Alzheimer's Disease

Description: The ApoE Genotype test is used to identify which Apolipoprotein E Genotype a patient has to determine the patient’s cardiovascular risk and lipid metabolism.

Also Known As: ApoE Cardiac Risk Test, ApoE Cardiovascular Disease Test, Apolipoprotein E Test, Apo E Test, ApoE Protein Test

Collection Method: Blood Draw

Specimen Type: Whole Blood

Test Preparation: No preparation required

When is an ApoE Genotype test ordered?

APOE genotyping is requested as a test to assess cardiovascular risk or lipid metabolism in those who have:

• Levels of cholesterol and triglycerides that are significantly increased and do not go down as a result of dietary and lifestyle adjustments
• A physician who is interested in determining whether a person may be more at risk for developing early heart disease because family members have APOE e2/e2
• Xanthomas, which are yellowish skin lesions, are suspected to be type III hyperlipoproteinemia by the medical professional.

What does an ApoE Genotype test check for?

A protein called apolipoprotein E aids in the movement of lipids through the blood. It can transfer lipids to cells for utilization or storage as well as extra lipid to the liver for excretion because it is recognized by particular cell surface receptors.

There are three genetic variants of the apoE protein, each of which has a slightly different structure. ApoE2, ApoE3, and ApoE4 are their names. While ApoE3 and ApoE4 bind strongly to those receptors, cell surface receptors do not identify ApoE2 very well. Since poor binding of ApoE2 to receptors impairs transport from blood to cells, patients with ApoE2 typically have higher blood lipid levels.

e2, e3, and e4 are three distinct genes that, respectively, code for ApoE2, ApoE3, and ApoE4. Each parent contributes one allele to the individual. Homozygous individuals are those who inherit the same allele from both parents (e2/e2, e3/e3, or e4/e4). Heterozygous individuals are those who have multiple alleles, such as e2/e3, e2/e4, or e3/e4.

A person's DNA is examined as part of the APOE genotyping test to ascertain which APOE forms are present.

The most prevalent genotype of APOE, e3/e3, is regarded as "neutral." Disease risks are calculated in relation to the e3/e3 population.

A higher risk of atherosclerosis is linked to APOE e4, which is present in 25% of the population. When eating a diet high in saturated fat, individuals with certain genotypes may be prone to considerably higher levels of LDL-C and triglycerides.

Those who carry the APOE e2 allele typically have higher triglycerides but lower LDL-C values. Type III hyperlipoproteinemia/hyperlipidemia, a rare genetic condition that results in xanthomas, which are fatty yellow deposits on the skin, elevated triglyceride levels in the blood, and early-onset atherosclerosis, is also linked to APOE e2. With the e2/e2 genotype, type III hyperlipoproteinemia/hyperlipidemia only occurs in roughly 2% of individuals.

Lab tests often ordered with an ApoE Genotype test:

• Lipoprotein Fractionation Ion Mobility
• Lipid Panel
• Apolipoprotein A1
• Apolipoprotein B
• Lipoprotein (a)

Conditions where an ApoE Genotype test is recommended:

• Cardiovascular Disease
• Hyperlipoproteinemia

How does my health care provider use an ApoE Genotype test?

APOE genotyping is typically carried out in research settings, but it can also be applied in clinical settings to aid in the diagnosis and management of increased lipid levels.

When a person exhibits symptoms suggestive of type III hyperlipoproteinemia, APOE testing may be performed to confirm the diagnosis and assess the risk of the problem in other family members. This uncommon genetic condition results in xanthomas, which are fatty, yellowish skin deposits, elevated blood triglyceride levels, and early-onset atherosclerosis.

The APOE genotyping procedure has the potential to direct lipid therapy. Statins are typically regarded as the therapy of choice in situations of high cholesterol and triglyceride levels to lower the risk of developing cardiovascular disease. The APOE genotype, however, has some bearing on the broad variation in response to these lipid-lowering medications. The full clinical utility of this kind of information is still not fully recognized at this time.

What do my ApoE Genotype test results mean?

Genotype e3/e3 of APOE is the most prevalent. Since APOE e3 is linked to "normal" lipid metabolism, it is possible that it has no hereditary bearing on the likelihood of developing cardiovascular disease.

A higher risk of atherosclerosis is linked to APOE e4, which is present in 25% of the population. When eating a diet high in saturated fat, people with certain genotypes may be prone to considerably higher levels of LDL-C and triglycerides.

People who carry the APOE e2/e2 allele typically have higher triglycerides but lower LDL-C values. Type III hyperlipidemia and hyperlipoproteinemia are both linked to APOE e2. Although those who carry the APOE e2/e2 genotype are more likely to experience early vascular disease, they may never experience disease. If symptoms are present, e2/e2 can assist confirm type III hyperlipoproteinemia and APOE genotyping adds more information.

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

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

Also Known As: CRP Test, Inflammation test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a C-Reactive Protein test ordered?

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

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

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

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

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

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

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

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

Conditions where a C-Reactive Protein test is recommended:

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

Commonly Asked Questions:

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

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

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

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

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

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

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

What do my C-Reactive Protein test results mean?

CRP levels in the blood are usually low.

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

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

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

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

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

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

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

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

Collection Method: Blood Draw 

Specimen Type: Whole Blood 

Test Preparation: No preparation required 

When is a Complete Blood Count test ordered?  

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

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

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

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

What does a Complete Blood Count test check for? 

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

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

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

The CBC focuses on three different types of cells: 

WBCs (White Blood Cells) 

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

RBCs (Red Blood Cells) 

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

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

Platelets 

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

Lab tests often ordered with a Complete Blood Count test: 

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

Conditions where a Complete Blood Count test is recommended: 

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

Commonly Asked Questions: 

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

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

What do my Complete Blood Count results mean? 

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

What do my Differential results mean? 

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

What do my Platelet results mean? 

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

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

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

Reflex Parameters for Manual Slide Review

CBC Reflex Pathway

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

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

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

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

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

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

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

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

Collection Method: 

Blood Draw 

Specimen Type: 

Serum 

Test Preparation: 

9-12 hours fasting is preferred. 

When is a Comprehensive Metabolic Panel test ordered:  

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

What does a Comprehensive Metabolic Panel blood test check for? 

