Digestive Health

Digestive Health - Basic contains the following tests

• CBC (includes Differential and Platelets) 
• Comprehensive Metabolic Panel (CMP)
• Fecal Globin by Immunochemistry (InSure®) 
• Celiac Disease Comprehensive Panel (w/ Reflexes)

Specimens from children less than 4 years of age (i.e., less than 48 months) are not appropriate for this test. The test for children 4 years of age and younger is the Celiac Disease Comprehensive Panel, Infant (test code 15981).

Includes

Tissue Transglutaminase, IgA with Reflexes; Total IgA with Reflex

IMPORTANT - Note this is Reflex Test which if additional tests are run you will be charged for the specific tests that the lab peforms. Additional test will be run if the following criteria are met.

If the Tissue Transglutaminase IgA is positive, 

1. Endomysial Antibody Screen (IgA) will be performed at an additional charge (CPT code(s): 86255).

If the Endomysial Antibody Screen (IgA) is positive, 

2. Endomysial Antibody Titer will be performed at an additional charge (CPT code(s): 86256).

If the Total IgA is less than the lower limit of the reference range, based on age, 

3. Tissue Transglutaminase IgG will be performed at an additional charge (CPT code(s): 83516).

Clinical Significance

Celiac disease is caused by an immune response to gluten in genetically sensitive individuals. The diagnosis is largely based on a biopsy of the small intestine, but serologic tests also help support a diagnosis and may assist identification of patients who may require biopsy.

Tissue transglutaminase antibodies (tTG, IgA) is a marker with 95% sensitivity and specificity. Total IgA is measured because 2-3% of celiac disease patients are IgA deficient. Because tTG, IgA, and anti-Gliadin IgA tend to decrease in patients on a gluten-free diet, these markers are also used to assess dietary compliance.

The endomysial antibody (EMA, IgA) assay has high specificity for celiac disease and is used to confirm positive anti-tTG results.

Digestive Health - Basic Plus contains the followwing tests: 

• C-Reactive Protein (CRP) 
• CBC (includes Differential and Platelets) 
• Comprehensive Metabolic Panel (CMP)
• Fecal Globin by Immunochemistry (InSure®) 
• Ferritin
• Iron and Total Iron Binding Capacity (TIBC)
• Celiac Disease Comprehensive Panel (w/ Reflexes)

 Specimens from children less than 4 years of age (i.e., less than 48 months) are not appropriate for this test. The test for children 4 years of age and younger is the Celiac Disease Comprehensive Panel, Infant (test code 15981).

Includes

Tissue Transglutaminase, IgA with Reflexes; Total IgA with Reflex

IMPORTANT - Note this is Reflex Test which if additional tests are run you will be charged for the specific tests that the lab peforms. Additional test will be run if the following criteria are met.

If the Tissue Transglutaminase IgA is positive, 

1. Endomysial Antibody Screen (IgA) will be performed at an additional charge (CPT code(s): 86255).

If the Endomysial Antibody Screen (IgA) is positive, 

2. Endomysial Antibody Titer will be performed at an additional charge (CPT code(s): 86256).

If the Total IgA is less than the lower limit of the reference range, based on age, 

3. Tissue Transglutaminase IgG will be performed at an additional charge (CPT code(s): 83516).

Clinical Significance

Celiac disease is caused by an immune response to gluten in genetically sensitive individuals. The diagnosis is largely based on a biopsy of the small intestine, but serologic tests also help support a diagnosis and may assist identification of patients who may require biopsy.

Tissue transglutaminase antibodies (tTG, IgA) is a marker with 95% sensitivity and specificity. Total IgA is measured because 2-3% of celiac disease patients are IgA deficient. Because tTG, IgA, and anti-Gliadin IgA tend to decrease in patients on a gluten-free diet, these markers are also used to assess dietary compliance.

The endomysial antibody (EMA, IgA) assay has high specificity for celiac disease and is used to confirm positive anti-tTG results.

The Digestive Health - Advanced contains the following tests

• C-Reactive Protein (CRP) 
• CBC (includes Differential and Platelets) 
• Comprehensive Metabolic Panel (CMP)
• Fecal Globin by Immunochemistry (InSure®) 
• Ferritin
• Folate, Serum
• Iron and Total Iron Binding Capacity (TIBC)
• QuestAssureD™ 25-Hydroxyvitamin D (D2, D3), LC/MS/MS 
• Transferrin
• Vitamin B12 (Cobalamin) 
• Celiac Disease Comprehensive Panel (w/ Reflexes)

Specimens from children less than 4 years of age (i.e., less than 48 months) are not appropriate for this test. The test for children 4 years of age and younger is the Celiac Disease Comprehensive Panel, Infant (test code 15981).

Includes

Tissue Transglutaminase, IgA with Reflexes; Total IgA with Reflex

IMPORTANT - Note this is Reflex Test which if additional tests are run you will be charged for the specific tests that the lab peforms. Additional test will be run if the following criteria are met.

If the Tissue Transglutaminase IgA is positive, 

1. Endomysial Antibody Screen (IgA) will be performed at an additional charge (CPT code(s): 86255).

If the Endomysial Antibody Screen (IgA) is positive, 

2. Endomysial Antibody Titer will be performed at an additional charge (CPT code(s): 86256).

If the Total IgA is less than the lower limit of the reference range, based on age, 

3. Tissue Transglutaminase IgG will be performed at an additional charge (CPT code(s): 83516).

Clinical Significance

Celiac disease is caused by an immune response to gluten in genetically sensitive individuals. The diagnosis is largely based on a biopsy of the small intestine, but serologic tests also help support a diagnosis and may assist identification of patients who may require biopsy.

Tissue transglutaminase antibodies (tTG, IgA) is a marker with 95% sensitivity and specificity. Total IgA is measured because 2-3% of celiac disease patients are IgA deficient. Because tTG, IgA, and anti-Gliadin IgA tend to decrease in patients on a gluten-free diet, these markers are also used to assess dietary compliance.

The endomysial antibody (EMA, IgA) assay has high specificity for celiac disease and is used to confirm positive anti-tTG results.

