rate at which the body utilizes energy. T4 in the blood is almost entirely linked to protein. The remaining portion is free and is the hormone's biologically active form. This test determines how much Bound T4 is present in the blood.

A feedback loop controls T4 production. The hypothalamus releases thyrotropin releasing hormone, which encourages the pituitary gland to generate and release thyroid-stimulating hormone when the amount of T4 in the blood drops. The thyroid gland is thus stimulated to produce and/or release more T4 as a result of TSH. TSH release is blocked as T4 content in the blood rises.

T4 accounts for over 90% of thyroid hormones. The thyroid gland releases accumulated T4 into circulation when the body requires it. T4 is either free or bound to protein in the blood. The amount of free T4 in the body is just about 0.1 percent of total T4. In the liver or other tissues, T4 is converted to T3. T3, like T4, is mainly attached to protein, however the physiologically active forms of T3 and T4 are the free versions. Free T3 in circulation is 4 to 5 times more active than free T4.

Dry skin, weight gain, cold intolerance, weariness, and irregular menstruation are among signs of hypothyroidism that occur when the thyroid gland does not produce enough T4 due to thyroid malfunction or insufficient TSH. Myxedema, or severe untreated hypothyroidism, can cause heart failure, convulsions, and coma. Hypothyroidism in children can slow growth and sexual development.

When the thyroid gland generates too much T4, the rate of a person's body functions increases, resulting in hyperthyroidism symptoms such as anxiety, increased heart rate, difficulty sleeping, weight loss, puffiness and dry itchy eyes, and hand tremors.

The most prevalent causes of thyroid dysfunction are connected to autoimmune illnesses. Hyperthyroidism is caused by Graves disease, while hypothyroidism is caused by Hashimoto thyroiditis. Thyroiditis, thyroid malignancy, and excessive or insufficient TSH production can all induce hyperthyroidism or hypothyroidism. By measuring Total T4, the influence of these variables on thyroid hormone synthesis can be recognized and monitored.

Note: Free T4 Index (T7) will only be calculated and reported if test code code 861 (T3 Uptake) is ordered as well.

Lab tests often ordered with a T4 Total test:

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

Conditions where a T4 Total test is recommended:

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

How does my health care provider use a T4 Total test?

Total thyroxine tests are used to assess thyroid function and detect thyroid disorders, such as hyperthyroidism and hypothyroidism, after the thyroid stimulating hormone level has been found to be abnormal.

The thyroid gland produces T4 and another hormone called triiodothyronine. They aid in the regulation of the rate at which the body expends energy and are governed by a feedback system. TSH promotes the thyroid gland's synthesis and release of T4 and T3.

The majority of T4 and T3 in the blood is attached to protein, while just a small amount is free. Total T4, free T4, total T3, and free T3 can all be measured in blood testing. The total T4 test has been around for a long time, but it is influenced by the quantity of protein in the blood that can bind to the hormone. The active form of thyroxine, free T4, is unaffected by protein levels. Many people believe that the free T4 test is a more accurate reflection of thyroid hormone activity, and it has largely supplanted the total T4 test.

A Total T4 test can be used in conjunction with or after a TSH test, and occasionally with a free T3 test to:

  • Help diagnose the cause of hyperthyroidism and hypothyroidism by detecting too much or too little thyroid hormone.
  • Differentiate between thyroid disorders.
  • Assist in the diagnosis of pituitary diseases
  • Assist in the diagnosis of infertility in women
  • In an individual with a known thyroid condition, track the effectiveness of treatment.
  • Monitor patients with pituitary disease to ensure that their thyroid is still operating, and thyroid hormone medication should be monitored if it isn't.
  • Monitor patients with thyroid cancer whose tumors respond to TSH. TSH and T4 levels will be monitored on a regular basis to ensure that adequate thyroid hormone is being administered to maintain TSH low while keeping T4 high.

In the United States, babies are routinely tested for T4 and TSH levels to rule out congenital hypothyroidism, which can lead to mental retardation if left untreated.

Thyroid abnormalities can sometimes be detected using Total T4 and TSH, however professional opinions differ on who should be screened and when they should start.

Thyroid antibodies, as well as a Total T4 test, may be ordered if a health practitioner suspects someone has an autoimmune-related thyroid problem.

