Malabsorption

Malabsorption Testing and health information

Are you experiencing symptoms of malabsorption?

We provide malabsorption syndrome lab testing to locate the cause of your symptoms and get you back on track.

Malabsorption is a condition in which the small intestine doesn't adequately extract nutrients from food. Malabsorption causes people to feel bloated and have excessive gas passing through their intestines. It can also lead to other digestive problems, like inflammation or diarrhea.

Malabsorption is a disorder in which sufferers struggle to digest foods or absorb their nutrients. This condition occurs in many different diseases. It can cause sufferers to become generally malnourished or deficient in essential nutrients. Lab testing is used to evaluate individuals at a higher risk for malabsorption on account of a condition they suffer from, find the root causes, and determine the type and extent of nutritional deficiencies and possible complications, like anemia.

We offer lab testing for malabsorption syndrome and bile acid malabsorption to help identify the root cause of your problems so you can start feeling better right away. If you are suffering from malnutrition due to malabsorption, our lab tests will help identify your specific needs so that you can choose personalized treatment plans that meet your unique health goals! We offer affordable lab testing services that are fast and accurate so you can get back on track as soon as possible! Our friendly staff members are here 24/7 if you have any questions about our services or want more information about how we can help improve your quality of life today!

To get the right test for you, choose from the selections below.

For additional information on Malabsorption and Lab Testing, click here.


Name Matches
Serum albumin measurements are used in the monitoring and treatment of numerous diseases involving those related to nutrition and pathology particularly in the liver and kidney. Serum albumin is valuable when following response to therapy where improvement in the serum albumin level is the best sign of successful medical treatment. There may be a loss of albumin in the gastrointestinal tract, in the urine secondary to renal damage or direct loss of albumin through the skin. More than 50% of patients with gluten enteropathy have depressed albumin. The only cause of increased albumin is dehydration; there is no naturally occurring hyperalbuminemia

Serum alkaline phosphatase levels are of interest in the diagnosis of hepatobiliary disorders and bone disease associated with increased osteoblastic activity. Moderate elevations of alkaline phosphatase may be seen in several conditions that do not involve the liver or bone. Among these are Hodgkin's disease, congestive heart failure, ulcerative colitis, regional enteritis, and intra-abdominal bacterial infections. Elevations are also observed during the third trimester of pregnancy.


AST is widely distributed throughout the tissues with significant amounts being in the heart and liver. Lesser amounts are found in skeletal muscles, kidneys, pancreas, spleen, lungs, and brain. Injury to these tissues results in the release of the AST enzyme to general circulation. In myocardial infarction, serum AST may begin to rise within 6-8 hours after onset, peak within two days and return to normal by the fourth or fifth day post infarction. An increase in serum AST is also found with hepatitis, liver necrosis, cirrhosis, and liver metastasis.

An increase in serum bile acids concentration in the fasting state or postprandial is considered to be a specific indicator of liver disease. A decreased level indicates bile acid malabsorption, possibly due to ileal dysfunction.

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

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

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

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a Bilirubin, Fractionated test ordered?

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

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

Other signs and symptoms to look out for include:

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

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

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

What does a Bilirubin, Fractionated blood test check for?

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

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

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

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

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

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

Lab tests often ordered with a Bilirubin, Fractionated test:

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

Conditions where a Bilirubin, Fractionated test is recommended:

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

Commonly Asked Questions:

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

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

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

Laboratory testing can measure or estimate two types of bilirubin:

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

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

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

Bilirubin is measured in adults and older children to:

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

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

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

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

What do my bilirubin test results mean?

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

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

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

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

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

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

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

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

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

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

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

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


Clinical Significance

Used to diagnose inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, or to differentiate IBD from irritable bowel syndrome (IBS).

 

Collection Instructions

Collect undiluted feces in clean, dry sterile leak-proof container. Do not add fixative or preservative.

 


 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.


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Description: Ceruloplasmin is a blood test that measures that amount of Ceruloplasmin in the blood’s serum. Ceruloplasmin, or Copper Oxide, is a protein that is created in the liver and is used to transport copper from the liver to the parts of the body that need it, including the blood.

Also Known As: Copper Oxide Test, Wilson’s Disease Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a Ceruloplasmin test ordered?

When somebody has symptoms that a health practitioner suspects are due to Wilson disease, a ceruloplasmin test may be ordered alone or in combination with blood and 24-hour urine copper testing.

