Preparations
for your Add-on Test • Wear sleeves that roll up easily • Be prepared to give a urine sample • Fasting required 12 hours before your test
ANEMIA SCREEN
The quickest and simplest way to find out if you have Anemia
is to measure your
Hemoglobin and/or Hematocrit levels. This Health
Panel will measure both.
Anemia indeed occurs when you have a below-normal level of
Hemoglobin or Hematocrit.
Hemoglobin
Hemoglobin is the compound that carries oxygen from the lungs to
other parts of the body. The human body can survive three weeks
without food, three days without drinking, but only three
minutes without oxygen. Sufficient oxygen to each cell in the
body is the basis of life itself.
Anemia can be a temporary or long-term
disease/illness, and can range from mild to severe. If you have
mild anemia, there may be no symptoms or only mild symptoms, but
severe anemia can result in a major impact on the quality of
life
People often equate anemia with iron-deficiency.
While this is partially true, anemia is actually any condition
where red blood cells are reduced in number or volume or are
deficient in the oxygen-carrying red pigmented protein
Hemoglobin.
In this scenario, a lack of iron can either be a
cause or a result.
Most anemias reduce the oxygen available to the body's tissues,
leading to fatigue, dizziness, fainting and shortness of breath.
This condition usually occurs as a symptom of another health
condition.
There are nearly one hundred varieties of anemia.
Each can be classified according to its cause:
Water, nutrients, and oxygen are transported into
the mitochondria and burned there to produce energy. If not
enough oxygen is available when nutrients are burned, the burn
is incomplete.
The amount of oxygen in our blood is directly
proportional to the number of red blood cells. Red blood cells
carry hemoglobin, which carries oxygen. Iron is also necessary,
as the agent that carries oxygen.
Normal range
for Females 18 yr and up is
11.5 - 15.0 g/dL
Normal range
for Males 18 yr and up
is 12.5 -
17.0 g/dL
The single most important measure of oxygen in our blood is
called the Hematocrit.
Hematocrit
Hematocrit is the volume of red blood cells as a percentage of
total blood volume.
Like a fireplace, our body needs sufficient
oxygen to burn food and produce energy efficiently. A lack of
oxygen can cause a lack of concentration, exhaustion, migraine
headaches, problems with digestion, poor muscle tone, a weak
immune system, accelerated aging, and chronic degenerative
diseases such as cancer. The value is expressed as a percentage
or fraction of cells in blood. For example, a Hematocrit value
of 40% means that there are 40 milliliters of red blood cells in
100 milliliters of blood.
The Hematocrit reflects both the number of red cells and their
volume (MCV). If the size of the red cell decreases, so will the
Hematocrit and vice versa.
The Hematocrit rises when the number of red blood
cells increases or when the plasma volume is reduced, as in
dehydration. The Hematocrit falls to less than normal,
indicating anemia, when your body decreases its production of
red blood cells or increases its destruction of red blood cells
or if blood is lost due to bleeding.
Normally functioning kidneys (at least one) are
necessary for a healthy life. The kidney performs essential functions for the
body in removing waste chemicals from metabolism of our tissue cells in
producing energy, chemicals that have been detoxified by the liver (such as
drugs, toxins and hemoglobin breakdown products) and has major roles in
maintaining the right amount of bodily water and salts, and in regulating our
blood pressure. The kidneys can be damaged as a
result of disease processes occurring elsewhere in the body, such as diabetes,
infections, blood vessel diseases, high (or low) blood pressure, diseases of the
blood, cancer, immune diseases such as lupus, trauma, etc.
The kidneys can also
have diseases of their own such as infections, structural abnormalities from
birth that bring about abnormal function, cancer, and can cause high blood
pressure.
Kidneys are incredibly resilient in functioning sufficiently well to
keep the body alive even after great or continuing damage. When the kidneys
begin to fail, the first signs are usually chemical, in the blood and urine.
Consequently, periodic checking of the kidneys’ functioning, along with checking
other bodily functioning, can be very beneficial in identifying problems early,
when many are curable or controllable.
Metabolism of both fat and sugar
eventually produces CO2, which exits the body mainly through the lungs and a
small amount through the skin. However, the metabolic breakdown product of
proteins, after conversion in the liver into a substance called urea, is
chemically such that it must be excreted in water. Likewise, creatine in muscle
is metabolized into a chemical called creatinine, which is also excreted in
water. If the kidneys are not functioning properly, the concentrations of these
chemicals will rise in the blood.
This Panel uses the Blood Urea Nitrogen
(BUN), the Creatinine and the BUN/Creatinine Ratio to assess kidney function.
An optional
Urinalysis can be requested to measure
kidney output function and health of the collecting system (lower portion of
kidney, ureters and bladder).
Blood Urea
Nitrogen (BUN)
The major breakdown product of bodily protein
(e.g., in that hamburger you had for lunch) is Urea, which is first formed in
the liver. Urea contains nitrogen and together, in excess quantity, they are
both toxic to the body and must be removed.
Kidneys normally do an excellent job
of removing urea, but when they start to fail, the blood concentration of urea
begins to rise. The reference range (or range within which most normal people's
test values fall) for BUN is 10-20 mg/dL. Other circumstances, such as blood in
the intestinal tract, a big meal of cooked meat, simple dehydration (too
little water in the tissues), or any condition which decreases blood flow to
the kidneys, can cause the concentration of blood urea to rise and suggest
there is something wrong in kidney function. Therefore, a second blood test
is done at the same time.
Creatinine
Creatinine is a normal blood
chemical that is a breakdown product of muscle metabolism. Kidneys are normally
very efficient filters of Creatinine. Unlike urea, the blood Creatinine
concentration is much less sensitive to the degree of bodily hydration, blood or
meat in the intestinal tract. The reference range for blood Creatinine is
0.3-1.5 mg/dL. Considered together, the BUN,
blood Creatinine and their ratio give very good evidence of the filtering
function of the kidneys and also, a measure of the degree of bodily hydration.
BUN/Creatinine Ratio
The ratio of BUN/Creatinine is normally 10:1. With dehydration, the ratio can
increase to 20:1 or even higher.
An increased BUN/Creatinine ratio may also be
due to certain types of kidney disease, breakdown of blood in the intestinal
tract, increased dietary protein, or any clinical circumstance in which
insufficient blood is flowing through the blood vessels to the kidneys (such as
heart failure or kidney artery disease).
