86900 ABO & RH (Lavendar Tube)

 

ABO type and Rh are needed to identify candidates for Rh immune globulin and to assess the risk of hemolytic disease of the newborn.

 

84075 ALKALINE PHOS

 

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.


82150 AMYLASE

The major sources of amylase are the pancreas and the salivary glands. The most common cause of elevation of serum amylase is inflammation of the pancreas (pancreatitis). In acute pancreatitis, serum amylase begins to rise within 6-24 hours, remains elevated for a few days and returns to normal in 3-7 days. Other causes of elevated serum amylase are inflammation of salivary glands (mumps), biliary tract disease and bowel obstruction. Elevated serum amylase can also be seen with drugs (e.g., morphine) which constrict the pancreatic duct sphincter preventing excretion of amylase into the intestine.


86006 ANA 

 

This assay may be useful in supporting or ruling out a diagnosis of Sjögren's syndrome.
 

86850 ANTIBODY SCREEN

An RBC antibody screen is used to screen an individual's blood for antibodies directed against red blood cell (RBC)antigens other than the A and B antigens. It is performed as part of a "type and screen" whenever a blood transfusion is anticipated. If an antibody is detected, then an antibody identification test must be done to determine which antibodies are present. During a crossmatch, a variation of the RBC antibody screen is performed if clinically significant antibodies are present. In the case of blood transfusions, RBC antibodies must be taken into account and donor blood must be found that does not contain the antigen(s) to which the person has produced antibodies.

 

If someone has an immediate or delayed reaction to a blood transfusion, a health practitioner will order a direct antiglobulin test (DAT) to help investigate the cause of the reaction. (The DAT detects RBC antibodies attached to red blood cells.) An RBC antibody screen will be performed to see if the affected person has developed any new antibodies if the DAT is positive.

 

During pregnancy, the RBC antibody screen is used to screen for antibodies in the blood of the mother that might cross the placenta and attack the baby's red cells, causing hemolytic disease of the newborn (HDN). The most serious cause is an antibody produced in response to the RBC antigen called the "D antigen" in the Rh blood group system. A person is considered to be Rh-positive if the D antigen is present on their RBCs and Rh-negative if the D antigen is not present. An Rh-negative mother may develop an antibody when she is exposed to blood cells from an Rh-positive fetus.

 

To prevent this, an Rh-negative mother should have an RBC antibody screen performed early in her pregnancy, at 28 weeks, and again at the time of delivery. If there are no Rh antibodies present at 28 weeks, then the woman is given an injection of Rh immune globulin (RhIg) to clear any Rh-positive fetal RBCs that may be present in her bloodstream to prevent the production of Rh antibodies by the mother.

 

At birth, the baby's Rh status is determined. If the baby is Rh-negative, then the mother does not require another RhIg injection; if the baby is Rh-positive and the mother's antibody status is negative for anti-D, the mother is given additional RhIG.

 

This test may be used to help diagnose autoimmune-related hemolytic anemia in conjunction with a DAT. This condition may be caused when a person produces antibodies against their own RBC antigens. This can happen with someautoimmune disorders, such as systemic lupus erythematosus, with diseases such as lymphoma or chronic lymphocytic leukemia, and with infections such as mycoplasma pneumonia and mononucleosis. It can also occur in some people with the use of certain medications, such as penicillin.


82250 BILIRUBIN TOTAL14

 

A bilirubin test is used to detect an increased level in the blood. It may be used to help determine the cause of jaundiceand/or help diagnose conditions such as liver disease, hemolytic anemia, and blockage of the bile ducts. Bilirubin is an orange-yellow pigment, a waste product primarily produced by the normal breakdown of heme. Heme is a component of hemoglobin, which is found in red blood cells (RBCs). Bilirubin is ultimately processed by the liver to allow its elimination from the body. Any condition that accelerates the breakdown of RBCs or affects the processing and elimination of bilirubin may cause an elevated blood level.

 

Two forms of bilirubin can be measured or estimated by laboratory tests:

  • Unconjugated bilirubin—when heme is released from hemoglobin, it is converted to unconjugated bilirubin. It is carried by proteins to the liver. Small amounts may be present in the blood.

  • Conjugated bilirubin—formed in the liver when sugars are attached (conjugated) to bilirubin. It enters the bile and passes from the liver to the small intestines and is eventually eliminated in the stool. Normally, no conjugated bilirubin is present in the blood

 

Usually, a chemical test is used to first measure the total bilirubin level (unconjugated plus conjugated bilirubin). If the total bilirubin level is increased, the laboratory can use a second chemical test to detect water-soluble forms of bilirubin, called "direct" bilirubin. The direct bilirubin test provides an estimate of the amount of conjugated bilirubin present. Subtracting direct bilirubin level from the total bilirubin level helps estimate the "indirect" level of unconjugated bilirubin. The pattern of bilirubin test results can give the healthcare provider information regarding the condition that may be present.

 

In adults and older children, bilirubin is measured to:

  • Diagnose and/or monitor diseases of the liver and bile duct (e.g., cirrhosis, hepatitis, or gallstones)

  • Evaluate people with sickle cell disease or other causes of hemolytic anemia; these people may have episodes called crises when excessive RBC destruction increases bilirubin levels.

 

In newborns with jaundice, bilirubin is used to distinguish the causes of jaundice.

  • In both physiologic jaundice of the newborn and hemolytic disease of the newborn, only unconjugated (indirect) bilirubin is increased.

  • In much less common cases, damage to the newborn's liver from neonatal hepatitis and biliary atresia will increase conjugated (direct) bilirubin concentrations as well, often providing the first evidence that one of these less common conditions is present.

 

It is important that an elevated level of bilirubin in a newborn be identified and quickly treated because excessive unconjugated bilirubin damages developing brain cells. The consequences of this damage include mental retardation, learning and developmental disabilities, hearing loss, eye movement problems, and death.

 

84520 BUN

 

The blood urea nitrogen or BUN test is primarily used, along with the creatinine test, to evaluate kidney function in a wide range of circumstances, to help diagnose kidney disease, and to monitor people with acute or chronic kidney dysfunction or failure. It also may be used to evaluate a person's general health status when ordered as part of a renal panel, basic metabolic panel (BMP) or comprehensive metabolic panel (CMP). Urea is a waste product formed in the liver when protein is metabolized. Urea is released by the liver into the blood and is carried to the kidneys, where it is filtered out of the blood and released into the urine. Since this is an ongoing process, there is usually a small but stable amount of urea nitrogen in the blood. However, when the kidneys cannot filter wastes out of the blood due to disease or damage, then the level of urea in the blood will rise.

 

The kidneys are a pair of bean-shaped organs that are located at the bottom of the ribcage in the right and left sides of the back. Within them are about a million tiny blood filtering units called nephrons. In each nephron, blood is continually filtered through a microscopic cluster of looping blood vessels, called a glomerulus. The glomerulus allows the passage of water and small molecules but retains blood cells and larger molecules. Attached to each glomerulus is a tiny tube (tubule) that collects the fluid and molecules that pass through the glomerulus and then reabsorbs what can be used by the body. The remaining waste forms urine.

 

If the creatinine and BUN tests are found to be abnormal or if someone has an underlying disease that is known to affect the kidneys, such as diabetes or high blood pressure, then creatinine and BUN tests may be used to monitor for kidney dysfunction and the effectiveness of treatment. Blood creatinine and BUN tests may also be ordered to evaluate kidney function prior to some procedures, such as a CT (computed tomography) scan, that may require the use of drugs that can damage the kidneys.


82310 CALCIUM

 

A blood calcium test is ordered to screen for, diagnose, and monitor a range of conditions relating to the bones, heart, nerves, kidneys, and teeth. The test may also be ordered if a person has symptoms of a parathyroid disorder, malabsorption, or an overactive thyroid; often ordered when a person undergoes a general medical examination. 


85025 CBC

 

How the complete blood count (CBC) test is used, when the Hemogram of white blood cells, red blood cells, and platelets is ordered, and what the results of a CBC with Differential might mean, including anemia, infection, inflammation, bleeding disorder, or cancer. 


