Performance

This panel contains Cortisol, A.M. #4212, which requires the patient to have their specimen collected between 7 a.m. - 9 a.m.

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

Description: Apo A1 and B is a blood test that measures that amount of Apolipoprotein A1 and Apolipoprotein B in the blood’s serum along with the ratio between B/A1. This test is used to assess cardiovascular risk. Low levels of APO A1 are associated with Coronary Artery Disease (CAD) and are said to predict CAD better then triglycerides and HDL does.

Also Known As: Apo A1 and B Test, Apo A1 Test, Apo B Test, APOAB Test, Apolipoprotein B-100 Test, Apolipoprotein Evaluation Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: Fasting for 12 hours is required.

When are Apolipoprotein A1 and B tests ordered?

Apolipoprotein A-I and B, as well as other lipid tests, may be ordered as part of a screening to identify a person's risk of cardiovascular disease.

Apo A-I is a protein that plays a key function in lipid metabolism and is the most abundant protein in HDL, or "good cholesterol." Excess cholesterol in cells is removed by HDL, which transports it to the liver for recycling or elimination. Apo A-I levels tend to rise and fall with HDL levels, and apo A-I deficits are linked to an increased risk of CVD.

Apo B is a protein that plays a role in lipid metabolism and is the major protein component of lipoproteins including VLDL and LDL, popularly known as "bad cholesterol." Apo B concentrations are similar to LDL-C concentrations.

What does Apolipoprotein A1 and B blood tests check for?

Lipids are transported throughout the bloodstream by apolipoproteins, which mix with them. Lipoproteins are held together by apolipoproteins, which protect the water-repellent lipids at their core.

Lipoproteins are cholesterol or triglyceride-rich proteins that transport lipids throughout the body for cell absorption. HDL, on the other hand, is like an empty cab or taxi. It travels to the tissues to collect excess cholesterol before returning it to the liver. Cholesterol is either recycled for future use or eliminated in bile in the liver. The only mechanism for cells to get rid of excess cholesterol is by HDL reverse transport. It protects the arteries and, if enough HDL is present, it can even reverse the formation of fatty plaques, which are deposits caused by atherosclerosis and can contribute to cardiovascular disease.

Sticking with the taxi analogy, the driver is Apolipoprotein A. It permits HDL to be detected and bound by receptors in the liver at the end of the transport by activating the enzymes that load cholesterol from the tissues into HDL. Apolipoprotein A is divided into two types: apo A-I and apo A-II. Apo A-I has a higher prevalence than apo A-II. Apo A-I concentrations can be evaluated directly, and they tend to rise and fall in tandem with HDL levels. Deficiencies in apo A-I are linked to an increased risk of cardiovascular disease.

Chylomicrons are lipoprotein particles that transport dietary fats from the digestive system to tissue, primarily the liver, via the bloodstream. These dietary lipids are repackaged in the liver and combined with apo B-100 to create triglyceride-rich VLDL. This combo is similar to a taxi with a full load of passengers and apo B-100 as the driver. The taxi moves from place to place in the bloodstream, releasing one passenger at a time.

Triglycerides are removed from VLDL by an enzyme called lipoprotein lipase, which produces intermediate density lipoproteins first, then LDL. VLDL contains one molecule of apo B-100, which is kept as VLDL loses triglycerides and shrinks to become the cholesterol-rich LDL. Apo B-100 is detected by receptors on the surface of many different types of cells in the body. The absorption of cholesterol into cells is aided by these receptors.

LDL and apo B-100 transport cholesterol that is essential for cell membrane integrity, sex hormone generation, and steroid production. Excess LDL, on the other hand, can cause fatty deposits in artery walls, as well as blood vessel hardening and scarring. Atherosclerosis is a condition in which fatty deposits restrict blood arteries. The risk of a heart attack increases as the atherosclerotic process progresses.

LDL-C levels, which are typically ordered as part of a lipid profile, tend to mimic Apo B-100 levels. Many experts believe that apo B levels will eventually show to be a more accurate predictor of CVD risk than LDL-C. Others disagree, believing that vitamin B is only a modestly superior choice and that it should not be used on a regular basis. The clinical utility of apo B, as well as other developing cardiac risk markers including apo A-I, Lp(a), and hs-CRP, is still unknown.

