Pancreatic Cancer

Description: CA 19-9 is a cancer antigen test that is testing for a protein that exists on the surface of certain cancer cells. The CA 19-9 test can be used to measure the level of these proteins in the blood and is useful as a tumor marker.

Also Known As: Carbohydrate Antigen (CA) 19-9 Test, Cancer Antigen 19-9 Test, Cancer Antigen (CA) 19-9, Carbohydrate Antigen 19-9 Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a CA 19-9 test ordered?

When a person has been diagnosed with pancreatic cancer or has signs and symptoms that could indicate pancreatic cancer, CA 19-9 may be ordered. Early warning signs and symptoms can be vague and ambiguous.

If CA 19-9 levels are initially increased in pancreatic cancer, a series of CA 19-9 tests may be conducted to assess response during therapy and on a frequent basis after treatment to assist detect recurrence.

When a healthcare practitioner suspects bile duct cancer in a person with a bile duct obstruction, CA 19-9 may be prescribed. CA 19-9 levels can spike due to non-cancerous reasons of bile duct obstruction, but they drop once the blockage is addressed. In these circumstances, re-checking CA 19-9 levels should be done at least a week or two after the blockage has been cleared.

What does a CA 19-9 blood test check for?

The protein cancer antigen 19-9 is found on the surface of some cancer cells. CA 19-9 does not cause cancer; rather, it is emitted by tumor cells and can be discovered in blood and other bodily fluids by laboratory tests. The level of CA19-9 is measured in this test.

Because CA 19-9 can be tested in the blood, it can be used as a tumor marker to track the progression of cancer. CA 19-9 levels are high in 70% to 95% of persons with advanced pancreatic cancer.

CA 19-9 levels may also be elevated in cancers of the gallbladder and bile ducts, colorectal cancer, gastric cancers, ovarian cancer, lung cancer, liver cancer, pancreatitis, thyroid disease, and liver disease, among other cancers, conditions, and diseases. CA 19-9 is found in trace levels in the blood of healthy humans. CA 19-9 cannot be utilized for screening or diagnosis by itself because it is not specific for pancreatic cancer.

Lab tests often ordered with a CA 19-9 test:

• Bilirubin
• Carcinoembryonic Antigen
• Hepatic Function Panel
• Tumor Markers

Conditions where a CA 19-9 test is recommended:

• Pancreatic Cancer
• Pancreatitis
• Colorectal Cancer
• Gastric Cancers
• Lung Cancer
• Ovarian Cancer
• Cystic Fibrosis
• Liver Cancer
• Thyroid Disease
• Liver Disease

How does my health care provider use a CA 19-9 test?

The CA 19-9 test, along with other tests like carcinoembryonic antigen, bilirubin, and/or a liver panel, can be used to evaluate and monitor someone who has been diagnosed with pancreatic cancer and is having treatment.

CA 19-9 can only be utilized as a tumor marker if it is produced in large amounts by the malignancy. CA 19-9 may be ordered to help evaluate and monitor persons with bile duct cancer because it is high in roughly 65 percent of those with this type of cancer.

The CA 19-9 test is insufficiently sensitive and specific to be used as a cancer screening test. Because non-cancerous diseases can induce elevated CA 19-9 levels, it is not yet effective for detection or diagnosis. Researchers are still looking at markers that can be used alone or in combination with CA 19-9 to help diagnose and screen for pancreatic cancer in its early stages, when it is most curable.

What do my CA 19-9 test results mean?

Healthy persons have low levels of CA 19-9, although numerous illnesses that affect the liver or pancreas can induce transitory spikes.

People with pancreatic cancer, other malignancies, and a variety of other diseases and ailments may have moderate to high levels. CA 19-9 levels are higher in cancers of the exocrine pancreas. This cancer develops in the tissues that manufacture food-digesting enzymes, as well as in the ducts that transport those enzymes to the small intestine. This kind of pancreatic cancer accounts for approximately 95% of all pancreatic cancers.

CA 19-9 levels that rise and then diminish over time may indicate that the treatment is functioning and/or that the malignancy was successfully removed during surgery. Levels that stay high or rise over time could suggest that treatment isn't working and/or that the cancer is reoccurring.

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

Description: CEA is a test that measures the levels of carcinoembryonic antigens in the blood. It is used to evaluate a person who has been diagnosed with cancer. The levels of CEA maybe elevated with certain types of cancer.

Also Known As: Carcinoembryonic antigen Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a CEA test ordered?

When a person is diagnosed with colon cancer or another type of cancer, a CEA test may be ordered. It will be evaluated before treatment begins and subsequently on a frequent basis to assess treatment success and detect recurrence.

When cancer is suspected but not yet diagnosed, a CEA test may be conducted. Although CEA can be increased with a variety of illnesses, this is not a popular usage for the test, it may provide additional information to a healthcare practitioner.

When a healthcare practitioner suspects that a cancer has metastasized, a CEA test may be conducted on a fluid other than blood.

What does a CEA blood test check for?