What does my T4 Total result mean?

In general, high total T4 levels suggest an overactive thyroid gland, while low total T4 levels suggest an underactive thyroid gland. The test results are not diagnostic in and of themselves, but they will urge the health care provider to conduct additional testing to determine the reason of the excess or deficiency.

A range of temporary and chronic thyroid disorders are linked to both decreased and increased total T4 levels. A pituitary gland issue could be indicated by low total T4 levels along with a low TSH level, or by high total T4 levels combined with a high TSH.

When thyroid tests are done to monitor treatment for thyroid or pituitary diseases, the results will tell the doctor whether the treatment is working and/or if a dose adjustment is required. People with hyperthyroidism, for example, have their total T4, total T3, and TSH levels examined on a regular basis while taking anti-thyroid medicines to ensure that the drugs are effective and to reduce doses if thyroid hormone levels fall too low. TSH and total T4 levels are monitored on a frequent basis in hypothyroid patients to ensure that the correct dose of thyroid hormone is being given to bring TSH levels back to normal.

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



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

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

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  • Complete Blood Count
  • Ferritin
  • Transferrin
  • Zinc Protoporphyrin

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

  • Anemia
  • Hemochromatosis

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

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

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

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

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

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

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

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

Additional information about iron

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

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

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


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Measurement of the levels of bilirubin is used in the diagnosis and treatment of liver, hemolytic, hematologic, and metabolic disorders, including hepatitis and gall bladder obstruction. The assessment of direct bilirubin is helpful in the differentiation of hepatic disorders. The increase in total bilirubin associated with obstructive jaundice is primarily due to the direct (conjugated) fraction. Both direct and indirect bilirubin are increased in the serum with hepatitis.

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Description: A cortisol test measures the amount of cortisol in the blood. These levels will start off high in the morning and throughout the say they become lower. At midnight they are typically at their lowest level. Someone who works a night shift or has an irregular sleep schedule may have a different pattern. This test can be used to determine Cushing's or Addison's Disease.

Also Known As: Cortisol AM Test, Cortisol Total Test, Cortisol Test, Cortisol Blood Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: Specimen must be drawn between 7 a.m. and 9 a.m. Test is not recommended for patients receiving prednisone/prednisolone therapy due to cross reactivity with the antibody used in this test.

When is a Cortisol AM test ordered?

When a person has symptoms that point to a high level of cortisol and Cushing syndrome, a cortisol test may be recommended.

Women with irregular menstrual periods and increased facial hair may be tested, and children with delayed development and small stature may also be tested.

When someone exhibits symptoms that point to a low cortisol level, adrenal insufficiency, or Addison disease, this test may be ordered.

What does a Cortisol AM blood test check for?

Cortisol is a hormone that plays a function in protein, lipid, and carbohydrate metabolism. It has an effect on blood glucose levels, blood pressure, and immune system regulation. Only a small fraction of cortisol in the blood is "free" and biologically active; the majority is attached to a protein. Cortisol is a hormone that is produced into the urine and found in the saliva. This test determines how much cortisol is present in the blood, urine, or saliva.

Cortisol levels in the blood usually rise and fall in a pattern known as "diurnal variation." It reaches its highest point early in the morning, then gradually decreases over the day, reaching its lowest point around midnight. When a person works irregular shifts and sleeps at different times of the day, this rhythm might fluctuate, and it can be disrupted when a disease or condition inhibits or stimulates cortisol production.

The adrenal glands, two triangle organs that sit on top of the kidneys, generate and emit cortisol. The hypothalamus in the brain and the pituitary gland, a small organ below the brain, control the hormone's production. The hypothalamus produces corticotropin-releasing hormone when blood cortisol levels drop, which tells the pituitary gland to create ACTH. The adrenal glands are stimulated by ACTH to generate and release cortisol. A certain amount of cortisol must be produced for normal adrenal, pituitary gland, and brain function.

Cushing syndrome is a collection of signs and symptoms associated with an unusually high cortisol level. Cortisol production may be increased as a result of:

  • Large doses of glucocorticosteroid hormones are given to treat a range of ailments, including autoimmune illness and certain cancers.
  • Tumors that produce ACTH in the pituitary gland and/or other regions of the body.
  • Cortisol production by the adrenal glands is increased as a result of a tumor or abnormal expansion of adrenal tissues.