Lab tests often ordered with Apolipoprotein A1 and B tests:

• Cholesterol Total
• HDL Cholesterol
• LDL Cholesterol
• Triglycerides
• Lipid Panel
• Lipoprotein (a)
• Homocysteine
• hs-CRP
• Lipoprotein Fractionation, Ion Mobility

Conditions where Apolipoprotein A1 and B tests are recommended:

• Cardiovascular Disease
• Heart Attack
• Stroke
• Congestive Heart Failure
• Angina

How does my health care provider use Apolipoprotein A1 and B tests?

An apo B/apo A-I ratio can be determined by ordering both an apo A-I and an apo B test. To assess the risk of developing CVD, this ratio is sometimes used instead of the total cholesterol/HDL ratio.

An apo A-I test may be ordered in the following situations:

Assist in the diagnosis of apo A-I deficiency caused by genetic or acquired diseases.

Assist those with a personal or family history of heart disease, high cholesterol, or triglycerides in their blood.

Keep track of how well lifestyle changes and lipid therapies are working.

An apo A-I test can be ordered in conjunction with an apo B test to determine the apo B/apo A-I ratio. This ratio is occasionally used instead of the total cholesterol/HDL ratio to assess the risk of developing CVD.

As an alternative to non-HDL-C, Apo B levels may be ordered to assess the success of lipid treatment.

An apo B test may be conducted in rare circumstances to assist determine a genetic issue that causes apo B overproduction or underproduction.

What do my Apolipoprotein A1 and B test results mean?

Low apo A-I levels are linked to low HDL levels and slowed elimination of excess cholesterol from the body. Low levels of apo A-I, as well as high levels of apo B, are linked to a higher risk of cardiovascular disease.

Deficiencies in apo A-I are caused by a number of hereditary diseases. Abnormal lipid levels, notably excessive amounts of low-density lipoprotein, are common in people with certain illnesses. They frequently have a higher rate of atherosclerosis. Low apo A-I levels are caused by several genetic diseases.

Raised apo B levels are linked to elevated LDL-C and non-HDL-C levels, and are linked to an increased risk of cardiovascular disease. Elevations may be caused by a high-fat diet and/or a reduction in LDL clearance from the blood.

A direct cause of abnormal apo B levels is some hereditary diseases. Familial combined hyperlipidemia, for example, is an inherited condition that causes excessive cholesterol and triglyceride levels in the blood. Apolipoprotein B deficiency, also known as Bassen-Kornzweig syndrome, is a relatively rare hereditary disorder that results in unusually low amounts of apo B.

A variety of underlying diseases and other factors might result in abnormal apo B levels.

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 hs-CRP or High Sensitivity C-Reactive Protein test is a blood test used to accurately detect lower concentrations of the protein C-Reactive Protein. This test is used to evaluate your risk of cardiovascular and heart disease and to check for inflammation and many other issues.

Also Known As: hsCRP Test, Cardiac CRP Test, high sensitivity C-reactive protein Test, CRP Test for heart disease.

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a hs-CRP test ordered?

There is currently no consensus on when to get an hs-CRP test. It may be beneficial for treatment purposes to order hs-CRP for those that have kidney disease, diabetes or inflammatory disorders.

It's possible that hs-CRP will be tested again to confirm that a person has persistently low levels of inflammation.

What does a hs-CRP blood test check for?

C-reactive protein is a protein found in the blood that rises in response to infection and inflammation, as well as after trauma, surgery, or a heart attack. As a result, it's one of numerous proteins referred to as acute phase reactants. The high-sensitivity CRP test detects low levels of inflammation in the blood, which are linked to an increased risk of developing cardiovascular disease.

According to the American Heart Association, CVD kills more people in the United States each year than any other cause. A number of risk factors have been related to the development of CVD, including family history, high cholesterol, high blood pressure, being overweight or diabetic, however a considerable number of people with few or no recognized risk factors will also acquire CVD. This has prompted researchers to investigate for new risk variables that could be causing CVD or could be used to identify lifestyle modifications and/or treatments that could lower a person's risk.

