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ABO Group and Rh Type

Blood typing is used to determine an individual's blood group, to establish whether a person is blood group A, B, AB, or O and whether he or she is Rh positive or Rh negative.

The Different Blood Types

There are four major blood groups and eight different blood types. Doctors call this the ABO Blood Group System.

The groups are based on whether or not you have two specific antigens -- A and B:

  • Group A has the A antigen and B antibody.
  • Group B has the B antigen and the A antibody.
  • Group AB has A and B antigens but neither A nor B antibodies.
  • Group O doesn’t have A or B antigens but has both A and B antibodies.

There’s also a third kind of antigen called the Rh factor. You either have this antigen (meaning your blood type is “Rh+” or “positive”), or you don’t (meaning your blood type is “Rh-” or “negative”). So, from the four blood groups, there are eight blood types:

  • A positive or A negative
  • B positive or B negative
  • AB positive or AB negative
  • O positive or O negative

AMH-MIS may be used in the investigation of ovarian reserve since AMH concentrations in adult women reflect the number of small antral and preantral follicles entering the growth phase of their life cycle. These follicles are proportional to the number of primordial follicles that still remain in the ovary, or the ovarian reserve.
AMH decreases throughout a woman's reproductive life, which reflects the continuous decline of the oocyte/follicle pool with age and, accordingly, ovarian aging.

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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.

This test detects 3 mutations which account for approximately 90% of the BRCA1 and BRCA2 mutations found in Ashkenazi Jews.

This test detects mutations in the BRCA1 and BRCA2 genes which are the most common causes of hereditary breast and ovarian cancers.

Increased CRP levels are found in inflammatory conditions including: bacterial infection, rheumatic fever, active arthritis, myocardial infarction, malignancies and in the post-operative state. This test cannot detect the relatively small elevations of CRP that are associated with increased cardiovascular risk.

C-Reactive Protein Cardiac (hs CRP) Useful in predicting risk for cardiovascular disease.

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CA 15-3 may be useful for monitoring patients with metastatic breast cancer and certain ovarian cancers. The CA 15-3 values from sequential samples have a high correlation with the clinical course in most patients with metastatic breast cancer.

CA 27.29 may be useful for monitoring patients for metastatic breast cancer.

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Increased serum CEA levels have been detected in persons with primary colorectal cancer and in patients with other malignancies involving the gastrointestinal tract, breast, lung, ovarian, prostatic, liver and pancreatic cancers. Elevated serum CEA levels have also been detected in patients with nonmalignant disease, especially patients who are older or who are smokers. CEA levels are not useful in screening the general population for undetected cancers. However, CEA levels provide important information about patient prognosis, recurrence of tumors after surgical removal, and effectiveness of therapy.

A Complete Blood Count (CBC) Panel is used as a screening test for various disease states including anemia, leukemia and inflammatory processes.

A CBC blood test includes the following biomarkers: WBC, RBC, Hemoglobin, Hematocrit, MCV, MCH, MCHC, RDW, Platelet count, Neutrophils, Lymphs, Monocytes, Eos, Basos, Neutrophils (Absolute), Lymphs (Absolute), Monocytes(Absolute), Eos (Absolute), Basos (Absolute), Immature Granulocytes, Immature Grans (Abs)

See individual tests

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Cortisol is increased in Cushing's Disease and decreased in Addison's Disease (adrenal insufficiency). Patient needs to have the specimen collected between 7 a.m.-9 a.m.

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Cortisol is increased in Cushing's Disease and decreased in Addison's Disease (adrenal insufficiency).

Test for myocardial infarction and skeletal muscle damage. Elevated results may be due to: myocarditis, myocardial infarction (heart attack), muscular dystrophy, muscle trauma or excessive exercise

Intrauterine or congenital CMV infections occur in 0.5 to 2.2% of all live births. Symptomatic congenital infections usually occur in infants born to nonimmune mothers who have primary infections during pregnancy. Latency and reactivation of CMV influence the interpretation of serological results. A single positive CMV IgG result is and indication of present or past infection. The presence of CMV IgM suggests a recent CMV exposure but does not differentiate between primary infection and reactivation.

DHEA is a weakly androgenic steroid that is useful when congenital adrenal hyperplasia is suspected. It is also useful in determining the source of androgens in hyperandrogenic conditions, such as polycystic ovarian syndrome and adrenal tumors.