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

The following tests are included in the CMP: 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Lab tests often ordered with a Comprehensive Metabolic Panel test: 

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

Conditions where a Comprehensive Metabolic Panel test is recommended: 

• Diabetes
• Kidney Disease
• Liver Disease
• Hypertension

Commonly Asked Questions: 

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

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

What do my Comprehensive Metabolic Panel test results mean? 

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

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

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

Is there anything else I should know? 

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

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

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

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

Please note the following regarding BUN/Creatinine ratio: 

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

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

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

Description: The electrolyte panel test is a blood test that measures levels of electrolytes in the blood’s serum.

Also Known As: Lytes Panel, Anion Gap Panel, Electrolyte Test, Lytes Test, Anion Gap Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is an Electrolyte Panel test ordered?

An electrolyte panel may be requested as part of a regular screening or as a diagnostic tool when an individual symptoms, such as:

• Accumulation of fluid
• Weakness Nausea or vomiting
• Confusion
• Heartbeat irregularity

It is usually requested as part of an examination when a person has an acute or chronic illness, as well as at regular intervals when a person has a disease or condition, or is receiving medication that can induce an electrolyte imbalance. Electrolyte tests are frequently requested at regular intervals to evaluate the therapy of disorders such as high blood pressure, heart failure, lung ailments, and liver and kidney disease.

What does an Electrolyte Panel test check for?

Electrolytes are minerals that are found as dissolved salts in bodily tissues and blood. Electrolytes help transfer nutrients into and waste out of the body's cells, maintain a healthy water balance, and control the body's acid/base level as electrically charged particles.

The electrolyte panel determines the concentrations of sodium, potassium, chloride, and bicarbonate in the blood.

Sodium, potassium, and chloride are all found in a person's diet. By reabsorption or disposal into the urine, the kidneys assist in maintaining correct levels. The lungs regulate CO2 and provide oxygen. The body produces CO2, which is balanced with bicarbonate. The total balance of these substances is a sign of how well various essential biological functions are working. They play a role in a variety of biological activities, including cardiac and skeletal muscle contraction, as well as nerve impulse conduction.

A fluid, electrolyte, or pH imbalance can be caused by any disease or condition that changes the volume of fluid in the body, such as dehydration, or affects the lungs, kidneys, metabolism, or respiration. To ensure the appropriate functioning of metabolic processes and the supply of the right quantity of oxygen to tissues, normal pH must be maintained within a limited range of 7.35-7.45 and electrolytes must be in balance.

The anion gap, which is a value calculated from the results of an electrolyte panel, is a related "test." It indicates the difference in charge between positively and negatively charged ions. Although an aberrant anion gap is non-specific, it can indicate the presence of hazardous chemicals or metabolic or respiratory problems.

Lab tests often ordered with an Electrolyte Panel test:

• Basic Metabolic Panel (BMP)
• Comprehensive Metabolic Panel (CMP)
• Creatinine
• Glucose

Conditions where an Electrolyte Panel test is recommended:

• Acidosis
• Alkalosis
• Kidney Disease
• Hypertension
• Dehydration
• Congestive Heart Failure

How does my health care provider use an Electrolyte Panel test?

An electrolyte, fluid, or pH imbalance is detected using the electrolyte panel. It's commonly ordered as part of a normal physical examination. It is available as a standalone test or as part of a basic or comprehensive metabolic panel. Other tests like as BUN, creatinine, and glucose may be included in these panels.

Electrolyte measures can be used to assess illnesses including dehydration, kidney disease, lung disease, or heart disease that induce electrolyte imbalances. Repeat testing can then be performed to track the progress of treatment for the ailment that caused the imbalance.

Because electrolyte and acid-base imbalances can occur in a wide range of acute and chronic disorders, the electrolyte panel is commonly used to assess patients in both the emergency room and the hospital.

The electrolyte panel includes tests for the following electrolytes:

• Sodium—the majority of sodium in the body is located in extracellular fluid, which is situated outside of cells and helps to regulate the quantity of water in the body.
• Potassium is an electrolyte that is mostly present inside the body's cells. The plasma, or liquid portion of the blood, contains a modest but vital amount of potassium. Potassium levels must be monitored since even modest variations might alter the heart's rhythm and ability to contract.
• Chloride—this electrolyte travels in and out of cells to assist maintain electrical neutrality, and its level is usually the same as sodium's.
• Bicarbonate—the primary function of bicarbonate, which is produced and reabsorbed by the kidneys, is to maintain a constant pH level and, secondarily, to maintain electrical neutrality.

An anion gap calculation may be included in the electrolyte panel data.

If a person has an electrolyte imbalance, such as sodium or potassium, the health practitioner may prescribe additional testing of that specific electrolyte, as well as monitoring the imbalance until it resolves. If someone has an acid-base imbalance, a health care provider may prescribe blood gas tests, which measure the pH, oxygen, and carbon dioxide levels in an arterial blood sample to assist assess the severity of the problem and track its progress.

What do my electrolyte panel test results mean?

Several disorders and diseases can induce high or low electrolyte levels. They are often influenced by the amount of food taken and absorbed by the body, the amount of water in the body, and the amount excreted by the kidneys. They are also influenced by hormones like aldosterone, which conserves sodium while promoting potassium disposal, and natriuretic peptides, which stimulate sodium excretion via the kidneys.

People with malfunctioning kidneys, for example, may retain an excessive amount of water in their bodies. This has the effect of diluting sodium and chloride, lowering their quantities below normal. People who have lost a lot of fluid, on the other hand, may have higher potassium, sodium, and chloride levels. Some diseases, such as heart disease and diabetes, can disrupt the body's fluid and electrolyte balance, resulting in abnormal electrolyte levels.

Knowing which electrolytes are out of balance can assist a health care provider in determining the underlying cause and making treatment recommendations to restore appropriate balance. An electrolyte imbalance, if left untreated, can cause dizziness, cramping, irregular heartbeat, and even death.

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

F2-Isoprostane/Creatinine Ratio (Urine Test)

Clinical Significance

The F2-Isoprostane/Creatinine ratio is used to measure oxidative stress, particularly in individuals with lifestyle risks due to poor diet or smoking, those with a family history of cardiovascular disease or those with hyperlipidemia.