High-sensitivity CRP is one of an increasing number of cardiac risk markers that may be used to assess an individual's risk. According to certain research, monitoring CRP with a highly sensitive assay can assist identify the risk level for CVD in persons who appear to be healthy. CRP levels at the higher end of the reference range can be measured with this more sensitive test. Even when cholesterol levels are within an acceptable range, these normal but slightly elevated levels of CRP in otherwise healthy persons might indicate the future risk of a heart attack, sudden cardiac death, stroke, and peripheral artery disease.

Lab tests often ordered with a hs-CRP test:

• Complete Blood Count
• Lipid Panel
• Comprehensive Metabolic Panel
• Lp-Pla2
• Glucose

Conditions where a hs-CRP test is recommended:

• Heart Attack
• Heart Disease
• Cardiovascular Disease
• Stroke

How does my health care provider use a hs-CRP test?

A test for high-sensitivity C-reactive protein can be used to assess a person's risk of cardiovascular disease. It can be used in conjunction with a lipid profile or other cardiac risk markers, such as the lipoprotein-associated phospholipase A2 test, to provide further information regarding the risk of heart disease.

CRP is a protein that rises in the bloodstream as a result of inflammation. A continuous low level of inflammation, according to studies, plays a crucial role in atherosclerosis, the narrowing of blood vessels caused by the build-up of cholesterol and other lipids, which is typically linked to CVD. The hs-CRP test successfully detects low levels of C-reactive protein, indicating low but chronic inflammation, and so aids in predicting a person's risk of developing CVD.

Some specialists believe that high-sensitivity CRP is a good test for assessing CVD, heart attacks, and stroke risk, and that it can help in the evaluation process before a person gets one of these health problems. Some experts believe that combining a good marker for inflammation, such as hs-CRP, with a lipid profile is the best way to predict risk. This test has been recommended by several organizations for persons who are at a moderate risk of having a heart attack in the following ten years.

What does my hs-CRP test result mean?

Even when cholesterol levels are within an acceptable range, high levels of hs-CRP in otherwise healthy people have been found to predict an elevated risk of future heart attacks, strokes, sudden cardiac death, and/or peripheral arterial disease.

Higher hs-CRP concentrations indicate a higher risk of cardiovascular disease, while lower values indicate a lower risk. Individuals with hs-CRP values at the high end of the normal range are 1.5 to 4 times more likely than those with low levels of hs-CRP to have a heart attack.

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

Description: Ion Mobility Lipoprotein Fractionation is a test that uses a gas-phase technology to separate the lipid particles by size. As each particle is separated, they are counted.

Also Known As: LDL Particle Testing, LDL-P Test, LDL Subclass Test, sdLDL Test, LDL Fractionations Test, LDL Particle Size Test, LDL Particle Number Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: Fasting preferred, but not required

When is a Lipoprotein Fractionation test ordered?

When someone has a personal or family history of early cardiovascular disease, this testing may be ordered as part of an overall evaluation of cardiac risk, especially if the person does not have typical cardiac risk factors like high cholesterol, high LDL cholesterol, high triglyceride, low HDL cholesterol, smoking, obesity, inactivity, diabetes, and/or hypertension.

When a person with elevated LDL-P and/or a high proportion of tiny, dense LDL particles has undertaken cholesterol-lowering treatment or lifestyle adjustments, the healthcare practitioner may conduct LDL lipoprotein subfraction testing, as well as other lipid tests, to assess treatment success.

Although LDL-P is not typically suggested as a screening test, some healthcare practitioners are using it in conjunction with a battery of other cardiac risk tests to evaluate a person's overall risk of getting CVD.

What does a Lipoprotein Fractionation blood test check for?

Low-density lipoproteins are lipid-transporting particles that travel throughout the body. Protein, cholesterol, triglyceride, and phospholipid molecules are all present in each particle. As they move through the bloodstream, their makeup changes. Lipoprotein particles range in size from large and fluffy to small and dense, depending on which molecules are eliminated and which are added. The relative amounts of particles with different characteristics in the blood are determined by LDL particle testing. Subfractionation testing is a term used to describe this process.

Traditional lipid testing determines the amount of LDL cholesterol in the blood but does not assess the number of LDL particles. Increased numbers of small, dense LDL particles have been linked to inflammation and are more likely to produce atherosclerosis than fewer light, fluffy LDL particles, according to some research. Researchers believe that the existence of an elevated quantity of sdLDL could be one of the reasons why some people have heart attacks while having relatively low total and LDL cholesterol levels.