The BUN/Creatinine ratio is decreased
in certain types of kidney disease, liver disease, malnutrition and in a
condition known as Sickle Cell Anemia.
The
fluids and electrolyte panel is used to detect, evaluate, and
monitor electrolyte imbalances. It may be ordered as
part of a routine exam or to help evaluate a chronic or
acute illness. It may be ordered at intervals to help
monitor conditions, such as kidney disease and
hypertension, and to monitor the effectiveness of
treatment for known imbalances.
As part of routine health
screening, when your doctor suspects that you have an
excess or deficit of one of the electrolytes (usually
sodium or potassium), or if your doctor suspects an
acid-base imbalance.
Electrolytes are electrically charged minerals that are
found in body tissues and blood in the form of dissolved
salts. They help move nutrients into and wastes out of
the body’s cells, maintain a healthy water balance, and
help stabilize the body’s pH level. The electrolyte
panel measures the main electrolytes in the body: sodium
(Na+), potassium (K+), chloride (Cl-), and carbon
dioxide (total CO2).
The Fluids & Electrolytes Panel includes:
Sodium - One of
the major salts in the body fluid; sodium is important
in the body's water balance and the electrical activity
of nerves and muscles.
Sodium is a mineral that is vital to normal body
function. It is an electrolyte, a positively charged
molecule that works with other electrolytes, such as
potassium, chloride and total carbon dioxide ( CO2), to
help regulate the amount of fluid in the body. Sodium is
present in all body fluids but is found in the highest
concentration in the blood and in the fluid outside of
the body’s cells. We get sodium in our diet, from table
salt (sodium chloride or NaCl), and to some degree from
most of the foods that we eat. Most people have an
adequate intake of sodium. The body uses what it
requires and the kidneys excrete the rest in the urine
to maintain sodium concentration within a very narrow
range. It does this by: producing hormones that can
increase (natriuretic peptides) or decrease (aldosterone)
sodium losses in urine, producing a hormone that
prevents water losses (antidiuretic hormone [ADH], and
controlling thirst. (Even a 1% increase in blood sodium
will make you thirsty and cause you to drink water,
returning your sodium level to normal.)
Abnormal blood sodium is usually due to some problem
with one of these systems. When the level of sodium in
the blood changes, the water content in your body also
changes. These changes can be associated with
dehydration or excess fluid (edema), especially in the
legs.
Chloride - Similar
to sodium, it helps to maintain the body's electrolyte
balance.
Chloride is an electrolyte, a
negatively charged molecule that works with other
electrolytes, such as potassium, sodium, and total
carbon dioxide (CO2), to
help regulate the amount of fluid in the body and
maintain the acid-base balance.
Chloride is present in all body fluids but is found in
the highest concentration in the blood and in the fluid
outside of the body’s cells. Most of the time, chloride
concentrations mirror those of sodium, increasing and
decreasing for the same reasons and in direct
relationship to sodium. When there is an acid-base
imbalance, however, blood chloride levels can change
independently of sodium levels as chloride acts as a
buffer. It helps to maintain electrical neutrality at
the cellular level by moving into or out of the cells as
needed.
Chloride is taken into the body through food and table
salt, which is made up of sodium and chloride molecules.
Most of the chloride is absorbed by the gastrointestinal
tract, and the excess is excreted in urine. The normal
blood level remains steady, with a slight drop after
meals (because the stomach produces acid after eating,
using chloride from blood).
Potassium - Helps to
control the nerves and muscles. Potassium is an
electrolyte, a positively charged molecule that works
with other electrolytes, to help regulate the amount of
fluid in the body, stimulate muscle contraction, and
maintain a stable acid-base balance. Potassium is
present in all body fluids, but most potassium is found
within your cells. Only about two percent is present in
fluids outside the cells and in the liquid part of the
blood (called serum or plasma). Because the blood
concentration of potassium is so small, minor changes
can have significant consequences. If potassium levels
go too low or too high, your health may be in
considerable danger: you are at risk for developing
shock, respiratory failure, or heart rhythm
disturbances. An abnormal concentration can alter the
function of neuromuscular tissue; for example, the heart
muscle may lose its ability to contract.
CO2
-
The CO2 test measures the total amount of carbon dioxide
in the blood, mostly in the form of bicarbonate (HCO3-).
Bicarbonate is a negatively charged electrolyte that is
excreted and reabsorbed by the kidneys. It is used by
the body to help maintain the body’s acid-base balance
(pH) and secondarily to work with sodium, potassium, and
chloride to maintain electrical neutrality at the
cellular level. Since the CO2 test measures all three
forms of carbon dioxide in the blood (bicarbonate, H2CO3
[also known as carbonic acid], and dissolved CO2) as a
total CO2, it will give a rough estimate but not an
exact determination of the bicarbonate concentration.
When
CO2 levels are higher or lower than normal, it suggests
that your body is having trouble maintaining its
acid-base balance or that you have upset your
electrolyte balance, perhaps by losing or retaining
fluid. Both of these imbalances may be due to a wide
range of dysfunctions.
Some
drugs may increase blood carbon dioxide levels
including: fludrocortisone, barbiturates, bicarbonates,
hydrocortisone, loop diuretics, and steroids.
Calcium -
Blood calcium
is tested to screen for, diagnose, and monitor a range of conditions
relating to the bones, heart, nerves, kidneys, and teeth. Blood calcium
levels do not directly tell how much calcium is in the bones, but
rather, how much total calcium or ionized calcium is circulating in the
blood.
Calcium levels in the blood are regulated and stabilized by a
feedback loop that includes: calcium, Parathyroid Hormone (PTH) ,
Vitamin D, Phosphorus, and magnesium. All these elements need to be in
balance. Conditions and diseases that disrupt this feedback loop can
cause inappropriate elevations or decreases in calcium and lead to
symptoms of high (hyper) or low (hypo) blood calcium. For example, when
parathyroid hormone (PTH) from the parathyroid gland is released, PTH
level rises, calcium also rises, and phosphorus drops. In some kidney
problems, a high phosphorus level in blood can depress calcium levels.