Alternative Name(s) 

IsoPF2,F2 Isoprostane,F2CR,F2-IsoPs

Includes

Arsenic, Cadmium, Lead, Mercury, Creatinine

Patient Preparation

Avoid seafood consumption for 48 hours prior to collection

Description: A heavy metals test is a blood test that measures levels of toxic metals in your blood to check for metal poisoning.

Also Known As: Toxic Metals Test, Heavy Metals Blood Test

Collection Method: Blood Draw

Specimen Type: Whole Blood

Test Preparation: Avoid seafood consumption for 48 hours prior to sample collection

When is a Heavy Metals Panel test ordered?

If a medical professional believes that a patient has been acutely or chronically exposed to one or more heavy metals, a heavy metals panel may be prescribed. Depending on the type and amount of metal involved, the nature and severity of the signs and symptoms of heavy metal exposure will vary; early signs of poisoning can be missed because they are frequently non-specific. Even if a person has no, few, or vague symptoms, excessive exposure can nonetheless cause harm to numerous organs.

Those who might be exposed to metals at work are typically periodically observed. Safety precautions reduce danger to workers and aid in resolving issues when they arise. Several dangerous metals that can be present at work are regulated by the U.S. Occupational Safety and Health Administration. The affected individuals are monitored and action is made to lessen their exposure if excessive quantities are found.

What does a Heavy Metals Panel blood test check for?

A heavy metals panel is a collection of tests that assesses the levels of particular potentially harmful metals in blood, urine, or, less frequently, hair or other body fluids or tissues. A laboratory might offer tests for individual metals as well as various groupings of heavy metals panels. Lead, mercury, and arsenic are the most typical mixture. Other panels might contain one or more other metals, such copper, zinc, or cadmium. In addition to considering the patient's clinical symptoms, a healthcare professional will decide which metals to test for depending on possible exposure.

The definition of "heavy metals" is ambiguous. It refers to a number of elements with high density or metallic qualities and is connected to the periodic table of elements. These substances are naturally present throughout the environment, and businesses employ them to create a variety of everyday goods. Some of them, such as copper, iron, molybdenum, selenium, and zinc, are required in tiny amounts by the body for regular function but can be harmful at higher levels. Any of the heavy metals can irritate or harm the body in high doses, and they can contaminate the soil, air, food, and water as well as linger in the environment for a very long time. The terms "heavy metals" and "toxic metals" are commonly used interchangeably because they are a potential source of harm.

The signs and symptoms that an individual may suffer are influenced by the type of metal, its form, the quantity, the time of exposure, the type of exposure, the individual's age, and the general health of the individual. One form of a metal may be more dangerous than another, such as an organic vs an inorganic metal compound, and some metals are significantly more toxic than others. The amount of metal absorbed and the areas of the body that are impacted can vary depending on how a person is exposed. For instance, a metal may be far more poisonous and cause serious lung damage when its fumes are inhaled than it may be when it is held in the hand or is just moderately dangerous and poorly absorbed when consumed.

Moderate exposure over time should also be evaluated because severe acute exposure can harm you and, in some situations, be fatal. Small amounts of heavy metals can be processed by the body, but moderate to large levels can build up in the kidneys, liver, bones, and brain. Some metals can impair the body's capacity to create red and white blood cells and are thought to be carcinogenic, which increases the risk of developing cancer. Because exposure to low or moderate concentrations can disrupt physical and cognitive development and can irreparably damage the organs and brain, fetuses and young children are most at danger. A significant portion of the metals can be transferred from the mother to the fetus, and some can be transferred to the baby through breast milk.

Lab tests often ordered with a Heavy Metals Panel test:

• Lead
• Mercury
• Iron
• Copper

Conditions where a Heavy Metals Panel test is recommended:

• Lead Poisoning
• Iron Toxicity
• Copper Toxicity
• Mercury Poisoning

How does my health care provider use a Heavy Metals Panel test?

For people who may have been exposed to one or more heavy metals, heavy metal testing is used to check for or diagnose heavy metal toxicity. It is also used to monitor excessive metal concentrations in people who work with different heavy metals. Construction, mining, radiator repair shops, and shooting ranges are a few examples of these professions. Testing is also done to check how well chelation therapy, a method of getting rid of heavy metals from the body, is working.

A series of studies using heavy metal panels is put up to simulate possible metal exposures. One or more distinct categories for either blood or urine may be available in a laboratory. A medical professional will place an order for the metals panel based on the patient's profession, interests, potential exposure, and/or clinical symptoms.

A doctor may prescribe a specific test in place of or in addition to a panel if they have reason to believe that a patient has been exposed to a particular metal, such as lead. When testing for exposure, lead is frequently ordered on its own, especially in youngsters due to their heightened sensitivity to its effects. Some metals can also be measured in bodily tissues, fluid, hair, and nails. These are often purchased separately.

What do my Heavy Metals Panel test results mean?

The evaluation of heavy metals test results must be done with care. A low concentration of a heavy metal in the blood does not always imply that an excessive amount of exposure has not taken place. Heavy metals do not persist in the blood for a long time and do not linger in the urine. For instance, over time, lead is absorbed into the bones when it moves from the blood into the body's organs. Lead may be found in a person's blood, urine, organs, and bones if they were exposed to lead on a regular basis.

Due to their widespread presence in our environment, several heavy metals may be found in extremely low concentrations in the blood and urine of individuals who appear to be in good health. Age-related recommendations for safe levels of heavy metals can change over time as new knowledge regarding their safety becomes available.

Scientists discovered detectable mercury in nearly 8,000 participants in a research done in 2004 according to the Centers for Disease Control and Prevention, for instance. They came to the conclusion that mercury levels in the blood and urine tend to rise with age. Additionally, they claim that the presence of mercury in detectable amounts in the blood or urine does not necessarily indicate that mercury levels have a negative impact on health. Physicians and public health officials can use reference values from monitoring studies on mercury levels in the body to assess if a patient has been exposed to levels of mercury above those in the general population.