82465 CHOLESTEROL

 

Cholesterol testing is recommended as a screening test to be done on all adults at least once every five years. It is frequently done in conjunction with a routine physical exam. It is usually ordered in combination with other tests includinghigh-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides — often called alipid profile.  Cholesterol is tested at more frequent intervals (often several times per year) in people who have been prescribed diet and/or drugs to lower their cholesterol. The test is used to track how well these measures are succeeding in lowering cholesterol to desired levels and in turn lowering the risk of developing heart disease.


82550 CPK

 

A creatine kinase (CK) test may be used to detect inflammation of muscles (myositis) or serious muscle damage and/or to diagnose rhabdomyolysis if a person has signs and symptoms, such as muscle weakness, muscle aches, and dark urine. The urine may be dark because of the presence of myoglobin, another substance released by damaged muscles that can be harmful to the kidneys. CK may be ordered by itself or along with other blood chemistry tests such as electrolytes, BUNor creatinine (to evaluate kidney function). A urine myoglobin may also be ordered. A person may have muscle injury with few or nonspecific symptoms, such as weakness, fever, and nausea, that may also be seen with a variety of other conditions. A health practitioner may use a CK test to help detect muscle damage in these cases, especially if someone is taking a drug such as a statin, using ethanol or cocaine, or has been exposed to a known toxin that has been linked with potential muscle damage. In those who have experienced physical trauma, a CK test may sometimes be used to evaluate and monitor muscle damage.

 

The CK test may be ordered if a person has chest pain or other symptoms that lead a doctor to suspect heart damage. This assay was once one of the primary tests ordered to help diagnose a heart attack, but in the U.S., this use of CK has been largely replaced by troponin. The CK test may sometimes be used to help detect a second heart attack that occurs shortly after the first.

 

A series of CK tests may be used to monitor muscle damage, including heart damage, to see if it resolves or continues. If a CK is elevated and the location of the muscle damage is unclear, then a health practitioner may order CK isoenzymes or aCK-MB as follow-up tests, to distinguish between the three types (isoenzymes) of CK: CK-MB (found primarily in heart muscle), CK-MM (found primarily in skeletal muscle), and CK-BB (found primarily in the brain; when present in the blood, it is primarily from smooth muscles, including those in intestines, uterus or placenta).


82570 CREATININE
 

The creatinine blood test is used to assess kidney function. It is frequently ordered along with a BUN (blood urea nitrogen) test or as part of a basic or comprehensive metabolic panel(BMP or CMP), groups of tests that are performed to evaluate the function of the body's major organs. BMP or CMP tests are used to screen healthy people during routine physical exams and to help evaluate acutely or chronically ill people in the emergency room and/or hospital. Sometimes, creatinine may be performed as part of a renal panel to evaluate kidney function.

 

Creatinine is a waste product produced by muscles from the breakdown of a compound called creatine. Almost all creatinine is filtered from the blood by the kidneys and released into the urine, so blood levels are usually a good indicator of how well the kidneys are working.

 

The kidneys are a pair of bean-shaped organs that are located at the bottom of the ribcage in the right and left sides of the back. Within them are about a million tiny blood filtering units called nephrons. In each nephron, blood is continually filtered through a microscopic cluster of looping blood vessels, called a glomerulus. The glomerulus allows the passage of water and small molecules but retains blood cells and larger molecules. Attached to each glomerulus is a tiny tube (tubule) that collects the fluid and molecules that pass through the glomerulus and then reabsorbs what can be used by the body. The remaining waste forms urine.

 

If the creatinine and BUN tests are found to be abnormal or if someone has an underlying disease that is known to affect the kidneys, such as diabetes or high blood pressure, then creatinine and BUN tests may be used to monitor for kidney dysfunction and the effectiveness of treatment. Blood creatinine and BUN tests may also be ordered to evaluate kidney function prior to some procedures, such as a CT (computed tomography) scan, that may require the use of drugs that can damage the kidneys.

 

86140 CRP

 

The C-reactive protein (CRP) test is used by a health practitioner to detect inflammation. CRP is an acute phase reactant, aprotein made by the liver and released into the blood within a few hours after tissue injury, the start of an infection, or other cause of inflammation. The CRP test is not diagnostic of any condition, but it can be used together with signs and symptomsand other tests to evaluate an individual for an acute or chronic inflammatory condition.

For example, CRP may be used to detect or monitor significant inflammation in an individual who is suspected of having an acute condition, such as:

  • A serious bacterial infection like sepsis

  • A fungal infection

  • Pelvic inflammatory disease (PID)

The CRP test is useful in monitoring people with chronic inflammatory conditions to detect flare-ups and/or to determine if treatment is effective. Some examples include:

  • Inflammatory bowel disease

  • Some forms of arthritis

  • Autoimmune diseases, such as lupus or vasculitis

CRP may sometimes be ordered along with an erythrocyte sedimentation rate (ESR), another test that detects inflammation. While the CRP test is not specific enough to diagnose a particular disease, it does serve as a general marker for infection and inflammation, thus alerting health practitioners that further testing and treatment may be necessary. Depending on the suspected cause, a number of other tests may be performed to identify the source of inflammation. 


82728 FERRITIN

 

The ferritin test may be ordered, along with other iron tests, when a routine CBC shows that a person's hemoglobin andhematocrit are low and their red blood cells are smaller and paler than normal (microcytic and hypochromic), suggestingiron deficiency anemia even though other clinical symptoms may not have developed yet.

In the early stage of iron deficiency, no physical effects are usually seen. If a person is otherwise healthy, symptoms seldom appear before the hemoglobin in the blood drops below a certain level (10 g per deciliter). However, as the iron-deficiency progresses, symptoms eventually begin to develop and a doctor may order ferritin as well as other iron-related tests. The most common symptoms of iron deficiency anemia include:

  • Chronic fatigue/tiredness

  • Weakness

  • Dizziness

  • Headaches

  • Pale skin (pallor)

 

As iron stores continue to be depleted, there may be shortness of breath, ringing in the ears (tinnitus), drowsiness, and irritability. If the anemia progresses in severity, chest pain, headaches, leg pains, shock, and even heart failure may occur. Children may develop learning (cognitive) disabilities. Besides the general symptoms of anemia, there are certain symptoms that are characteristic of iron deficiency. These include pica (cravings for specific substances, such as licorice, chalk, dirt, or clay), a burning sensation in the tongue or a smooth tongue, sores at the corners of the mouth, and spoon-shaped finger- and toe-nails.

A ferritin level may also be ordered when iron overload is suspected. Symptoms of iron overload will vary from person to person and tend to worsen over time. They are due to iron accumulation in the blood and tissues. Symptoms may include:

  • Joint pain

  • Fatigue, weakness

  • Weight loss

  • Lack of energy

  • Abdominal pain

  • Loss of sex drive

  • Loss of body hair

  • Heart problems such as congestive heart failure (CHF)

To confirm the presence of iron overload, other iron tests (iron, TIBC) and a genetic test for hereditary hemochromatosismay be ordered as well.


82746 FOLATE/B12

 

Vitamin B12 and folate are separate tests often used in conjunction to detect deficiencies and to help diagnose the cause of certain anemias, such as pernicious anemia, an autoimmune disease that affects the absorption of B12.

 

B12 and folate are two vitamins that cannot be produced in the body and must be supplied by the diet. They are required for normal red blood cell (RBC) formation, repair of tissues and cells, and synthesis of DNA, the genetic material in cells. B12 is essential for proper nerve function. (For more, see the "What is being tested?" section.)

 

B12 and folate tests may also be used to help evaluate an individual with an altered mental state or other behavioral changes, especially in the elderly. A B12 test may be ordered with folate, by itself, or with other screening laboratory tests such as a complete blood count (CBC), comprehensive metabolic panel (CMP), antinuclear antibody (ANA), C-reactive protein (CRP) and rheumatoid factor (RF) to help determine why a person shows signs and symptoms of a condition affecting nerves (neuropathy).