Large fluctuations in free calcium can cause the heart to slow down or
to beat too rapidly, can cause muscles to go into spasm (tetany), and
can cause confusion or even coma.
Calcium can be used as a diagnostic test if you go to your doctor with
symptoms that suggest:
kidney
stones,
bone disease,
or
neurologic
(nerve-related) disorders.
Your doctor also
may order a calcium test if:
you have
kidney disease, because low calcium is especially common in those
with kidney failure;
you have
symptoms of too much calcium, such as fatigue, weakness, loss of
appetite, nausea, vomiting, constipation, abdominal pain, urinary
frequency, and increased thirst;
you have
symptoms of low calcium, such as cramps in your abdomen, muscle
cramps, or tingling fingers; or
you have
other diseases that can be associated with abnormal blood calcium,
such as thyroid disease, intestinal disease, cancer, or poor
nutrition.
Your doctor may
order an ionized calcium test if you have numbness around the mouth and
in the hands and feet and muscle spasms in the same areas, which are
symptoms of low levels of ionized calcium. If calcium levels fall
slowly, however, many people have no symptoms at all.
A Liver panel, also known as Liver (hepatic) Function Tests or LFT, is
used to detect liver damage or disease. It usually includes seven tests
that are run at the same time on a blood sample. These include:
Total Serum Protein
The
total protein test is a rough measure of all of the proteins in the
plasma portion of your blood. Proteins are important building blocks of
all cells and tissues; they are important for body growth and health.
Total protein measures the combined amount of two classes of proteins,
albumin and globulin. Albumin is a carrier of many small molecules, but
its main purpose is to keep fluid from leaking out of blood vessels,
while globulin proteins include enzymes, antibodies, and more than 500
other proteins. The ratio of albumin to globulin (A/G ratio) is
calculated from values obtained by direct measurement of total protein
and albumin. It represents the relative amounts of albumin and
globulins.
Albumin
Albumin is the most abundant protein in the blood plasma It keeps fluid
from leaking out of blood vessels; nourishes tissues; and transports
hormones, vitamins, drugs, and ions like calcium throughout the body.
Albumin is made in the liver and is extremely sensitive to liver damage.
The concentration of albumin drops when the liver is damaged, with
kidney disease (nephrotic syndrome), when a person is malnourished, if a
person experiences inflammation in the body, or with shock. Albumin
increases when a person is dehydrated. Albumin is made in the liver and is the major
protein of the blood, helping to keep water in blood vessels and
transport substances. Decreased albumin levels can be associated with
malnutrition, liver disease, and kidney disease.
Globulin
Total protein measures the combined amount of two classes of proteins,
albumin and globulin. Albumin is a carrier of many small molecules, but
its main purpose is to keep fluid from leaking out of blood vessels,
while globulin proteins include enzymes, antibodies, and more than 500
other proteins. The immunoglobulin are the globulins of our immune
systems and of antibodies while many other globulin are carriers of
hormones or important components of enzymes.
AG
Ratio
The total protein test is a rough measure of all of
the proteins in the plasma portion of your blood. Proteins are important
building blocks of all cells and tissues; they are important for body
growth and health. Total protein measures the combined amount of two
classes of proteins, albumin and globulin. Albumin is a carrier of many
small molecules, but its main purpose is to keep fluid from leaking out
of blood vessels, while globulin proteins include enzymes, antibodies,
and more than 500 other proteins. The ratio of albumin to globulin (A/G
ratio) is calculated from values obtained by direct measurement of total
protein and albumin. It represents the relative amounts of albumin and
globulins. Normally, there is a little more albumin than globulins,
giving a normal A/G ratio of slightly over 1.
Alkaline Phosphatase
Alkaline
phosphate is an enzyme, a protein that helps cells work. You find
alkaline phosphate in high concentrations in the cells that make bone
and in the liver. In the liver, it is found on the edges of cells that
join to form bile ducts (tiny tubes that drain bile from the liver to
the bowels where it is needed to help digest fat in the diet). Smaller
amounts of ALP are found in the placenta (afterbirth) of women who are
pregnant, and in the bowel. Each of these body parts makes different
forms of ALP. The different forms are called isoenzymes.
When a person has evidence of liver disease, very high ALP levels can
tell the doctor that the person’s bile ducts are somehow blocked. Often,
ALP is high in persons who have cancer that has spread to the liver or
the bones, and doctors can do further testing to see if this has
happened. If a person with bone or liver cancer responds to treatment,
ALP levels will decrease. When a person has high levels of ALP, and the
doctor is not sure why, s/he may also order ALP isoenzyme tests to try
to determine the cause.
In some forms of liver disease, such as hepatitis, ALP
is usually much less elevated than AST and ALT. When the bile ducts are
blocked (usually by gallstones, scars from previous gallstones or
surgery, or by cancers), ALP and bilirubin may be increased much more
than AST or ALT. In a few liver diseases, ALP may be the only test that
is high.
Total Bilirubin
As red blood cells normally age and break down, bilirubin—a
by-product—is released into the blood and is cleared by the liver.
Bilirubin is an orange-yellow pigment found in bile. Red blood cells (RBCs)
normally degrade after 120 days in the circulation. At this time, a
component of the RBCs, hemoglobin (the red-colored pigment of red blood
cells that carries oxygen to tissues), breaks down into bilirubin.
Approximately 250 to 350 mg of bilirubin is produced daily in a normal,
healthy adult, of which 85% is derived from damaged or old red cells
that have died, with the remaining amount from the bone marrow or liver.
High bilirubin values may indicate a liver function problem, bile duct
blockage, or excessive destruction of red blood cells.
Unconjugated bilirubin is carried to the liver, where sugars are
attached to it, producing conjugated bilirubin. This conjugated
bilirubin is passed to the bile by the liver and is further broken down
by bacteria in the small intestines and eventually excreted in the
feces, of which the characteristic color is due to the break down of
bilirubin. Some bile is stored in the gall bladder. As bilirubin levels
increase, the appearance of jaundice becomes more evident. Normally,
almost all bilirubin in the blood is unconjugated.
AST
{Aspartate
aminotransferase}
AST {Aspartate aminotransferase} which used to be called SGOT is an
enzyme found mostly in the heart and liver, and to a lesser extent in
other muscles. When liver or muscle cells are injured, they release AST
into the blood. Testing for AST is usually used to detect liver damage.
