will often order Blood tests on a regular basis to monitor your health.
The Blood chemistry test, also known as the Complete Metabolic Profile (CMP),
measures some of the most important chemicals required and produced by your
body, to function properly, Blood chemicals like those produced by the liver, as
well as nutritional elements such as vitamins, proteins,
fats, and sugar. A CMP can involve dozens of
different tests, but the tests as ordered usually measure many chemicals. We may
order only a Basic Metabolic Profile (BMP) which has just electrolytes, sugar
and kidney test. A blood count (CBC) measures your blood cells, not chemicals in
the blood. Tests may be ordered
individually since some insurances such as Medicare require a specific reason
for each test. Some important
tests are discussed below.
Total Protein (TP) - A rough measure of the total amount of
serum protein in your body. Protein measurements can reflect not only liver
disease, but nutritional state, kidney disease, and many other conditions as
well. If the total protein result is abnormal, further tests must be performed
to identify which protein fraction, and then which specific protein, is
Albumin - The most abundant protein found in Blood plasma,
representing 40% to 66% of the total protein in your body. Albumin keeps water
inside your Blood vessels. Reduced levels of albumin may reflect a variety of
conditions, including primary liver disease, increased breakdown of
macromolecules resulting from tissue damage or inflammation, malnutrition,
malabsorption syndromes, and renal diseases.
Globulin - Globulins are a diverse group of proteins in the
Blood that grouped together represent the second most common proteins (after
albumin) in the Bloodstream. Globulin is actually made up of about 60
different important proteins and is one of the components that help to fight
infections. Some of the proteins in this group play an important role in
Blood clotting. An elevation in the level of serum globulin can indicate the
presence of cirrhosis of the liver.
ALT/SGPT (Alanine Aminotransferase) - Found mainly in the
liver, the activity of this enzyme is measured in Blood plasma. Damage from
alcohol, strenuous exercise, some medications and a number of diseases can
cause high test values. Elevated levels of this enzyme can be an indication of
viral hepatitis and other forms of liver disease.
AST/SGOT Aspartate Aminotransferase - An
increase of aspartate aminotransferase (AST, formerly referred to as
"SGOT") is found in any condition involving necrosis of hepatocytes,
myocardial cells, or skeletal muscle cells. As in AST/SGPT, damage from alcohol,
strenuous exercise, some medications and a number of diseases can cause
high test values. Decreased serum AST is of no known clinical significance.
Bilirubin, Total - The coloring agent in the Blood that makes
the plasma (serum) part of your Blood yellow. When the bilirubin level is very
high for an extended period of time, the whites of your eyes and even your
skin may become yellow (jaundice). Bilirubin comes from the breakdown of old red
cells in the Blood. Total bilirubin is increased most commonly in liver disease
(hepatitis, malignancy, advanced cirrhosis) and due to obstruction of the
biliary system (gall stones, pancreatic cancer). Severe haemolytic anaemia can
cause moderate increases which are almost entirely made up of the unconjugated
fraction. Moderate to marked hyperbilirubinaemia is seen in some neonates
especially if premature and can be caused by inborn errors of bilirubin
metabolism or transport is a small number of cases.
Bilirubin, Direct - A specific form of bilirubin
(conjugated) that is formed in the liver and excreted in bile. Under normal
conditions very little of this form of bilirubin is found in the Blood. In liver
disease, however, this form of bilirubin enters the Bloodstream so that even
a slightly high level may indicate a problem with the liver cells, an
obstruction of the bile ducts, or impairment of liver cell function.
Alkaline Phosphatase - An enzyme found in all body tissue, but
primarily in bones, bile ducts and in the liver. A high level may indicate bone,
liver, or bile duct disease. Some drugs may also cause increased levels.
Expected values are higher for those who are growing (children and pregnant
women) or when damage to bones or liver has occurred or with a gallstone
condition. Low values are probably not significant.
KIDNEY / Electrolytes
BUN (Blood Urea Nitrogen) - A waste product, derived from
protein breakdown, produced in the liver and excreted by way of the kidneys.
High values may mean that the kidneys are not working as well as they should.