 

Additionally, B12 and folate tests may be used in conjunction with an assortment of other tests to help evaluate the general health and nutritional status of a person with signs and symptoms of significant malnutrition or dietary malabsorption. This may include people with, for example, alcoholism, liver disease, gastric cancer, or individuals with malabsorption conditionssuch as celiac disease, inflammatory bowel disease, or cystic fibrosis.

 

In those treated for known B12 and folate deficiencies, testing may be used to monitor the effectiveness of treatment. This is especially true for those who cannot properly absorb B12 and/or folate and must have lifelong treatment.

 

Folate levels in the liquid portion of blood (serum) can vary based on a person's recent diet. Because red blood cells store 95% of circulating folate, a test to measure the folate level within RBCs may be used in addition to or instead of the serum test. Some health practitioners feel that the RBC folate test is a better indicator of long-term folate status and is more clinically relevant than serum folate, but there is not widespread agreement on this.

 

Other laboratory tests that may be used to help detect B12 and folate deficiencies include homocysteine and methylmelonic acid (MMA). Homocysteine and MMA are elevated in B12 deficiency while only homocysteine, and not MMA, is elevated in folate deficiency. This distinction is important because giving folate to some who is B12-deficient will treat the anemia but does not treat the neurologic damage, which may be irreversible.

 

82950 1 HR GLUCOSE

 

The blood glucose test may be used to:

  • Detect high blood glucose (hyperglycemia) and low blood glucose (hypoglycemia)

  • Screen for diabetes in people who are at risk before signs and symptoms are apparent; in some cases, there may be no early signs or symptoms of diabetes. Screening can therefore be useful in helping to identify it and allowing for treatment before the condition worsens or complications arise.

  • Help diagnose diabetes, prediabetes and gestational diabetes

  • Monitor glucose levels in people diagnosed with diabetes

A few different testing protocols may be used to evaluate blood glucose levels, depending on the purpose.

Screening and Diagnosis
The following tests may be used for screening and diagnosis of type 1, type 2 or prediabetes. (Gestational diabetes testing is different—see below.) If the initial screening result from one of the tests is abnormal, the test is repeated on another day. The repeat result must also be abnormal to confirm a diagnosis of diabetes.

  • Fasting glucose (fasting blood glucose, FBG) – this test measures the level of glucose in the blood after fasting for at least 8 hours.

  • 2-hour glucose tolerance test (GTT) – for this test, the person has a fasting glucose test done (see above), then drinks a 75-gram glucose drink. Another blood sample is drawn 2 hours after the glucose drink. This protocol "challenges" the person's body to process the glucose. Normally, the blood glucose level rises after the drink and stimulates the pancreas to release insulin into the bloodstream. Insulin allows the glucose to be taken up by cells. As time passes, the blood glucose level is expected to decrease again. When a person is unable to produce enough insulin, or if the body's cells are resistant to its effects (insulin resistance), then less glucose is transported from the blood into cells and the blood glucose level remains high.

  • A different test called hemoglobin A1c may be used as an alternative to glucose testing for screening and diagnosis. (For more, see the article on A1c.).

Sometimes a blood sample may be drawn and glucose measured when a person has not been fasting, for example, when a comprehensive metabolic panel (CMP) is performed. If the result is abnormal, it is typically followed up with a fasting blood glucose test or a GTT.

Glucose blood tests are also used to screen pregnant women for gestational diabetes between their 24th and 28th week ofpregnancy. The American Diabetes Association and the U.S. Preventive Services Task Force recommend that pregnant women not previously known to have diabetes be screened and diagnosed, using either a one-step or two-step approach. The American College of Obstetricians and Gynecologists (ACOG) recommends the two-step approach.

  • One-step 2-hour oral glucose tolerance test (OGTT). After a fasting glucose level is measured, a woman is given a 75-gram dose of glucose to drink and her glucose levels are measured at 1 hour and 2 hours after the dose. Only one of the values needs to be above a cutoff value for diagnosis.

  • Two-step

    • Perform a glucose challenge test as a screen: a woman is given a 50-gram glucose dose to drink and her blood glucose level is measured after 1 hour.

    • If the challenge test is abnormal, perform a 3-hour oral glucose tolerance test. After a woman's fasting glucose level is measured, she is given a 100-gram glucose dose and her glucose is measured at timed intervals. If at least two of the glucose levels at fasting, 1 hour, 2 hour, or 3 hour are above a certain level, then a diagnosis of gestational diabetes is made.

Glucose testing is also used to test women who were diagnosed with gestational diabetes 6-12 weeks after they have delivered their baby to detect persistent diabetes.

Monitoring
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.

Urine
Urine glucose is one of the substances tested when a urinalysis is performed. A urinalysis may be done routinely as part of a physical or prenatal checkup. The health practitioner may follow up an elevated urine glucose test with blood glucose testing. Urine glucose testing is a screening tool, but it is not sensitive enough for diagnosis or monitoring.

Other tests, such as diabetes autoantibodies, insulin, and C-peptide, may sometimes be performed along with these tests to help determine the cause of abnormal glucose levels, to distinguish between type 1 and type 2 diabetes, and to evaluate insulin production.


82947 GLUCOSE FASTING

 

he blood glucose test may be used to:

  • Detect high blood glucose (hyperglycemia) and low blood glucose (hypoglycemia)

  • Screen for diabetes in people who are at risk before signs and symptoms are apparent; in some cases, there may be no early signs or symptoms of diabetes. Screening can therefore be useful in helping to identify it and allowing for treatment before the condition worsens or complications arise.

  • Help diagnose diabetes, prediabetes and gestational diabetes

  • Monitor glucose levels in people diagnosed with diabetes

A few different testing protocols may be used to evaluate blood glucose levels, depending on the purpose.

Screening and Diagnosis
The following tests may be used for screening and diagnosis of type 1, type 2 or prediabetes. (Gestational diabetes testing is different—see below.) If the initial screening result from one of the tests is abnormal, the test is repeated on another day. The repeat result must also be abnormal to confirm a diagnosis of diabetes.

  • Fasting glucose (fasting blood glucose, FBG) – this test measures the level of glucose in the blood after fasting for at least 8 hours.

  • 2-hour glucose tolerance test (GTT) – for this test, the person has a fasting glucose test done (see above), then drinks a 75-gram glucose drink. Another blood sample is drawn 2 hours after the glucose drink. This protocol "challenges" the person's body to process the glucose. Normally, the blood glucose level rises after the drink and stimulates the pancreas to release insulin into the bloodstream. Insulin allows the glucose to be taken up by cells. As time passes, the blood glucose level is expected to decrease again. When a person is unable to produce enough insulin, or if the body's cells are resistant to its effects (insulin resistance), then less glucose is transported from the blood into cells and the blood glucose level remains high.

  • A different test called hemoglobin A1c may be used as an alternative to glucose testing for screening and diagnosis. (For more, see the article on A1c.).

Sometimes a blood sample may be drawn and glucose measured when a person has not been fasting, for example, when a comprehensive metabolic panel (CMP) is performed. If the result is abnormal, it is typically followed up with a fasting blood glucose test or a GTT.

Glucose blood tests are also used to screen pregnant women for gestational diabetes between their 24th and 28th week ofpregnancy. The American Diabetes Association and the U.S. Preventive Services Task Force recommend that pregnant women not previously known to have diabetes be screened and diagnosed, using either a one-step or two-step approach. The American College of Obstetricians and Gynecologists (ACOG) recommends the two-step approach.

  • One-step 2-hour oral glucose tolerance test (OGTT). After a fasting glucose level is measured, a woman is given a 75-gram dose of glucose to drink and her glucose levels are measured at 1 hour and 2 hours after the dose. Only one of the values needs to be above a cutoff value for diagnosis.

  • Two-step

    • Perform a glucose challenge test as a screen: a woman is given a 50-gram glucose dose to drink and her blood glucose level is measured after 1 hour.