AST levels are
also often compared with levels of other liver enzymes, alakline
phosphatase ( ALP) and alanine aminotransferase ( ALT), to determine
which form of liver disease is present.
Even though AST is
found in heart and other muscles, another enzyme, cratine kinase ( CK),
is present in much higher amounts and is usually used to detect heart or
muscle injury.
An AST test
is ordered along with several other tests to evaluate a patient who
seems to have symptoms of a liver disorder. Some of these symptoms
include jaundice(yellowing of the eyes and skin),
dark urine, nausea, vomiting, abdominal swelling, unusual weight gain,
and abdominal pain. AST can also be ordered, either by itself or with
other tests, for:
persons who
might have been exposed to hepatitis viruses
those who
drink too much alcohol,
persons who
have a history of liver disease in their family, or
persons
taking drugs that can occasionally damage the liver.
Persons who have
mild symptoms, such as fatigue, may be tested for ALT to make sure they
do not have chronic liver disease. ALT is often measured to monitor
treatment of persons with liver disease, and may be ordered either by
itself or along with other tests.
Very high levels
of AST (more than 10 times the highest normal level) are usually due to
acute hepatitis, often due to a virus infection. In acute hepatitis, AST
levels usually stay high for about 1–2 months, but can take as long as
3–6 months to return to normal. In chronic hepatitis, AST levels are
usually not as high, often less than 4 times the highest normal level.
In chronic hepatitis, AST often varies between normal and slightly
increased, so doctors typically will order the test frequently to
determine the pattern.
In some diseases of the liver, especially when the bile ducts are
blocked, or with cirrhosis and certain cancers of the liver, AST may be
close to normal, but it increases more often than ALT. When liver damage
is due to alcohol, AST often increases much more than ALT (this is a
pattern seen with few other liver diseases. AST is also increased after
heart attacks and with muscle injury, usually to a much greater degree
than is ALT.
Pregnancy may
decrease AST levels. A shot or injection of medicine into muscle tissue,
or even strenuous exercise, may increase AST levels. In rare instances,
some drugs can damage the liver or muscle, increasing AST levels. This
is true of both prescription drugs and some “natural” health products.
If your doctor finds that you have high levels of AST, tell him or her
about all the drugs and health products you are taking.
ALT
(Alanine Aminotransferase)
ALT (Alanine
Aminotransferase) which used to be called SGTP is an enzyme found mostly
in the liver; smaller amounts of it are also in the kidneys, heart, and
muscles. Under normal conditions, ALT levels in the blood are low. When
the liver is damaged, ALT is released into the blood stream, usually
before more obvious symptoms of liver damage occur, such as jaundice
(yellowing of the eyes and skin).
The ALT test detects
liver injury. ALT values are usually compared to the levels of other
enzymes, such as alkaline phosphatase ( ALP) and aspartate
aminotransferase ( AST) to help determine which form of liver disease is
present.
A physician
usually orders an ALT test (and several others) to evaluate a patient
who has symptoms of a liver disorder. Some of these symptoms include
jaundice, dark urine, nausea, vomiting, abdominal swelling, unusual
weight gain, and abdominal pain. ALT can also be ordered, either by
itself or with other tests, for:
persons who
have a history of known or possible exposure to Hepatitis Viruses,
those who
drink too much alcohol,
individuals
whose families have a history of lived disease, or
persons who
take drugs that might occasionally damage the liver.
In persons with
mild symptoms, such as fatigue or loss of energy, ALT may be tested to
make sure they do not have chronic liver disease. ALT is often used to
monitor the treatment of persons who have liver disease, to see if the
treatment is working, and may be ordered either by itself or along with
other tests.
Blood
glucose testing can be used to screen healthy, asymptomatic individuals
for diabetes and pre-diabetes because diabetes is a common disease that
begins with few symptoms.
The
blood glucose test is ordered to measure the amount of glucose in the
blood right at the time of sample collection. It is used to detect both
hyperglycemia and hypogltcemia and to help diagnose diabetes. Blood
glucose may be measured on a fasting basis (collected after an 8 to 10
hour fast), randomly (anytime), post prandial (after a meal), and/or as
part of an Ooral Glucose Tolerance Test (OGTT or GTT). An OGTT is
a series of blood glucose tests. A fasting glucose is collected; then
the patient drinks a standard amount of a glucose solution to
"challenge" their system. This is followed by one or more additional
glucose tests performed at specific intervals to track glucose levels
over time. The OGTT may be ordered to help diagnose diabetes and as a
follow-up test to an elevated blood glucose.
The
American Diabetes Association recommends either the fasting glucose or
the OGTT to diagnose diabetes but says that testing should be done
twice, at different times, in order to confirm a diagnosis of diabetes.
Most
pregnant women are screened for gestational diabeetes, a temporary form
of hyperglycemia, between their 24th and 28th week of pregnancy using a
version of the OGTT, a 1-hour glucose challenge. If either fasting
glucose or a random glucose is above the values used to diagnose
diabetes in those who are not pregnant, the woman is considered to have
gestational diabetes and neither the screening nor the glucose tolerance
test is needed. If the 1-hour level is higher than the defined value, a
longer OGTT is performed to clarify the patient’s status.
Diabetics must monitor their own blood glucose levels, often several
times a day, to determine how far above or below normal their glucose is
and to determine what oral medications or insulin(s) they may need. This
is usually done by placing a drop of blood from a skin prick onto a
glucose strip and then inserting the strip into a glucose meter, a small
machine that provides a digital readout of the blood glucose level.
In
those with suspected hypoglycemia, glucose levels are used as part of
the "Whipple triad" to confirm a diagnosis. (See “Is there anything else
I should know?” section).
The
urine glucose is seldom ordered by itself. At one time, it was used to
monitor diabetics, but it has been largely replaced by the more
sensitive and “real time” blood glucose. The urine glucose is, however,
one of the substances measured when a urinalysis is performed. A
urinalysis may be done routinely as part of a physical, when a doctor
suspects that a patient may have a urinary tract infection, or for a
variety of other reasons. The doctor may follow an elevated urine
glucose test with blood glucose testing.
When
is it ordered?