BUN is also elevated by Blood loss, dehydration, high protein diets and/or
strenuous exercise which may temporarily and artificially raise levels. A low
BUN level may be the result of liver disease, a low protein diet,
pregnancy, or drinking an extreme amount of water. Normal BUN levels should be
between eight and 23 milligrams per deciliter of Blood (mg/dL); normal
creatinine levels should be between 0.7 and 1.3 mg/dL.
Creatinine - A waste product largely from muscle metabolism
(breakdown). Concentration of creatinine in the Blood depends upon the amount of
muscle that you have and the ability of your kidneys to excrete creatinine.
High values, especially with high BUN levels, may indicate problems with the
kidneys. Because of its insensitivity in detecting early renal failure, the
creatinine clearance is significantly reduced before any rise in serum
creatinine occurs. The renal impairment may be due to intrinsic renal lesions,
decreased perfusion of the kidney, or obstruction of the lower urinary tract.
Low values are generally not considered significant.
BUN/Creatinine Ratio - By comparing the BUN level in the Blood
to the creatinine level, your physician can determine if a high BUN level
is caused by kidney disease, dehydration, or by gastrointestinal bleeding.
Calcium - Controlled in the Blood by the parathyroid glands and
the kidneys, calcium is one of the most important elements in the body.
Virtually all of the calcium in your body is found in bone (99%). That other 1%
is very important for proper Blood clotting, nerve, and cell and enzyme
activity. The parathyroid gland is the main regulator of calcium in the body. An
elevated calcium can be due to medication, inherited disorders of calcium
handling in the kidneys, bone disease, or excess parathyroid gland activity or
vitamin D. Low calcium can be due to malnutrition, drugs and certain metabolic
disorders and should be re-evaluated.
Sodium - An electrolyte regulated by the kidneys and adrenal
glands. This element plays an important role in the water/salt balance in your
body. There are numerous causes of high and low sodium levels, but the most
common causes of low sodium are diuretic usage, and excessive water intake in
patients with heart or liver disease. A high level can be caused by an
excessive intake of salt or even an insufficient intake of water. Sodium levels
should be between 136 and 144 millimoles per liter of Blood (mmol/L).
Potassium - Controlled very carefully by the kidneys, potassium
is an electrolyte found primarily inside cells. Its role is to maintain
water balance inside the cells and to help in the transmission of nerve
impulses. It is very important for the proper functioning of the nerves and
muscles, particularly the heart. Any value outside the expected range, high or
low, requires immediate medical evaluation. This is especially important if you
are taking a diuretic (water pill) or heart pill (Digitalis, Lanoxin, etc.) A
low potassium level can cause muscle weakness and heart problems. A high potassium
level can be found in kidney disease or in over ingestion of potassium
supplements. Potassium levels should be between 3.6 and 5.1 mmol/L.
Chloride - Important to the function of nerves, muscles,
and cells. Chloride is an electrolyte regulated by the kidneys and adrenal
glands. It is usually associated with a high or low level of sodium or
potassium. Increase in serum chloride is seen in
dehydration, renal tubular acidosis, acute renal failure, diabetes insipidus,
prolonged diarrhea, and some other rare conditions or medications.
Some drugs cause decreased chloride levels. Levels should be between 99
and 108 mmol/L.
- Reflects the acid status of your Blood. Abnormally high or low levels may
indicate severe problems if you have had prolonged vomiting, are on lots of
fluid pills or if you have out of control diabetes. Normal values for CO2
in Blood range from 20 to 29 milliequivalents per liter (mEq/L).
Total Cholesterol - Cholesterol in itself is not all bad, in
fact, our bodies need a certain amount of this substance to function properly.
When the level gets too high, however, serious problems can result. Levels of
200 or more are considered too high for good health. Levels of 240 and above are
considered very high risk, and may indicate the need for cholesterol lowering
medication. A low fat diet and regular exercise are recommended. As the level of
Blood cholesterol increases, so does the possibility of plugging the arteries
due to cholesterol plaque build-up. Such a disease process is called
"hardening of the arteries" or atherosclerosis. When the arteries
feeding the heart become plugged, a heart attack may occur. If the arteries that
go to the brain are affected, then the result is a stroke.