Digestive Health - Comprehensive contains the following tests: 

• C-Reactive Protein (CRP) 
• CBC (includes Differential and Platelets) 
• Comprehensive Metabolic Panel (CMP)
• Fecal Globin by Immunochemistry (InSure®) 
• Ferritin
• Folate, Serum
• Gliadin (Deamidated Peptide) Antibody (IgA) 
• Gliadin (Deamidated Peptide) Antibody (IgG) 
• Iron and Total Iron Binding Capacity (TIBC)
• Lipid Panel with Ratios
• Magnesium
• Prealbumin 
• QuestAssureD™ 25-Hydroxyvitamin D (D2, D3), LC/MS/MS 
• Transferrin
• TSH
• Vitamin A (Retinol)
• Vitamin B12 (Cobalamin) 
• Vitamin K
• Celiac Disease Comprehensive Panel (w/ Reflexes)

Specimens from children less than 4 years of age (i.e., less than 48 months) are not appropriate for this test. The test for children 4 years of age and younger is the Celiac Disease Comprehensive Panel, Infant (test code 15981).

Includes

Tissue Transglutaminase, IgA with Reflexes; Total IgA with Reflex

IMPORTANT - Note this is Reflex Test which if additional tests are run you will be charged for the specific tests that the lab peforms. Additional test will be run if the following criteria are met.

If the Tissue Transglutaminase IgA is positive, 

1. Endomysial Antibody Screen (IgA) will be performed at an additional charge (CPT code(s): 86255).

If the Endomysial Antibody Screen (IgA) is positive, 

2. Endomysial Antibody Titer will be performed at an additional charge (CPT code(s): 86256).

If the Total IgA is less than the lower limit of the reference range, based on age, 

3. Tissue Transglutaminase IgG will be performed at an additional charge (CPT code(s): 83516).

Clinical Significance

Celiac disease is caused by an immune response to gluten in genetically sensitive individuals. The diagnosis is largely based on a biopsy of the small intestine, but serologic tests also help support a diagnosis and may assist identification of patients who may require biopsy.

Tissue transglutaminase antibodies (tTG, IgA) is a marker with 95% sensitivity and specificity. Total IgA is measured because 2-3% of celiac disease patients are IgA deficient. Because tTG, IgA, and anti-Gliadin IgA tend to decrease in patients on a gluten-free diet, these markers are also used to assess dietary compliance.

The endomysial antibody (EMA, IgA) assay has high specificity for celiac disease and is used to confirm positive anti-tTG results.

Description: Irritable Bowel Syndrome (IBS), among other gastrointestinal problems, are understood only by ruling out other conditions. This requires some sleuthing—tests that measure some common and less recognized problems that result in GI symptoms. For example, frequent antibiotics, inadequate nutrient intake, and gut infections can cause nutrient deficiencies. And these deficiencies can cause more digestive problems. A vicious positive feedback cycle. With nutrients, such as zinc and RBC magnesium along with comprehensive celiac and inflammation results, this panel leaves few stones unturned. There are even tests for allergy (IgE total) and full thyroid activity. Once again, it is worth stating that a skilled professional eye is helpful to understand meaning and possible unique interactions taking place.

• CBC (includes Differential and Platelets) #6399
• Comprehensive Metabolic Panel (CMP) #10231
• Ferritin #457
• Hemoglobin A1c with eAG #16802
• Insulin #561
• Lipid Panel with Ratios #19543
• Vitamin B12 (Cobalamin) #927
• Vitamin D, 25-Hydroxy, Total, Immunoassay #17306
• Gliadin (Deamidated Peptide) Antibody (IgG) #11212
• Celiac Disease Comprehensive Panel #19955
• C-Reactive Protein (CRP) #4420
• Magnesium, RBC #623
• Prealbumin #4847
• Zinc #945
• T3, Free #34429
• T4, Free #866
• TSH #899
• IgE #542

Description: The C-Reactive Protein (CRP) test measures the levels of C-reactive protein, a substance produced by the liver in response to inflammation in the body. It is a non-specific marker of inflammation and is used to evaluate the presence and intensity of inflammation. The CRP test helps healthcare providers assess the severity of an inflammatory condition and monitor response to treatment.

Also Known As: CRP Test, Inflammation test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

Average Processing Time: 2 to 3 days

When is a C-Reactive Protein test ordered?

A C-Reactive Protein (CRP) test may be ordered in several situations to assess a patient's inflammation levels:

1. Infection or Inflammatory Diseases: The test is ordered when a patient shows signs of infection or has symptoms of inflammatory diseases such as rheumatoid arthritis, lupus, or inflammatory bowel disease.

2. Monitoring Response to Treatment: For patients with known inflammatory conditions, the CRP test helps healthcare providers monitor the effectiveness of treatment and track changes in inflammation levels over time.

3. Cardiovascular Risk Assessment: The CRP test may be ordered as part of a cardiovascular risk assessment to identify individuals at higher risk of developing heart disease or to assess the severity of existing cardiovascular conditions.

4. Post-Surgery Monitoring: After surgical procedures, the CRP test can be ordered to monitor post-operative inflammation levels and identify any complications or infections.

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:

A C-Reactive Protein (CRP) test is commonly ordered for:

1. Inflammatory Diseases: The test helps assess the severity of inflammatory diseases such as rheumatoid arthritis, lupus, vasculitis, or inflammatory bowel disease.

2. Infections: Elevated CRP levels can indicate the presence of infections, whether bacterial, viral, or fungal, and help healthcare providers identify the site of inflammation.

3. Cardiovascular Diseases: The CRP test is used as part of cardiovascular risk assessment to identify individuals at higher risk of developing heart disease or to assess the severity of existing cardiovascular conditions.

Commonly Asked Questions:

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

Healthcare providers use the results of a C-Reactive Protein (CRP) test to:

1. Assess Inflammation Levels: Elevated CRP levels indicate the presence and intensity of inflammation in the body, helping healthcare providers evaluate the severity of an inflammatory condition.

2. Monitor Treatment Response: Regular CRP testing allows healthcare providers to monitor the effectiveness of treatments for inflammatory conditions and track changes in inflammation levels over time.

3. Guide Diagnosis and Further Testing: Elevated CRP levels, combined with other clinical findings, can help healthcare providers diagnose and differentiate between different inflammatory conditions and guide the need for further diagnostic tests or evaluations.

By effectively utilizing the results of a C-Reactive Protein (CRP) test, healthcare providers can assess inflammation levels, monitor treatment response, and make informed decisions regarding patient care, including treatment adjustments and further investigations if necessary.

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.

Clinical Significance
Micronutrient, Cadmium, Blood - Cadmium is a naturally occurring element that is mined and used in industrial production because of its durability. Excessive cadmium exposure can damage lungs, kidneys, and the digestive tract.

Patients must be 18 years of age or greater.

Reference Range(s)

Reference range not available for individuals <18 years for this micronutrient test.