Screening for glucose may occur during public health fairs or as part of
workplace health programs. It may also be ordered when a patient has a
routine physical exam. Screening is especially important for people at
high risk of developing diabetes, such as those with a family history of
diabetes, those who are overweight, and those who are more than 40 to 45
years old.
The
glucose test may also be ordered to help diagnose diabetes when someone
has symptoms of hyperglycemia, such as:
Increased thirst
Increased urination
Fatigue
Blurred vision
Slow-healing infections
or
symptoms of hypoglycemia, such as:
Sweating
Hunger
Trembling
Anxiety
Confusion
Blurred Vision
Blood
glucose testing is also done in emergency settings to determine if low
or high glucose is contributing to symptoms such as fainting and
unconsciousness. If a patient has pre-diabetes (characterized by fasting
or OGTT levels that are higher than normal but lower than those defined
as diabetic), the doctor will order a glucose test at regular intervals
to monitor the patient’s status. With known diabetics, doctors will
order glucose levels in conjunction with other tests such as Hemoglobin
A1c to monitor glucose control over a period of time. Occasionally, a
blood glucose level may be ordered along with insulin and C-peptide to
monitor insulin production.
Diabetics may be required to self-check their glucose, once or several
times a day, to monitor glucose levels and to determine treatment
options as prescribed by their doctor.
Pregnant women are usually screened for gestational diabetes late in
their pregnancies, unless they have early symptoms or previously have
had gestational diabetes. When a woman has gestational diabetes, her
doctor will usually order glucose levels throughout the rest of her
pregnancy and after delivery to monitor her condition.
High levels of glucose most frequently
indicate diabetes, but many other diseases and conditions can also cause
elevated glucose. The following information summarizes the meaning of the
test results. These are based on the clinical practice recommendations of
the American Diabetes Association.
Fasting Blood Glucose
Interpretation
From 70 to 99 mg/dL
(3.9 to 5.5 mmol/L)
Normal glucose
tolerance
From
100 to 125 mg/dL (5.6 to 6.9 mmol/L)
Impaired fasting glucose (pre-diabetes)
126 mg/dL (7.0 mmol/L)
and above on more than one testing occasion
Diabetes
Oral
Glucose Tolerance Test (OGTT) [except pregnancy]
(2 hours after a 75-gram glucose drink)
Interpretation
Less than 140 mg/dL
(7.8 mmol/L)
Normal glucose
tolerance
From 140 to 200 mg/dL
(7.8 to 11.1 mmol/L)
Impaired glucose
tolerance (pre-diabetes)
Over 200 mg/dL (11.1
mmol/L) on more than one testing occasion
Diabetes
Gestational Diabetes
Screening: Glucose Challenge Test
(1 hour after a 50-gram glucose drink)
Interpretation
Less than 140* mg/dL
(7.8 mmol/L)
Normal glucose
tolerance
140* mg/dL (7.8 mmol/L)
and over
Abnormal, needs OGTT
(see below)
* Some
use a cutoff of >130 mg/dL (7.2 mmol/L) because that identifies
90% of women with gestational diabetes, compared to 80%
identified using the threshold of >140 mg/dL (7.8 mmol/L).
*
If two or
more values are above the criteria, gestational diabetes is
diagnosed.
** A 75-gram glucose load may be used, although this method is
not as well validated as the 100-gram OGTT; the 3-hour sample is
not drawn if 75 grams is used.
Some of the other
diseases and conditions that can result in elevated glucose levels
include:
Acromegaly
Acute stress
(response to trauma, heart attack, and stroke for instance)
Chronic renal
failure
Cushing
syndome
Drugs,
including: corticosteroids, tricyclic antidepressants, diuretics,
epinephrine, estrogens (birth control pills and hormone
replacement), lithium, phenytoin (Dilantin), salicylates,
Excessive
food intake
Hyperthyroidism
Pancreatic
cancer
Pancreatitis
Low to
non-detectible urine glucose results are considered normal. Anything
that raises blood glucose levels also has the potential to elevate urine
glucose levels. Increased urine glucose levels may be seen with
medications, such as estrogens and chloral hydrate, and with some forms
of renal disease.
Moderately
increased levels may be seen with pre-diabetes. This condition, if left
un-addressed, often leads to type 2 diabetes.
Low glucose levels
(hypoglycemia) are also seen with:
Adrenal
Insufficiency
Drinking
alcohol
Drugs, such
as acetaminophen and anabolic steroids
Extensive
liver disease
Hypopituitarism
Hypothyroidism
Insulin
overdose
Insulinomas
(insulin-producing pancreatic tumors)
Starvation
Hypoglycemia
( Low glucose level) is characterized by a drop in blood glucose to a
level where first it causes nervous system symptoms (sweating,
palpitations, hunger, trembling, and anxiety), then begins to affect the
brain (causing confusion, hallucinations, blurred vision, and sometimes
even coma and death). An actual diagnosis of hypoglycemia requires
satisfying the "Whipple triad." These three criteria include:
Documented
low glucose levels (less than 40 mg/dL (2.2 mmol/L) often tested
along with insulin levels and sometimes with C-Peptide levels)
Symptoms of
hypoglycemia
Reversal of
the symptoms when blood glucose levels are returned to normal.
Primary
hypoglycemia is rare and often diagnosed in infancy. People may have
symptoms of hypoglycemia without really having low blood sugar. In such
cases, dietary changes such as eating frequent small meals and several
snacks a day and choosing complex carbohydrates over simple sugars may
be enough to ease symptoms. Those with fasting hypoglycemia may require
IV (intravenous) glucose if dietary measures are insufficient.
This profile requires you to be
fasting 12-14 hours.
No appointment necessary.
Components of a Lipid Profile
Total Cholesterol
Cholesterol is a necessary substance in your body from your first day of life. Experts recommend a cholesterol level below 200 for good health. Between 200 and 239 is borderline and above 240 is dangerous. When associated with at least two risk factors such as high blood pressure, diabetes, previous heart disease or stroke, excess weight and being a smoker, it increases the incidence of having coronary artery disease and heart attacks.
HDL (Good
Cholesterol)
High density lipoproteins (HDL) are proteins coated "packages" that carry fat and cholesterol through the body. The function of HDL is to remove cholesterol from the blood by transporting it to the liver where it will be prepared for excretion through the bile. HDL has a protective effect on the deposit of fat in the wall of blood vessels. Increasing its level in the blood will reduce the risk of cardiovascular disease. The use of polyunsaturated, monounsaturated fats (Olive Oil), and physical exercise may increase the level of HDL.