HDL Cholesterol - (High Density Lipoprotein) A ‘good
cholesterol’ as it protects against heart disease by helping remove excess
cholesterol deposited in the arteries. High levels seem to be associated with
low incidence of coronary heart disease. Latest guidelines recommend a HDL
>45. If your level is below 30,
it can signal a significant risk of early heart disease.
Tryglycerides - Fat carried in the Blood. Normal triglycerides
should be between 50 and 200 mg/dL. Triglyceride levels over 150 mg/dl may be
associated with problems other than heart disease. If levels exceed 500 mg/dL,
the situation is considered acute. The ways to lower triglycerides are: 1)
weight reduction, if overweight; 2) reduce animal fats in the diet: eat more
fish; 3) take certain medications that your physician can prescribe such as
Lopid, Tricor or Niacin; 4) get regular aerobic exercise; and, 5) decrease
alcohol and sugar consumption. Alcohol and sugar are not fats, but the body can
convert them into fats, then dump those fats into your Blood stream. High
triglycerides are also associated with pancreatitis.
LDL Cholesterol - (Low Density Lipoprotein) Considered
"bad cholesterol" because cholesterol deposits form in the arteries
when LDL levels are high. An LDL level of less than 130 is recommended; 100
is ideal; values greater than 160 are considered high risk and should be
followed up by your physician. Those persons who have established coronary or
vascular disease or Diabetes may be instructed by their doctor to get their LDL
Cholesterol well below 100. You should ask your doctor which LDL target he or
she wants for you.
VLDL Cholesterol - (Very Low Density Lipoprotein) A type of
cholesterol found in the Blood that is considered to be the most dangerous form
of lipoprotein. They carry the least amount of protein and the most amount of
fat. They also stick to artery walls and contribute to plaque build-up.
CK/CPK - An enzyme which is very useful for diagnosing diseases
of the heart and skeletal muscle. This enzyme is the first to be elevated after
a heart attack (three to four hours). If CPK is high in the absence of
heart muscle injury, this is a strong indication of skeletal muscle disease.
Sometimes this is checked to monitor possible muscle irritation from cholesterol
LDH - The enzyme present in all human cells. Anything that
damages cells, including Blood drawing itself, will raise amounts in the Blood.
If Blood is not processed promptly and properly, high levels may occur. If all
values except LDH are within expected ranges, it is probably a processing error
and does not require further evaluation.
Calcium - Increased levels of plasma calcium may indicate the presence of
malignant disease or hyperparathyroidism. Less commonly, it could reflect
thyrotoxicosis, vitamin D intoxication, the use of thiazide diuretics,
sarcoidosis, and other disorders. Reduced levels of calcium may reflect vitamin
D deficiency, renal disease, hypoparathyroidism, magnesium deficiency and other
(ALP) - Alkaline phosphatases are a family of enzymes that are present
throughout the body, but the most important places are in bone, liver and bile
ducts,. Elevated levels of ALP are associated with liver and bile duct disorders
and bone diseases. Growing children, because of bone growth, normally have
higher levels than adults. Low values are not generally considered significant.
Glucose - Glucose is a chief source of energy for all
living organisms. Elevated Blood glucose levels (hyperglycemia), in someone who has
fasted for 12 hours, may be an indication of diabetes mellitus if the fasting
level is above 124. Lower-than-normal Blood glucose levels (hypoglycemia) may
mean too much insulin in your Blood, or could be caused in a variety of
other ways, often transiently, and must be carefully examined under specific
clinical conditions before expanding the diagnosis.
Iron - The body must have iron to make hemoglobin and to
help transfer oxygen to the muscles. If the human body is low in iron, all
body cells, particularly muscles in adults, do not function properly.
Conversely, too much iron can cause injury to the heart, pancreas, joints,
and genital parts in both males and females. Excess iron is found in the
hereditary Blood disease called hemochromatosis.