Rarely, CRH-producing malignancies in various regions of the body.

Cortisol production may be reduced as a result of:

  • Secondary adrenal insufficiency is caused by an underactive pituitary gland or a pituitary gland tumor that prevents ACTH production.
  • Primary adrenal insufficiency, often known as Addison disease, is characterized by underactive or injured adrenal glands that limit cortisol production.

After quitting glucocorticosteroid hormone medication, especially if it was abruptly stopped after a long time of use.

Lab tests often ordered with a Cortisol AM test:

  • Cortisol PM
  • ACTH
  • Aldosterone
  • 17-Hydroxyprogesterone
  • Growth Hormone

Conditions where a Cortisol AM test is recommended:

  • Addison’s Disease
  • Cushing’s Syndrome
  • Endocrine Syndromes
  • Hypertension
  • Pituitary Disorders

How does my health care provider use a Cortisol AM test?

A cortisol test can be used to detect Cushing syndrome, which is characterized by an excess of cortisol, as well as adrenal insufficiency or Addison disease, which are characterized by a deficiency of cortisol. Among other things, the hormone cortisol controls how proteins, lipids, and carbohydrates are metabolized. Cortisol levels in the blood normally increase and fall in a "diurnal variation" pattern, rising early in the morning, dropping during the day, and reaching their lowest point around midnight.

The adrenal glands generate and excrete cortisol. The hypothalamus in the brain and the pituitary gland, a small organ below the brain, control the hormone's production. The hypothalamus produces corticotropin-releasing hormone when blood cortisol levels drop, which tells the pituitary gland to create ACTH. Cortisol production and release are triggered by ACTH in the adrenal glands. A certain amount of cortisol must be produced for normal brain, pituitary, and adrenal gland function.

Only a small fraction of cortisol in the blood is "free" and biologically active; the majority is attached to a protein. Blood cortisol testing assesses both protein-bound and free cortisol, but urine and saliva cortisol testing assesses only free cortisol, which should be in line with blood cortisol levels. Multiple blood and/or saliva cortisol levels collected at various times, such as 8 a.m. and 4 p.m., can be used to assess cortisol levels and diurnal variation. A 24-hour urine cortisol sample will not reveal diurnal variations; instead, it will assess the total quantity of unbound cortisol voided over the course of 24 hours.

If an elevated amount of cortisol is found, a health professional will conduct additional tests to confirm the results and discover the cause.

If a person's blood cortisol level is abnormally high, a doctor may order additional tests to be sure the high cortisol is indeed abnormal. Additional testing could involve monitoring 24-hour urinary cortisol, doing an overnight dexamethasone suppression test, and/or obtaining a salivary sample before sleep to detect cortisol at its lowest level. Urinary cortisol testing necessitates collecting urine over a set length of time, usually 24 hours. Because ACTH is released in pulses by the pituitary gland, this test can assist evaluate whether a raised blood cortisol level is a true rise.

An ACTH stimulation test may be ordered if a health practitioner feels that the adrenal glands are not releasing enough cortisol or if initial blood tests reveal insufficient cortisol production.

The purpose of ACTH stimulation is to compare the levels of cortisol in a person's blood before and after receiving an injection of synthetic ACTH. If the adrenal glands are healthy, the reaction to ACTH stimulation will be an increase in cortisol levels. Low amounts of cortisol will result if they are broken or not functioning properly. To distinguish between adrenal and pituitary insufficiency, a lengthier variant of this test can be used.

What do my Cortisol AM test results mean?

Cortisol levels are typically lowest before bedtime and highest shortly after awakening, though this pattern can be disrupted if a person works rotating shifts and sleeps at various times on separate days.

Excess cortisol and Cushing syndrome are indicated by an increased or normal cortisol level shortly after awakening, as well as a level that does not diminish by bedtime. If the excess cortisol is not suppressed after an overnight dexamethasone suppression test, the 24-hour urine cortisol is elevated, or the late-night salivary cortisol level is elevated, the excess cortisol is likely due to abnormal increased ACTH production by the pituitary or a tumor outside of the pituitary, or abnormal production by the adrenal glands. Additional tests will aid in determining the root of the problem.