Triglycerides
Triglycerides are a type of fatty substance which must be measured together with your cholesterol for a complete picture of your circulating blood fats. Blood triglycerides tend to be elevated in people who have high cholesterol levels, in people
with diabetes or chronic kidney disease, and in those who are obese. The relationship between triglycerides and coronary artery disease is still controversial. Some studies suggest that high blood triglycerides might increase the risk
of coronary artery disease. If your blood level of triglycerides is elevated you
should consult your doctor for dietary changes and weight loss and exercise program or for the use of medication which may be necessary in some cases.
LDL
(Bad
Cholesterol)
Low density lipoproteins (LDL) transport one half to two thirds of all blood cholesterol to various body tissues. A certain amount of LDL cholesterol (up to 130) is normal. But when the level increases, LDL promotes plaque development on the walls of the coronary arteries, slowing the flow of blood and sometimes blocking the artery entirely. Levels of 130-160 are considered borderline high and levels of 160 or higher are definitely abnormal and should be reduced with rigorous diet, other lifestyle changes, and/or with drug therapy.
Controversies are now surfacing on the danger of having LDL blood levels which are too low. The relation to some type of cancers and other diseases have been noticed with LDL levels reduced below 90 and closer to 50. Therefore is unclear today how safe is to lower your LDL blood level. A safer level seems to be between 90-130 and should
be associated with an increase in the HDL levels.
VLDL (Very Low Density Lipoprotein)
VLDL (Very Low Density Lipoprotein) is a fraction of Triglycerides circulating in your blood stream. Not as important as the LDL, this blood fats follows the levels of your Triglycerides.
Tryglycerides levels may be elevated either for the presence of high fats in your food which when absorbed in your intestine is transformed as Chylomicrons and give a milky appearance to the liquid part of your blood ( serum ) or for the presence of Very Low Density Lipoproteins (VLDL) which is the part of Triglycerides produced by your body and not ingested with food.
Cholesterol/HDL Ratio.
The HDL in the blood is believed to serve two
functions: 1) it coats the inside of the artery wall and provide a kind of protective layer of grease to prevent fat deposits from building up and 2) it serves as scavenger by actually helping dissolve fatty deposits when they occur. The basic rule of balance for your blood is to have a relatively high amount of HDL in your body in relation to your total amount of cholesterol. This is called the
Cholesterol/HDL Ratio.
The ratio in men should always be less than 5.0, and preferably less than 4.5. For women, the ratio should be lower and always under 4.0 and preferably under 3.5. In other words the man's HDL
should always represent at least 20% of the total cholesterol count (and
preferably should be 25% or greater). For a woman the HDL cholesterol should make up at least 25% (or preferably 30%) of the total cholesterol. The Cholesterol/HDL Ratio is probably the best predictor of future coronary disease. Active people with low levels of body fat tend to show the best cholesterol balance (ratio) in their blood.
The symptoms of a low body temperature are
classic for low thyroid function and they often get better with thyroid
medicine. Body temperatures are normally lower in the morning, higher in the
afternoon, and lower again in the evening. So if the temperatures are low
during the day when they're supposed to be at their highest, that's better
evidence that there's a problem. Temperature patterns are also important and
illuminating. How patients feel can be affected not only by how high or low
their temperatures are but also on how steady their temps are. One temperature reading a day is not
enough to see how widely the temperature is fluctuating, but more than three
a day can be too time consuming.
T3 uptake
This test measures the
amount of triiodothyronine, or T3, in the blood. T3 is one of two
majorhormones produced by the thyroid gland (the other hormone is called
thyroxine, or T4). The thyroid gland is a small butterfly-shaped organ that
lies flat across your windpipe. The hormones it produces control the rate at
which the body uses energy. Their production is regulated by a feedback
system. When blood levels of thyroid hormones decline, the hypothalamus (an
organ in the brain) releases thyrotropin releasing hormone, which stimulates
the pituitary (a tiny organ below the brain and behind the sinus cavities)
to produce and release thyroid-stimulating hormone (TSH). TSH then
stimulates the thyroid gland to produce and/or release more thyroid
hormones. Most of the thyroid hormone produced is T4. This hormone is
relatively inactive, but it is converted into the much more active T3 in the
liver and other tissues.
If the thyroid gland
produces excessive amounts of T4 and T3, then the patient may have symptoms
associated with hyperthyroidism, such as nervousness, tremors of the hands,
weight loss, insomnia, and puffiness around dry, irritated eyes. In some
cases, the patient’s eyes cannot move normally and they may appear to be
staring. In other cases, the patient’s eyes may appear to bulge.
If the thyroid gland
produces insufficient amounts of thyroid hormones, then the patient may have
symptoms associated with hypothyroidism and a slowed metabolism, such as
weight gain, dry skin, fatigue, and constipation. Blood levels of hormones
may be increased or decreased because of insufficient or excessive
production by the thyroid gland, due to thyroid dysfunction, or due to
insufficient or excessive TSH production related to pituitary dysfunction.
Fatigue
Headaches & Migraines
PMS
Easy Weight Gain
Depression
Irritability
Fluid Retention
Anxiety & Panic Attacks
Hair Loss
Poor Memory
Poor Concentration
Low Sex Drive
Unhealthy Nails
Dry Skin & Hair
Cold Intolerance
Low Motivation
Low Ambition
Insomnia - Heat Intolerance
Allergies
Acne
Carpal Tunnel Syndrome
Hives.....and many others
About 99.7% of the T3
found in the blood is attached to a protein (primarily thyroxine-binding
globulin ( TBG) but also several other proteins) and the rest is free
(unattached). Separate blood tests can be performed to measure either the
total (both bound and unattached) or free (unattached) T3 hormone in the
blood.
When TBG is increased, T3 uptake is decreased, and
vice versa. T3 Uptake does not measure the level of T3 or T4 in serum.
Increased T3 uptake (decreased TBG) is seen in chronic
liver disease, protein-losing states, and with use of the following drugs:
androgens, barbiturates, bishydroxycourmarin, chlorpropamide,
corticosteroids, danazol, d-thyroxine, penicillin, phenylbutazone, valproic
acid, and androgens. It is also seen in hyperthyroidism.