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

Includes

Arsenic, Mercury, Lead, Creatinine

Patient Preparation

Avoid seafood consumption for 48 hours prior to collection

Excessive exposure to heavy metals can cause acute and chronic toxicity. Heavy Metals Panel is intended to evaluate and monitor exposure to heavy metals and evaluate the process of detoxification.

Description: A Potassium test is normally part of an electrolyte panel or Comprehensive Metabolic panel to help diagnose and monitor any electrolyte imbalances.

Also Known As: K Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a Potassium test ordered?

When patients get a normal medical exam or are being assessed for a serious illness, potassium levels may be required.

When a healthcare provider is diagnosing and monitoring hypertension, diabetic ketoacidosis, and renal disease, as well as monitoring a patient on dialysis, diuretic medication, or intravenous fluids, potassium tests may be performed at regular intervals.

What does a Potassium blood test check for?

Potassium is a necessary electrolyte for cell metabolism. It assists in the delivery of nutrients into cells and the removal of waste materials from cells. It also plays a role in muscle function by assisting in the transmission of messages between neurons and muscles. This test determines how much potassium is present in the blood and/or urine.

Potassium, along with other electrolytes like sodium, chloride, and bicarbonate, aids in fluid regulation and maintains a stable acid-base balance in the body. Potassium is found in all body fluids, although it is concentrated in the cells. Only a trace amount is found in fluids outside of cells and in the blood's liquid portion.

The majority of the potassium we require comes from the foods we eat, and most people consume enough potassium. The body consumes what it needs and excretes the rest through the urine. The body works to keep the potassium level in the blood within a restricted range. Aldosterone, a hormone generated by the kidney's adrenal glands, is the key regulator.

Because potassium levels in the blood are so low, even little adjustments can have a big impact. There might be major health effects if potassium levels are either low or too high; a person may get shock, respiratory failure, or heart rhythm abnormalities. An abnormal potassium level can affect neuron and muscle function; for example, the heart muscle's capacity to contract may be impaired.

Lab tests often ordered with a Potassium test:

• Chloride
• Sodium
• Bicarbonate
• Electrolytes
• Basic Metabolic Panel (BMP)
• Comprehensive Metabolic Panel (CMP)
• Aldosterone
• Renin

Conditions where a Potassium test is recommended:

• Hypertension
• Acidosis
• Alkalosis
• Kidney Disease
• Heart Disease
• Conn Syndrome
• Addison Disease

How does my health care provider use a Potassium test?

A potassium test is used to detect irregular potassium values, such as high and low potassium. It's frequently utilized as part of a standard physical's electrolyte panel or basic metabolic panel.

Potassium is a necessary electrolyte for cell metabolism. It assists in the delivery of nutrients into cells and the removal of waste materials from cells. It also has a role in muscular function, assisting in the transmission of messages between nerves and muscles, as well as heart function.

The potassium test can be used to detect and/or monitor kidney disease, which is the most prevalent cause of elevated potassium levels in the blood. When someone has diarrhea and vomiting, excessive sweating, or a range of symptoms, it can also be utilized to check for abnormal levels. Many disorders can cause elevated potassium levels in the blood. If metabolic acidosis is suspected, or if high blood pressure or other indications of disease are present, a healthcare practitioner may order this test, along with others, to discover an electrolyte imbalance. When there are symptoms involving the heart, potassium in particular might be assessed.

The potassium test can also be used to track the effects of medicines that cause potassium loss in the kidneys, such as diuretics, or pharmaceuticals that reduce potassium clearance from the body, resulting in high potassium levels.

What do my Potassium test results mean?

Conditions that cause high potassium levels include:

• Kidney failure
• The disease Addison's
• Tissue damage Infection
• Diabetes
• Dehydration
• Too much potassium intake
• Excessive IV potassium in individuals receiving intravenous fluids
• Nonsteroidal anti-inflammatory medicines, ACE inhibitors, beta blockers, and potassium-sparing diuretics are among the pharmaceuticals that can induce excessive potassium in a tiny percentage of persons.

Low potassium levels can be detected in a variety of situations, including:

• Conn syndrome
• Diarrhea and vomiting.
• An acetaminophen overdose complication
• When someone with diabetes takes insulin, their potassium level may drop, especially if they have not properly managed their diabetes.
• Low potassium is usually caused by "water pills," and if someone is taking them, their potassium level will be checked on a regular basis by their healthcare professional.

Furthermore, medicines including corticosteroids, beta-adrenergic agonists like isoproterenol, alpha-adrenergic antagonists like clonidine, antibiotics like gentamicin and carbenicillin, and the antifungal amphotericin B can cause potassium loss.

Urine potassium concentrations must be compared to blood potassium levels. Because the body generally removes excess potassium, the concentration in the urine may be higher than the blood. When the body loses too much potassium, it can also show up in the urine; in this situation, the blood level will be normal to low. If potassium levels in the blood are low due to insufficient consumption, urine concentrations will be low as well.

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

Description: The RPR test is used to determine if a person has been infected with syphilis. An RPR can be used to monitor treatment for syphilis and the effectiveness of syphilis treatment. Syphilis testing is a two-part test. The first round of testing for syphilis is an RPR test. If these results come back positive, a second round of testing will be required. A positive RPR result will be followed by a second method that will be used to confirm the results. If the second syphilis test comes back positive, the affected person will be diagnosed with syphilis. If the second test comes back negative, it could mean that the first test is a false positive and more testing may be necessary.

Also Known As: Rapid Plasma Reagin with Reflex to Titer, Syphilis RPR, Syphilis Titer test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

IMPORTANT

A positive RPR screen must be followed by a specific treponemal antibody test (e.g., FTA-ABS):

A positive result on the second method confirms the screening result and the affected person is diagnosed with syphilis.

A negative result on the treponemal test may mean that the initial RPR test was falsely positive. Further testing and investigation may be done to determine the cause of the false positive.

Limitations

False-positive results have been associated in patients with infections, pregnancy, autoimmune disease, old age, Gaucher disease, and malignancy.

When is a Syphilis RPR test ordered?

When a person shows signs and symptoms of syphilis, a syphilis test may be done.