Carnitine, LC/MS/MS Includes: Carnitine, Total; Carnitine, Free; Carnitine, Esters; Esterified/Free Ratio

Clinical Significance

Serum carnitine analysis is useful in the diagnosis and monitoring of patients with carnitine deficiency (either primary or secondary). Primary carnitine deficiency is an autosomal recessively inherited genetic condition that affects carnitine uptake by cells and tissues through a defect in the plasma membrane carnitine transporter. Secondary carnitine deficiency can be seen in some disease states or in patients on carnitine-poor diets, but is also seen in a number of metabolic disorders. In these disorders, carnitine complexes with the accumulated substrate of the blocked metabolic step, and the resulting acylcarnitine ester is excreted in the urine, leading to a depletion of carnitine in the patient

Description: The celiac disease comprehensive panel test screens for antibodies associated with celiac disease in your blood’s serum.

Specimens from children less than 4 years of age (i.e., less than 48 months) are not appropriate for this test. The test for children 4 years of age and younger is the Celiac Disease Comprehensive Panel, Infant (test code 15981).

Also Known As: Anti-Tissue Transglutaminase Antibody test, tTG Test, tTGA Test, Endomysial Antibody Test, EMA Test, DGP Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

Average Processing Time: 4 to 5 days

IMPORTANT - Note this is Reflex Test which if additional tests are run you will be charged for the specific tests that the lab peforms. Additional test will be run if the following criteria are met.
If the Tissue Transglutaminase IgA is positive,

1. Endomysial Antibody Screen (IgA) will be performed at an additional charge (CPT code(s): 86255).
2. If the Endomysial Antibody Screen (IgA) is positive, Endomysial Antibody Titer will be performed at an additional charge (CPT code(s): 86256).
3. If the Total IgA is less than the lower limit of the reference range, based on age, Tissue Transglutaminase IgG will be performed at an additional charge (CPT code(s): 83516).

When is a Comprehensive Celiac Disease Panel test ordered?

Celiac disease tests are requested when signs and symptoms of celiac disease, malnutrition, and/or malabsorption are present. The condition is difficult to diagnose because the symptoms are typically ambiguous and varied. The symptoms may be faint at first and go unrecognized, but they will gradually worsen or appear irregularly. The illness can affect several sections of the body.

When somebody with celiac disease has been on a gluten-free regimen for a while, one or more antibody tests may be required. This is done to ensure that antibody levels have dropped and that the diet has been successful in reversing the damage to the gut lining.

Asymptomatic people may be examined if they have a close family with celiac disease, such as a parent or sibling, but celiac disease testing is not suggested as a general population screening at this time.

What does a Comprehensive Celiac Disease Panel blood test check for?

Celiac disease is an autoimmune condition marked by an abnormal immune response to gluten, a protein present in wheat and related grains such as rye and barley. Antibodies to celiac disease have been created to aid in the diagnosis and monitoring of the disease as well as a few other gluten-sensitive disorders. These tests look for autoantibodies in the blood, which are produced by the body as part of the immune response.

The small intestine is inflamed, and the villi that line the intestinal wall are damaged and destroyed as a result of the immunological response. The villi are tiny tissue folds that enhance the surface area of the intestine, allowing nutrients, vitamins, minerals, fluids, and electrolytes to be absorbed. When a gluten-sensitive person is exposed to gluten, the body releases autoantibodies that attack intestinal villi constituents. When villi are damaged or eliminated, the body's ability to absorb food is greatly reduced, and signs of malnutrition and malabsorption appear.

Celiac disease was previously only diagnosed by examining a tissue biopsy of the small intestine. The emergence of less invasive blood tests to check for celiac disease has lowered the amount of biopsies required.

The level of certain autoantibodies in the blood is measured in Celiac disease blood tests. There are tests to detect the IgA and IgG classes of autoantibodies, but the ones that assess IgA are more specific and are virtually solely utilized. IgG and IgA are two of five antibody protein classes produced by the immune system in reaction to a perceived danger. In gastrointestinal secretions, IgA is the most common antibody.

If a person has an IgA deficit, autoantibody testing for IgG may be ordered. This happens roughly 3% of the time in celiac disease patients and can result in false-negative test findings.

Celiac disease tests include:

• IgA anti-tissue transglutaminase antibody detects antibodies to tissue transglutaminase, an enzyme that induces protein crosslinking. The most sensitive and specific blood test for celiac disease is anti-tTG, IgA. People with an IgA deficiency may be prescribed anti-tTG from the IgG class.
• Quantitative immunoglobulin A: determines if someone is deficient in the IgA class of antibodies by measuring the total amount of IgA in their blood.
• Anti-DGP IgA antibodies are detected by deamidated gliadin peptide antibodies, IgA; like anti-tTG, the IgG class can be used to diagnose an IgA deficit.

Lab tests often ordered with a Comprehensive Celiac Disease Panel test:

• Immunoglobulin A
• Immunoglobulin G
• Fecal globulin
• Total Protein
• Albumin
• Calcium
• Iron Total
• Iron and Total Iron Binding Capacity
• Ferritin
• Vitamin B12
• Vitamin D
• Comprehensive Metabolic Panel (CMP)
• Complete Blood Count (CBC)
• Antibody Testing
• ANA Screen
• Sed Rate
• C-Reactive Protein
• F-Actin

Conditions where a Comprehensive Celiac Disease Panel test is recommended:

• Celiac Diseae
• Autoimmune Disorders
• Malabsorption
• Malnutrition
• Osteoporosis
• Lactose Intolerance
• Iron Deficiency Anemia
• Inflammatory Bowel Disease

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

Celiac disease antibody tests are used to diagnose and monitor celiac disease, an autoimmune condition caused by an abnormal immune response to gluten, a protein found in wheat and related food proteins found in rye and barley. Celiac disease tests are typically recommended for persons who have symptoms including anemia and gastrointestinal pain.

Because about four to twelve percent of people with close relatives that have celiac disease have or will develop celiac disease themselves, celiac testing may be used to screen for asymptomatic celiac disease. Those with other autoimmune illnesses may also be subjected to testing.