Carcinoembryonic antigen is a protein found in the developing tissues of a fetus. It drops to a very low level by the time a baby is delivered. CEA is generally seen in extremely low amounts in the blood of people, but it can be raised in cancer patients. This test examines the quantity of CEA in the blood to aid in the evaluation of cancer patients.

CEA is a tumor indicator. CEA was once assumed to be a particular marker for colon cancer, however subsequent research has revealed that an elevation in CEA can be detected in a variety of malignancies. Non-cancer disorders such as inflammation, cirrhosis, peptic ulcer, ulcerative colitis, rectal polyps, emphysema, and benign breast disease, as well as smokers, can cause an increase in CEA. As a result, it is ineffective as a general cancer screening tool, although it does play a role in assessing cancer therapy response. An initial CEA baseline test may be performed after a person has been diagnosed with cancer. If this level is raised, serial CEA testing may be used to track the cancer's progress as the patient receives treatment.

Lab tests often ordered with a CEA test:

• Tumor Markers
• CSF Analysis
• Body Fluid Analysis
• CA 19-9
• Calcitonin
• Alpha Fetoprotein
• Antiphospholipid Antibodies

Conditions where a CEA test is recommended:

• Colon Cancer
• Colorectal Cancer
• Pancreatic Cancer
• Ovarian Cancer
• Breast Cancer
• Thyroid Cancer
• Lung Cancer

How does my health care provider use a CEA test?

The carcinoembryonic antigen test can be utilized in the following situations:

• To keep track of the treatment of persons who have been diagnosed with colon cancer. It can also be used as a marker for rectum, lung, breast, liver, pancreatic, stomach, and ovary malignancies. Prior to therapy, a CEA test is usually ordered as a "baseline" measurement. If the level is high, the test can be used to track a patient's response to treatment and see if the cancer has advanced or returned.
• Cancer staging entails determining the size of the tumor as well as the extent to which it has spread.
• CEA testing in a bodily fluid sample can help doctors figure out if cancer has progressed to a body cavity like the chest or abdomen.
• In the examination of cancer, a CEA test can be performed in conjunction with other tumor markers.

CEA is not produced by all malignancies, therefore a positive CEA test does not always indicate cancer.

What do my CEA test results mean?

Monitoring treatment and recurrence: CEA levels that are first raised but later return to normal following treatment indicate that the cancer has been successfully treated. The first symptom of tumor recurrence is frequently a progressively rising CEA level.

Staging: People with smaller and early-stage tumors are more likely to have a normal or slightly raised CEA score on initial testing. A high CEA value is more probable in people with larger tumors, later-stage cancer, or cancers that have disseminated throughout the body.

Testing for metastasis: If CEA is found in a bodily fluid other than blood, the cancer has most likely migrated to that part of the body. If CEA is found in CSF fluid, for example, it could suggest that cancer has spread to the central nervous system.

Because not all malignancies produce CEA, it's possible to have cancer and a normal CEA at the same time. The test will be useless as a surveillance tool if a malignancy does not produce CEA.

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

Description: Amylase is a blood test that is used to measure the amount of amylase in the blood’s serum. It is used to assess for and detect a pancreatic disorder.

Also Known As: Amy Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is an Amylase test ordered?

When a person displays symptoms of a pancreatic disease, a blood amylase test may be conducted.

• Abdominal or back pain that is severe
• Fever
• Appetite loss.
• Nausea

A urine amylase test may be requested in conjunction with or after a blood amylase test. A health practitioner may conduct one or both of these tests on a regular basis to evaluate the success of treatment and see whether amylase levels are increasing or decreasing over time.

What does an Amylase blood test check for?

Amylase is one of numerous pancreatic enzymes that aid in carbohydrate digestion. This test detects the presence of amylase in the blood.

Amylase is produced from the pancreas into the duodenum, the first region of the small intestine, where it aids in the digestion of carbohydrates. Other organs, including the salivary glands, generate it as well.

Amylase is normally found in modest amounts in the blood and urine. Increased levels of amylase are released into the blood when pancreatic cells are harmed, as in pancreatitis, or when the pancreatic duct is obstructed by a gallstone or, in rare situations, a pancreatic tumor. This raises amylase levels in the blood.

Lab tests often ordered with an Amylase test:

• Lipase
• Trypsin
• Trypsinogen

Conditions where an Amylase test is recommended:

• Cystic Fibrosis
• Pancreatic Cancer
• Pancreatic Diseases
• Pancreatitis

How does my health care provider use an Amylase test?

An amylase test is used to identify and track acute pancreatitis. It's frequently ordered in conjunction with a lipase test. It can also be used to detect and track chronic pancreatitis and other pancreas-related conditions.

A urine amylase test may be requested as well. Its level will usually correspond to blood amylase concentrations, but the rise and decrease will occur later. A urine creatinine clearance test may be ordered in conjunction with a urine amylase test to determine the ratio of amylase to creatinine filtered by the kidneys. Because poor kidney function might result in a decreased rate of amylase clearance, this ratio is used to assess renal function.