DHEA-S is the sulfated form of DHEA and is the major androgen produced by the adrenal glands. This test is used in the differential diagnosis of hirsute or virilized female patients and for the diagnosis of isolated premature adrenarche and adrenal tumors. About 10% of hirsute women with Polycystic Ovarian Syndrome (PCOS) have elevated DHEA-S but normal levels of other androgens.

Epstein-Barr Virus (EBV) Antibody Panel

Includes: Epstein-Barr Virus VCA Antibody (IgM), Epstein-Barr Virus VCA Antibody (IgG), Epstein-Barr Virus Nuclear Antigen (EBNA) Antibody (IgG)

Clinical Significance: Primary infection by EBV causes infectious mononucleosis, usually a self-limiting disease in children and young adults. Infection with EBV can cause lymphoproliferative disorders including tumors. VCA-IgM is typically detectable at clinical presentation, then declines to undetectable levels within a month in young children and within 3 months in other individuals. VCA-IgG is typically detectable at clinical presentation, and persists for life. EBNA IgG typically appears during convalescence (3-4 months after clinical presentation) and remains detectable for life.

EBV-VCA IgG/IgM (viral capsid antigen): A positive IgG means you’ve had or currently have the infection; A positive IgM means the virus has been reactivated.

EBV-EBNA IgG (nuclear antigen): A positive test result is usually associated with past infections.

Reference Range(s)

Epstein-Barr Virus VCA Antibody (IgM)


  • <36.00 Negative
  • 36.00-43.99Equivocal
  • >43.99Positive

Epstein-Barr Virus VCA Antibody (IgG)


  • <18.00 Negative
  • 18.00-21.99Equivocal
  • >21.99Positive

Epstein-Barr Virus Nuclear Antigen (EBNA) Antibody (IgG)


  • <18.00 Negative
  • 18.00-21.99Equivocal
  • >21.99Positive

Alternative Name(s)

EBV Comprehensive,Infectious Mononucleosis Panel


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Measuring the circulating levels of estradiol is important for assessing the ovarian function and monitoring follicular development for assisted reproduction protocols. Estradiol plays an essential role throughout the human menstrual cycle. Elevated estradiol levels in females may also result from primary or secondary ovarian hyperfunction. Very high estradiol levels are found during the induction of ovulation for assisted reproduction therapy or in pregnancy. Decreased estradiol levels in females may result from either lack of ovarian synthesis (primary ovarian hypofunction and menopause) or a lesion in the hypothalamus-pituitary axis (secondary ovarian hypofunction). Elevated estradiol levels in males may be due to increased aromatization of androgens, resulting in gynecomastia.

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

IMPORTANT - Note the Estradiol test included in this panel 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 Estradiol, Free, LC/MS/MS at an additional fee of $290.00

IMPORTANT - Note the Estradiol test included in this panel 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 Estradiol, Free, LC/MS/MS at an additional fee of $290.00

Estrogens are secreted by the gonads, adrenal glands, and placenta. Total estrogens provide an overall picture of estrogen status for men and women.

Vaginosis (yeast infection) is a bacterial infection/inflammation commonly caused by the overgrowth of bacteria in the vagina. Vaginitis can also be defined as the inflammation of the vagina caused by several factors, including an irritant, allergy, and a decrease in estrogen levels. Vaginitis is very popular with women in the childbearing age. This bacterial infection affects around 21 million women in the world, most of whom are aged between 14 and 49 years. This is according to data released by the CDC (Centers for Disease Control and Prevention). This condition is characterized by abnormal vaginal discharge, pain, burning sensation, and itching in and around the genitals. The vulva (external genitals) also be affected by this, causing it to be inflamed, thus leading to another condition known as vulvovaginitis. Cervicitis or inflammation of the cervix may also occur from this as well.  

The vagina is home to a host of good bacteria ‘microbes’ that help discourage the growth of disease-causing bacteria by maintaining a moderately acidic environment. These bacteria keep a healthy acidic balance hence keep the vagina protected.  The bacteria involved include lactobacilli, corynebacterial, some yeast, and a mixture of other microbes.  

It is normal for one to produce a small amount of vaginal discharge every day. The discharge is usually milky or clear and with varying quantities and consistency, all of which depend on the woman’s menstrual cycle.  