The number of certain antibodies in the blood is measured in Celiac disease blood tests. The following are the most common tests:

• The primary test ordered to screen for celiac disease is tissue transglutaminase antibody, IgA class. According to the American College of Gastroenterology's 2013 guidelines, it is the single test preferred by the American Gastroenterology Association and the American Gastroenterology Association for the identification of celiac disease in persons over the age of two years. If you have an IgA deficiency, you can obtain anti-tTG from the IgG class as an alternative. If the anti-tTG, IgA, or IgG test is positive, it can be used to monitor a person with celiac disease and assess treatment success; antibody levels should reduce as gluten is removed from the diet. Although these tests are called "tissue tests," they actually measure blood.
• Immunoglobulin quantification A test that is ordered in conjunction with, prior to, or after an anti-tTG test to detect IgA deficiency, which occurs in about 2-3 percent of celiac disease patients and can result in false-negative test results. If a person has an IgA deficit, a test for autoantibodies of the IgG class may be ordered.
• Antibodies to deamidated gliadin peptides, IgA or IgG, may be positive in certain celiac disease patients who are negative for anti-tTG, particularly children under the age of two. It's sometimes ordered in conjunction with or after an anti-tTG test, especially if the latter is negative. The American College of Gastroenterology recommends DGP IgG testing in addition to anti-tTG IgG testing for persons with low IgA or IgA deficiency. If the anti-DGP test is positive, celiac disease can be monitored.

Less frequently used tests include:

• Anti-endomysial antibodies – antibodies produced in response to continuing injury to the intestinal lining; tTg was discovered to be the chemical detected in this test. Anti-EMA antibodies of the IgA class are found in nearly 100% of persons with active celiac disease and 70% of people with dermatitis herpetiformis. Because the test is more difficult to perform and interpret than anti-tTg, it is utilized less frequently.
• Anti-reticulin antibody test — not as specific or sensitive as the other autoantibodies; it's identified in roughly 60% of celiac disease patients and 25% of dermatitis herpetiformis patients; it's rarely requested.
• A biopsy of the small intestine is used to confirm a diagnosis of celiac disease by looking for damage to the intestinal villi. Due to the invasive nature and high expense of a biopsy, antibody tests are frequently used to identify persons with a high risk of celiac disease.

Other tests may be conducted to establish the severity of the disease and the extent of any consequences that may occur, such as malnutrition, malabsorption, and organ involvement. Examples of tests include:

• Anti-F-actin — A positive result may suggest greater intestine damage if a person has been diagnosed with celiac disease and a health practitioner wants to assess the severity of intestinal damage.
• CBC to rule out anemia
• ESR is used to assess inflammation.
• CRP is used to assess inflammation.
• CMP is used to check electrolyte, protein, and calcium levels, as well as the kidney and liver's health.
• Vitamin D, B12, and folate are used to assess vitamin deficiency.
• To detect iron shortage, doctors use iron, iron binding capacity, or transferrin, and ferritin.
• Stool fat is used to assess malabsorption.

Because celiac disease patients may also have lactose intolerance, celiac disease testing may be combined with other intolerance and allergy testing.

What do my Celiac Disease panel test results mean?

An intestinal biopsy is usually performed after all positive and ambiguous celiac disease testing. Celiac disease is diagnosed definitively with a biopsy.

When a person with celiac disease avoids gluten from his or her diet, autoantibody levels should decrease. If they don't go down and the symptoms don't go away, there could be hidden gluten in the diet that hasn't been eliminated, or the person could have one of the uncommon kinds of celiac disease that is resistant to dietary adjustments. Rising levels of autoantibodies suggest noncompliance with a gluten-free diet when celiac disease tests are used to track progress.

Celiac disease tests may be negative if the person being tested has not consumed gluten for several weeks to months prior to the test. If the doctor suspects celiac disease, he or she may administer a gluten challenge, which involves introducing gluten into the patient's diet for several weeks or months to see if symptoms reappear. Celiac disease tests may be redone at that time, or a biopsy may be performed to look for damage to the villi in the intestine.

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

Description: A Complete Blood Count (CBC) test is a common laboratory test that provides valuable insights into a patient's overall health and helps detect potential blood disorders or abnormalities. It examines the three major components of blood: red blood cells (RBCs), white blood cells (WBCs), and platelets. By measuring various parameters related to these blood cells, the CBC test offers essential information for diagnosis, monitoring, and treatment planning.

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

Collection Method: Blood Draw 

Specimen Type: Whole Blood 

Test Preparation: No preparation required 

Average Processing Time: 1 to 2 days

When is a Complete Blood Count test ordered?  

A CBC test may be ordered in various situations. These include:

1. Routine Check-ups: Doctors often include a CBC test as part of routine check-ups to assess overall health and screen for any underlying blood-related conditions.

2. Evaluation of Symptoms: When a patient presents with unexplained symptoms such as fatigue, weakness, frequent infections, bruising, or excessive bleeding, a CBC test can help identify potential causes or abnormalities.

3. Monitoring Chronic Conditions: Patients with chronic conditions like anemia, infections, autoimmune disorders, or blood-related diseases require regular CBC tests to monitor their condition, track treatment effectiveness, and adjust therapies accordingly.

4. Pre-Surgical Assessment: Prior to surgery or invasive medical procedures, doctors order CBC tests to evaluate a patient's blood cell counts and ensure their ability to handle the procedure safely.

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: 

A CBC test can assist in diagnosing and monitoring various conditions or diseases, including:

1. Anemia: CBC helps identify different types of anemia, such as iron deficiency anemia, vitamin B12 deficiency anemia, or autoimmune hemolytic anemia.

2. Infections: An abnormal CBC count can indicate the presence of an infection, whether bacterial, viral, or fungal. It provides information about the severity and type of infection.

3. Leukemia: CBC abnormalities may suggest the presence of certain blood cancers, including leukemia. Further tests are necessary to confirm the diagnosis.

4. Inflammatory Disorders: Conditions like rheumatoid arthritis, lupus, or vasculitis can cause changes in the CBC results, indicating ongoing inflammation or autoimmune processes.

Commonly Asked Questions: 

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

Health care providers use the results of a CBC test to:

1. Confirm Diagnoses: Abnormal CBC findings help in diagnosing specific conditions or diseases, such as anemia, infections, blood disorders, or certain cancers.

2. Monitor Treatment Progress: Regular CBC tests allow doctors to evaluate the effectiveness of treatments or therapies and make necessary adjustments based on blood cell count improvements or changes.

3. Guide Further Investigations: If CBC results indicate abnormalities, doctors may recommend additional specialized tests or refer the patient to a hematologist or other relevant specialists for further evaluation and diagnosis.

By understanding the purpose, significance, and applications of a CBC test, patients and healthcare providers can utilize this valuable diagnostic tool to aid in the management of various health conditions and ensure optimal patient care.

What do my Complete Blood Count results mean? 

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

What do my Differential results mean? 

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

What do my Platelet results mean? 