Decreased T3 uptake
(increased TBG) may occur due to the effects of exogenous estrogens
(including oral contraceptives), pregnancy, acute hepatitis, and in
genetically-determined elevations of TBG. Drugs producing increased TBG
include clofibrate, lithium, methimazole, phenothiazines, and
propylthiouracil. Decreased T3 uptake may occur in hypothyroidism.
T4
T4 is one of two major
hormones produced by the thyroid gland (the other is called triiodothyronine,
or T3). The thyroid is a small, butterfly-shaped gland located just below
the Adam's apple. This gland plays a vital role in controlling the rate at
which your body uses energy.
The body has a
feedback system that turns thyroid hormone production on and off. When the
level of T4 in the bloodstream decreases, the hypothalamus (an organ in the
brain) releases thyrotropin releasing hormone, which stimulates the
pituitary gland (an organ below the hypothalamus) to release
thyroid-stimulating hormone (TSH), which in turn stimulates the thyroid
gland to make and/or release more T4. As blood concentrations of T4
increase, the amount of TSH released decreases.
T4 makes up nearly all
of what we call thyroid hormone, while T3 makes up less than 10%. Inside the
thyroid gland, T4 is produced, bound to a protein called thyroglobulin, and
stored. When the body requires thyroid hormone, the thyroid gland produces
some T4 or T3 and/or releases stored T4 into circulation. In the blood, T4
is present in a free (not bound) and protein-bound form (primarily bound to
thyroxine-binding globulin). The concentration of free T4 is only about 0.1%
of that of total T4, but the free T4 is the portion of thyroxine that is
active. T4 only becomes an active thyroid hormone when it is converted into
T3 in the liver or other tissues.
If the thyroid gland
does not produce sufficient T4 (due to thyroid dysfunction or to
insufficient TSH), then the affected patient experiences symptoms of
hypothyroidism such as weight gain, dry skin, cold intolerance, irregular
menstruation, and fatigue. If the thyroid gland produces too much T4, the
rate of the patient’s body functions will increase and cause symptoms
associated with hyperthyroidism such as increased heart rate, anxiety,
weight loss, difficulty sleeping, tremors in the hands, and puffiness around
dry, irritated eyes.
The most common causes
of thyroid dysfunction are autoimmune-related Graves' disease causes
hyperthyroidism and Hashimoto's thyroiditis causes hypothyroidism. Both
hyper- and hypothyroidism can also be caused by thyroiditis (thyroid
inflammation), thyroid cancer, and excessive or deficient production of TSH.
The effect of these conditions on thyroid hormone production can be detected
and monitored by measuring the total T4 (includes bound and free portion) or
the free T4 (only unbound).
This is a measurement of the total thyroxine in the serum, including both
the physiologically active (free) form, and the inactive form bound to
thyroxine-binding globulin (TBG). It is increased in hyperthyroidism and in
euthyroid states characterized by increased TBG (See "T3 uptake," above, and
"FTI," below). Occasionally, hyperthyroidism will not be manifested by
elevation of T4 (free or total), but only by elevation of T3 (triiodothyronine).
Therefore, if thyrotoxicosis is clinically suspect, and T4 and FTI are
normal, the test "T3-RIA" is recommended (this is not the same test as "T3
uptake," which has nothing to do with the amount of T3 in the patient's
serum).
T4 is decreased in hypothyroidism and in euthyroid states
characterized by decreased TBG. A separate test for "T4" is available, but
it is not usually necessary for the diagnosis of functional thyroid
disorders.
T7 (FTI)
This is a convenient parameter with mathematically accounts for the
reciprocal effects of T4 and T3 uptake to give a single figure which
correlates with free T4. Therefore, increased FTI is seen in
hyperthyroidism, and decreased FTI is seen in hypothyroidism. Early cases of
hyperthyroidism may be expressed only by decreased thyroid stimulation
hormone (TSH) with normal FTI.
This test measures the
amount of thyroid-stimulating hormone (TSH) in your blood. TSH is produced
by the pituitary gland, a tiny organ located below the brain and behind the
sinus cavities. It is part of the body’s feedback system to maintain stable
amounts of the thyroid hormones thyroxine (T4) and triiodothyronine (T3) in
the blood. Thyroid hormones help control the rate at which the body uses
energy. When concentrations decrease in the blood, the hypothalamus (an
organ in the brain) releases thyrotropin releasing hormone (TRH). This
stimulates the release of TSH by the pituitary gland, and then TSH in turn
stimulates the production and release of T4 and T3 by the thyroid gland, a
small butterfly-shaped gland that lies flat against the windpipe. When all
three organs are functioning normally, thyroid production turns on and off
to maintain blood thyroid hormone levels.
If there is pituitary
dysfunction, then increased or decreased amounts of TSH may result. If TSH
concentrations are increased, the thyroid will make and release
inappropriate amounts of T4 and T3 and the patient may experience symptoms
associated with hyperthyroidism (overactive thyroid), such as rapid heart
rate, weight loss, nervousness, hand tremors, irritated eyes, and difficulty
sleeping. If there is decreased production of thyroid hormones
(hypothyroidism), then the patient may experience symptoms such as weight
gain, dry skin, constipation, cold intolerance, and fatigue. In addition to
pituitary dysfunction, hyper- or hypothyroidism can occur if there is a
problem with the hypothalamus (insufficient or excessive TRH). They may also
occur with a variety of thyroid diseases that affect thyroid hormone
production regardless of the amount of TSH present in the blood
Early cases of hypothyroidism may be
expressed only by increased TSH with normal T7 FTI. Currently, the method of
choice for screening for both hyper- and hypothyroidism is the serum TSH.
Modern methodologies ("ultra sensitive TSH") allow accurate determination of
the very low concentrations of TSH at the physiological cutoff between the
normal and hyperthyroid states
TSH has been recognized as an exquisitely sensitive indicator of thyroid
status. TSH assays (second or third generation) have therefore been widely
adopted as the front-line thyroid function test. In ambulatory patients with
intact hypothalamic and pituitary function, a normal TSH result excludes
hypo or hyperthyroidism; whereas elevated and suppressed TSH results are
diagnostic of hypo and hyperthyroidism, respectively.