An amylase test on peritoneal fluid may be used to assist diagnose pancreatitis in some instances, such as when there is a buildup of fluid in the abdomen.

Amylase tests are often used to track the progress of pancreatic cancer treatment and after gallstone resection that has resulted in gallbladder attacks.

What do my Amylase test results mean?

A high level of amylase in the blood may suggest the presence of a pancreas problem.

Amylase levels in the blood often rise to 4 to 6 times higher than the highest reference value, also known as the upper limit of normal, in acute pancreatitis. The increase happens within 4 to 8 hours following a pancreas damage and usually lasts until the cause is effectively treated. In a few days, the amylase levels will return to normal.

Amylase levels in chronic pancreatitis are initially fairly increased, although they frequently decline over time as the pancreas deteriorates. Returning to normal levels may not signal that the source of damage has been rectified in this scenario. The size of the amylase rise does not indicate the severity of pancreatic illness.

Amylase levels may also be elevated in persons who have pancreatic duct obstruction or pancreatic cancer.

Urine amylase levels rise in lockstep with blood amylase levels and remain elevated for several days after blood levels have returned to normal.

A high amount of amylase in the peritoneal fluid can indicate acute pancreatitis, but it can also indicate other abdominal problems including a clogged intestine or poor blood supply to the intestines.

A low amylase level in the blood and urine of a person with pancreatitis symptoms could indicate that the amylase-producing cells in the pancreas have been permanently damaged. Reduced levels can also be caused by renal illness or pregnancy toxemia.

Increased blood amylase levels along with normal to low urine amylase levels could indicate the presence of a macroamylase, a harmless compound of amylase and other proteins that builds up in the bloodstream.

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

Description: A Lipase test is used to measure the amount of lipase in the blood’s serum. Lipase is an enzyme that is produced by the pancreas. This test can be used to help diagnose acute pancreatic diseases and monitor chronic ones. It can also be used to measure the progress of pancreatic disease treatment.

Also Known As: LPS Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a Lipase test ordered?

When a person shows signs of acute pancreatitis or another pancreatic condition, a lipase test may be recommended.

It may also be ordered at regular intervals when a doctor wishes to monitor someone with a pancreatic issue to see how well medication is working and whether lipase levels are rising or falling over time.

What does a Lipase blood test check for?

Lipase is one of numerous pancreatic enzymes that aid in the digestion of dietary lipids. This test determines how much lipase is present in the blood.

Lipase travels from the pancreas to the first portion of the small intestine, where it aids in the breakdown of dietary lipids into fatty acids. Lipase is produced mostly by the pancreas, but it is also produced by cells in the tongue, stomach, and liver, which are all involved in digestion and nutritional absorption.

Lipase is normally found in modest amounts in the blood. When pancreatic cells are harmed, as in pancreatitis, or the pancreatic duct is obstructed by a gallstone or, in rare situations, a pancreatic tumor, more lipase enters the bloodstream, resulting in greater blood concentrations.

Lab tests often ordered with a Lipase test:

• Amylase
• Trypsin
• Trypsinogen

Conditions where a Lipase test is recommended:

• Cystic Fibrosis
• Diabetes
• Pancreatic Diseases
• Pancreatitis
• Pancreatic Cancer
• Celiac Disease
• Crohn Disease

How does my health care provider use a Lipase test?

To diagnose and monitor acute pancreatitis, a blood test for lipase is frequently performed in conjunction with an amylase test. It can also be used to diagnose and monitor chronic pancreatitis and other pancreatic illnesses, but it isn't as good a test for these conditions because lipase levels stay raised for extended periods of time and don't always reflect clinical progress.

Lipase testing is sometimes used to diagnose and monitor cystic fibrosis, celiac disease, and Crohn's disease.

What do my Lipase test results mean?

A high lipase level in the blood could suggest the presence of a pancreas problem.

Lipase levels are usually quite high in acute pancreatitis, generally 5 to 10 times higher than the maximum reference point. Lipase levels normally rise within 4 to 8 hours of an acute pancreatitis incident and stay high for 7 to 14 days. The severity of an acute pancreatic attack cannot be determined by lipase levels.

Pancreatic duct obstruction, pancreatic cancer, and other pancreatic illnesses, as well as gallbladder inflammation and renal dysfunction, can raise concentrations.

Lipase levels in the blood may suggest persistent damage to the pancreas' lipase-producing cells. This can happen in pancreas-related chronic disorders like cystic fibrosis.

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

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

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

Collection Method: 

Blood Draw 

Specimen Type: 

Serum 

Test Preparation: 

9-12 hours fasting is preferred. 

When is a Comprehensive Metabolic Panel test ordered:  

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

What does a Comprehensive Metabolic Panel blood test check for? 

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

The following tests are included in the CMP: 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Lab tests often ordered with a Comprehensive Metabolic Panel test: 

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

Conditions where a Comprehensive Metabolic Panel test is recommended: 

• Diabetes
• Kidney Disease
• Liver Disease
• Hypertension

Commonly Asked Questions: 

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

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

What do my Comprehensive Metabolic Panel test results mean? 