Regardless of symptoms, a person should be tested for syphilis if they:

• Are being treated for gonorrhea or another sexually transmitted disease?
• If a woman is pregnant, she should be seen during the first prenatal visit, then again in the third trimester and at the time of delivery if she is at high risk.
• Are a man who has sex with other males; testing should be done at least once a year or every 3-6 months if the risk is significant.
• Engages in high-risk sexual behavior, such as having intercourse with several partners without protection.
• If you have HIV, you should get tested when you're initially diagnosed and then at least once a year after that; if you're at high risk, you should get tested more frequently.
• Has one or more partners who have tested positive for syphilis
• Officials from the Department of Public Health have told him or her that he or she has been exposed to an infected partner.

When a person has been treated for syphilis, the CDC recommends doing follow-up testing, such as assessing antibody levels, to ensure that the therapy was successful and the infection was cured.

What does a Syphilis RPR blood test check for?

Syphilis is a bacterial infection caused by Treponema pallidum that is primarily spread during sexual activity, such as by direct contact with a syphilis sore. The majority of common syphilis tests can detect antibodies in the blood that were produced in response to a T. pallidum infection. Some less common methods can be used to locate the bacterium or its genetic components.

Syphilis is easily treated with medications, but if left untreated, it can cause serious health concerns. A mother who is afflicted can convey the disease to her unborn child, which can have serious and even fatal effects for the newborn.

With syphilis, there are numerous stages that can occur:

• The primary stage of syphilis begins about 2-3 weeks following infection. One or more chancres emerge, usually on the body portion exposed to the chancre of the sexual partner, such as the penis or vaginal area. The chancre, on the other hand, is usually painless and may go unnoticed, especially if it is in the rectum or on the cervix, and it goes away within 4-6 weeks, mending whether or not the infected person is treated.
• If primary syphilis is left untreated, secondary syphilis can develop anywhere from 6 weeks to 6 months after the chancre initially emerges. It is characterized by a rough, red, and speckled skin rash that appears regularly on the palms of the hands and the bottoms of the feet and does not itch. Fever, weariness, enlarged lymph nodes, sore throat, and body aches are some of the other symptoms that can occur.
• Secondary syphilis can progress to a latent stage, during which an infected individual has no symptoms but still retains the infection, and this stage can remain for years if left untreated. If left untreated, roughly 15% of persons will develop late, or tertiary, syphilis issues. Bacteria can harm the heart, eyes, brain, neurological system, bones, joints, and practically any other component of the body in these situations. Neurosyphilis is a disease that affects the central nervous system. Tertiary syphilis can linger for years, leading to mental illness, blindness, other neurological issues, heart disease, and death in the ultimate stage.
• If left untreated, syphilis progresses.

The basic and secondary stages of syphilis are the most contagious. About a third of the approximately 63,000 new cases of syphilis reported to the CDC in 2014 were main or secondary stage syphilis. Eighty-three percent of these cases included guys having intercourse with other men.

Antibiotics, usually penicillin, can be used to cure syphilis. Infections that have been acquired recently can be rapidly healed; however, someone who has been infected for more than a year may require prolonged therapy.

Lab tests often ordered with a Syphilis RPR test:

• HIV Antibody
• HIV Antigen
• Gonorrhea
• Chlamydia
• Herpes 1 and 2
• Trichomonas
• STD Panel

Conditions where a Syphilis RPR test is recommended:

• Sexually Transmitted Diseases
• Syphilis
• Gonorrhea
• Chlamydia
• Herpes 1
• Herpes 2
• HIV and AIDS
• Pregnancy

How does my health care provider use a Syphilis RPR test?

Syphilis tests are used to detect and/or diagnose infection with the bacterium Treponema pallidum, which causes syphilis.

There are a variety of tests to choose from. The most common type of test is an antibody test.

Antibody tests identify antibodies in the blood and, occasionally, in the cerebrospinal fluid. Nontreponemal antibody test and treponemal antibody test are the two types of syphilis tests available. Syphilis screening can be done with any type, but it must be followed by a second test that employs a different approach to confirm a positive result and identify active syphilis:

Antibodies that aren't specifically directed towards the Treponema pallidum bacterium are detected by nontreponemal antibody testing. The body produces these antibodies when a person has syphilis, but they can also be produced in a variety of other situations. Because the tests are non-specific, false-positive findings can be produced by things like IV drug usage, pregnancy, Lyme disease, certain types of pneumonia, malaria, tuberculosis, or certain autoimmune disorders like lupus. A positive screening result must be double-checked with a more detailed test. Nontreponemal testing include the following:

RPR—in addition to screening, this test can be used to track syphilis therapy. Antibody levels are tested for this reason. When an initial test for treponemal antibodies is positive, it can also be used to confirm the existence of an active infection.

VDRL—in addition to blood, this test is largely used to identify neurosyphilis in the CSF.

Antibodies to T. pallidum are detected by treponemal antibody tests, which are blood tests. Because they are extremely specific for syphilis, they are unlikely to produce a positive result in other diseases. Once a person is infected and these antibodies form, they remain in the bloodstream for the rest of their lives. Nontreponemal antibodies, on the other hand, usually vanish within 3 years in a properly treated person. As a result, a positive treponemal screening result must be followed by a nontreponemal test in order to distinguish between an active infection and one that has been successfully treated in the past. FTA-ABS is a treponemal antibody test that is beneficial after the first 3-4 weeks after exposure. It can be used to assess antibodies to T. pallidum in the CSF to assist diagnose neurosyphilis in addition to blood testing.

• TP-PA—instead of FTA-ABS, this test is sometimes used because it is more specific and has less false positives.
• Another confirmatory approach is MHA-TP, which is presently used considerably less frequently.
• Immunoassays—Several automated tests have been developed in recent years, making them useful for screening applications.

What do my Syphilis test results mean?

A negative blood test indicates that there is most likely no infection. A negative screening test, on the other hand, simply states that there was no evidence of disease at the time of the test. Antibodies may not be detected for several weeks following bacterial contact. If a person is aware that he or she has been exposed, or if the risk of infection remains high, additional testing may be required. It is also critical for persons who are at a higher risk of contracting syphilis to get regular screening tests to check for infection.

A particular treponemal antibody test must be performed after a positive RPR or VDRL screen:

The infected person is diagnosed with syphilis once a positive result on the second method confirms the screening result.