    • If the challenge test is abnormal, perform a 3-hour oral glucose tolerance test. After a woman's fasting glucose level is measured, she is given a 100-gram glucose dose and her glucose is measured at timed intervals. If at least two of the glucose levels at fasting, 1 hour, 2 hour, or 3 hour are above a certain level, then a diagnosis of gestational diabetes is made.

Glucose testing is also used to test women who were diagnosed with gestational diabetes 6-12 weeks after they have delivered their baby to detect persistent diabetes.


82950 2 HR GLUCOSE

 

2-hour postprandial blood sugar measures blood glucose exactly 2 hours after you start eating a meal. This is not a test used to diagnose diabetes. This test is used to see if someone withdiabetes is taking the right amount of insulin with meals. 

 

A glycohemoglobin test

 

A glycohemoglobin test, or hemoglobin A1c, is a blood test that checks the amount of sugar (glucose) bound to the hemoglobin  in the redblood cells. When hemoglobin and glucose bond, a coat of sugar forms on the hemoglobin. That coat gets thicker when there's more sugar in the blood. A1c tests measure how thick that coat has been over the past 3 months, which is how long a red blood cell lives. People who have diabetes or other conditions that increase their blood glucose levels have more glycohemoglobin (sugar bound to hemoglobin) than normal.

An A1c test can be used to diagnose prediabetes or diabetes. The A1c test checks the long-term control of blood glucose levels in people with diabetes. Most doctors think checking an A1c level is the best way to check how well a person is controlling his or her diabetes. A home blood glucose test measures the level of blood glucose only at that moment. Blood glucose levels change during the day for many reasons, including medicine, diet, exercise, and the level of insulin in the blood. It is useful for a person who has diabetes to have information about the long-term control of blood sugar levels. The A1c test result does not change with any recent changes in diet, exercise, or medicines.

Glucose binds to hemoglobin in red blood cells at a steady rate. Since red blood cells last 3 to 4 months, the A1c test shows how much glucose is in the plasma part of blood. This test shows how well your diabetes has been controlled in the last 2 to 3 months and whether your diabetes treatment plan needs to be changed.


86701 HIV 

 

HIV antibody testing is used to screen for and diagnose HIV infections. Since there is no cure, early treatment of HIV infection and immune system monitoring can greatly improve long-term health and survival. Also, if a person knows his HIV status, it may help change behaviors that can put him and others at risk.

Screening

Different types of antibody tests may be used for HIV screening:

  • All HIV tests used in the U.S. detect HIV-1, and some tests have been developed that can also detect HIV-2. (HIV-1 is the most common type found in the United States, while HIV-2 has a higher prevalence in parts of Africa.)

  • Combination tests have been developed that detect HIV antibody and the HIV antigen called the p24 antigen. Levels of p24 antigen are typically high early in the course of infection. A combination test may be performed to increase the likelihood that HIV infection is detected sooner after exposure occurs.

Various options are available for getting tested:

  • A blood or oral sample can be collected in a doctor's office or a local clinic and sent to a laboratory for testing.

  • In these same settings, there may be a rapid test available in which results are generated in about 20 minutes.

  • There is also a home collection kit approved by the U.S. Food and Drug Administration (FDA) that is available for HIV antibody testing. This allows a person to take a sample at home and then mail it to a testing center. Results are available over the phone, along with appropriate counseling.

  • In July 2012, the FDA approved for marketing the first HIV test for home use. The testing kit is the same as that used in many doctors' offices and clinics in which an oral sample is collected for testing and results are available in about 20 minutes. The home test has two limitations: 1) testing on oral fluid is less sensitive than a blood test so the home test may miss some cases of HIV that a blood test would detect; and 2) the home test is not as accurate when it is performed at home by a lay person compared to when it is performed by a trained health care professional. However, the FDA felt that the convenience of home testing would encourage some people who might otherwise be reluctant to go to a doctor or clinic to learn their HIV status. 

     

     

86293 HBs ANTIGEN / 86295 HBs ANTIBODY / 86302 HEPATITIS C

 

Hepatitis B virus (HBV) tests may be used for a variety of reasons. Some of the tests detect antibodies produced in response to HBV infection; some detect antigens produced by the virus, and others detect viral DNA.

The main uses for HBV tests include:

  • To determine whether acute signs and symptoms are due to HBV infection; two tests, hepatitis B surface Ag and hepatitis B core antibody IgM, may be performed as part of an acute viral hepatitis panel along with tests for hepatitis A (HAV) and hepatitis C (HCV) to determine which virus may be causing the infection.

  • To diagnose chronic HBV hepatitis

  • To monitor chronic hepatitis B infection and its treatment

  • To detect previous exposure to hepatitis B, in a person who is immune compromised (when the virus can become reactivated)

Some of the secondary reasons to perform testing include: to screen for hepatitis B infection in at-risk populations or in blood donors, to determine if someone is a carrier, to detect previous infection (with subsequent immunity), and to determine if immunity has developed due to vaccination.

Generally, one set of tests is used as an initial panel of tests to detect HBV infection or to determine the cause of acutesymptoms while another set of tests may be used after a diagnosis is made to monitor possible progression of the disease, to detect chronic infection, and/or to determine carrier status.


83020 HEMOGLOBIN ELECT

 

A hemoglobin electrophoresis test is a blood test done to check the different types of hemoglobin in the blood. Hemoglobin is thesubstance in red blood cells  that carries oxygen.

The most common types of normal hemoglobin are:

  • Hemoglobin A. This is the most common type of hemoglobin found normally in adults. Some diseases, such as severe forms ofthalassemia, may cause hemoglobin A levels to be low and hemoglobin F levels to be high.

  • Hemoglobin F (fetal hemoglobin). This type is normally found infetuses and newborn babies. Hemoglobin F is replaced by hemoglobin A (adult hemoglobin) shortly after birth; only very small amounts of hemoglobin F are made after birth. Some diseases, such as sickle cell disease, aplastic anemia, and leukemia, have abnormal types of hemoglobin and higher amounts of hemoglobin F.

  • Hemoglobin A2. This is a normal type of hemoglobin found in small amounts in adults.

There are more than 350 types of abnormal hemoglobin.1 The most common are:

  • Hemoglobin S. This type of hemoglobin is present in sickle cell disease.

  • Hemoglobin C. This type of hemoglobin does not carry oxygen well.

  • Hemoglobin E. This type of hemoglobin is found in people of Southeast Asian descent.

  • Hemoglobin D. This type of hemoglobin is present in some sickle cell disorders.

Hemoglobin S and hemoglobin C are the most common types of abnormal hemoglobin that may be found by an electrophoresis test.

Electrophoresis uses an electrical current to separate normal and abnormal types of hemoglobin in the blood. Hemoglobin types have different electrical charges and move at different speeds. The amount of each hemoglobin type in the current is measured.

An abnormal amount of normal hemoglobin or an abnormal type of hemoglobin in the blood may mean that a disease is present. Abnormal hemoglobin types may be present without any other symptoms, may cause mild diseases that do not have symptoms, or cause diseases that can be life-threatening. For example, hemoglobin S is found in sickle cell disease, which is a serious abnormality of the blood and causes serious problems.


83540 IRON

 

Iron status may be evaluated by ordering one or more tests to determine the amount of circulating iron in the blood, the capacity of the blood to transport iron, and the amount of stored iron in tissues. Testing may also help differentiate various causes of anemia and may include:

  • Serum iron measures the level of iron in the blood.

  • TIBC (total iron-binding capacity) measures all of the proteins in the blood that are available to bind with iron, including transferrin. Since transferrin is the primary iron-binding protein, the TIBC test is a good indirect measurement of transferrin. The body produces transferrin in relationship to the need for iron. When iron stores are low, transferrin levels increase and vice versa. In healthy people, about one-third of the binding sites on transferrin are used to transport iron.

  • UIBC (unsaturated iron-binding capacity) measures the reserve capacity of transferrin, the portion of transferrin that has not yet been saturated. UIBC also reflects transferrin levels.

  • Transferrin saturation is a calculation that is done with the iron test result and TIBC or UIBC. It represents the percentage of the transferrin that is saturated with iron.