What does a Ceruloplasmin blood test check for?

Ceruloplasmin is a copper-containing enzyme that aids in iron metabolism in the body. The level of ceruloplasmin in the blood is measured with this test.

Copper is a vital mineral that regulates iron metabolism, connective tissue creation, cellular energy production, and nervous system function. The intestines absorb it from meals and liquids, and it is subsequently transferred to the liver, where it is stored or used to make a variety of enzymes.

To make ceruloplasmin, the liver binds copper to a protein and then releases it into the bloodstream. Ceruloplasmin binds about 95 percent of the copper in the blood. As a result, the ceruloplasmin test can be performed in conjunction with one or more copper tests to assist diagnose Wilson disease, a genetic illness in which the liver, brain, and other organs store too much copper.

Lab tests often ordered with a Ceruloplasmin test:

  • Copper

Conditions where a Ceruloplasmin test is recommended:

  • Wilson’s Disease
  • Liver Diseases

How does my health care provider use a Ceruloplasmin test?

Wilson disease is a rare genetic ailment characterized by excessive copper accumulation in the liver, brain, and other organs, as well as low levels of ceruloplasmin. Ceruloplasmin testing is performed in conjunction with blood and/or urine copper assays to assist diagnosis Wilson disease.

Copper is a mineral that plays an important role in the human body. Ceruloplasmin binds about 95 percent of the copper in the blood. In an unbound state, just a minimal quantity of copper is present in the blood.

A ceruloplasmin test may be ordered in conjunction with a copper test to assist diagnose problems in copper metabolism, copper deficiency, or Menkes kinky hair syndrome, a rare genetic condition.

What do my Ceruloplasmin test results mean?

Ceruloplasmin levels are frequently tested in conjunction with copper testing because they are not indicative of a specific illness.

Wilson disease can be identified by low ceruloplasmin and blood copper levels, as well as high copper levels in the urine.

About 5% of persons with Wilson disease who have neurological symptoms, as well as up to 40% of those with hepatic symptoms, especially if they are critically unwell, will have normal ceruloplasmin levels.

The person tested may have a copper deficiency if ceruloplasmin, urine, and/or blood copper values are low.

Anything that affects the body's ability to metabolize copper or the supply of copper has the potential to impact blood ceruloplasmin and copper levels.

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


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

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

Collection Method: Blood Draw 

Specimen Type: Whole Blood 

Test Preparation: No preparation required 

When is a Complete Blood Count test ordered?  

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

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

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

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

What does a Complete Blood Count test check for? 

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

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

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

The CBC focuses on three different types of cells: 

WBCs (White Blood Cells) 

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

RBCs (Red Blood Cells) 

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

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

Platelets 

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

Lab tests often ordered with a Complete Blood Count test: 

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

Conditions where a Complete Blood Count test is recommended: 

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

Commonly Asked Questions: 

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

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

What do my Complete Blood Count results mean? 

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

What do my Differential results mean? 

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

What do my Platelet results mean? 

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

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

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

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

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

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

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

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

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

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

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

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

Collection Method: 

Blood Draw 

Specimen Type: 

Serum 

Test Preparation: 

9-12 hours fasting is preferred. 

When is a Comprehensive Metabolic Panel test ordered:  

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

What does a Comprehensive Metabolic Panel blood test check for? 

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

The following tests are included in the CMP: 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Lab tests often ordered with a Comprehensive Metabolic Panel test: 

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

Conditions where a Comprehensive Metabolic Panel test is recommended: 

  • Diabetes
  • Kidney Disease
  • Liver Disease
  • Hypertension

Commonly Asked Questions: 

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

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

What do my Comprehensive Metabolic Panel test results mean? 

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

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

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

Is there anything else I should know? 

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

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

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

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

Please note the following regarding BUN/Creatinine ratio: 

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

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

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


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Description: Copper is a blood test that measures the amount of copper in the blood's plasma. Copper levels in the blood can help to diagnose Wilson's Disease.

Also Known As: Cu Test, Blood Copper Test, Free Copper Test, Hepatic Copper Test, Copper Serum Test, Copper Plasma Test, Copper Blood Test

Collection Method: Blood Draw

Specimen Type: Plasma or Serum

Test Preparation: No preparation required

When is a Copper test ordered?

When a health practitioner suspects Wilson disease, excess copper storage, or copper poisoning, one or more copper tests are requested along with ceruloplasmin.