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

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

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

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

Reflex Parameters for Manual Slide Review

CBC Reflex Pathway

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

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

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

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

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

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

Description: The Comprehensive Metabolic Panel (CMP) test is a widely used blood test that provides valuable insights into a patient's overall health and helps evaluate the function of various organs and systems in the body. It measures a comprehensive set of chemical substances in the blood, including electrolytes, kidney and liver function markers, glucose, and protein levels. The CMP test offers a comprehensive overview of the body's metabolic state and aids in diagnosing and monitoring various conditions.

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

Collection Method: Blood Draw 

Specimen Type: Serum 

Test Preparation: 9-12 hours fasting is preferred.

Average Processing Time: 1 to 2 days 

When is a Comprehensive Metabolic Panel test ordered:  

A Comprehensive Metabolic Panel (CMP) test may be ordered in several situations to assess a patient's health:

1. Routine Health Check-ups: Doctors often include a CMP test as part of routine check-ups to assess overall health, screen for underlying conditions, and establish a baseline for future comparisons.

2. Evaluation of Organ Function: The CMP test provides valuable information about the function of vital organs such as the liver, kidneys, and pancreas. It helps detect abnormalities or diseases affecting these organs, such as liver disease, kidney dysfunction, or diabetes.

3. Monitoring Medications or Treatments: Patients undergoing certain medications or treatments, such as those that may impact liver or kidney function, require regular monitoring through CMP tests to ensure the treatments are well-tolerated and effective.

4. Investigation of Symptoms: When patients present with symptoms like fatigue, abdominal pain, jaundice, frequent urination, or unexplained weight loss, a CMP test can aid in identifying potential underlying causes or imbalances.

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: 

A Comprehensive Metabolic Panel (CMP) test can assist in diagnosing and monitoring various conditions or diseases, including:

1. Liver Diseases: The CMP helps identify liver diseases such as hepatitis, cirrhosis, or liver damage due to alcohol abuse or medication toxicity.

2. Kidney Diseases: Abnormalities in kidney function markers on the CMP test can indicate conditions like chronic kidney disease, kidney infections, or kidney stones.

3. Diabetes or Glucose Imbalances: The CMP provides crucial information on blood glucose levels, aiding in the diagnosis and management of diabetes or identifying glucose imbalances.

4. Electrolyte Imbalances: Abnormal levels of electrolytes detected by the CMP can indicate conditions such as dehydration, kidney dysfunction, or hormonal disorders.

Commonly Asked Questions: 

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

Health care providers use the results of a Comprehensive Metabolic Panel (CMP) test to:

1. Diagnose Medical Conditions: Abnormalities in CMP test results can help healthcare providers diagnose various conditions such as liver disease, kidney dysfunction, diabetes, or electrolyte imbalances.

2. Monitor Treatment Effectiveness: Regular CMP tests allow healthcare providers to monitor the impact of treatments or medications on organ function, glucose control, or electrolyte balance.

3. Evaluate Overall Health: The CMP test provides a comprehensive snapshot of the patient's metabolic state and aids in evaluating overall health, identifying potential risk factors, and guiding further investigations if necessary.

By effectively utilizing the results of a Comprehensive Metabolic Panel (CMP) test, healthcare providers can diagnose conditions, monitor treatment progress, and make informed decisions regarding patient care and management.

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: Fecal Globulin by immunochemistry is a test that measures the amount of blood present in fecal samples. The results from the fecal globulin test can be used to detect a lower gastrointestinal disorder. It is recommended to be a part of the routine physical examination.

Also Known As: Fecal Immunochemical Test, Fecal Occult Blood Test, Stool Occult Blood Test, FIT, FOBT

Collection Method: Fecal specimen collected from toilet water and brushed onto InSure® FOBT test card

Specimen Type: Fecal Specimen

Test Preparation: No preparation required

Average Processing Time: 6 to 7 days

When is a Fecal Globin test ordered?

When a person chooses fecal occult blood testing as a method of colon cancer screening, the American Cancer Society and other major healthcare organizations recommend yearly testing. The American Cancer Society and others recommend that colon cancer screening begin around age 50 for the general population, but it may begin earlier if a person has a family history of colon cancer.

An FOBT may be ordered by a doctor if a patient has unexplained anemia that could be caused by gastrointestinal bleeding.

What does a Fecal Globin test check for?

The majority of colon cancer cases begin with the formation of benign intestinal polyps. Benign polyps are quite common in adults over 50, and while the majority do not cause health problems, some can turn malignant and spread to other parts of the body. These finger-like growths protrude into the rectum or the intestinal cavity. They can be delicate and bleed on occasion, as when food debris rubs against them.

The blood expelled is normally not visible in the stool, but a fecal occult blood test or a fecal immunochemical test can detect it. The FOBT and FIT are effective colorectal cancer screening techniques because this small amount of blood may be the earliest and sometimes only evidence of early colon cancer. A guaiac-based test, an over-the-counter flushable reagent pad, and an immunochemical technique are all options for testing.

It is advised that at least three stool samples be taken on different days be tested. According to the American Cancer Society, a single test performed during a digital rectal exam at a doctor's office is not recommended since it may not be sensitive enough to detect cancer. Because collecting feces on three different days increases the chances of identifying cancer, the home FOBT or FIT is advised. Additionally, those who choose this type of colon cancer screening should be screened every year.

Lab tests often ordered with a Fecal Globin test:

• Complete Blood Count (CBC)
• Calprotectin

Conditions where a Fecal Globin test is recommended:

• Colon Cancer

How does my health care provider use a Fecal Globin test?

The fecal occult blood test, also known as the fecal immunochemical test, is primarily used to screen for early colon cancer. The majority of colon cancer cases begin with the formation of benign intestinal polyps. People over the age of 50 are more likely to develop benign polyps. The majority are non-cancerous, however some can develop malignant.

Blood in the stool could be the only sign of early cancer, so if caught early, therapy can begin right away, increasing the chances of a cure.

What do my Fecal Occult Blood test results mean?

Normally, the fecal occult blood test is negative.

A positive test result for the guaiac-based FOBT shows that abnormal bleeding is occurring anywhere in the digestive tract. Ulcers, diverticulosis, polyps, inflammatory bowel disease, hemorrhoids, blood eaten owing to bleeding gums or nosebleeds, or benign or malignant tumors could all cause blood loss.

A positive result for the fecal immunochemical test shows abnormal bleeding in the lower digestive tract. Other sources of blood, such as those found in the diet, do not generate a positive result since this test only identifies human hemoglobin. Furthermore, hemoglobin from upper digestive tract hemorrhage is broken down before reaching the lower digestive tract and is undetectable by the FIT. As a result, the FIT is a more precise test than the gFOBT.