  • Serum ferritin reflects the amount of stored iron in the body; ferritin is the main storage protein for iron inside of cells.

These tests are often ordered together, and the results of each can help the doctor to determine the cause of iron deficiency or iron overload.


83350 TIBC

 

Total iron-binding capacity (TIBC) is most frequently used along with a serum iron test to evaluate people suspected of having either iron deficiency or iron overload. These two tests are used to calculate the transferrin saturation, a more useful indicator of iron status than just iron or TIBC alone. In healthy people, about 20-40% of available transferrin sites are used to transport iron.

In iron deficiency, the iron level is low but the TIBC is increased, thus transferrin saturation becomes very low. In iron overload states, such as hemochromatosis, the iron level will be high and the TIBC will be low or normal, causing the transferrin saturation to increase. UIBC may be ordered as an alternative to TIBC.

It is customary to test for transferrin (instead of TIBC or UIBC) when evaluating a person's nutritional status or liver function. Because it is made in the liver, transferrin will be low in those with liver disease. Transferrin levels also drop when there is not enough protein in the diet, so this test can be used to monitor nutrition.


83690 LIPASE

 

The blood test for lipase is most often used, along with an amylase test, to help diagnose and monitor acute pancreatitis. It may also be used to diagnose and monitor chronic pancreatitis and other disorders that involve the pancreas but is not as useful of a test for these conditions because lipase levels remain elevated for longer periods and may not reveal clinical progress. Lipase testing is also occasionally used in the diagnosis and follow-up of cystic fibrosis, celiac disease, and Crohn disease.

 

83625 LDH

 

A lactate dehydrogenase (LD or LDH) test is a non-specific test that may be used in the evaluation of a number of diseases and conditions. LD is an enzyme that is found in almost all of the body's cells (as well as in bacteria) and is released from cells into the fluid portion of blood (serum or plasma) when cells are damaged or destroyed. Thus, the blood level of LD is a general indicator of tissue and cellular damage. The level of LD may also rise in other types of body fluids (e.g.,cerebrospinal fluid, pleural fluid, etc.) in the presence of certain diseases.

An LD blood test may be used:

  • As a general indicator of the existence and severity of acute or chronic tissue damage

  • To detect and monitor progressive conditions such as anemia, including hemolytic anemia and megaoloblastic anemia, or severe infections

  • To help stage, determine prognosis, and/or monitor treatment (i.e., chemotherapy) of cancers, such as germ cell tumors (e.g., some types of testicular cancer and ovarian cancer), lymphoma, leukemia, melanoma, and neuroblastoma

An LD test is performed on body fluids for a few different reasons:

  • To help evaluate cerebrospinal fluid and distinguish between bacterial or viral meningitis

  • To evaluate other body fluids such as pleural, peritoneal or pericardial fluid and help determine whether the accumulation of fluid is due to injury and inflammation (exudate) or due to an imbalance of pressure within blood vessels and the amount of protein in the blood (transudate). This information is helpful in guiding treatment.

The article on Body Fluid Analysis lists some fluids other than blood that may be evaluated with an LD test.


84100 PHOSPHORUS

 

Phosphorus tests are most often ordered along with other tests, such as those for calcium, parathyroid hormone (PTH), and/or vitamin D, to help diagnose and/or monitor treatment of various conditions that cause calcium and phosphorus imbalances. While phosphorus tests are most commonly performed on blood samples, phosphorus is sometimes measured in urine samples to monitor its elimination by the kidneys.


84132 POTASSIUM

 

A potassium test is used to detect abnormal concentrations of potassium, including high potassium (hyperkalemia) and low potassium (hypokalemia). It is often used as part of an electrolyte panel or basic metabolic panel for a routine physical.

Potassium is an electrolyte that is vital to cell metabolism. It helps transport nutrients into cells and removes waste products out of cells. It is also important in muscle function, helping to transmit messages between nerves and muscles, and is important to heart function.

 

The potassium test may be used to help diagnose and/or monitor kidney disease, the most common cause of high blood potassium. It may also be used to evaluate for abnormal values when someone has diarrhea and vomiting, excessive sweating, or with a variety of symptoms. Blood potassium can be abnormal in many diseases. A healthcare practitioner may order this test, along with other electrolytes, to identify an electrolyte imbalance, if metabolic acidosis is suspected, or if there is high blood pressure or other symptoms of illness present. Potassium in particular may be measured when there are symptoms involving the heart.

 

The potassium test may also be used to monitor effects of drugs that can cause the kidneys to lose potassium, particularlydiuretics, or drugs that decrease potassium elimination from the body and result in high potassium.

Urine potassium levels may be tested in people who have abnormal blood potassium levels to help determine the cause, such as dehydration. Urine potassium testing is also used for people with abnormal kidney tests to help the healthcare practitioner determine the cause of kidney disease and to help guide treatment.


84703 HCG QUANT.

 

The quantitative human chorionic gonadotropin (hCG) blood test measures the level of hCG hormone present in a sample of your blood. HCG is a hormone that is produced during pregnancy. Your doctor may refer to the hCG quantitative test by another name, including:

  • quantitative serial beta-hCG test

  • repeat quantitative beta-hCG test

  • beta-hCG blood test

  • quantitative blood pregnancy test

In some cases, the hCG quantitative blood test may also be used to evaluate and manage certain types of cancer.

 

84155 PROTEIN TOTAL

 

The total protein test measures the amount of the proteins albumin and globulin in your body.

It’s usually done as a part of a regular checkup. Your doctor may also order it if you have symptoms like weight loss or fatigue or if you’re showing signs of kidney or liver disease. You’ll need to have blood drawn so a sample can be analyzed in a lab. You should discuss your results with your doctor.  Albumin and globulin are two types of protein in your body. The total protein test measures the total amount albumin and globulin in your body. It’s used as part of your routine health checkup. It may also be used if you have unexpected weight loss, fatigue, or the symptoms of a kidney or liver disease.


86762 RUBELLA

 

The rubella test is used to detect antibodies in the blood that develop in response to a rubella infection or immunization. Rubella testing may be used to:

  • Confirm the presence of adequate protection against the rubella virus (immunity)

  • Detect a recent or past infection

  • Identify those who have never been exposed to the virus and those who have not been vaccinated

  • Verify that all pregnant women and those planning to become pregnant have a sufficient amount (titer) of rubella antibodies to protect them from infection

Rubella is a viral infection that is usually mild and marked by fever and rash that last about 2 to 3 days. The infection usually resolves without treatment. However, if a pregnant woman contracts it for the first time during the first three months of herpregnancy, rubella can cause serious complications in the developing baby (fetus). (For more on this, read the "What is being tested?" section.)

A rubella test may be ordered for a person, pregnant or not, who has symptoms that a health practitioner suspects are due to a rubella infection. It may also be ordered for a newborn who is suspected to have become infected during pregnancy or that presents with congenital birth defects that a health practitioner suspects may be due to a rubella infection.

There are two types of rubella antibodies that lab tests can detect, IgM and IgG:

  • The first type to appear in the blood after exposure is the IgM rubella antibody. The level of this protein rises and peaks in the blood within about 7 to 10 days after infection and then tapers off over the next few weeks, except in an infected newborn, in whom it may be detected for several months to a year.

  • The IgG rubella antibody takes a bit longer to appear than the IgM, but once it does, it stays in the bloodstream for life, providing protection against re-infection. The presence of IgM rubella antibodies in the blood indicates a recent infection while the presence of IgG antibodies may indicate a recent or past rubella infection, or indicate that a rubella vaccine (a measles, mumps, rubella vaccine) has been given and is providing adequate protection.

The IgM rubella test is the standard test for the rapid laboratory diagnosis of rubella. Detection of a rise in IgG rubella in blood samples collected when a person is acutely ill and then as the person begins to recover (convalescent phase) can be used to confirm infection. The antibody tests vary among laboratories and the state health department can provide guidance on available laboratory services and preferred tests.