A negative treponemal test result could indicate that the initial RPR or VDRL test was incorrectly positive. To discover the reason of the false positive, more testing and investigation may be conducted.

A treponemal antibody test, on the other hand, will be used as an initial test by a healthcare practitioner or laboratory. A positive result indicates the presence of syphilis antibodies in the blood, but because treponemal antibodies stay positive even after an infection is treated, it does not indicate whether the person is now afflicted or has previously been infected. Nontreponemal antibodies found with an RPR, on the other hand, usually vanish after 3 years in a properly treated person. If the initial treponemal test is positive, an RPR can be used to determine whether the infection is active or past. A positive RPR in this scenario would establish that the person has been exposed to syphilis and, if not previously treated, has an ongoing infection or, if treatment occurred more than 3 years ago, possible re-infection.

The results of one or more RPR titers may be used to monitor treatment and/or determine if treatment was successful. Antibodies to syphilis should be decreased after therapy. If the RPR was 1:256 before therapy, a number of 1:16 after treatment would indicate a reduced amount of antibody. The affected person may have a persistent infection or was reinfected if the titer stays the same or rises. The results can also be transformed to a whole number or reported as dilutions.

Nontreponemal antibodies fade away over time after effective treatment, whereas treponemal antibodies remain in the blood for the rest of one's life.

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

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

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

Collection Method: Blood Draw

Specimen Type: Whole Blood

Test Preparation: No preparation required

When is a Sed Rate test ordered?

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

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

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

What does a Sed Rate blood test check for?

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

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

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

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

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

Lab tests often ordered with a Sed Rate test:

• C-Reactive Protein
• ANA
• Rheumatoid Factor

Conditions where a Sed Rate test is recommended:

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

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

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

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

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

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

What do my Sed Rate test results mean?

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

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

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

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

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

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

Description: The sodium blood test is a test that measures levels of the electrolyte sodium in your blood’s serum.

Also Known As: Na Test, Sodium Serum Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a Sodium test ordered?

Most people's normal lab examination includes sodium tests as part of an electrolyte panel or a basic metabolic panel. These may be requested as part of an annual physical examination or when a person has non-specific health concerns.

When a person exhibits symptoms of low sodium, such as weakness, disorientation, or lethargy, a blood sodium test may be requested. If the sodium level drops too quickly, the individual may get weak and tired; in severe circumstances, the person may become confused or even coma. However, there may be no symptoms if the sodium level drops slowly. That is why, even if there are no symptoms, sodium levels are frequently monitored.

When a person shows signs of elevated sodium, such as thirst, dry mucous membranes, less frequent urine, muscle twitching, and/or agitation, sodium blood testing may be required. If the sodium level reaches to dangerously high levels, restlessness, illogical behavior, and coma or convulsions can occur.

Electrolytes are tested when intravenous fluids are administered or when dehydration is a risk. Electrolyte panels and basic metabolic panels are frequently requested to track the progress of treatment for illnesses such high blood pressure, heart failure, and liver and kidney disease.

What does a Sodium blood test check for?

Sodium is an electrolyte found in all body fluids and is essential for proper physiological functions such as nerve and muscle function. This test determines how much salt is present in the blood and/or urine.

Sodium, along with other electrolytes like potassium, chloride, and bicarbonate, aids cell activity and helps the body manage fluid levels. While sodium can be found in all physiological fluids, it is most concentrated in the blood and the fluid surrounding the body's cells. The kidneys control this extracellular sodium as well as all bodily water.

We receive sodium through table salt and, to a lesser extent, from most of the foods we eat. The majority of people consume enough salt. The body consumes what it needs and excretes the rest through the urine. The body tries to control salt levels in the blood within a fairly narrow range. It accomplishes this by:

• Producing hormones that can alter the quantity of sodium excreted in urine
• Generating a hormone that stops water loss
• Controlling thirst; merely a 1% increase in blood sodium causes a person to become thirsty and drink water, bringing the sodium level back to normal.

A malfunction with one of these systems is frequently the cause of abnormal blood sodium levels. The water content of the body changes when the salt level in the blood fluctuates. These alterations are commonly coupled with either too little or too much fluid, resulting in leg edema.

Lab tests often ordered with a Sodium test:

• Chloride
• Potassium
• Bicarbonate
• Electrolyte
• Basic Metabolic Panel (BMP)
• Comprehensive Metabolic Panel (CMP)
• Aldosterone
• Renin
• Renal Panel
• ADH

Conditions where a Sodium test is recommended:

• Kidney Disease
• Dehydration
• Adrenal Insufficiency
• Addison Disease

How does my health care provider use a Sodium test?

A sodium blood test detects aberrant sodium concentrations, such as low sodium and excessive sodium. It's frequently utilized as part of a normal health checkup's electrolyte panel or basic metabolic panel.

Sodium is an electrolyte found in all body fluids and is essential for proper physiological functions such as nerve and muscle function. It aids regular cell activity and regulates the quantity of fluid in the body.

In persons who have dehydration, excess fluid, or a range of symptoms, a blood sodium test can be done to determine the reason and monitor treatment. Many disorders can cause elevated sodium levels in the blood. This test, along with others, may be ordered by a doctor to detect an electrolyte imbalance or symptoms of illness involving the brain, heart, lungs, thyroid gland, liver, kidney, or adrenal glands.

A blood sodium test may be performed to assess the success of treatment or to monitor persons using drugs that can impact sodium levels, such as diuretics, in people who have a known electrolyte imbalance.

What do my sodium test results mean?

A low sodium level in the blood could be caused by:

• Too much sodium is lost, most usually due to diarrhea, vomiting, excessive perspiration, diuretics, kidney illness, or low cortisol, aldosterone, and sex hormone levels.
• Excessive water consumption, which may occur during exercise
• Heart failure, cirrhosis, and kidney disorders induce excess fluid accumulation in the body, resulting in protein loss or malnutrition. The body produces too much anti-diuretic hormone in a number of disorders, particularly those involving the brain and lungs, as well as many types of cancer and several medicines, leading a person to retain too much water in the body.

Reduced sodium consumption is rarely the cause of low blood sodium.