The number of sdLDL particles in a person's blood is determined in part by genetics, in part by sex, and in part by lifestyle and overall health. Increased levels of sdLDL are linked to certain diseases and disorders, like as diabetes and hypertension.

By examining a person's triglyceride and high-density lipoprotein cholesterol levels, it is usually able to estimate whether they have a high amount of sdLDL particles. Typically, these tests are done as part of a lipid profile. People with high triglycerides and low HDL-C have higher levels of sdLDL. More sdLDL is connected with a triglyceride level greater than 120 mg/dL and an HDL-C level less than 40 mg/dL in men and less than 50 mg/dL in women.

Other lipoprotein particles, such as HDL and VLDL, can also be subfractionated, however these tests are generally utilized in research settings and are not discussed on this page.

Lab tests often ordered with a Lipoprotein Fractionation test:

• Lipid Panel
• HDL Cholesterol
• LDL Cholesterol
• Direct LDL
• Apolipoprotein A-1
• Apolipoprotein B
• Lipoprotein (a)
• Triglycerides
• Homocysteine
• Hs-CRP
• VAP

Conditions where a Lipoprotein Fractionation test is recommended:

• Cardiovascular Disease
• Heart Disease

How does my health care provider use a Lipoprotein Fractionation test?

Low-density lipoprotein particle testing determines the number, size, density, and/or electrical charge of LDL particles. It may be useful in determining cardiac risk in patients with a personal or family history of heart disease at a young age, particularly if their total cholesterol and LDL cholesterol levels are not markedly increased. LDL subfraction testing is usually done in conjunction with or after a lipid profile.

While the LDL-C test is a good predictor of cardiovascular disease risk for many people, research has indicated that certain persons with healthy LDL-C levels nonetheless have an increased risk of CVD. Similarly, even if their LDL-C is at a safe level, people with chronic diseases like diabetes may be at higher risk. The quantity of LDL particles and/or their size has been recommended as an additional factor to consider when assessing CVD risk in these populations. Lipoprotein subfraction testing may be done in these situations to further assess a person's CVD risk.

LDL-P is sometimes requested to see how well a treatment is working at reducing the quantity of tiny, dense LDL particles.

LDL subfraction testing has been employed in clinical settings, although VLDL or HDL subfraction testing is primarily used in research. This is because LDL cholesterol has been established as the key risk factor for heart disease, and LDL assessment has received increased attention in research and development.

What do my Lipoprotein Fractionation test results mean?

The method and reporting format utilized in an LDL-P test, as well as the person's total cholesterol, LDL-C, VLDL, and/or HDL cholesterol, are all reflected in the results. Because different methods divide subclasses based on different physical qualities, results may not be immediately comparable from one method to the next or from one laboratory to the next.

Usually, the result is evaluated in context of a lipid profile and the risk it implies:

• If a person has a high number of mostly tiny, dense LDL and an elevated LDL-P, this result will enhance the person's risk of cardiovascular disease beyond the risk associated with total LDL.
• If a person only has large, fluffy LDL and a low LDL-P, this discovery will not put them at any greater risk.

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

Clinical Significance
Lipoprotein Fractionation, NMR - The Lipoprotein Fractionation, NMR test is used to help assess the risk for cardiovascular disease (CVD) in patients with intermediate or high risk based on traditional or emerging risk factors, and to assess therapeutic response in patients undergoing lipid-lowering therapy.

Includes
LDL P, Small LDL P, LDL Size
HDL P, Large HDL P, HDL Size
Large VLDL P, VLDL Size

Patient Preparation
Patient should be fasting 12 hours

CoQ10 (Coenzyme Q10)

Coenzyme Q10 (CoQ10) is a substance similar to a vitamin. It is found in every cell of the body. Your body makes CoQ10, and your cells use it to produce energy your body needs for cell growth and maintenance. It also functions as an antioxidant, which protects the body from damage caused by harmful molecules.

Clinical Significance
Micronutrient, Coenzyme Q10 (CoQ10) - CoQ10 testing is useful for individuals on statin therapy who may or may not be experiencing myalgia symptoms, hypercholesterolemic individuals, and asymptomatic individuals at risk for vascular disease who may have low ApoA1 and/or HDL levels.