85651 SED RATE

 

The erythrocyte sedimentation rate (ESR or sed rate) is a relatively simple, inexpensive, non-specific test that has been used for many years to help detect inflammation associated with conditions such as infections, cancers, and autoimmune diseases.

ESR is said to be a non-specific test because an elevated result often indicates the presence of inflammation but does not tell the health practitioner exactly where the inflammation is in the body or what is causing it. An ESR can be affected by other conditions besides inflammation. For this reason, the ESR is typically used in conjunction with other tests, such as C-reactive protein.

ESR is used to help diagnose certain specific inflammatory diseases, temporal arteritis, systemic vasculitis and polymyalgia rheumatica. A significantly elevated ESR is one of the main test results used to support the diagnosis.

This test may also be used to monitor disease activity and response to therapy in both of the above diseases as well as some others, such as systemic lupus erythematosus (SLE).

 

84450 SGOT

 

An aspartate aminotransferase (AST) test measures the amount of this enzyme in the blood. AST is normally found in red blood cells, liver, heart, muscle tissue, pancreas, and kidneys. AST formerly was calledserum glutamic oxaloacetic transaminase (SGOT). Low levels of AST are normally found in the blood.


84460 SGPT

 

This blood test measures an enzyme called alanine transaminase (ALT). Enzymes are chemicals that help the cells of your body work. ALT is an enzyme made in the liver. It is released into the blood when tissues are damaged.

This enzyme is also called serum glutamic-pyruvic transaminase, or SGPT. The ALT test checks for and measures damage to the liver. It is also done to check medical treatments that may affect the liver.


85660 SICKLE CELL

 

A blood test can check for hemoglobin S — the defective form of hemoglobin that underlies sickle cell anemia. In the United States, this blood test is part of routine newborn screening done at the hospital. But older children and adults can be tested, too. In adults, a blood sample is drawn from a vein in the arm.


84295 SODIUM

 

A sodium blood test is used to detect abnormal concentrations of sodium, including low sodium (hyponatremia) and high sodium (hypernatremia). It is often used as part of an electrolyte panel or basic metabolic panel for a routine health checkup.  Sodium is an electrolyte present in all body fluids and is vital to normal body function, including nerve and muscle function. It helps cells function normally and helps regulate the amount of fluid in the body.

 

A blood sodium test may also be used to detect the cause and help monitor treatment in people with dehydration, excess fluid (edema), or with a variety of symptoms (e.g., weakness, confusion, thirst and/or dry mucous membranes). Blood sodium can be abnormal in many diseases. A health practitioner may order this test, along with other electrolytes, to identify an electrolyte imbalance or if there are symptoms of illness involving the brain, lungs, liver, heart, kidney, thyroid, or adrenal glands.

 

In people with a known electrolyte imbalance, a blood sodium test may be used to monitor the effectiveness of treatment or to monitor people taking medications that can affect sodium levels, such as diuretics.

Urine sodium levels may be tested in people who have abnormal blood sodium levels to help determine whether an imbalance is due to, for example, consuming too much sodium or losing too much sodium. Urine sodium testing is also used for people with abnormal kidney tests to help the healthcare practitioner determine the cause of kidney disease and to help guide treatment.


84479 T3 UPTAKE

 

This test was once used to help calculate the Free Thyroxine Index (FTI), an estimation of the free T4 concentration. It is determined from the total T4 test and some estimation of the level of thyroid hormone binding proteins. The T3 uptake test was the original test for estimating the level of binding proteins, and later versions were called T-uptake methods. These are rarely used now that there are methods available to measure free T4 and free T3 directly.


84439 T4 FREE

 

Free thyroxine (free T4) tests are used to help evaluate thyroid function and diagnose thyroid diseases, includinghyperthyroidism and hypothyroidism, usually after discovering that the thyroid stimulating hormone (TSH) level is abnormal.  T4 and another hormone called triiodothyronine (T3) are produced by the thyroid gland. They help control the rate at which the body uses energy and are regulated by a feedback system. TSH stimulates the production and release of T4 (primarily) and T3 from the thyroid gland.  Most of the T4 and T3 circulates in the blood bound to protein, while a small percentage is free (not bound). Blood tests can measure total T4, free T4, total T3, or free T3. The total T4 test has been used for many years, but it can be affected by the amount of protein available in the blood to bind to the hormone. Free T4 is not affected by protein levels and is the active form of thyroxine. The free T4 test is thought by many to be a more accurate reflection of thyroid hormone function and, in most cases, its use has replaced that of the total T4 test.

A free T4 test may be used along with or following a TSH test and sometimes with a free T3 test to:

  • Help detect too much or too little thyroid hormone (hyperthyroidism and hypothyroidism) and diagnose the cause

  • Distinguish between different thyroid disorders

  • Help diagnose pituitary disorders

  • Aid in the diagnosis of female infertility

  • Monitor the effectiveness of treatment in a person with known thyroid disorder

  • Monitor people with pituitary disease, to make sure that the thyroid is still working, and to monitor thyroid hormone treatment if it is not

  • Monitor individuals with thyroid cancer, in which the tumors respond to TSH. TSH and T4 levels will be regularly checked to make sure that enough thyroid hormone is being given to keep TSH low without making T4 too high.

  • In the United States, newborns are commonly screened for T4 levels as well as TSH concentrations to check for congenital hypothyroidism, which can cause mental retardation if left untreated.

Free T4 along with TSH may sometimes be used to screen for thyroid disorders, but expert opinions vary on who can benefit from screening and at what age to begin.

If a health practitioner suspects that someone may have an autoimmune-related thyroid condition, then thyroid antibodiesmay be ordered along with a free T4 test.

 

84436 T4 

 

T4 (thyroxine) is the main hormone produced by the thyroid gland. A laboratory test can be done to measure the amount of T4 in your blood.


84480 TOTAL T3

 

A free or total triiodothyronine (free T3 or total T3) test is used to assess thyroid function. It is ordered primarily to help diagnose hyperthyroidism and may be ordered to help monitor treatment of a person with a known thyroid disorder.

T3 and T4 (thyroxine) are hormones produced by the thyroid gland. They help control the rate at which the body uses energy and are regulated by a feedback system. Thyroid-stimulating hormone (TSH) stimulates the production and release of T4 (primarily) and T3. As needed, T4 is converted into T3 by the liver and other tissues.

Most of the T4 and T3 circulates in the blood bound to protein, while a small percentage is free (not bound). Blood tests can measure total T4 (unbound plus bound), free T4, total T3 (bound plus unbound), or free T3.

Since most T3 is bound to protein, the total T3 can be affected by protein levels and protein binding ability, but the free T3 is not. However, some professional guidelines recommend the total T3, so either test may be used to assess thyroid function. For example, free T3 or sometimes total T3 may be ordered along with thyroid antibodies to help diagnose Graves disease, an autoimmune disorder that is the most common cause of hyperthyroidism.

The free or total T3 test is usually ordered following an abnormal TSH, particularly if the free T4 test is not elevated.


84443 TSH

 

TSH test. A TSH test measures the amount of thyroid stimulating hormone (TSH) in your blood. TSH is produced by the pituitary gland. It tells the thyroid gland to make and release thyroid hormones into the blood.


84403 TESTOSTERONE

 

A testosterone test checks the level of this male hormone (androgen) in the blood. Testosterone affects sexual features and development. In men, it is made in large amounts by the testicles . In both men and women, testosterone is made in small amounts by the adrenal glands , and in women, by the ovaries


84478 TRIGLYCERIDE

 

Triglycerides are a type of fat found in the blood. High levels of triglycerides may raise the risk of coronary artery disease, especially in women. A person's triglyceride levels are measured with a blood test along with testing cholesterol levels in the blood. 


84550 URIC ACID

 

The uric acid blood test is used to detect high levels of this compound in the blood in order to help diagnose gout. The test is also used to monitor uric acid levels in people undergoing chemotherapy or radiation treatment for cancer.