When copper and ceruloplasmin results are abnormal or inconclusive, a hepatic copper test may be conducted to further evaluate copper storage.

What does a Copper blood test check for?

Copper is an important mineral that the body uses to make enzymes. These enzymes are involved in the regulation of iron metabolism, the development of connective tissue, cellular energy production, the production of melanin, and nervous system function. This test determines how much copper is present in the blood, urine, or liver.

Nuts, chocolate, mushrooms, seafood, whole grains, dried fruits, and liver are all high in copper. Copper may be absorbed into drinking water as it passes through copper pipes, and copper may be absorbed into food as it is cooked or served on copper dishes. Copper is absorbed from food or liquids in the intestines, converted to a non-toxic form by binding it to a protein, and transported to the liver in normal circumstances. To make the enzyme ceruloplasmin, the liver saves some copper and binds the remainder to another protein called apoceruloplasmin. Ceruloplasmin binds about 95 percent of the copper in the blood, with the rest attached to other proteins like albumin. In a free condition, only a little amount is present in the blood. Excess copper is excreted by the liver in the bile, which is then excreted by the body in the feces. Copper is also excreted in the urine in small amounts.

Copper excess and deficiency are uncommon. Wilson disease is a rare genetic ailment that causes the liver, brain, and other organs to store too much copper. Excess copper can arise when a person is exposed to and absorbs high amounts of copper in a short period of time or little amounts over a long period of time.

Copper deficiency can arise in patients with severe malabsorption diseases such cystic fibrosis and celiac disease, as well as infants who are exclusively fed cow-milk formulas.

Menkes kinky hair syndrome is a rare X-linked hereditary disorder that causes copper shortage in the brain and liver of affected babies. Seizures, delayed development, aberrant artery growth in the brain, and unique gray brittle kinky hair are all symptoms of the condition, which mostly affects men.

Lab tests often ordered with a Copper test:

  • Ceruloplasmin
  • Heavy Metals
  • ACTH
  • Aldosterone
  • 17-Hydroprogesterone
  • Growth Hormone

Conditions where a Copper test is recommended:

  • Wilson Disease
  • Malnutrition

How does my health care provider use a Copper test?

Copper testing is largely used to detect Wilson disease, a rare genetic ailment in which the liver, brain, and other organs accumulate an excessive amount of copper. A copper test is less usually used to detect copper excess caused by another ailment, to diagnose a copper deficit, or to track treatment for one of these conditions.

Copper is a necessary mineral, but too much of it can be harmful. The majority of it is bound to the enzyme ceruloplasmin in the blood, leaving only a little quantity "free" or unbound.

A whole blood copper test is usually ordered in conjunction with a ceruloplasmin level. If the findings of these tests are abnormal or ambiguous, a 24-hour urine copper test to monitor copper elimination and/or a copper test on a liver biopsy to check copper storage in the liver may be conducted.

A free blood copper test is sometimes ordered as well. If Wilson disease is suspected, genetic testing for mutations in the ATP7B gene may be undertaken. However, these tests are only available in a restricted number of locations and are usually carried out in specialized reference or research laboratories.

A copper test may be used to identify Menkes kinky hair syndrome, a rare inherited copper transport failure condition.

What do my Copper test results mean?

Copper test findings are frequently linked to ceruloplasmin levels and considered in context. Copper results that are abnormal are not indicative of a specific illness; rather, they signal that more research is needed. Because ceruloplasmin is an acute phase reactant, it might be raised if inflammation or severe infections are present, making interpretation difficult. Ceruloplasmin and copper levels rise during pregnancy, as well as with the use of estrogen and oral contraceptives.

Wilson disease is characterized by low blood copper concentrations, elevated urine copper levels, low ceruloplasmin levels, and increased liver copper.

Elevated copper concentrations in the blood and urine, as well as normal or increased ceruloplasmin levels, may suggest excessive copper exposure or be linked to disorders that reduce copper excretion, such as chronic liver disease, or release copper from tissues, such as acute hepatitis. Chronic diseases can cause an increase in hepatic copper levels.

Copper deficiency is indicated by lower copper concentrations in the blood and urine, as well as lower ceruloplasmin levels.

A normal hepatic copper test could mean that copper metabolism is normal, or that the distribution of copper in the liver is uneven, and that the sample isn't reflective of the person's health.