Patients must be 18 years of age or greater.

Patient Preparation
Fasting is not required. Patients should not take Coenzyme Q10 supplements the morning of the test. They may take other nutritional supplements prior to testing.

Reference Range(s)
>0.35 ug/mL

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

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

Collection Method: Blood Draw

Specimen Type: Serum

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

When is a Cortisol AM test ordered?

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

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

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

What does a Cortisol AM blood test check for?

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

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

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

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

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

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

Cortisol production may be reduced as a result of:

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

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

Lab tests often ordered with a Cortisol AM test:

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

Conditions where a Cortisol AM test is recommended:

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

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

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

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

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

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

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

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

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

What do my Cortisol AM test results mean?

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

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

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

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

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

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

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

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

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: Test not recommended when patient is on prednisone/prednisolone therapy due to cross reactivity with the antibody used in this test

When is a Cortisol Total test ordered?

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

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

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

What does a Cortisol Total blood test check for?

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

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

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

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

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

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

Cortisol production may be reduced as a result of:

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

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

Lab tests often ordered with a Cortisol Total test:

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

Conditions where a Cortisol Test is recommended:

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

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

A cortisol test can be used to detect Cushing syndrome, which is characterized by an excess of cortisol, as well as adrenal insufficiency or Addison disease, which are characterized by a deficiency of cortisol. Cortisol is a hormone that regulates protein, lipid, and carbohydrate metabolism, among other functions. Cortisol levels in the blood normally increase and fall in a "diurnal variation" pattern, rising early in the morning, dropping during the day, and reaching their lowest point around midnight.

The adrenal glands generate and excrete cortisol. The hypothalamus in the brain and the pituitary gland, a small organ below the brain, control the hormone's production. The hypothalamus produces corticotropin-releasing hormone when blood cortisol levels drop, which tells the pituitary gland to create ACTH. The adrenal glands are stimulated by ACTH to generate and release cortisol. The brain, pituitary, and adrenal glands must all be operating properly in order to produce enough levels of cortisol.

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

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

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

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

ACTH stimulation is a test that measures the amount of cortisol in a person's blood before and after a synthetic ACTH injection. Cortisol levels will rise in response to ACTH stimulation if the adrenal glands are functioning normally. Cortisol levels will be low if they are damaged or not working properly. To distinguish between adrenal and pituitary insufficiency, a lengthier variant of this test can be used.

What do my Cortisol Total test results mean?

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

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

If the person examined responds to an ACTH stimulation test and has insufficient cortisol, the problem is most likely due to insufficient ACTH production by the pituitary. If the person does not respond to the ACTH stimulation test, the problem is most likely to be with the adrenal glands. Secondary adrenal insufficiency occurs when the adrenal glands are underactive as a result of pituitary dysfunction and/or insufficient ACTH synthesis. Adrenal injury causes decreased cortisol production, which is referred to as primary adrenal insufficiency or Addison disease.

Once an irregularity has been found and linked to the pituitary gland, adrenal glands, or another source, the health practitioner may utilize additional testing, such as a CT scan, to determine the extent of any gland damage.

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

Brief Description: DHEA Sulfate is a blood test that is measuring the levels of Dehydroepiandrosterone Sulfate in the blood. It is often used to diagnose any problems in the adrenal glands such as cancer or a tumor. It can also be used to evaluate the cause of early puberty in young boys and male characteristics or appearance in women.

Also Known As: DHEA-SO4 Test, DHEAS Test, DHES1 Test, Dehydroepiandrosterone Sulfate Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a DHEA Sulfate test ordered?

When excess androgen production is suspected and/or a health practitioner wants to analyze a person's adrenal gland function, a DHEAS test, along with other hormone testing, may be requested.

It can be assessed when a woman exhibits signs and symptoms of amenorrhea, infertility, and/or virilization. The intensity of these alterations varies, but they may include:

• A huskier voice
• Hair on the face or on the body that is excessive
• Baldness in men
• Muscularity
• Acne
• The Adam's apple has been enlarged
• Breast size has shrunk

It may also be ordered if a young girl exhibits evidence of virilization or if a female infant's external genitalia are not clearly male or female.

When young males show indicators of premature puberty, such as a deeper voice, pubic hair, muscularity, and an enlarged penis before the age of typical puberty, DHEAS may be evaluated.