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

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

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

Is there anything else I should know? 

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

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

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

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

Please note the following regarding BUN/Creatinine ratio: 

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

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

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

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

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

Collection Method: Blood Draw 

Specimen Type: Whole Blood 

Test Preparation: No preparation required 

When is a Complete Blood Count test ordered?  

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

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

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

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

What does a Complete Blood Count test check for? 

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

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

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

The CBC focuses on three different types of cells: 

WBCs (White Blood Cells) 

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

RBCs (Red Blood Cells) 

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

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

Platelets 

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

Lab tests often ordered with a Complete Blood Count test: 

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

Conditions where a Complete Blood Count test is recommended: 

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

Commonly Asked Questions: 

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

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

What do my Complete Blood Count results mean? 

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

What do my Differential results mean? 

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

What do my Platelet results mean? 

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

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

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

Reflex Parameters for Manual Slide Review

CBC Reflex Pathway

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

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

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

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

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

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

Description: An Albumin test is a blood test used to screen for a diagnose kidney disease, liver disorders, and evaluate a patient’s nutritional status.

Also Known As: ALB Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is an Albumin test ordered?

A panel of tests is commonly ordered as part of a health check, including an albumin test.

If a person exhibits any of the following signs of a liver problem, an albumin test may be requested along with other tests:

• skin or eyes turning yellow
• weakness, exhaustion
• Unaccounted-for weight loss
• reduced appetite
• edema and/or pain in the abdomen
• Dark feces and pale urine
• Itching

When someone exhibits the following nephrotic syndrome symptoms, for example:

• Swelling or puffiness, especially in the face, wrists, abdomen, thighs, or ankles, or around the eyes
• Foamy, bloody, or coffee-colored urine
• a reduction in the urine's volume
• problems urinating, such as a burning sensation or an unusual discharge, or a change in frequency, particularly at night
• discomfort in the middle of the back, below the ribs, and next to the kidneys
• elevated blood pressure

An albumin test may also be requested by a medical professional to assess or track a patient's nutritional condition. A reduction in albumin, however, needs to be carefully examined because, in addition to starvation, albumin concentrations respond to a number of other diseases.

What does an Albumin blood test check for?

The liver produces a protein called albumin. It has numerous roles and makes up roughly 60% of the blood's overall protein content. The amount of albumin in the blood is determined by this test.

Albumin nourishes tissues, transports hormones, vitamins, medicines, and chemicals like calcium throughout the body, and prevents fluid from seeping out of blood vessels. When factors affect the liver's ability to produce albumin, increase protein breakdown, increase protein loss through the kidneys, and/or increase plasma volume, albumin levels may decline to a greater or lower extent.

Low blood albumin can result from two key factors, including:

• Severe liver disease: Since the liver produces albumin, its level may drop with loss of liver function; however, this is usually only the case in cases of severe liver illness.
• Kidney disease: One of the kidneys' numerous jobs is to preserve plasma proteins like albumin so that they don't pass through the urine production process with other waste materials. High levels of albumin are found in the blood, and when the kidneys are working well, very little albumin is excreted in the urine. However, the ability to preserve albumin and other proteins starts to deteriorate if a person's kidneys become harmed or ill. Chronic disorders like diabetes and hypertension are prone to this. Extremely large amounts of albumin are lost through the kidneys in nephrotic syndrome.

Lab tests often ordered with an Albumin test:

• Hepatic Function Panel
• Comprehensive Metabolic Panel
• Urine Albumin
• Urinalysis
• Total Protein
• Creatinine
• Blood Urea Nitrogen (BUN)
• Renal Panel

Conditions where an Albumin test is recommended:

• Liver Disease
• Kidney Disease
• Malnutrition
• Proteinuria

How does my health care provider use an Albumin test?

An albumin test is widely used to assess a person's general health state since it is typically included in the panels of tests run as part of a health check, such as a thorough metabolic panel.

Albumin may also be used in a variety of situations to aid in the diagnosis of disease, to track changes in health status due to therapy or disease progression, and as a screen that may suggest the need for other types of testing because it can be low in a range of diseases and disorders.

The liver produces albumin, a protein that nourishes cells, prevents fluid from seeping out of blood vessels, carries hormones, vitamins, medications, and other chemicals like calcium throughout the body.

A creatinine, blood urea nitrogen, or renal panel may be ordered in addition to an albumin test to assess liver function or in conjunction with one of these tests to assess kidney function. Additionally, albumin can be requested to assess a person's nutritional status.

What do my Albumin test results mean?

The results of an albumin test are assessed in conjunction with those from other tests carried out concurrently, such as those in a comprehensive metabolic panel or during follow-up.

A low albumin level could be a red flag and a sign that more research may be necessary. A low albumin level could indicate a short-term issue that will go away on its own or it could indicate an acute or chronic disease that calls for medical attention.