If a person is being treated for Wilson disease or copper toxicity with copper-binding medicines, their 24-hour urine copper levels may be high until their body copper stores are depleted. Copper concentrations in the blood and urine should return to normal over time.

If a person is being treated for a copper deficient disorder and their ceruloplasmin and total copper levels start to rise, the condition is likely responding to the treatment.

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


Clinical Significance

Copper is an essential element that is a cofactor of many enzymes. Copper metabolism is disturbed in Wilson's disease, Menkes disease, primary biliary cirrhosis, and Indian childhood cirrhosis. Copper concentrations increase in acute phase reactions. Copper concentrations are decreased with nephrosis, malabsorption, and malnutrition. Copper concentrations are also useful to monitor patients, especially preterm newborns, on nutritional supplementation. Results of copper are often interpreted together with ceruloplasmin.


This test will identify approximately 90% of Cystic Fibrosis (CF) mutations in the Caucasian population, and 97% in the Ashkenazi Jewish population. For prenatal specimens, use test code 10226.

Vitamin D (distinct from the vitamin D metabolites, 25-hydroxyvitamin D or 1, 25 dihydroxyvitamin D) is an essential nutrient obtained via exposure to sunlight (cholecalciferol) or diet (ergocalciferol). Measuring the vitamin D cholecalciferol and ergocalciferol can be used in the diagnosis and management of disorders of fat absorption such as Crohn's Disease.

IMPORTANT - Requires a Prescription for 50,000 UNITS VITAMIN D2 to conduct this test that is not part of this test.


Fatty Acid Profile, Comprehensive


Fatty Acid Profile, Essential (C12-C22)


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

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.


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

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

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a Hepatic Function Panel test ordered?

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

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

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

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

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

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

What does a Hepatic Function Panel blood test check for?

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

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

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

Lab tests often ordered with a Hepatic Function Panel test:

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

Conditions where a Hepatic Function Panel test is recommended:

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

Commonly Asked Questions:

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

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

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

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

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

What do my Liver Panel Test results mean?

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

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

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

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


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Immunoglobulin A (IgA)

Test Highlight

 

   

Clinical Use

  • Diagnose IgA deficiencies

  • Determine etiology of recurrent infections

  • Diagnose infection

  • Diagnose inflammation

  • Diagnose IgA monoclonal gammopathy

Clinical Background

IgA is the first line of defense for the majority of infections at mucosal surfaces and consists of 2 subclasses. IgA1 is the dominant subclass, accounting for 80% to 90% of total serum IgA and greater than half of the IgA in secretions such as milk, saliva, and tears. IgA2, on the other hand, is more concentrated in secretions than in blood. IgA2 is more resistant to proteolytic cleavage and may be more functionally active than IgA1.

IgA deficiency is the most prevalent isotype deficiency, occurring in 1/400 to 1/700 individuals. Many patients with IgA deficiency are asymptomatic, while others may develop allergic disease, repeated sinopulmonary or gastroenterologic infections, and/or autoimmune disease. Individuals with complete absence of IgA (<5 mg/dL) may develop autoantibodies to IgA after blood or intravenous immunoglobulin infusions and may experience anaphylaxis on repeat exposure. 

Elevated serum IgA levels are associated with infection, inflammation, or IgA monoclonal gammopathy.

 

The Lactoferrin IBD-CHEKĀ® is a qualitative (QL) Enzyme Linked Immunosorbent Assay (ELISA) for measuring concentrations of fecal lactoferrin, a marker for leukocytes. A positive level is an indicator of intestinal inflammation. The test can be used as an in vitro diagnostic aid to distinguish patients with active inflammatory bowel disease (IBD) from those with non inflammatory irritable bowel syndrome (IBS).

This is an Enzyme-Linked Immunosorbent Assay (ELISA) for measuring concentrations of fecal lactoferrin, a marker for leukocytes. An elevated level is an indicator of intestinal inflammation. The test can be used as an in vitro diagnostic aid to distinguish patients with active inflammatory bowel disease (IBD) from those with noninflammatory irritable bowel syndrome (IBS).

The methylmalonic acid (MMA) test may be used to help diagnose an early or mild vitamin B12 deficiency. It may be ordered by itself or along with a homocysteine test as a follow-up to a vitamin B12 test result that is in the lower end of the normal range.