81015 URINALYSIS

 

urinalysis is used as a screening and/or diagnostic tool because it can help detect substances or cellular material in the urine associated with different metabolic and kidney disorders. It is ordered widely and routinely to detect any abnormalities that require follow up. Often, substances such as protein or glucose will begin to appear in the urine before people are aware that they may have a problem. It is used to detect urinary tract infections (UTIs) and other disorders of the urinary tract. In those with acute or chronic conditions, such as kidney disease, the urinalysis may be ordered at intervals as a rapid method to help monitor organ function, status, and response to treatment.

 

Immunology

86255 ANA TITER

 

antinuclear antibody (ANA) test is used as a primary test to help evaluate a person for autoimmune disorders that affect many tissues and organs throughout the body (systemic) and is most often used as one of the tests to help diagnosesystemic lupus erythematosus (SLE).

ANA are a group of autoantibodies produced by a person's immune system when it fails to adequately distinguish between "self" and "nonself." They target substances found in the nucleus of a cell and cause organ and tissue damage.

Depending on a person's signs and symptoms and the suspected disorder, ANA testing may be used along with or followed by other autoantibody tests. Some of these tests are considered subsets of the general ANA test and detect the presence of autoantibodies that target specific substances within cell nuclei, including anti-dsDNA, anti-centromere, anti-nucleolar, anti-histone and anti-RNA antibodies. An ENA panel may also be used in follow up to an ANA.

These supplemental tests are used in conjunction with a person's clinical history to help diagnose or rule out other autoimmune disorders, such as Sjögren syndrome, polymyositis and scleroderma.

Different laboratories may use different test methods to detect ANA. Two common methods include immunoassay and indirect fluorescent antibody (IFA). IFA is considered the gold standard. Some laboratories will use immunoassay to screen for ANA and use IFA to confirm positive or equivocal results.

  • Indirect fluorescent antibody (IFA)—this is a method in which a person's blood sample is mixed with cells that are affixed to a slide. Autoantibodies that may be present in the blood react with the cells. The slide is treated with a fluorescent antibody reagent and examined under a microscope. The presence (or absence) and pattern of fluorescence is noted.

  • Immunoassays--these methods are usually performed on automated instrumentation but may be less sensitive than IFA in detecting ANA.

Other laboratory tests associated with the presence of inflammation, such as erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP), may also be used to evaluate a person for SLE or other autoimmune disese.


 

 

 

 

 


86063 ASO

 

Antistreptolysin O (ASO) titer is a blood test to measure antibodies against streptolysin O, a substance produced by group A Streptococcus bacteria. Antibodies are proteins our bodies produce when they detect harmful substances, such as bacteria.


86140 CRP

 

The C-reactive protein (CRP) test is used by a health practitioner to detect inflammation. CRP is an acute phase reactant, a protein made by the liver and released into the blood within a few hours after tissue injury, the start of an infection, or other cause of inflammation.


86160 C3 COMPLEMENT

 

Complement C3 is a blood test that measures the activity of a certain protein that is part of the complement system. The complementsystem is a group of proteins that move freely through your bloodstream. The proteins work with your immune system and play a role in the development of inflammation.


86161 C4 COMPLEMENT

 

Complement tests, most commonly C3 and C4, are used to determine whether deficiencies or abnormalities in the complement system are causing, or contributing to, a person's disease or condition. Total complement activity (CH50 or CH100) may be ordered to look at the integrity of the entire classical complement pathway. Other complement components are ordered as needed to look for deficiencies.

Complement testing may be used to:

  • Help diagnose the cause of recurrent microbial infections (such as Streptococcus pneumoniae, Neisseria meningitides,Neisseria gonorrhea), angioedema, or inflammation.

  • Help diagnose and monitor the activity and treatment of acute or chronic autoimmune diseases such as systemic lupus erythematosus (SLE) and rheumatoid arthritis.

  • Monitor immune complex-related diseases and conditions such as glomerulonephritis (a kidney disorder), serum sickness, and vasculitis.

 

86677 HELICOBACTER PYLORI
 

Helicobacter pylori testing is used to diagnose an infection due to the bacteria and to evaluate the effectiveness of treatment. H. pylori infection is associated with an increased risk of developing ulcers (peptic ulcer disease), chronic gastritis, and gastric (stomach) cancer.

There are several different types of H. pylori testing that can be performed. Some require a sample of breath or stool while others are more invasive and require a tissue sample obtained using a procedure called endoscopy. Tests include:

 

Without Endoscopy

 

Stool/fecal antigen testDetects the presence of H. pylori antigen in a stool sample

Urea breath testA person drinks a liquid containing a low level of radioactive material that is harmless or a nonradioactive material. If H. pylori is present in the person's gastrointestinal tract, the material will be broken down into "labeled" carbon dioxide gas that is expelled in the breath.

H. pyloriantibody testingTest not recommended for routine diagnosis or for evaluation of treatment effectiveness. Detects antibodiesto the bacteria and will not distinguish previous infection from a current one. If test is negative, then it is unlikely that a person has had an H. pylori infection. If ordered and positive, results should be confirmed using stool antigen or breath test.

 

With Endoscopy: tissue biopsy sample obtained; good tests but less frequently ordered because invasive

 

HistologyTissue examined under a microscope by a pathologist, who will look for H. pylori bacteria and any other signs of disease that may explain a person's symptoms.

Rapid urease testingH. pylori produces urease, an enzyme that allows it to survive in the acidic environment of the stomach. The laboratory test can detect urease in the tissue sample.

CultureThe bacteria are grown on/in a nutrient media; results can take several weeks. This test is necessary if the health practitioner wants to evaluate which antibiotic will likely cure the infection. (See alsoSusceptibility Testing.)

PCR (polymerase chain reaction)Fragments of H. pylori DNA are amplified and used to detect the bacteria; primarily used in a research setting.

The stool antigen test and urea breath test are recommended for the diagnosis of an H. pylori infection and for the evaluation of the effectiveness of treatment. These tests are the most frequently performed because they are fast and noninvasive. Endoscopy-related tests may also be performed to diagnose and evaluate H. pylori but are less frequently performed because they are invasive.

The testing recommendations come from recently published guidelines by the American Gastroenterology Association (AGA), the American College of Gastroenterologists (ACG), and the Infectious Diseases Society of America (IDSA) / the American Society for Microbiology (ASM).

 

86300 MONO TEST
 

Mononucleosis tests are blood tests to look for antibodies that indicatemononucleosis (mono), which is usually caused by the Epstein-Barr virus (EBV). The antibodies are made by the immune system to fight an infection. Mono tests include: Monospot test (heterophiltest).

 

Hormones

82533 CORTISOL

 

A cortisol test is done to measure the level of the hormone cortisol in the blood. The cortisol level may show problems with the adrenal glands or pituitary gland. Cortisol is made by the adrenal glands .Cortisol levels go up when the pituitary gland releases another hormone called adrenocorticotropic hormone (ACTH).

 

84999 DHEA-S
 

DHEA-S (dehydroepiandrosterone sulfate) is a male hormone (androgen) that is made in the adrenal glands. The body turns it intotestosterone. A test for DHEA-S checks the level of this hormone in theblood.

Testosterone affects sexual features and development. In men, it is made in large amounts by the testicles. In both men and women, testosterone is made in small amounts by the adrenal glands. In women, small amounts are made by the ovaries.

 

Why It Is Done

 

This test is usually done along with tests of other hormone levels. DHEA-S might be tested to:

  • Look for the cause of facial hair, a deep voice, or other signs of too much male hormone in a girl or woman. It may be one of the tests done to diagnose polycystic ovary syndrome.

  • To help find other conditions, such as:

    • Congenital adrenal hyperplasia. This is a condition that causes the adrenal glands to make too much male sex hormone.

    • Infertility.

    • Delayed puberty.

    • Cushing's disease.

    • A tumor in an adrenal gland.

       

 

82670 ESTRADIOL

 

An estradiol test is a blood test that measures the amount of estradiolin your blood. It's also called an E2 test. Estradiol is a form of the hormone estrogen, and it's also called “17 beta-estradiol.” The ovaries, breasts, and adrenal glands make estradiol.