When conditions affect albumin production, increase protein breakdown, increase protein loss, and/or expand plasma volume, albumin levels may decline to a greater or lower extent. Additional testing may be carried out to look into a low result, depending on the patient's medical history, signs and symptoms, and physical examination.

Low albumin levels may signal liver illness. To pinpoint precisely which sort of liver illness may be present, liver enzyme tests or a liver panel may be prescribed. However, until the disease has progressed to an advanced degree, a person with liver disease may have normal or nearly normal albumin levels. For instance, albumin is frequently low in cirrhotic individuals while albumin is typically normal in most chronic liver illnesses that have not progressed to cirrhosis.

Low albumin levels can be a sign of illnesses where the kidneys are unable to stop albumin from leaking into the urine and being lost. In this situation, tests for creatinine, BUN, or a renal panel may be requested, along with measurements of the albumin or protein levels in the urine.

Inflammation, shock, and starvation are among conditions that can cause low albumin levels. They may exhibit symptoms of diseases like Crohn's disease or celiac disease, which affect how well the body absorbs and digests protein, as well as circumstances where significant amounts of protein are wasted from the intestines.

A low albumin level can also occur in a number of different illnesses, including:

• Infections
• Burns
• Surgery
• chronic disease
• Cancer
• Diabetes
• Hypothyroidism
• the cancer syndrome
• Plasma volume enlargement brought on by congestive heart failure and occasionally pregnancy
• Dehydration can cause high albumin levels, albeit this condition is not routinely tracked or detected by the test.

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

Description: An Alkaline Phosphatase test or ALP is a blood test that is used to screen for and monitor liver disease, bone disorders, and gallbladder disease.

Also Known As: ALP Test, Alk Phos Test, Alkp Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is an Alkaline Phosphatase test ordered?

An ALP test may be requested as a standard laboratory test, frequently in conjunction with a liver panel of further assays. When a person exhibits signs of a liver or bone issue, it is frequently requested in conjunction with a number of additional tests.

What does an Alkaline Phosphatase test check for?

An enzyme called alkaline phosphatase is present in many bodily tissues. The cells that make up bone and the liver have the highest quantities of ALP. Liver illness or bone diseases are the most frequent causes of high blood levels of ALP. The blood's concentration of ALP is determined by this test.

ALP is located in the liver on the margins of cells that converge to form bile ducts, which are minuscule tubes that transport bile from the liver to the bowels, where it is required to aid in the digestion of dietary fat. Osteoblasts, specialized cells involved in bone production, are responsible for producing ALP in bone. Isoenzymes, which are produced in unique forms by each type of tissue, are ALP.

For instance, when one or more bile ducts are obstructed, ALP blood levels may significantly rise. Gallbladder inflammation or gallstones may be the cause of this. Blood ALP levels rise slightly more subtly in cirrhosis, liver cancer, hepatitis, and when liver-toxic medications are used.

Increased ALP levels can result from any condition that promotes excessive bone growth, including bone diseases like Paget's disease. Because their bones are still growing, children and adolescents often have higher blood ALP levels. Because of this, the ALP test needs to be interpreted differently for children and adults.

It is feasible to distinguish between the various ALP forms generated by various bodily tissues. A test may be run to identify which isoenzyme is elevated in the blood if it is unclear from clinical signs and symptoms whether the cause of a high ALP test result is liver or bone illness.

Lab tests often ordered with an Alkaline Phosphatase test:

• AST
• ALT
• GGT
• Bilirubin
• Comprehensive Metabolic Panel
• Hepatic Function Panel
• Alkaline Phosphatase Isoenzymes

Conditions where an Alkaline Phosphatase test is recommended:

• Lier Disease
• Hepatitis
• Cirrhosis
• Jaundice
• Osteoporosis
• Paget’s Disease
• Vitamin D Deficiency

How does my health care provider use an Alkaline Phosphatase test?

Using the alkaline phosphatase test, liver disease and bone diseases can be found.

Damaged liver cells produce more ALP into the blood under situations that harm the liver. Because ALP levels are particularly high at the margins of the cells that unite to form bile ducts, this test is frequently used to identify obstructed bile ducts. Blood levels of ALP are frequently high when one or more of them are blocked, such as by a tumor.

ALP levels in the blood can be impacted by any illness or disease that hinders bone development or increases bone cell activity. For instance, an ALP test may be used to identify tumors that have metastasized to the bones or to identify Paget's disease, a condition that results in deformed bones. This examination could occasionally be used to track the progress of patients being treated for Paget's disease or other bone disorders such vitamin D insufficiency.

Tests for the ALP isoenzyme may be performed to identify the cause if ALP readings are elevated but it is unclear whether this is related to liver or bone illness. To distinguish between liver and bone illness, one may additionally perform a GGT test and/or a test for 5'-nucleotidase. The levels of GGT and 5'-nucleotidase are elevated in liver illness but not in disorders of the bones.

What do my Alkaline Phosphatase test results mean?

High ALP typically indicates the presence of a disease that increases bone cell activity or liver damage.