The Nonesterified Fatty Acids (Free Fatty Acids) assay is useful in evaluating lipolysis and fatty acid oxidation. Nonesterified Fatty Acids may be useful in evaluating patients with hypoglycemia and for nutritional assessment.



Malabsorption is a disorder in which sufferers struggle to digest foods or absorb their nutrients. This condition occurs in many different diseases. It can cause sufferers to become generally malnourished or deficient in essential nutrients.

For the body to function, it needs nutrients that allow it to maintain and repair itself. Nutrients are also used to produce energy and fight off infections. There are many essential vitamins and minerals that people derive from their diet.

When we eat food, it goes through three stages of digestion.

The fats, proteins, and complex sugars that we eat are broken down by the acids in our stomach, bile from our livers, and enzymes from our pancreas. When these nutrients are broken down, micronutrients are released.

The cells around our small intestines absorb most of the nutrients we eat.

From there, these nutrients travel throughout the body, where they used or stored for later.

If this process is halted in any way, malabsorption can occur. The seriousness of this issue and the symptoms that it causes can vary based on several factors. Is the disorder inhibiting the body’s ability to digest food? Which nutrients is the body struggling to digest?

Digestive Issues

Enzymes from the pancreas and bile are both required to correctly digest proteins, fats, and carbohydrates. If the liver or pancreas is diseased, it could inhibit the body’s ability to produce these substances. This can also occur in patients that suffer from cystic fibrosis. Enzymes from the pancreas may struggle to reach the body’s digestive tract.

Issues With Absorption

When the intestines cannot properly absorb nutrients, these nutrients are expelled from the body through bowel movements. This may occur when the tissue or cells of the intestine has been damaged in some way. This can also happen when the intestine has been shortened it some way, which could happen after surgery. This reduces the intestine surface area, which means there is less time for the body to absorb nutrients from food as it moves throughout the digestive tract.

For the body to absorb vitamin B12, it needs acid from the stomach as well as a substance called intrinsic factor, which is made by the stomach’s parietal cells. Acid from the stomach causes B12 to separate from proteins, which allows the intrinsic factor and the B12 to bind. If either stomach acids or intrinsic factor is not present, B12 cannot be absorbed by the intestines, which can cause a deficiency in vitamin B12. This may occur as people grow older. Several medications can cause less stomach acid to be produced. This issue may also occur after gastric bypass surgery if someone has a disorder that has caused damage to their parietal cells, or in patients that are suffering from general malabsorption.

Issues With Transport

After nutrients have been absorbed, they are transported through the body by cells. In some cases, transport problems may occur. This may happen in patients that are experiencing issues with their lymphatic system, which can be caused by lymphoma or abetalipoproteinemia, which is a rare hereditary disorder.

Malabsorption And Its Causes

Many disorders and diseases that can lead to malabsorption. These are just a few examples:

  • Cancers, such as stomach cancer, pancreatic cancer, or lymphoma
  • Conditions that cause the bile ducts to close, narrow, or disappear like biliary atresia, or block bile flow, like cholestasis, which leaves the body with insufficient bile for digestion
  • Celiac disease, a type of autoimmune disease that causes the lining of the intestines to be damaged
  • Intestinal damage, like the damage that can occur during radiation treatment
  • Cystic fibrosis, a hereditary disorder that can impact the pancreas and make it more difficult for enzymes from the pancreas to be transported through the body
  • A decrease in the production of intrinsic factor
  • Disorders that make it more difficult for the body to circulate throughout the body, like heart disease
  • Enzyme deficiencies, or intolerances to foods, like lactose intolerance
  • Hyperthyroidism
  • AIDS
  • Digestive tract infections, such as parasitic, bacterial, and viral infections
  • Inflammatory bowel diseases, such as ulcerative colitis or Crohn’s disease
  • Medications that inhibit the production of stomach acid, like phenytoin
  • Liver disease
  • Pancreatic disease or insufficiency, which can cause the amounts of enzymes the pancreas produces to be decreased
  • Certain types of surgeries, like gastric bypass or bowel resection s
  • Scleroderma
  • Zollinger-Ellison syndrome, a rare disorder that causes tumors to develop on the intestines or pancreas

Symptoms Of Malabsorption

The symptoms of a patient with malabsorption can vary based on the root cause of their condition. The type of nutrient someone is deficient in and the extent of the deficiency. The signs may be severe immediately, or they may gradually get worse in time. The body stores certain nutrients, like vitamin B12. Because of this, symptoms of deficiency will only become apparent after stores have been depleted. This is also true of pancreatic enzyme deficiency. Symptoms may not show until approximately 90% of the production capacity in the body has been halted.