What does a DHEA Sulfate blood test check for?

Male sex hormone dehydroepiandrosterone sulfate is found in both men and women. This test determines the amount of DHEAS in your blood.

DHEAS:

• At puberty, it aids in the development of male secondary sexual traits.
• Can be transformed into more strong androgens like testosterone and androstenedione by the body.
• It has the ability to transform into estrogen.

DHEAS is almost entirely produced by the adrenal glands, with minor contributions from a woman's ovaries and a man's testicles.

It's a good indicator of how well the adrenal glands are working. Overproduction of DHEAS can be caused by malignant and non-cancerous adrenal tumors, as well as adrenal hyperplasia. DHEAS can be produced by an ovarian tumor in rare cases.

DHEAS excess:

• In adult men, it may go unnoticed.
• In young boys, it can cause early puberty.
• Menstrual irregularities and the development of masculine physical traits in girls and women, such as excess body and facial hair
• Can result in a female infant being born with genitals that aren't clearly male or female

Lab tests often ordered with a DHEA Sulfate test:

• Testosterone
• ACTH
• FSH
• LH
• Prolactin
• Estrogen
• Estradiol
• Sex Hormone Binding Globulin
• 17-Hydroxyprogesterone
• Androstenedione

Conditions where a DHEA Sulfate test is recommended:

• PCOS
• Infertility
• Endocrine Syndromes
• Adrenal Insufficiency
• Congenital Adrenal Hyperplasia

How does my health care provider use a DHEA Sulfate test?

The dehydroepiandrosterone sulfate test is ordered in conjunction with testosterone and other male hormones assays to:

• Examine the adrenal glands' performance.
• Differentiate DHEAS-secreting disorders produced by the adrenal glands from those caused by the testicles or, in rare cases, the ovaries
• Adrenocortical tumors and adrenal malignancies can be diagnosed with this test.
• Assist in the diagnosis of congenital and adult-onset adrenal hyperplasia.

DHEAS levels are frequently examined in women, along with other hormones like FSH, LH, prolactin, estrogen, and testosterone, to help diagnose polycystic ovarian syndrome and rule out other reasons of infertility, lack of monthly cycle, and excess facial and body hair.

DHEAS levels, along with other hormones, may be requested to examine and diagnose the cause of young females developing masculine physical traits and young boys developing early puberty.

What do my DHEA-S test results mean?

A normal DHEAS level, together with other normal male hormone levels, suggests that the adrenal gland is working properly. When an adrenal tumor or cancer is present but not secreting hormones, DHEAS may be normal.

A high DHEAS blood level could indicate that the person's symptoms are caused or exacerbated by excessive DHEAS production. An elevated level of DHEAS, on the other hand, is not used to make a diagnosis of any particular condition; rather, it usually signals that further testing is required to determine the source of the hormone imbalance. An adrenocortical tumor, Cushing illness, adrenal cancer, or adrenal hyperplasia, as well as a DHEAS-producing ovarian tumor, can all cause high DHEAS.

DHEAS levels may be high in polycystic ovary syndrome, but they may also be normal, as PCOS is usually associated with ovarian androgen production.

Adrenal insufficiency, adrenal dysfunction, Addison disease, or hypopituitarism, a disorder characterized by low levels of pituitary hormones that govern the generation and secretion of adrenal hormones, can all produce low DHEAS levels.

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

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

Also Known As: E2 Test, Estrogen 2 Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is an Estradiol test ordered?

Tests for estradiol for women may be ordered if:

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

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

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

What does an Estradiol blood test check for?

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

Lab tests often ordered with an Estradiol test:

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

Conditions where an Estradiol test is recommended:

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

Commonly Asked Questions:

How does my health care provider use an Estradiol test?

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

In the case of girls and women

Estradiol testing may be requested for the following reasons:

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

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

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

What do my Estradiol test results mean?

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

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

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

Description: Estrogen is a blood test that will measure the amount of estrogen in the blood's serum. It is used in fertility treatment, hormone treatment, and can be used to help diagnose a problem with the endocrine system.

Also Known As: Estrogen Estrogenic Hormones Test, Estrogen Test, Total Estrogen Test, Estrogen Serum Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is an Estrogen Total test ordered?