The liver is typically where the elevated ALP is coming from if other liver tests, such as bilirubin, aspartate aminotransferase, or alanine aminotransferase, are also high. The high ALP is probably the result of liver illness if GGT or 5-nucleotidase levels are also elevated. If one of these two tests comes out normal, a bone issue is probably to blame for the high ALP. The ALP is typically coming from bone if calcium and/or phosphorus readings are abnormal.

A test for ALP isoenzymes may be required to differentiate between bone and liver ALP if it is unclear from signs and symptoms or other regular testing whether the high ALP is from the liver or bone.

ALP test findings are typically analyzed alongside those of other liver disease testing. ALP is commonly significantly less increased than AST and ALT in several types of liver illness, such as hepatitis. ALP and bilirubin may increase substantially higher than AST or ALT when the bile ducts are obstructed. ALP levels in liver cancer may also be higher.

ALP may be elevated in some bone illnesses, such as Paget's disease, which causes enlarged and misshapen bones, or in some cancers that extend to the bone.

ALP levels will eventually drop or return to normal if Paget's disease is successfully treated in a patient. ALP levels should fall if someone with liver or bone cancer responds to therapy.

Other illnesses include Hodgkin's lymphoma, congestive heart failure, ulcerative colitis, and specific bacterial infections can cause moderately high ALP.

ALP levels may briefly drop after cardiac bypass surgery or blood transfusions. Levels may drop as a result of a zinc deficiency. Hypophosphatasia, a rare genetic bone metabolism condition, can result in extremely low levels of ALP that persist for a long time. Wilson disease, protein insufficiency, and malnutrition are further potential reasons of low ALP.

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

Description: An ALT test is a blood test that is used to screen for and diagnose liver disease.

Also Known As: Alanine Aminotransferase Test, Alanine Transaminase Test, GPT Test, SGPT Test, Serum Glutamic Pyruvic Transaminase Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is an Alanine Transaminase test ordered?

When a person undergoes a standard health examination, ALT may be ordered as part of a full metabolic panel.

When a person has signs and symptoms of a liver problem, a healthcare provider will usually prescribe an ALT test.

Because many people with minor liver damage have no signs or symptoms, ALT may be ordered alone or in combination with other tests for persons who are at an elevated risk for liver disease. With modest liver injury, ALT levels will rise even if there are no other symptoms.

ALT may be ordered on a frequent basis during the course of treatment to establish whether the medication is effective when it is used to monitor the treatment of persons with liver disease.

What does an Alanine Transaminase blood test check for?

Alanine aminotransferase is an enzyme found mostly in liver and kidney cells. It's also found in much lesser concentrations in the heart and muscles. This test determines the amount of ALT in your blood.

The enzyme ALT converts alanine, a protein amino acid, into pyruvate, an important intermediary in cellular energy production. ALT levels in the blood are low in healthy people. ALT is released into the bloodstream when the liver is injured, frequently before more evident indications of liver injury, such as jaundice, appear. As a result, ALT is a useful test for detecting liver disease early on.

The liver is a critical organ positioned directly behind the rib cage on the upper right side of the abdomen. It is engaged in a variety of vital bodily functions. The liver aids in the digestion of nutrients, creates bile to aid in fat digestion, produces a variety of essential proteins such as blood clotting factors and albumin, and breaks down potentially hazardous compounds into safe substances that the body may utilize or discard.

Damage to liver cells can be caused by a variety of factors, resulting in an elevation in ALT. The test is most useful for detecting damage caused by hepatitis or medications or other toxins that are harmful to the liver.

As part of a liver panel, ALT is frequently tested alongside aspartate aminotransferase, another liver enzyme. When the liver is injured, both ALT and AST levels rise, albeit ALT is more specific for the liver and may be the only one to rise in some circumstances. An AST/ALT ratio can be used to help distinguish between different types of liver injury and their severity, as well as to distinguish liver injury from heart or muscle damage.

Lab tests often ordered with an Alanine Transaminase test:

• AST
• ALP
• GGT
• Bilirubin
• Liver Panel
• Comprehensive Metabolic Panel
• Albumin
• Total Protein
• Prothrombin Time
• Hepatitis Panel General

Conditions where a an Alanine Transaminase test is recommended:

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

How does my health care provider use an Alanine Transaminase test?

The alanine aminotransferase test is commonly used to diagnose liver damage. It's frequently ordered as part of a liver panel or complete metabolic panel with aspartate aminotransferase to screen for and/or diagnose liver disease.

ALT is an enzyme found mostly in liver and kidney cells. ALT is released into the bloodstream when the liver is injured. As a result, ALT is a useful test for detecting liver disease early on.

Although ALT is more specific to the liver than AST, they are both considered to be two of the most significant tests for detecting liver impairment. When AST is directly compared to ALT, an AST/ALT ratio is calculated. This ratio can assist distinguish between different types of liver disease and identify cardiac or muscle harm.

To assess which type of liver illness is present, ALT values are frequently matched to the results of other tests such as alkaline phosphatase, total protein, and bilirubin.