Ferritin - Measured to assess the amount of iron, important for
red Blood cell production, in the body. Ferritin is useful for early detection
of iron deficiency. Ferritin is the major iron storage protein. The serum
ferritin level is directly proportional to the amount of iron stored in the
Magnesium - Magnesium, a Blood salt, found primarily inside the
cells, helps regulate energy production in the cells, and is necessary for nerve
function. This test is not often ordered for adults.
Phosphorus - Phosphorus is closely associated with calcium in
bone development. Most of the phosphorus in the body is found in the bones.
An adequate phosphorus level in the Blood is very important for muscle and nerve
function. Increased levels of plasma phosphate ion may indicate imminent renal
failure, hypoparathyroidism, acromegaly, excessive phosphate intake, and vitamin
D intoxication. Sharply decreased levels of plasma phosphate may reflect
starvation or malnutrition, vitamin D deficiency, primary hyperparathyroidism,
magnesium deficiency, and diabetic ketoacidosis.
These tests are the most commonly used Blood test tool to
measure the number and amount of formed elements in the Blood. Formed elements
include red Blood cells, white Blood cells,
COMPLETE BLOOD COUNT
Red Blood Cells (RBC) - Also called erythrocytes, RBCs are
responsible for delivering oxygen throughout the body. There are between 3.6 to
6.1 million red Blood cells in a single cubic millimeter of Blood. Anemia, a
condition generally defined as a decreased number of red Blood cells, can be
caused by certain anti-HIV drugs or be a sign of an underlying illness. Women of
child-bearing age may also experience anemia as a result of Blood loss from
their menstrual periods. One of the most common physical symptoms of anemia is
Hemoglobin (HGB) - A protein which enables the RBCs to
distribute oxygen throughout the body. A hemoglobin test is done when a person
is ill or during a general physical examination. Good health requires an
adequate amount of hemoglobin. The amount of oxygen in the body tissues depends
on how much hemoglobin is in the red cells. Without enough hemoglobin, the
tissues lack oxygen, and the heart and lungs must work harder to try to
compensate. If the test indicates a "less than" or "greater
than" normal amount of hemoglobin, the cause of the decrease or increase
must be discovered. A low hemoglobin usually means the person has anemia. Anemia
results from conditions that decrease the number or size of red cells, such as
excessive bleeding, a dietary deficiency, destruction of cells because of a
transfusion reaction or mechanical heart valve, or an abnormally formed
hemoglobin. A high hemoglobin may be caused by polycythemia vera, a disease in
which too many red Blood cells are made. Hemoglobin levels also help determine
if a person needs a Blood transfusion. Normal hemoglobin levels range from 12 to
16 grams per deciliter (g/dL) of Blood. Usually a person's hemoglobin must be
below eight gm/dl before a transfusion is considered.
Hematocrit - Hematocrit measures the percentage of Blood
that is occupied by RBCs. Generally speaking, red Blood cells should make up 40%
to 52% of the total Blood volume in men and 35% to 46% in women. The hematocrit
is a compound measure of red Blood cell number and size.
Calculated Results (Indices) - The values that measure hemoglobin,
hematocrit, and platelet components found in red Blood cells. There are five
- (Mean Corpuscular Volume) - Measures the average size of red Blood
cells. Range: 80 to 95 femtoliter;
(Mean Corpuscular Hemoglobin) - Reflects the average weight of
hemoglobin found in the red Blood cell. Range: 27 to 31 pg/cell;
(Mean Corpuscular Hemoglobin Concentration) - reflects the average amount
of hemoglobin in the red Blood cell. Range: 32 to 36 gm/dl;
(Mean Platelet Volume) - Reflects the average volume of platelets.
Range: 7.4 - 10.4 fL; and,
RDW (Red Blood Cell Distribution Width) - Reflects the distribution of
the size of the red Blood cell population. Range: 2 to 8% of
white Blood cells.