If the subject of the examination reacts to an ACTH stimulation test and has insufficient cortisol levels, the issue is most likely brought on by the pituitary's insufficient production of ACTH. The adrenal glands are most likely the source of the issue if the subject does not react to the ACTH stimulation test.

 

An additional test, like as a CT scan, may be used by the medical professional to evaluate the degree of any gland damage once an irregularity has been identified and related to the pituitary gland, the adrenal glands, or another cause.

Important: Patient needs to have the specimen collected between 7 a.m.-9 a.m.

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


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Cortisol is increased in Cushing's Disease and decreased in Addison's Disease (adrenal insufficiency). Patient needs to have the specimen collected between 3 p.m - 5 p.m.



Bones and joints play an integral role in the body. The bones provide a solid framework, and the joints and fluid in the joints work to keep the body mobile while working together with the soft tissue and muscles. Working together, they support the weight of the body.  

Unfortunately, the bones and joints may become weak. Let's examine some of the reasons that the bones and joints may become weak and the various reasons that may cause them to become weak.  

Afterwards, we'll learn why and how lab testing can help keep the joints, bones, and nervous system in peak condition.  

Factors That Affect Bones and Joints 

  • Aging - Over time, aging can lead to gradual weakening and deterioration of the bones and joints. 
  • Injury - Bones and or joints may become injured due to overexertion or an accident. 
  • Hereditary Factors - Genetic predisposition can cause the bones and joints to be more susceptible to many bone and joint conditions. 

Conditions Impacting Bones and Joints 

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, some health conditions may impact the bones and joints. There may be skin diseases as well. 

  • Osteoporosis - When bone mineral density and bone mass are gradually reduced, osteoporosis is the outcome. 
  • Scoliosis - Scoliosis produces a side curve of the spinal column. 
  • Paget's Disease - This is a bone disorder that causes bones to grow bigger and weaken. 
  • Osteopetrosis - A rare disorder giving rise to abnormal bone growth and bone density. 
  • Tendonitis - Brought on via repetitive injuries to tendons. 
  • Rheumatoid Arthritis or RA. - An immune system malfunction causes the body to attack the linings of the joints mistakenly. It's an inflammatory kind of arthritis. 

Signs And Symptoms of Joint and Bone Conditions 

Here are some of the signs and symptoms of joint and bone conditions:  

  • Brittle, weak bones 
  • Joint pain 
  • Bones that are deformed 
  • Inflammation in joints 
  • Pain in bones 
  • C or S-shaped spinal curves 

Lab Tests for Joints and Bones 

Other than a complete medical history, a lab test can help a doctor diagnose bones and joints issues. Here are a few of the lab tests that can be given: 

Blood Tests: These can measure a variety of components in the blood. Helpful in detecting rheumatoid arthritis as well as other joint and bone disorders.  

Functional Lab Panels for Bone and Joint Tests 

X-Rays: Imagery testing can point out abnormalities. 

  • CT or Computed Tomography and MRI or Magnetic Resonance Imaging - These are also imagery tests that can offer a more detailed image giving more details on bone and joint structure than an X-ray can show.  

FAQs On Bone and Joint Lab Tests 

Which lab tests are done for bone and joint disorders? 

Bone and joint disorders can be diagnosed via various tests such as X-rays, CT scans, an MRI, evaluations of bones, and bone-specific alkaline phosphatase testing

What Does a Bone Profile Blood Test Reveal? 

This test will reveal and measure proteins, enzymes, and minerals in bone turnover. They can potentially diagnose bone issues.  

Benefits Of Bone and Joint Lab Tests from Ulta Lab Tests 

Testing helps people stay on top of their health needs and manage and monitor their bone and joint health status. Lab tests from Ulta Lab Tests are easy and convenient to order and receive results. Once you have your results, please consult your healthcare provider to obtain their recommended next steps to improve or maintain your health.

Ulta Lab Tests offer highly accurate and reliable tests to help you make informed decisions about bones and joints' health issues.  

Benefits of using Ulta Lab Tests include: 

  • Confidential and secure results
  • No insurance referral required 
  • Affordable pricing
  • 100% guaranteed satisfaction 

Order your bone and joint health lab tests with Ulta Lab Tests