ALT is frequently requested to monitor the therapy of people with liver disease to evaluate if it is effective, and it can be ordered alone or in combination with other tests.

What do my ALT test results mean?

A low ALT level in the blood is normal and anticipated. The most prevalent cause of ALT levels that are higher than normal is liver disease.

Acute hepatitis and viral infections are the most common causes of very elevated ALT values. ALT levels are normally elevated for 1-2 months after acute hepatitis, but they might take up to 3-6 months to return to normal. ALT levels may also be significantly raised as a result of exposure to liver-toxic medications or other chemicals, or in situations that produce reduced blood flow (ischemia) to the liver.

In chronic hepatitis, ALT levels are frequently less than four times normal. Because ALT levels in this scenario regularly fluctuate between normal and slightly elevated, the test may be ordered frequently to observe if a trend emerges. Other reasons of mild ALT elevations include bile duct obstruction, cirrhosis, heart damage, alcohol addiction, and liver cancers.

ALT is frequently used in conjunction with an AST test or as part of a liver panel. See the Liver Panel article for more information on ALT values in relation to other liver tests.

The ALT level is usually greater than the AST level in most forms of liver disorders, and the AST/ALT ratio is low. There are a few exceptions: in alcoholic hepatitis, cirrhosis, and heart or muscle injury, the AST/ALT ratio is frequently more than 1, and it may be greater than 1 for a day or two after the onset of acute hepatitis.

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

Description: An AST blood test is a test that is used to screen for and diagnose liver disease.

Also Known As: Aspartate Aminotransferase Test, Serum Glutamic-Oxaloacetic Transaminase Test, SGOT Test Transaminase, Serum AST Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is an Aspartate Aminotransferase test ordered?

When someone undergoes a standard health examination, an AST test may be requested as part of a full metabolic panel.

When a person exhibits indications and symptoms of a liver problem, an AST test may be ordered along with numerous other tests.

Because many persons with minor liver damage have no signs or symptoms, AST may be ordered alone or in combination with other tests for people who are at an elevated risk for liver disease.

When AST is used to evaluate the effectiveness of treatment for people with liver disease, it may be ordered on a frequent basis during the course of treatment.

What does an Aspartate Aminotransferase blood test check for?

Aspartate aminotransferase is an enzyme found in cells all over the body, but especially in the heart and liver, as well as the kidneys and muscles to a lesser amount. AST levels in the blood are typically low in healthy people. AST is released into the bloodstream when liver or muscle cells are damaged. As a result, AST can be used to detect or monitor liver disease.

The liver is a critical organ found directly behind the rib cage in the upper right side of the abdomen. It is engaged in a variety of vital bodily functions. The liver aids in the digestion of nutrients, creates bile to aid in fat digestion, manufactures numerous vital proteins such as blood clotting factors, and breaks down potentially hazardous compounds into safe substances that the body may utilize or expel.

A variety of disorders can harm liver cells and cause AST levels to rise. The test is most effective in detecting liver damage caused by hepatitis, liver-toxic medications, cirrhosis, or alcoholism. AST, on the other hand, is not particular to the liver and can be elevated in diseases affecting other organs.

Alanine aminotransferase testing is frequently combined with an AST test. When the liver is injured, both of these enzymes become high in the bloodstream. A computed AST/ALT ratio can help distinguish between different types of liver injury and determine whether elevated levels are due to something else, such as a heart or muscle injury.

Lab tests often ordered with an Aspartate Aminotransferase test:

• GGT
• ALT
• ALP
• Bilirubin
• Hepatic Function Panel
• Comprehensive Metabolic Panel (CMP)
• Albumin
• Total Protein

Conditions where an Aspartate Aminotransferase test is recommended:

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

How does my health care provider use an Aspartate Aminotransferase test?

The aspartate aminotransferase blood test is commonly used to identify liver disease. It is frequently ordered in conjunction with alanine aminotransferase, another liver enzyme, or as part of a liver panel or comprehensive metabolic panel to screen for and/or diagnose liver problems.

Although ALT is more specific for the liver than AST and is more usually elevated than AST, both are regarded to be two of the most significant tests for detecting liver impairment. When AST is directly compared to ALT, an AST/ALT ratio is calculated. This ratio can be used to differentiate between different types of liver disease and hepatic harm from heart or muscle damage.

To assess which type of liver illness is present, AST levels are frequently compared to the results of other tests such as alkaline phosphatase, total protein, and bilirubin.

AST is frequently evaluated to monitor the treatment of people with liver disease, and it can be ordered alone or in combination with other tests.

AST is sometimes used to monitor persons who are receiving potentially hazardous drugs for the liver. If the person's AST levels rise, he or she may be moved to another medicine.

What do my AST test results mean?

Low AST levels in the blood are typical and anticipated.

Acute hepatitis and viral infections are the most common causes of very high AST values. AST values are normally elevated for 1-2 months after acute hepatitis, but they might take up to 3-6 months to recover to normal. AST levels can also be significantly high as a result of exposure to liver-toxic medications or other chemicals, as well as situations that produce reduced blood supply to the liver.