83001 FSH

 

The test for follicle-stimulating hormone (FSH), a hormone associated with reproduction and the development of eggs in women and sperm in men, has several uses.

In both women and men, the test may be used with other hormone tests such as luteinizing hormone (LH), testosterone,estradiol, and/or progesterone to help:

  • Determine the cause of infertility

  • Diagnose conditions associated with dysfunction of the ovaries or testicles

  • Aid in the diagnosis of pituitary or hypothalamus disorders, which can affect FSH production

In women, FSH levels are also useful in:

  • The investigation of menstrual irregularities

  • Predicting onset or confirmation of menopause

In men, FSH levels are used to help determine the reason for a low sperm count.

In children, FSH and LH are used to help diagnose delayed or precocious (early) puberty. Irregular timing of puberty may be an indication of a more serious problem involving the hypothalamus, the pituitary gland, the ovaries or testicles, or other systems. The measurement of LH and FSH may differentiate between benign symptoms and true disease. Once it is established that symptoms are a result of true disease, further testing can be done to discern the underlying cause

 

83002 LH
 

The test for luteinizing hormone (LH), a hormone associated with reproduction and the stimulation of the release of an egg from the ovary (ovulation) in women and testosterone production in men, has several uses.

In both women and men, LH is often used in conjunction with other tests (FSH, testosterone, estradiol and progesterone):

  • In the workup of infertility

  • To aid in the diagnosis of pituitary disorders that can affect LH production

  • To help diagnose conditions associated with dysfunction of the ovaries or testicles

In women, LH levels are useful:

  • In the investigation of menstrual irregularities

  • To evaluate LH levels during the menstrual cycle; multiple urine LH tests may be ordered for this purpose. These LH "spot tests" can be performed at home and used to detect the surge in LH that indicates that ovulation will occur in the next 1-2 days. The tests can help determine when a woman is likely to be the most fertile.

In children, FSH and LH are used to diagnose delayed and precocious (early) puberty. Irregular timing of puberty may be an indication of a more serious problem involving the hypothalamus, the pituitary gland, the ovaries or testicles, or other systems. The measurement of LH and FSH may differentiate between benign symptoms and true disease. Once it is established that symptoms are a result of true disease, further testing can be done to discern the underlying cause.

In persons with evidence of poor ovarian or testicular function, LH is sometimes measured in response to administration of gonadotropin releasing hormone (GnRH) to distinguish between disorders involving the hypothalamus or pituitary gland. GnRH is the hormone produced by the hypothalamus that stimulates the pituitary to release LH and FSH. For this test, a baseline blood sample is drawn and then the person is given an injection of GnRH. Subsequent blood samples are drawn at specified times and the level of LH is measured. This test can help differentiate between a disorder of the pituitary (secondary), when LH will not respond to GnRH, or hypothalamus (tertiary), when LH responds to GnRH. It is also often helpful in the evaluation of precocious or delayed puberty.

 

84144 PROGESTERONE

 

 progesterone test may be used:

  • To help recognize and manage some causes of infertility. Since progesterone levels vary throughout the menstrual cycle, multiple (serial) measurements can be used for this purpose.

  • To determine whether or not a woman has ovulated, when ovulation occurred, or to monitor the success of induced ovulation

  • In early pregnancy to help diagnose an ectopic or failing pregnancy, along with human chorionic gonadotropin (hCG) testing 

  • To monitor a high-risk pregnancy to help evaluate placenta and fetal health

  • If a woman is receiving progesterone injections to help support her early pregnancy, to help determine the effectiveness of the replacement treatment

  • Along with other tests such as an FSH, LH, hCG, thyroid tests, clotting tests, and a complete blood count (CBC) to help determine the cause of abnormal uterine bleeding in non-pregnant women

 


84146 PROLACTIN

 

rolactin (also called PRL or lactogenic hormone) is a hormone produced by the pituitary gland in the brain. Prolactin plays an important role in the reproductive health of both women and men. Its main role, however, is to stimulate the production of milk in women after childbirth.


84403 TESTOSTERONE

 

A testosterone test checks the level of this male hormone (androgen) in the blood. Testosterone affects sexual features and development. In men, it is made in large amounts by the testicles . In both men and women, testosterone is made in small amounts by the adrenal glands , and in women, by the ovaries .

 

Toxicology

Tumor Markers

 

Tumor markers are substances, often proteins, that are produced by the cancer tissue itself or sometimes by the body in response to cancer growth. Because some of these substances can be detected in body samples such as blood, urine, and tissue, these markers may be used, along with other tests and procedures, to help detect and diagnose some types of cancer, predict and monitor a person's response to certain treatments, and detect recurrence.

More recently, the idea of what constitutes a tumor marker has broadened. Newer types of tests have been developed that look for changes in genetic material (DNA, RNA), rather than proteins, in patient samples. The genetic changes have been found to be associated with certain cancers and can be used as tumor markers to help determine prognosis, guide targeted treatment, and/or detect cancers early on. Moreover, advances in technology have led to tests that can evaluate several genetic markers or panels of markers at the same time, providing expanded information about characteristics of a tumor. Examples of these are included, along with more traditional tumor markers, in the table within this article.

While quite a few tumor markers are available and have been found to be clinically useful, others are available but not ordered frequently because they have been found to be less sensitive and/or specific. Still others are currently used only in research settings and continue to be evaluated in clinical trials. With ongoing research, and as the field continues to evolve, it is likely that more tumor markers with greater effectiveness will come on the market in the coming years, eventually replacing less useful ones.

Limitations

While tumor marker tests can provide very useful information, they do have limitations:

  • Many tumor markers may also be elevated in persons with diseases other than cancer.

  • Some tumor markers are specific for a particular type of cancer, while others are seen in several different types of cancer.

  • Not every person with a particular type of cancer will have an elevated level of the corresponding tumor marker.

  • Not every cancer has a tumor marker that has been identified as associated with it.

Consequently, tumor markers alone are not diagnostic for cancer; for some types of cancer, they provide additional information that can be considered in conjunction with a patient's medical history and physical exam as well as other laboratory and/or imaging tests.

 

86244 ALPHA-FETO PROTEIN

 

AFP is used as a tumor marker to help detect and diagnose cancers of the liver, testes, and ovaries. Though the test is often ordered to monitor people with chronic liver diseases such as cirrhosis, chronic hepatitis B or hepatitis C because they have an increased lifetime risk of developing liver cancer, most current guidelines do not recommend this use. A doctor may order an AFP test, along with imaging studies, to try to detect liver cancer when it is in its earliest and most treatable stages.

If a person has been diagnosed with hepatocellular carcinoma or another form of AFP-producing cancer, an AFP test may be ordered periodically to help monitor the person's response to therapy and to monitor for cancer recurrence.

An AFP-L3% is sometimes also ordered to compare the amount of the AFP variant called AFP-L3 to the total amount of AFP. The AFP-L3% test is not yet widely used in the U.S. but has gained wider acceptance in other countries such as Japan. The test is used to help evaluate the risk of developing hepatocellular carcinoma, especially in those with chronic liver disease, and also to evaluate response of hepatocellular carcinoma to treatment.


86316 CA-125
 

A CA 125 test measures the amount of the protein CA 125 (cancerantigen 125) in your blood. A CA 125 test may be used to monitor certain cancers during and after treatment. In some cases, a CA 125 test may be used to look for early signs of ovarian cancer in women with a very high risk of the disease.

 

36151 CEA

 

The carcinoembryonic antigen (CEA) test measures the amount of this protein that may appear in the blood of some people who have certain kinds of cancers, especially cancer of the large intestine (colon and rectal cancer). It may also be present in people with cancer of the pancreas, breast, ovary, or lung

 

86316 PSA

 

Prostate-specific antigen, or PSA, is a protein produced by cells of the prostate gland. The PSA test measures the level of PSA in a man's blood. For this test, a blood sample is sent to a laboratory for analysis. The results are usually reported as nanograms of PSA per milliliter (ng/mL) of blood.

 

 

 

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