A complete blood count (CBC) provides important information about the kinds
and numbers of cells in the blood: red blood cells, white blood cells and
platelets. A CBC can help you and your health professional evaluate symptoms (such as
weakness, fatigue, or bruising) and diagnose conditions (such as anemia,
infection, and many other disorders).
A CBC test includes:
White blood cell (WBC) count. White blood cells protect the body
against infection. If an infection develops, white blood cells attack and
destroy the bacteria, virus, or other organism causing it. White blood cells
are bigger than red blood cells and normally fewer in number. When a person
has a bacterial infection, the number of white cells can increase
dramatically. The white blood cell count shows the number of white blood cells
in a sample of blood. The number of white blood cells is sometimes used to
identify an infection or monitor the body's response to cancer treatment.
White blood cell types (WBC differential). There are five major
kinds of white blood cells: neutrophils, lymphocytes, monocytes, eosinophils,
and basophils. Immature neutrophils, called band neutrophils, are also
included and counted as part of this test. Each type of cell plays a different
role in protecting the body. The numbers of each one of these types of white
blood cells give important information about the immune system. An increase or
decrease in the numbers of the different types of white blood cells can help
identify infection, an allergic or toxic reaction to certain medications or
chemicals, and many conditions (such as leukemia ).
Red blood cell (RBC) count. Red blood cells carry oxygen from the
lungs to the rest of the body. They also help carry carbon dioxide back to the
lungs so it can be exhaled. The red blood cell count shows the number of red
blood cells in a sample of blood. If the RBC count is low, the body may not be
getting the oxygen it needs. If the count is too high (a condition called
polycythemia), there is a risk that the red blood cells will clump together
and block tiny blood vessels (capillaries).
Hematocrit (HCT, packed cell volume, PCV). This test measures the
amount of space (volume) red blood cells occupy in the blood. The value is
given as a percentage of red blood cells in a volume of blood. For example, a
hematocrit of 38 means that 38% of the blood's volume is composed of red
cells.
Hemoglobin (Hgb). Hemoglobin is the substance in a red blood cell
that carries oxygen. The hemoglobin test measures the amount of hemoglobin in
blood and is a good indication of the blood's ability to carry oxygen
throughout the body.
Red blood cell indices. There are three red blood cell indices:
mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean
corpuscular hemoglobin concentration (MCHC). They are not measured directly
but are determined from other measurements noted during a CBC. The MCV shows
the size of the red blood cells. The MCH value is the amount of hemoglobin in
an average red blood cell. The MCHC measures the concentration of hemoglobin
in an average red blood cell. These numbers help in the diagnosis of different
types of anemia.
Add-On to CBC
Separate charges applied
Platelet (thrombocyte) count. Platelets (thrombocytes) are the
smallest type of blood cell. They play a major role in blood clotting. When
bleeding occurs, the platelets swell, clump together, and form a sticky plug
that helps stop the bleeding. If there are too few platelets, uncontrolled
bleeding may be a problem. If there are too many platelets, there is a risk of
a blood clot forming in a blood vessel.
Blood smear. In this test, a drop of blood is spread (smeared) on a
slide and stained with a special dye. The slide is then examined under a
microscope. The numbers, size, and shape of red blood cells, white blood
cells, and platelets are recorded. Blood cells with unusual shapes or sizes
can help diagnose many blood diseases, such as leukemia, malaria, or sickle
cells anemia.
Growth hormone (22,000 MW) is essential for linear growth and is necessary
for normal metabolism of protein, carbohydrate, lipid and minerals. The
growth promoting aspects are mediated by somatomedin IGF-1 produced
primarily in the liver in response to GH. GH causes an increase in lean body
mass, a decrease in body fat, an increase in metabolic rate and a decrease
in plasma cholesterol. GH is a unique hormone in that animal forms are
inactive in humans. However, recombinant hGH is available for the treatment
of disease. While it has been touted as a "fountain of youth", current data
does not support the use of GH to reverse the changes seen in normal aging
HGH is referred to by medical
science as the master hormone. Growth hormone affects virtually all areas of
the body -- influencing the growth of cells, bones, muscles and organs. When
deficient in GH our symptoms include loss of muscle, decreased energy, an
increase in fat, diminished sexual drive, a greater risk of cardiovascular
disease and a lower life expectancy. In other words, the symptoms we call
aging.
Human Growth Hormone (HgH), also
called somatotropin, is produced in the anterior of the pituitary gland deep
inside the brain. It influences the growth of cells, bones, muscles and
organs throughout the body.
Production of HgH peaks at adolescence when accelerated growth occurs. If
growing children have too little they remain as dwarfs, while if they have
too much they become giants. Ample in our youth, production of HGH falls 80%
from age 21 to 61. Daily growth hormone secretion diminishes with age to the
extent that a 60 year old may secrete only 25% of the HGH secreted by a 20
year old.
Human Growth Hormone
Deficiency
HgH is one of many endocrine hormones, like estrogen, progesterone,
testosterone, melatonin and DHEA, that all decline in production with age.
While many of these hormones can be replaced to deter some of the effects of
aging, HgH reaches far beyond the scope of any of these hormones. By ages 70
to 80, virtually everyone is deficient in growth hormone, resulting in SDS,
or Somatotropin (growth hormone) Deficiency Syndrome.
Recombinant Human Growth Hormone has been approved for use in Growth Hormone
Deficiency Syndrome. Since measurement of hGH is difficult, the accepted
method is to measure Somatomedin-C, or by its newer name, Insulin Growth
Factor-1 (IGF-1). Depending on the laboratory used to measure IGF-1 and
the work of leading researchers, Somatotropin Deficiency Syndrome is defined
as a value below 160 ug/ml.
Human
Chorionic Gonadotropin (hCG) is the "pregnancy hormone" that keeps
the corpus luteum producing progesterone when conception occurs. It is this
hormone that is measured by Blood Pregnancy Tests. An hCG blood test is much
more sensitive than a urine test, and can detect pregnancy as early as 10
days after fertilization.
Add
On to Pregnancy test
Separate Charges Applied
Pregnancy Test - Blood Quantitative
When to use a
quantitative Pregnancy Blood Test. As a general rule, hCG numbers
should double every two to three days. However, if you have been
(watch video)