Follow-up testing is required after a positive result from either the guaiac-based FOBT or the immunochemical FIT. Direct imaging of the colon and rectum is generally used.

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

Description: A Ferritin test is a blood test that measures Ferritin levels in your blood’s serum to evaluate the level of iron stored in your body.

Also Known As: Ferritin Serum Test, Ferritin Test, Ferritin Blood Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

Average Processing Time: 1 to 2 days

When is a Ferritin test ordered?

When a CBC test’s implies iron deficiency anemia due to small red blood cells or low hematocrit and hemoglobin levels, the ferritin test, and other iron tests, may be requested, even if other clinical symptoms have not yet arisen.

There are frequently no physical symptoms in the early stages of iron insufficiency. Symptoms rarely develop before hemoglobin falls below dangerous levels. However, when the iron deficit continues, symptoms emerge, prompting a doctor to order ferritin and other iron-related testing. The following are the most prevalent symptoms of iron deficiency anemia:

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

Shortness of breath, ringing in the ears, sleepiness, and irritability may occur as iron levels are reduced. Chest pain, headaches, limb pains, shock, and even heart failure may occur as the anemia worsens. Learning impairments can occur in children. There are some symptoms that are specific to iron deficiency, in addition to the usual signs of anemia. Pica, a burning feeling in the tongue or a smooth tongue, ulcers at the corners of the mouth, and spoon-shaped finger- and toe-nails are only a few of the symptoms.

When iron overload is suspected, a ferritin level may be requested. Iron overload symptoms differ from person to person and tend to worsen over time. They are caused by an excess of iron in the blood and tissues. Among the signs and symptoms are:

• Joint discomfort
• Weakness and exhaustion
• Loss of weight
• Energy deficiency
• Pain in the abdomen
• Suffering from a lack of sexual desire
• Hair loss on the body
• Congestive heart failure is an example of a cardiac issue

Other iron tests including a genetic test for hereditary hemochromatosis may be conducted to confirm the existence of iron excess.

What does a Ferritin blood test check for?

Ferritin is an iron-containing protein that stores iron in cells in its most basic form. The amount of total iron stored in the body is reflected in the little amount of ferritin released into the blood. This test determines how much ferritin is present in the blood.

About 70% of the iron consumed by the body is integrated into the hemoglobin of red blood cells in healthy humans. The remaining 30% is stored primarily as ferritin or hemosiderin, which is a combination of iron, proteins, and other elements. Hemosiderin and ferritin are typically found in the liver, although they can also be found in the bone marrow, spleen, and skeletal muscles.

Iron stores are depleted and ferritin levels fall when available iron is insufficient to meet the body's needs. This can happen owing to a lack of iron, poor absorption, or an increased need for iron, such as during pregnancy or if you have a condition that causes persistent blood loss. Before any indicators of iron shortage appear, significant loss of iron reserves may occur.

When the body absorbs more iron than it needs, iron storage and ferritin levels rise. Chronic iron absorption causes a gradual buildup of iron compounds in organs, which can eventually lead to organ malfunction and failure. Even on a typical diet, this happens in hemochromatosis, a hereditary disorder in which the body absorbs too much iron.

Lab tests often ordered with a Ferritin test:

• Complete Blood Count
• Iron Total
• Iron Total and Total Iron binding capacity
• Transferrin
• Comprehensive Metabolic Panel
• Lipid Panel
• Zinc Protoporphyrin

Conditions where a Ferritin test is recommended:

• Anemia
• Hemochromatosis
• Lead poisoning
• Pregnancy
• Restless Leg Syndrome

How does my health care provider use a Ferritin test?

The ferritin test is used to determine the amount of iron a person has in their body. To determine the existence and severity of iron shortage or iron overload, the test is sometimes ordered in conjunction with an iron test and a TIBC test.

One source of iron overload can be the use of iron supplements.

What does my ferritin lab test result mean?

Ferritin levels are frequently measured alongside other iron tests.

Ferritin levels are low in iron deficient people and high in people who have hemochromatosis or have had several blood transfusions.

Ferritin is an acute phase reactant that can be elevated in persons who have inflammation, liver illness, chronic infection, autoimmune disorders, or cancer. Ferritin isn't commonly utilized to detect or monitor these problems.

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

Description: A Folate test measures the levels of folic acid in the blood. These results can be used to determine a folate deficiency and evaluate a person's nutritional status. Anemia and Neuropathy can also be evaluated using the results from this test.

Also Known As: Folate Serum Test, Folic Acid Test, Vitamin B9 Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

Average Processing Time: 1 to 2 days

When is a Folate 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, B12 and folate levels may be ordered. A high mean corpuscular volume, in particular, implies that the RBCs are enlarged.

When a person exhibits the following signs and symptoms of a deficit, testing for folate 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, folate testing may be ordered.

Individuals being treated for malnutrition or a 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 Folate blood test check for?

The B complex of vitamins includes vitamins including vitamin B12 and folate. They are required for the creation of normal red blood cells, tissue and cell repair, and the synthesis of DNA, the genetic material in cells. Both are nutrients that the body cannot make and must be obtained from the diet.

Vitamin B9 tests, also known as folate tests, diagnose vitamin deficiencies by measuring vitamin levels in the liquid section of the blood. The amount of folate in red blood cells is sometimes tested as well.

Folate is a naturally occurring form of the vitamin, whereas folic acid is a supplement that can be added to foods and beverages. Leafy green vegetables, dry beans and peas, citrus fruits, yeast, and liver all contain it. Vitamin B12, also known as cobalamin, can be found in animal-based foods such red meat, fish, poultry, milk, yogurt, and eggs. Fortified cereals, breads, and other grain products have become key sources of B12 and folate in recent years

A lack of folate can cause macrocytic anemia, a condition in which red blood cells 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 counts are two more test results linked to megaloblastic anemia.

Folate is required for cell division, which occurs in the developing fetus. In a growing fetus, a lack of folate during early pregnancy can raise the chance of neural tube abnormalities such spina bifida.

Folate deficiency is most commonly caused by inadequate intake of the vitamin through diet or supplements, poor absorption, or increased bodily requirement, as observed during pregnancy:

• Dietary deficiencies are uncommon in the United States since many meals and beverages are fortified with vitamins that the body stores. Adults normally have around three months' worth of folate stored in their liver. Dietary deficiencies normally do not manifest symptoms until the body's vitamin supplies have been exhausted.
• Increased demand—this can occur as a result of a range of diseases and disorders. When a woman is pregnant or nursing, in early childhood, with malignancies, or with chronic hemolytic anemias, there is an increased demand for folate.