AST values are usually lower in chronic hepatitis, generally less than 4 times normal, and are more likely to be normal than ALT levels. With chronic hepatitis, AST levels typically fluctuate between normal and slightly elevated, so the test may be ordered repeatedly to detect the pattern. Other illnesses of the liver, particularly when the bile ducts are clogged, as well as cirrhosis and certain malignancies of the liver, can cause moderate increases. AST can also rise after a heart attack or a muscular damage, although to a far higher extent than ALT.

The AST test is frequently done in conjunction with the ALT test or as part of a liver panel. See the Liver Panel article for more information on AST values in relation to other liver tests.

The ALT level is usually greater than the AST level in most kinds of liver disease, and the AST/ALT ratio is low. There are a few exceptions: in alcoholic hepatitis, cirrhosis, hepatitis C virus-related chronic liver disease, and the first day or two of acute hepatitis or injury from bile duct obstruction, the AST/ALT ratio is frequently elevated. AST levels are generally substantially higher than ALT after cardiac or muscle injury, and they tend to stay higher than ALT for longer than they do after liver injury.

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

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

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

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a Bilirubin, Fractionated test ordered?

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

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

Other signs and symptoms to look out for include:

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

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

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

What does a Bilirubin, Fractionated blood test check for?

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

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

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

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

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

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

Lab tests often ordered with a Bilirubin, Fractionated test:

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

Conditions where a Bilirubin, Fractionated test is recommended:

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

Commonly Asked Questions:

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

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

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

Laboratory testing can measure or estimate two types of bilirubin:

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

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

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

Bilirubin is measured in adults and older children to:

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

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

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

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

What do my bilirubin test results mean?

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

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

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

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

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

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

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

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

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

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

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

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

Chromogranin A, LC/MS/MS - Chromogranin-A (CgA) is an acidic glycoprotein expressed in the secretory granules of most normal and neoplastic neuroendocrine (NE) cell types, where it is released together with peptide hormones and biogenic amines. Neuroendocrine tumors (NETs) are a form of cancer that differ from other neoplasia in that they synthesize, store, and secrete peptides, e.g., CgA and amines. CgA is secreted from neuroendocrine-derived tumors including foregut, midgut and hindgut gastrointestinal NETs, pheochromocytomas, neuroblastomas, medullary thyroid carcinomas, some pituitary tumors, functioning and non-functioning pancreatic NETs.
Significantly elevated CgA levels have been found in patients with other diseases, such as impaired renal function, untreated benign essential hypertension, gastritis, prostatic carcinoma, and hyperparathyroidism. The best-characterized circulating biomarker that identifies NETs in general is CgA. Monitoring blood CgA levels may effectively provide information that is helpful in delineating tumor burden and rate of tumor growth, predicting tumor response to therapy and providing some indication as to prognosis.

Galectin-3

Clinical Significance

A galectin-3 test may be ordered for the identification of individuals with chronic heart failure at elevated risk of disease progression.

Performing Laboratory 

Cleveland HeartLab, Inc 
6701 Carnegie Avenue, Suite 500
Cleveland, OH 44103-4623

Clinical Significance

The glucagon assay is useful primarily when considering a glucagon-secreting tumor of the pancreas. Glucagonomas cause an unusual but characteristic syndrome consisting of a rash, mild diabetes, weight loss and hypoamninoacidemia. Measurement of plasma glucagon confirms the diagnosis; glucagon levels are very high in the setting of glucagonoma.

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

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

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a Hepatic Function Panel test ordered?

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

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

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

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

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

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

What does a Hepatic Function Panel blood test check for?

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

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

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

Lab tests often ordered with a Hepatic Function Panel test:

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

Conditions where a Hepatic Function Panel test is recommended:

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

Commonly Asked Questions:

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

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

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

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

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

What do my Liver Panel Test results mean?

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

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

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

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

Pancreatic polypeptide tests are used in the assessment of pancreatic tumor burden and to assist in the early diagnosis of pancreatic tumors. The measurement of its concentrations is also used to monitor pancreatic carcinoma therapy and to predict the recurrence of pancreatic tumors

Clinical Significance 

Matrix metalloproteinases (MMPs) are a family of Zinc-dependent endopeptidases that degrade extracellular matrix proteins. Human MMP-9 Matrix metalloproteinase-9 (Gelatinase-B), with a molecular weight of 82 Kd, is inhibited by TIMP-1 and alpha 2 macroglobulin. MMP-9 is secreted by tumor cells, endothelial cells, fibroblasts and leucocytes.MMP-9 is involved in inflammation, tissue modeling, wound healing and processing of cytokines. Expression of MMP-9 correlates with abnormal collagen deposition that accompanies pancreatic cancer, with the metastasis to lymph nodes by human breast cancer cells and invasion of regional vessels in giant cell tumors of bones. MMP-9 is elevated in saliva in patients with gingivitis and periodontal diseases.