Testing for estrogen for girls and women may be ordered if:

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

Boys and men may be subjected to estrogen testing if:

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

What does an Estrogen Total blood test check for?

Estrogens are a class of steroids that have a role in the development and operation of female reproductive organs, as well as the generation of secondary sex characteristics. They help regulate the menstrual cycle, are essential in the growth of breasts and the uterus, and aid in the maintenance of a healthy pregnancy, together with another hormone, progesterone. Though they are primarily associated with women, they are also prevalent in men and play a role in bone metabolism and growth in both genders.

The amount of estrogen in a man's blood varies, but it does so much less over time and is much lower than in a woman's.

Lab tests often ordered with an Estrogen Total test:

• Estradiol
• Estriol
• Estrone
• Testosterone Free and Total
• Sex Hormone Binding Globulin
• FSH
• LH
• Progesterone

Conditions where an Estrogen Total test is recommended:

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

How does my health care provider use an Estrogen Total test?

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

What do my Estrogen test results mean?

The sex and age of the person being tested determine the normal estrogen levels. It also depends on a woman's menstrual cycle or whether she is pregnant. The normal values indicated and the units used in reference ranges will differ slightly between laboratories.

Estrogen levels can be elevated or lowered in a variety of metabolic disorders. Because the levels of estrone, estradiol, and estriol change from day to day and throughout a woman's menstrual cycle, care must be used when interpreting the results.

Rather than examining single numbers, a health practitioner monitoring a woman's hormones will look at trends in the levels, rising or falling over time in connection with the menstrual cycle or pregnancy.

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

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 Fibrinogen Activity Clauss test is a blood test that measures the amount of active Fibrinogen in your blood to evaluate your blood’s ability to form clots.

Also Known As: Fibrinogen Activity Test, Factor 1 Assay Test, Cardiac Fibrinogen Test, Fibrinogen Test, Clotting factors Test

Collection Method: Blood Draw

Specimen Type: Whole Blood

Test Preparation: No preparation required

When is a Fibrinogen test ordered?

A fibrinogen activity test may be ordered by a doctor if someone:

• Has any unexplained or prolonged bleeding
• Has thrombosis
• Has a PT and PTT test result that is abnormal
• Has DIC or abnormal fibrinolysis symptoms or is being treated for it.
• Has or may have inherited coagulation factor deficiency or dysfunction
• Has a bleeding issue, and their health care provider wishes to assess and monitor their clotting capacity

When someone obtains a low result on a fibrinogen activity test, a fibrinogen antigen test may be used to establish whether the low result is due to insufficient or malfunctioning fibrinogen.

Coronary heart disease, myocardial infarction, and peripheral artery disease have all been linked to high fibrinogen levels. When a health practitioner wants to assess an individual's risk of developing cardiovascular disease, fibrinogen activity testing may be used in conjunction with other tests.

What does a Fibrinogen blood test measure?

Fibrinogen is a protein that is a coagulation factor in the production of blood clots. A fibrinogen activity test determines how well fibrinogen aids in the formation of a blood clot, whereas a fibrinogen antigen test determines the amount of fibrinogen in the blood.

Fibrinogen is produced in the liver, and is then delivered into the bloodstream along with many other coagulation factor proteins. Hemostasis stops bleeding at the site of injury when a blood vessel or body tissue is damaged. Platelets, small cell fragments, stick to and cluster at the site, triggering a coagulation cascade in which clotting components are activated one by one.

As the cascade develops, soluble fibrinogen turns into insoluble fibrin strands. At the wound site, a fibrin net is created by the crosslinking of these threads and stabilizes it. Together with the platelets, the fibrin net adheres to the area of injury and creates a solid blood clot. This barrier prevents more blood loss and is present while the injured area recovers.

There must be enough typically functioning platelets and coagulation factors for a stable clot to form. It can cause bleeding episodes and/or the creation of an inappropriate blood clot if there are defective factors or platelets, or if there are too few or too many of them. Hemostasis can be assessed using a variety of laboratory techniques, including fibrinogen assays.

Coagulation tests are now known to be based on what happens artificially in the test setting and so do not always reflect what happens in the body. The tests can, however, be used to assess individual components of the hemostasis system. The fibrinogen activity test measures the amount of soluble fibrinogen that is transformed into fibrin threads during the hemostatic process. The fibrinogen test bypasses the rest of the coagulation factors and concentrates on the function of fibrinogen after adding thrombin to the test sample.