Lab tests often ordered with a Folate test:

• Complete Blood Count
• Methylmalonic Acid
• Homocysteine
• Vitamin B1
• Vitamin B3
• Vitamin B5
• Vitamin B6
• Vitamin B7
• Vitamin B12
• Intrinsic Factor Antibody
• Parietal Cell Antibody
• Reticulocyte Count

Conditions where a Folate test is recommended:

• Neural Tube Defects
• Vitamin B12 and Folate Deficiencies
• Anemia
• Alcoholism
• Malnutrition
• Celiac Disease
• Malabsorption
• Neuropathy
• Nervous System Disorders
• Inflammatory Bowel Disease

How does my health care provider use a Folate test?

Separate tests for 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're needed for red blood cell creation, tissue and cell repair, and DNA synthesis, which is 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 disorder.

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 liquid part 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 Folate Serum test results mean?

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

A low 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 folate levels can be caused by a variety of factors.

Dietary folate deficiency 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.

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
• 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.
• Increased requirement 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. People who have cancer that has spread or who have chronic hemolytic anemia require more folate.
• Smoking

If a person is taking supplements to treat a folate deficiency, normal or higher findings indicate that the treatment is working.

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

Clinical Significance
Micronutrient, Folate

Patients must be 18 years of age or greater.

Reference Range(s)
≥18 years    >5.4 ng/mL
Reference range not available for individuals <18 years for this micronutrient test.

Clinical Significance
Micronutrients, Antioxidants Panel

Patients must be 18 years of age or greater.

Includes
Micronutrient, Coenzyme Q10 (CoQ10)
Micronutrient, Vitamin A (Retinol)
Micronutrient, Vitamin C
Micronutrient, Vitamin E

Patient Preparation
Overnight fasting required.
Avoid taking Coenzyme Q10 supplements the morning of the test.
Refrain from eating fruits or taking vitamin C supplements 24 hours prior to collection.

Reference Range(s)
Coenzyme Q10 (CoQ10)    >35 ug/mL
Vitamin A (Retinol)
18-19 years    26-72 mcg/dL
>19 years    38-98 mcg/dL
Reference range not available for individuals <18 years for this micronutrient test.

Vitamin C
Male ≥18 years    0.2-2.1 mg/dL
Female ≥18 years    0.3-2.7 mg/dL
Reference range not available for individuals <18 years for this micronutrient test.

Vitamin E
Alpha Tocopherol    ≥18 years    5.7-19.9 mg/L
Beta-Gamma Tocopherol    ≥18 years    <4.4 mg/L
Reference range not available for individuals <18 years for this micronutrient test.

Description: Hemoglobin A1c is the protein Hemoglobin found in red blood cells, but with glucose attached to it. Hemoglobin A1c is used to check for and monitor diabetes as it shows average blood glucose levels over the past 2 to 3 months.

Also Known As: A1c Test, Glycohemoglobin Test, Glycated Hemoglobin Test, Glycosylated Hemoglobin Test, HbA1c Test, Estimated Average Glucose Test

Collection Method: Blood Draw

Specimen Type: Whole Blood

Test Preparation: No preparation required

Average Processing Time: 1 to 2 days

When is a Hemoglobin A1c with eAG test ordered?

A1c may be requested as part of a routine physical examination or when a practitioner suspects a patient of having diabetes due to characteristic signs or symptoms of high blood sugar, such as:

• Increased thirst and fluid intake
• Increased urination
• Increase in hunger
• Fatigue
• Vision is hazy
• Infections that take a long time to heal

Adults who are overweight and have the following additional risk factors may consider doing the A1c test:

• Physically inactive
• Diabetes in a first-degree relative
• Race/ethnicity that is at high risk such as African Americans, Latinos, Native Americans, Asian Americans, and Pacific Islanders
• Blood pressure that is high
• A lipid profile that is abnormal.
• Polycystic ovarian syndrome 
• Cardiovascular disease 
• Insulin resistance and other conditions links to insulin resistance

People who have not been diagnosed with diabetes but have been assessed to be at an increased risk of developing diabetes should have their A1c levels tested at least once a year.

Monitoring

The A1c test may be performed 2 to 4 times a year, depending on the type of diabetes a person has, how well their diabetes is controlled, and the healthcare provider's recommendations. If diabetics are fulfilling treatment goals and have stable glycemic control, the American Diabetes Association advises A1c testing at least twice a year. A1c may be ordered quarterly when someone is first diagnosed with diabetes or if control isn't good.

What does a Hemoglobin A1c with eAG blood test check for?

Hemoglobin A1c, often known as A1c or glycated hemoglobin, is hemoglobin that has been attached to glucose. By assessing the proportion of glycated hemoglobin, the A1c test determines the average quantity of glucose in the blood during the previous 2 to 3 months.

Hemoglobin is a protein present inside red blood cells that transports oxygen.

Glycated hemoglobin is generated in proportion to the amount of glucose in the blood. Once glucose attaches to hemoglobin, it stays there for the duration of the red blood cell's life, which is usually about 120 days. The most common kind of glycated hemoglobin is known as A1c. A1c is created on a daily basis and is gradually removed from the bloodstream as older RBCs die and younger RBCs replace them.

This test can be used to detect and diagnose diabetes, as well as the risk of developing it. According to the American Diabetes Association's standards of medical care in diabetes, diabetes can be diagnosed using either A1c or glucose.

This test can also be used to track the progress of a diabetic patient's treatment. It aids in determining how well a person's glucose levels have been controlled over time by medication. An A1c of less than 7% suggests good glucose control and a lower risk of diabetic complications for the majority of diabetics for monitoring reasons.

eAG may help you understand your A1C value because eAG is a unit similar to what you see regularly through self-monitoring on your meter.

Lab tests often ordered with a Hemoglobin A1c with eAG test:

• Complete Blood Count
• Glucose
• Frucstosamine
• Albumin
• Comprehensive Metabolic Panel
• Microalbumin w/creatinine
• Lipid panel

Conditions where a Hemoglobin A1c with eAG test is recommended:

• Type 1 Diabetes
• Type 2 Diabetes

How does my health care provider use a Hemoglobin A1c with eAG test?

Adults can use the hemoglobin A1c test to screen for and diagnose diabetes and prediabetes.

A fasting glucose or oral glucose tolerance test should be done to screen or diagnose diabetes in these instances.