Causes of Yeast Infection (Vaginitis and Vaginosis)  

Yeast infection may occur if/when the healthy balance of flora is disrupted.  Any form of irritation on the vulva and vaginal tissues may lead to vaginitis as well.   

The most common causes of vaginosis/vaginitis are infections due to: 

  • Bacterial vaginosis: This type of infection is caused by changes in the vaginal flora. It is commonly characterized by an increase in other bacteria (mycoplasma hominis and Gardnerella vaginalis, among others), and a decrease in the number of lactobacilli populations.   
  • Yeast (Candida albicans) infection: Commonly known as candidiasis and caused by candida species  
  • Trichomonas vaginalis infection: Also known as trichomoniasis or ‘Trich,’ a sexually transmitted disease (parasitic).   

Other Causes 

  • Allergic reaction to irritants from feminine hygiene products, petroleum products used within the vagina, tight underclothing, bubble baths, deodorant soaps, perfumes, latex condoms, and use of fabric softeners in sheets.   
  • Loss of lubrication and thinning of vaginal skin due to low estrogen levels. Decreased estrogen levels cause a condition known as atrophic vaginitis, which only affects women in their menopause.  
  • Foreign object/body in the vagina. This can be a forgotten tampon (in a menstruating woman) or a small piece of toilet paper in a child.  

Bacterial vaginosis tends to increase the risk of infections in the woman’s genitalia. The most common of these are sexually transmitted diseases. 

Some of the STDs that can cause vaginitis or vaginosis include:  

  • Gonorrhea 
  • Herpes 
  • Chlamydia 
  • Human Papilloma Virus (HPV) 
  • HIV 

It is worth noting that vaginosis/vaginitis can occur in both girls and women of childbearing age. These conditions are, however, more common in sexually active individuals as compared to non-active ones. This, however, doesn’t mean girls who are not sexually active cannot contract the infection. Studies also show that vaginosis/vaginitis can be a result of more than one cause.  

Risk Factors for Vaginosis/Vaginitis 

These include: 

  • Pregnancy (hormonal changes during pregnancy may cause vaginal irritation)  
  • Antibiotic use (this reduces populations of good bacteria in the vagina)  
  • Frequent douching (causes loss of healthy flora)  
  • Sexual activity (with a new partner and/or multiple sex partners)  
  • IUD (intrauterine device) use  
  • Oral contraceptive use  
  • Poor hygiene  
  • Smoking 
  • Emotional/physical stress 
  • Underlying health conditions (e.g., poorly controlled diabetes, dermatitis, etc.)  

Sign and Symptoms of Vaginosis/Vaginitis 

There are no specific symptoms and signs associated with vaginosis. Some of the perceivable ones include burning, itching, redness, pain, and swelling of the vagina. The more distinctive signs are depending on the main cause of the same. These may include:  

  • Bacterial infection (vaginosis): This is characterized by a smelly thin, milky, or grey vaginal discharge, commonly surfacing after sexual intercourse. The unpleasant ‘fishy’ smell is mainly due to the increased pH levels and the presence of amines (chemicals) in the vagina. Most women with bacterial vaginosis (85%) hardly have any symptoms. 
  • Yeast infection (candidiasis):  Candidiasis is characterized by a white and thick vaginal distance that resembles cottage cheese.  The person may also experience itching, redness, and swelling, burning with urine, and painful sexual intercourse.  
  • Trichomoniasis: This causes a yellowish-greenish, unpleasant smelling, and sometimes ‘frothy’ vaginal discharge, as well as redness, itching, painful urination, and painful sexual intercourse. There may also be visible small red sores on the vaginal walls and cervix (during a pelvic exam). Most women with trichomoniasis do not have noticeable symptoms.  
  • Atrophic vaginitis: This condition affects women approaching or in menopause. It is characterized by thinning of vaginal walls. The women may experience itching, burning, vaginal dryness, and painful sexual intercourse. Some bleeding may occur after having sex.  

These infections rarely lead to pelvic inflammatory disease (PID) or inflammation of the cervix.  Vaginosis can (in some cases) cause preterm birth, low birth weight in infants, premature labor, and even be transmitted to the newborn.  Vitamin D deficiency in pregnant women is also believed to increase the risk of bacterial vaginosis too. Bacterial vaginosis is commonly associated with miscarriages, and especially in the second trimester of the pregnancy.  