Losing too much water while not drinking enough nearly usually causes a high blood salt level. It could be related to a high salt intake without enough water, Cushing syndrome, or diabetes insipidus, a disorder characterized by a lack of ADH.

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

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

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

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a TSH test ordered?

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

Hyperthyroidism can cause the following signs and symptoms:

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

Hypothyroidism can cause the following signs and symptoms:

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

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

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

What does a TSH blood test check for?

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

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

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

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

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

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

Lab tests often ordered with a TSH test:

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

Conditions where a test TSH is recommended:

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

Commonly Asked Questions:

How does my health care provider use a TSH test?

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

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

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

TSH is used to:

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

What does my TSH blood test result mean?

A high TSH level could indicate that:

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

A low TSH level could imply the following:

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

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

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

Clinical Significance
Micronutrient, Vitamin B12 - B12 is decreased in pernicious anemia, total or partial gastrectomy, malabsorption and certain congenital and biochemical disorders.

Patients must be 18 years of age or greater.

Reference Range(s)
≥18 years    200-1100 pg/mL
Reference range not available for individuals <18 years for this micronutrient test.

Description: A Vitamin B12 test is a blood test that measures the level of Vitamin B12 in the blood’s serum and is used to detect Vitamin B12 deficiency.

Also Known As:  B12 Test, Cobalamin Test, Vitamin B12 test, Serum B12 Test 

Collection Method: Blood Draw 

Specimen Type: Serum 

Test Preparation: No preparation required. 

When is a Vitamin B12 test ordered?  

When a complete blood count and/or blood smear, performed as part of a health checkup or anemia evaluation, reveal a low red blood cell count with the presence of big RBCs, vitamin B12 levels may be ordered. A high mean corpuscular volume implies that the RBCs have grown in size. 

When a person exhibits the following signs and symptoms of a deficit, testing for B12 levels may be necessary: 

• Diarrhea 
• Dizziness 
• Muscle weakness, fatigue 
• Appetite loss. 
• Skin that is pale 
• Irregular heartbeats, rapid heart rate 
• Breathing problems 
• Tongue and mouth ache 
• In the feet, hands, arms, and legs, there is tingling, numbness, and/or burning 
• Confusion or obliviousness 
• Paranoia 

When a person is at risk of deficiency, such as those with a history of malnutrition or a condition associated to malabsorption, B12 tests may be required. 

Individuals being treated for malnutrition or a B12 or folate deficit may have these tests done on a frequent basis to see how effective their treatments are. This could be part of a long-term therapy plan for people who have a disease that causes chronic deficiency.  

What does a Vitamin B12 blood test check for? 

Vitamin B12 is a member of the vitamin B complex. It is required for the creation of normal red blood cells, tissue and cell healing, and the synthesis of DNA, the genetic material in cells. Vitamin B12 is a nutrient that the body cannot make and must be obtained through the diet. 

Vitamin B12 deficiency is detected by measuring vitamin B12 in the liquid portion of the blood. 

A B12 deficiency can cause macrocytic anemia, which is characterized by red blood cells that are bigger than normal. Megaloblastic anemia is a kind of macrocytic anemia marked by the generation of fewer but larger RBCs known as macrocytes, as well as cellular abnormalities in the bone marrow. Reduced white blood cell and platelet count are two other test results linked to megaloblastic anemia. 

B12 is also necessary for nerve function, and a lack of it can induce neuropathy, which causes tingling and numbness in the hands and feet of those who are affected. 

B12 deficiency is most commonly caused by a lack of vitamin B12 in the diet or supplements, insufficient absorption, or an increased requirement, such as during pregnancy. 

Lab tests often ordered with a Vitamin B12 test: 

• Folate 
• Methylmalonic Acid (MMA) 
• Homocysteine 
• Vitamin B1 
• Vitamin B2 
• Vitamin B3 
• Vitamin B5 
• Vitamin B6 
• Vitamin B7 
• Rheumatoid factor 

Conditions where a Vitamin B12 test is recommended:

• Vitamin B12 Deficiency 
• Pernicious Anemia 
• Nerve Damage 
• Malabsorption 
• Malnutrition 

How does my health care provider use a Vitamin B12 test? 

Vitamin B12 and folate are frequently used in conjunction to detect deficiencies and to aid in the diagnosis of anemias such as pernicious anemia, an inflammatory condition that inhibits B12 absorption. 

B12 and folate are two vitamins that the body cannot generate and must be obtained from the diet. They are essential for the creation of normal red blood cells, tissue and cell repair, and the synthesis of DNA, the genetic material in cells. B12 is required for normal nerve function. 

B12 and folate tests can also be used to assess someone who is experiencing mental or behavioral changes, especially in the elderly. A B12 test can be ordered with or without folate, as well as with other screening laboratory tests like a complete blood count, comprehensive metabolic panel, antinuclear antibody, C-reactive protein, and rheumatoid factor to help determine why a person is exhibiting signs and symptoms of a nerve condition. 

B12 and folate tests can also be performed in conjunction with a variety of other tests to assess a person's overall health and nutritional status if they have signs and symptoms of substantial malnutrition or dietary malabsorption. People with alcoholism, liver disease, stomach cancer, or malabsorption diseases including celiac disease, inflammatory bowel disease, or cystic fibrosis may fall into this category. 

Testing may be performed to assess the success of treatment in patients with known B12 and folate deficits. This is especially true for people who cannot absorb B12 and/or folate effectively and must be treated for the rest of their lives. 

Folate levels in the blood's serum might fluctuate depending on a person's recent diet. Because red blood cells contain 95 percent of circulating folate, a test to evaluate folate levels inside RBCs could be employed instead of or in addition to the serum test. Some doctors believe that the RBC folate test is a better predictor of long-term folate status and is more clinically useful than serum folate, however there is no consensus on this. 

Homocysteine and methylmalonic acid are two more laboratory tests that can be used to detect B12 and folate deficits. In B12 deficiency, both homocysteine and MMA are high, whereas in folate deficit, only homocysteine, not MMA, is elevated. This distinction is critical because treating anemia with folate treats the anemia but not the brain damage, which may be irreparable. 

What do my Vitamin B12 test results mean? 