The A1c test is also used to track diabetics' glucose control over time. Diabetics strive to maintain blood glucose levels that are as close to normal as feasible. This helps to reduce the risks of consequences associated with chronically high blood sugar levels, such as progressive damage to body organs such as the kidneys, eyes, cardiovascular system, and nerves. The result of the A1c test depicts the average quantity of glucose in the blood over the previous 2-3 months. This can help diabetics and their healthcare professionals determine whether the steps they're taking to control their diabetes are working or if they need to be tweaked.

A1c is a blood test that is usually used to help newly diagnosed diabetics identify how high their uncontrolled blood glucose levels have been in the previous 2-3 months. The test may be ordered multiple times throughout the control period, and then at least twice a year after that to ensure that good control is maintained.

What does my Hemoglobin A1c test result mean?

HbA1c levels is currently reported as a percentage for monitoring glucose control, and it is suggested that most diabetics try to keep their hemoglobin A1c below 7%. The closer diabetics can keep their A1c to the therapeutic objective of less than 7% without experiencing abnormally low blood glucose, the better their diabetes is controlled. The risk of problems rises as the A1c rises.

However, a person with type 2 diabetes may have an A1c goal set by their healthcare professional. The length of time since diagnosis, the presence of other diseases as well as diabetes complications, the risk of hypoglycemia complications, life expectancy, and whether or not the person has a support system and healthcare resources readily available are all factors that may influence the goal.

For example, a person with heart disease who has had type 2 diabetes for many years without diabetic complications may have a higher A1c target set by their healthcare provider, whereas someone who is otherwise healthy and newly diagnosed may have a lower target set by their healthcare provider as long as low blood sugar is not a significant risk.

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

Description: The Histamine plasma test is used by physicians to help with identifying possible anaphylaxis, mastocytosis, or severe allergies if other test results are inconsistent.

Collection Method: Blood Draw

Specimen Type: Plasma

Test Preparation: Avoid taking allergy causing drugs, antihistamines, oral corticosteroids and substances which block H2 receptors 24 hours prior to collection.

Average Processing Time: 5 to 6 days

When is a Histamine test ordered?

Histamine testing is not usually requested. Histamine or tryptase tests are typically not used to identify anaphylaxis, and mastocytosis is uncommon. When a person exhibits symptoms that could indicate anaphylaxis, histamine and tryptase tests may be requested, particularly if the diagnosis is hazy and/or the symptoms are persistent. Anaphylaxis symptoms include:

• breathing issues and wheeze
• Flushing
• Itching, frequently accompanied with hives,
• dizziness or lightheadedness
• reduced blood pressure
• throat, face, tongue, and/or eye swelling
• Several of these symptoms are also present in other diseases.

A doctor may also recommend testing if they believe a patient has mastocytosis or a condition involving mast cells. Many of the symptoms and signs shared by people with severe allergies are also present in people with these illnesses, but there is no known trigger, such as exposure to certain foods or bee stings. Peptic ulcers, persistent diarrhea, joint pain, enlargement of the liver, spleen, or lymph nodes, rashes, or the distinctive red, blistering lesions may appear singly or in large numbers in people with systemic mastocytosis.

What does a Histamine blood test check for?

When mast cells, specialized cells, are triggered, a chemical known as histamine is released, frequently as a result of an allergic immunological reaction. Histamine levels in the blood is determined by this test.

Large tissue cells called mast cells can be found all over the body. They are primarily found in the bone marrow, skin, and lining of the intestine and air passageways. Mast cells are a typical component of both the body's response to damage and allergy reactions. Histamine and tryptase, which are released when mast cells are triggered, are stored in granules that are found in them. Many allergy sufferers' symptoms are brought on by histamine.

Histamine levels in the blood and urine are typically quite low. Those who have a strong allergic reaction and those who have a disease in which the number of mast cells grows and/or activates without obvious sensitivities can both experience significant increases.

Anaphylaxis, a severe type of acute allergic reaction that can result in hives, skin reddening, low blood pressure, severely narrowed airways, and even death, is linked to the activation of numerous mast cells. Histamine levels in the blood rise quickly in anaphylaxis, peaking within 10 minutes of the onset of symptoms and returning to normal in between 30 and 60 minutes. Shortly after this increased production, histamine and its main metabolite, N-methylhistamine, are eliminated, which is reflected in the urine as well.

Mastocytosis patients may have chronically elevated levels of tryptase and histamine. This uncommon illness is characterized by aberrant mast cell proliferation, infiltration, and accumulation in the skin and/or other body organs.

Lab tests often ordered with a Histamine test:

• Tryptase
• N-Methylhistamine
• Allergy testing

Conditions where a Histamine test is recommended:

• Allergies
• Asthma
• Bone Marrow Disorders

How does my health care provider use a Histamine test?

The mast cell activation test with histamine is a helpful tool. The test may be used to support the diagnosis of mastocytosis, a rare category of illnesses defined by aberrant mast cell proliferation, or it may be used to support the confirmation of an anaphylactic reaction in a patient.

Although tryptase and a histamine test may be performed in conjunction to assist confirm anaphylaxis as the cause of someone's severe symptoms, anaphylaxis is often diagnosed clinically. This is particularly valid if the patient experiences recurrent episodes or if the diagnosis is unclear. As soon as symptoms appear, blood must be drawn for a blood histamine test.

To assist in the diagnosis of mastocytosis or mast cell activation disease, histamine testing may occasionally be requested in addition to a tryptase test. Often, cutaneous mastocytosis only results in skin issues. Anaphylaxis and its symptoms can occur in people who have mast cell activation disease or systemic mastocytosis.

What do my Histamine test results mean?

Strong evidence for the diagnosis of anaphylaxis is the presence of abnormally high histamine and/or tryptase levels in a patient exhibiting those symptoms.

Normal histamine readings could mean that the patient's symptoms have another underlying cause or that the sample wasn't taken at the appropriate time. Blood histamine levels rise quickly during anaphylaxis and can return to normal in 30 to 60 minutes. Results may be normal if a sample is drawn too late. The results of a tryptase test can be compared to the results of the histamine tests. Tryptase levels rise and fall more gradually than histamine levels, peaking within 1 to 2 hours after symptom development.

It is less likely that someone experienced anaphylaxis if the timing of sample collection was proper and neither the blood histamine nor tryptase concentration were increased. Even when the test came back negative, the diagnosis cannot be ruled out because a person can have anaphylaxis or mastocytosis without having raised histamine levels.

Elevated histamine and/or N-methylhistamine concentrations in a 24-hour urine sample signify a mast cell activation event. It is more likely that a person has mastocytosis if they have persistently high histamine and/or tryptase levels and this disease. Further testing is still required to confirm the diagnosis.

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