A fibrinogen activity test determines how long it takes for a fibrin clot to form after a standard dose of thrombin is added to plasma. This test assesses the function of fibrinogen, specifically its capacity to convert into fibrin. The amount of active fibrinogen present directly correlates with the time it takes for a clot to develop. Prolonged clot formation periods can be caused by low levels of normal fibrinogen or by fibrinogen that is dysfunctional.

Acute phase reactants are a group of blood components that include fibrinogen. When conditions cause acute tissue inflammation or injury, blood levels of fibrinogen and other acute phase reactants rise dramatically. These acute phase reactants, including fibrinogen, can be tested to see how much inflammation is present in the body.

Lab tests often ordered with a Fibrinogen test:

• PT and INR
• PTT
• D-Dimer
• Coagulation Factors
• Thrombin Time
• Hs-CRP
• Complete Blood Count CBC

Conditions where a Fibrinogen test is recommended:

• Excessive Clotting Disorders
• Bleeding Disorders
• Liver Disease
• Cardiovascular Disease
• DIC

Commonly Asked Questions:

How does my health care provider use a Fibrinogen test?

This test is designed to assess fibrinogen, a protein that is required for the production of blood clots. When an injury happens and bleeding occurs, the body goes through a sequence of actions to build a blood clot. One of the final phases is converting soluble fibrinogen into insoluble fibrin threads that crosslink to form a net that stabilizes and binds to the injured site until it heals.

A fibrinogen activity test assesses fibrinogen's function and capacity to convert to fibrin. It's utilized to:

• It's utilized to:
• As follow-up testing to an abnormal bleeding disorder test result and/or an episode of prolonged or inexplicable bleeding
• To help detect disseminated intravascular coagulation or aberrant fibrinolysis, testing such as Prothrombin, Partial Thromboplastin Times, Platelet Count, and D-dimer are often ordered.
• Occasionally, to aid in the monitoring of the progress of a progressive disease over time, or, in rare cases, to aid in the monitoring of the treatment of an acquired ailment.

Other cardiac risk markers, such as C-reactive protein, are sometimes used to assist in evaluating a person's overall risk of developing cardiovascular disease. However, because there are no direct treatments for increased levels, this application of the test has not achieved general adoption. Many health professionals, on the other hand, believe that measuring fibrinogen activity provides them with extra information that may drive them to be more aggressive in addressing those risk factors that they can control.

What do my fibrinogen activity test results mean?

The concentration of protein in the blood is reported as the result of a fibrinogen test. 

The presence of normal fibrinogen activity usually indicates that the blood clotting ability is normal.

Reduced or malfunctioning fibrinogen may be the cause of significantly reduced fibrinogen activity. Reduced fibrinogen activity and antigen levels can make it more difficult for the body to produce a stable blood clot.

Reduced production owing to a hereditary illness such as afibrinogenemia or hypofibrinogenemia, or a condition such as malnutrition or liver disease, can cause chronically low levels.

Acutely low levels are frequently associated with fibrinogen consumption, such as in disseminated intravascular coagulation and irregular fibrinolysis, which happens when the body is overly active in removing blood clots. Reduced fibrinogen levels can also occur as a result of quick, large-volume blood transfusions or in malnourished patients.

A ratio of the antigen test and the activity test is sometimes used by a doctor. This is to differentiate dysfibrinogenemia from hypofibrinogenemia.

Fibrinogen is an acute phase reactant, which means that it can rapidly rise in amounts in any situation that causes inflammation or tissue injury. Elevated fibrinogen concentrations aren't specific, which means they don't inform the doctor what's causing the problem or where it's happening. These increases in fibrinogen are usually just transitory, returning to normal after the underlying problem is treated. Elevated levels can be seen in the following ways:

• Infections that are severe
• Cancer
• Myocardial infarction, coronary artery disease
• Stroke
• Inflammatory conditions
• Trauma
• Smoking a cigarette
• Pregnancy
• Peripheral artery disease, a condition that affects the arteries
• When fibrinogen levels are high, a person's risk of cardiovascular disease and producing a blood clot is raised

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