Normal B12 and folate levels may indicate that a person does not suffer from a deficiency and that the signs and symptoms they are experiencing?are caused by something else. Normal levels, on the other hand, may indicate that a person's stored B12 and/or folate has not yet been depleted. 

A health practitioner may order a methylmalonic acid test as an early sign of B12 deficiency if a B12 level is normal but a deficiency is still suspected. 

A low B12 and/or folate level in a person with signs and symptoms implies a deficiency, although it does not always indicate the severity of the anemia or related neuropathy. Additional tests are frequently performed to determine the source of the deficit. Low B12 or folate levels can be caused by a variety of factors. 

Dietary folate or B12 deficiency, which?is uncommon in the United States. It can be evident in people who are malnourished in general and vegans who do not eat any animal products. Folate deficiency has become extremely rare since the development of fortified cereals, breads, and other grain products. 

Both B12 and folate deficits can be caused by diseases that prevent them from being absorbed in the small intestine. These may include the following: 

• Pernicious anemia 
• Celiac disease 
• Crohn's disease and ulcerative colitis are examples of inflammatory bowel disease. 
• Bacterial overgrowth or the presence of parasites in the intestines, such as tapeworms 
• Long-term usage of antacids or H2 proton pump inhibitors reduces stomach acid production. 
• Absorption can be considerably reduced by surgery that removes part of the stomach or the intestines, such as gastric bypass. 
• Insufficiency of the pancreas 
• Chronic alcoholism or heavy drinking 
• Some treatments, such as metformin, omeprazole, methotrexate, or anti-seizure medications like phenytoin, are used. 
• Increased requirements for healthy fetal development, all pregnant women require an increased amount of folate and are advised to consume 400 micrograms of folic acid every day. The need for folate is higher in those who have cancer that has spread or who have chronic hemolytic anemia. 
• Smoking 

If a person is being treated for a B12 or folate deficit with supplements, normal or higher findings suggest that the treatment is working. 

High amounts of B12 are uncommon, and they aren't routinely evaluated clinically. If a person has a condition such chronic myeloproliferative neoplasm, diabetes, heart failure, obesity, AIDS, or severe liver disease, their vitamin B12 level may be elevated. High B12 levels can also be caused by using estrogens, vitamin C, or vitamin A. 

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

Alzheimer's ReCODE Protocol (Baseline Labs w/ApoE) - Dr. Dale Bredesen MD

IMPORTANT - this panel contains Estradiol #4021 which 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

• ApoE Genotype, Cardio IQ™
• Arsenic, Blood
• CBC (includes Differential and Platelets)
• Comprehensive Metabolic Panel (CMP)
• Copper
• Cortisol, Total
• DHEA Sulfate, Immunoassay
• Estradiol
• Ferritin
• Hemoglobin A1c (HgbA1C)
• Homocysteine
• hs-CRP
• Insulin
• Lead, Blood
• Lipid Panel with Ratios
• Magnesium, RBC
• MATRIX METALLOPROTEINASE 9 (MMP 9)
• Mercury, Blood
• Progesterone, Immunoassay
• T3 Reverse (RT3), LC/MS/MS
• T3, Free
• T4, Free
• Testosterone, Free (Dialysis) and Total MS
• Total Glutathione in Whole Blood
• TSH
• Vitamin B12 (Cobalamin) and Folate Panel, Serum
• Vitamin D, 25-Hydroxy, Total, D (D2, D3), LC/MS/MS (QuestAssureD™)
• Vitamin E
• Zinc
   

IMPORTANT - this panel contains Estradiol #4021 which 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

Alzheimer's ReCODE Protocol (Baseline Labs w/o ApoE) - Dr. Dale Bredesen MD

• Arsenic, Blood
• CBC (includes Differential and Platelets)
• Comprehensive Metabolic Panel (CMP)
• Copper
• Cortisol, Total
• DHEA Sulfate, Immunoassay
• Estradiol
• Ferritin
• Hemoglobin A1c (HgbA1C)
• Homocysteine
• hs-CRP
• Insulin
• Lead, Blood
• Lipid Panel with Ratios
• Magnesium, RBC
• MATRIX METALLOPROTEINASE 9 (MMP 9)
• Mercury, Blood
• Progesterone, Immunoassay
• T3 Reverse (RT3), LC/MS/MS
• T3, Free
• T4, Free
• Testosterone, Free (Dialysis) and Total MS
• Total Glutathione in Whole Blood
• TSH
• Vitamin B12 (Cobalamin) and Folate Panel, Serum
• Vitamin D, 25-Hydroxy, Total, D (D2, D3), LC/MS/MS (QuestAssureD™)
• Vitamin E
• Zinc

The Dementia Blood Test Panel is a standard set of tests used to distinguish Alzheimer's disease from other types of dementia. CBC, Electrolytes, TSH, T4 total, Vitamin B12, CRP, and Sedimentation Rate are all included.

• C-Reactive Protein (CRP)
• CBC (includes Differential and Platelets)
• Electrolyte Panel
• Sed Rate by Modified Westergren (ESR)
• T4 (Thyroxine), Total
• T4, Free
• TSH
• Vitamin B12 (Cobalamin)

Alzheimer's disease is just one of many things that can cause dementia. 

It's normal to forget things sometimes, and you shouldn't worry about it unless it happens more often or gets in the way of your daily life. But Alzheimer's isn't the only thing that can lead to a decline in cognitive function. 

• Nutritional deficiencies, such as vitamin B12 deficiency 
• Having a history of another illness that can cause mental changes, such as diabetes, high blood pressure, or problems with the kidneys, liver, or thyroid. 
• Over-medication, drug interactions, or side effects 
• Brain tumors, head injuries, and normal pressure hydrocephalus are all examples of structural diseases. 
• Degenerative diseases, such as Alzheimer's, Huntington's Chorea, Parkinson's, and Pick disease, cause the body to break down. 
• HIV/AIDS, Creutzfeldt-Jakob, meningitis, encephalitis, and syphilis are all infectious diseases. 
• Anxiety and depression are both common. 
• Poisoning from heavy metals (for example, lead poisoning) 
• Seizures 

A variety of standard laboratory tests are used to rule out deficiencies and other diseases and disorders that may be affecting the person's memory. The Dementia Blood Test Panel includes many of the tests ordered for this purpose.