Tests for Vaginitis/Vaginosis 

The process of diagnosis vaginosis and vaginitis is dependent on the risk factors for infection, and the patient’s age. For women within the childbearing age bracket, tests may include a physical exam, one’s medical history, and a pelvic exam. The doctor will also want to know what symptoms you have, how long they have lasted, the frequency of the same, any prescribed medications you might have taken (including oral contraceptives and antibiotics), as well as over-the-counter treatments used.  You might also be required to share information about your sexual history and personal habits (use of scented soaps, tight clothing, and douching, etc.) as well.  The health practitioner will use the information provided to determine the best type of tests to be done.  

The main reason for ordering the tests is to diagnose vaginosis or vaginitis, as well as determine the primary cause of the condition. This helps guide the practitioner on a plausible medication or treatment method.  These tests also help identify treatment options your body will respond to, and especially if you have had recurrent infections.  

Diagnosis of bacterial vaginosis (clinically) is recommended if 3 of 4 of the following symptoms are present. 

  • 4.5 or higher vaginal pH  
  • Graying-white vaginal discharge 
  • Fishy odor when 10% potassium hydroxide is added 
  • Presence of ‘clue’ cells (described below)   

Lab Tests  

The health practitioner may collect a few samples to be sent to the laboratory or perform a few tests in the clinic or medical office as well.  Bacterial vaginosis is, however tested through direct examination of vaginal secretions. The samples can then be examined microscopically as a Gram-stained or wet mount slide.  

1. Wet Prep (Wet Smear/Mount)  

The vaginal discharge sample is placed on a glass slide, which is then examined through the microscope.  The findings include: 

  • Candida: Yeast may be seen in the form of branch-like structures, also known as pseudohyphae, or budding yeast.  
  • Bacterial vaginosis: This is basically the presence of cells (from the vaginal lining) coated by bacteria. These are also known as ‘clue’ cells. The vaginal discharge will also have very few to no white blood cells.  
  • Trichomonas: These are oval-shaped parasites with moving flagella (hair-like structures). An abnormally high number of white blood cells may also be seen in the sample. 

2. Gram Stain 

The vaginal discharge sample is placed on a glass slide, which is then stained with the gram stain (a special dye). The stain is put under the lens where health practitioner looks out for specific cell types, type of bacteria, and the quantity. Should 20% or more of these cells be covered in the ‘clue cells’ (bacteria), then the patient may have bacterial vaginitis. A reduction in Lactobacillus bacteria may also be an indicator of bacterial vaginosis. The Gram stain may also help detect the presence of yeast cells too. This testing method might, however, not detect the trichomonas parasite.  

3. pH Test  

This involves testing vaginal discharge’s acidity. pH levels of less than 4.5 are perfectly normal, though they could also indicate a yeast infection. Any pH greater than 5.0 is seen with trichomoniasis and bacterial vaginosis infections.  

4. KOH Prep  

The sample of the discharge collected is placed on a glass slide, where a drop of potassium hydroxide (at 10% concentration) is added. The findings include:  

  • Bacterial vaginosis: A fishy odor is released, showing the presence of amines in the discharge. 
  • Candidiasis: KOH makes it possible to see the pseudohyphae and yeast in the sample. 
  • Trichomoniasis: An unpleasant odor is released. 

Additional tests may be required to identify the causes of vaginosis/vaginitis. These include: 

  • Molecular methods: To identify yeast infection, bacterial vaginosis, and trichomonas. Examples of molecular methods include NAAT and nucleic acid amplification.  
  • Rapid point-of-care tests:  Used to detect bacterial vaginosis and trichomonas.  

5. Vaginal Cultures  

This method of testing isn’t recommended for bacterial vaginitis diagnosis. The growth of bacterial in the culture can be quite difficult to understand. This is because Gardnerella vaginalis can be cultured from asymptomatic and healthy women.  

  • Candidiasis: A fungal culture may be used to help diagnose recurrent and persistent infections. It can also be used to determine the type of yeast present.  
  • Trichomoniasis: A special culture for the same may be used to detect trichomonads. This test is recommended if the microscopic exam seems insufficient.  

6. Other Tests 

Other tests may be ordered if the health practitioner suspects the patient has contracted STDs. Some of the STDs tested for include: 

Follow-up tests may also be required to determine the reason for some cases, especially recurrent yeast infections. An underlying condition, such as diabetes, may be the reason for the recurring conditions.