A few of the symptoms that are most associated with general malabsorption are:

  • Chronic diarrhea
  • Steatorrhea, which causes bulky and oily stools with a strong odor
  • Children may be diagnosed with failure to thrive.
  • Cramps, gas, bloating, and general abdominal pain.

Many symptoms may be caused by nutritional deficiencies or by poor health. Some of these symptoms are:

  • Fatigue
  • Ascites, which causes a build-up of fluid in the abdomen
  • Rashes or dry and scaly skin
  • Glossitis, which is inflammation of the tongue
  • Unexplained weight loss or decrease in muscle mass
  • Nausea
  • Accumulation of fluid in the feet, legs, and hands
  • Mouth inflammation
  • Gum disease
  • Paleness
  • Tingling or a number feeling in the hands or feet.
  • Pain in the muscles or bones
  • Issues that can occur when someone suffers from chronic malabsorption, include:
  • Iron deficiency (anemia)
  • Confusion or difficulty concentrate
  • Failure to grow or develop in children
  • Osteoporosis
  • Malnutrition
  • Deficiencies in key vitamins, like vitamins D, k, and A

Testing For Malabsorption

Testing is primarily done to:

Evaluate patients that may be at a higher risk for malabsorption on account of a condition they suffer from, like cystic fibrosis

Diagnose malabsorption, find the root causes, and determine the type and extent of nutritional deficiencies

Diagnose possible complications, like anemia

Determine how effective malabsorption treatment has been

While there are many tests that a doctor might order if they suspect malabsorption, there isn’t any single test that can provide a diagnosis. In most cases, when a professional is ordering tests, they will look at additional factors as well, such as medical and family history, symptoms, and the results of a general examination. In many cases, testing will be done in stages so that other possible causes can be ruled out before a doctor provides a diagnosis. Examples of tests that may be run include:

Typically, the first set of tests will look at the condition of cells, organs, and the digestive system. From there, healthcare providers will search for a cause for primary symptoms, such as chronic diarrhea, which is one of the most common malabsorption symptoms.

After that, follow-up tests may be ordered to find or rule out any diseases that are linked with malabsorption. Tests can also find deficiencies and potential complications.

Lab Tests

Common initial tests are:

Complete blood count: Evaluates red blood cells and checks for anemia, which can be caused by B12, folate, or iron deficiency.

Comprehensive metabolic panel: Detects electrolyte imbalances, evaluates proteins, and function of various organs, like the liver.

Prealbumin: Checks for protein malabsorption and can provide information about general nutritional deficiency

Erythrocyte sedimentation rate: Detects bodily inflammation, which can be caused by conditions like inflammatory bowel disease

Fecal fat testing: To see if the body is properly digesting fat

Stool culture: Used to check for bacterial infection

Diff toxin and Clostridium difficile testing: Checks for bacterial overgrowth, which can cause chronic diarrhea

Ova and parasite examination: Checks for parasites, which can cause chronic diarrhea

White blood cells in stool: Can be found in patients suffering from certain inflammatory intestinal conditions

Gastrointestinal pathogen testing: Looks for bacteria, parasites, and viruses in the stool, which can cause both diarrhea and infections of the digestive tract

Thyroid-stimulating hormone: Identifies or eliminated thyroid disease

After the initial round of tests, healthcare practitioners will look at those results as well as the information from examinations and order additional tests. Examples of tests that may be ordered include:

Fecal occult blood test: Looks for digestive tract bleeding

Testing for deficiency in vitamins like AB12and D

Prothrombin time: Tests for deficiency in vitamin K

Celiac disease testing

Celiac disease testing, such as trypsinogen, CF gene mutation panels, and sweat tests

Tests that evaluate the pancreatic function, like stool trypsin, fecal elastase, and blood tests

Other tests that may be ordered are:

Hydrogen breath test: Can identify digestive system bacterial overgrowth and lactose intolerance

Methylmalonic Acid: Can detect vitamin B12 deficiency before signs are shown

Xylose absorption test: Carbohydrate digestive testing

Lactose tolerance test: This test, which can be used when testing for lactose intolerance, can also be used when diagnosis malabsorption