WHITE BLOOD CELLS
Neutrophils - Neutrophilia (>25,000/µL) brings up the
problem of hematologic malignancy (leukemia, myelofibrosis) versus reactive
leukocytosis, including "leukemoid reactions." Laboratory tests of
this problem may include expert review of the peripheral smear, leukocyte
alkaline phosphatase, and cytogenetic analysis of peripheral Blood or marrow
granulocytes. Neutropenia may be found in certain
infections, including typhoid fever, brucellosis, viral illnesses, rickettsioses,
and malaria. Other causes include aplastic anemia (see list of drugs above),
aleukemic acute leukemias, thyroid disorders, hypopitituitarism, cirrhosis, and
Lymphocytes - Lymphocytosis is seen in
infectious mononucleosis, viral hepatitis, cytomegalovirus infection, other
viral infections, pertussis, toxoplasmosis, brucellosis, TB, syphilis,
lymphocytic leukemias, and lead, carbon disulfide, tetrachloroethane, and
arsenical poisonings. A mature lymphocyte count >7,000/µL in an individual
over 50 years of age is highly suggestive of chronic lymphocytic leukemia (CLL).
Drugs increasing the lymphocyte count include aminosalicyclic acid, griseofulvin,
haloperidol, levodopa, niacinamide, phenytoin, and mephenytoin. Lymphopenia
is a characteristic indication of AIDS. It is also seen in acute infections,
Hodgkin's Disease, systemic lupus, renal failure, carcinomatosis, and with
administration of corticosteroids, lithium, mechlorethamine, methysergide,
niacin, and ionizing irradiation. Of all hematopoietic cells lymphocytes are the
most sensitive to whole-body irradiation, and their count is the first to fall
in radiation sickness.
Eosinophils - Eosinophilia is seen in
allergic disorders and invasive parasitoses. Other causes include pemphigus,
dermatitis herpetiformis, scarlet fever, acute rheumatic fever, various
myeloproliferative neoplasms, irradiation, polyarteritis nodosa, rheumatoid
arthritis, sarcoidosis, tuberculosis, coccidioidomycosis, smoking,
idiopathically as an inherited trait, and in the resolution phase of many acute
infections. Eosinopenia is seen in the early phase of
acute insults, such as shock, major pyogenic infections, trauma, surgery, etc.
Drugs producing eosinopenia include corticosteroids, epinephrine, methysergide,
niacin, niacinamide, and procainamide.
Basophils - Basophilia, if absolute and
of marked degree, is a great clue to the presence of myeloproliferative disease
as opposed to leukemoid reaction. Other causes of basophilia include allergic
reactions, chickenpox, ulcerative colitis, myxedema, chronic hemolytic anemias,
Hodgkin's Disease, and status post-splenectomy. Estrogens, antithyroid drugs,
and desipramine may also increase basophils.
Platelets are cells in the Blood which are necessary to help Blood clot. A
normal platelet count is between 150 to 440 thousand per cubic millimeter. Low
platelet counts are called thrombocytopenia which can be caused by some drugs.
Pancreatic Tests –
Amylase and Lipase, enzymes produced by the pancreas to aid in the digestion of
carbohydrates, are strong indicators of pancreatic disease (pancreatitis) if
they are elevated. Pancreatitis, if not properly dealt with, can cause serious
nutritional problems and even death. Pancreatitis, diagnosed early, is most
often reversible once revealed and treated. Amylase is also found in saliva, and
elevated Blood levels of amylase are sometimes due to leakage from the salivary
glands. Further tests can be done to distinguish between these two sources of
Unlike microbiological tests, which look for the presence of a disease causing
microorganism, serologic tests most often look for specific antibodies produced
by the immune system in response to specific disease causing microorganisms.
Also unlike microbiology tests, serology tests are very useful to determine if
the patient has been exposed to an infection before they begin showing signs of
– STS or VDRL - Syphilis is a potentially fatal bacterial infection usually
spread via sexual activity (i.e., vaginal, or oral, or anal sex). If detected
and treated early, usually during the first year of infection, syphilis can be
controlled. If left unchecked, it becomes much more difficult to treat and can
result in serious disease of the brain and death. It is generally recommended
that those who are sexually active be tested for syphilis antibodies at least
annually. Serology testing can also be used to determine if the infection has
responded effectively to therapy.
Hepatitis B and
Hepatitis C Serology -
Hepatitis B virus (HBV) and Hepatitis
C virus (HCV) can both cause liver problems. HBV is not usually
fatal, but can cause liver problems in a small percentage of those infected. HCV,
on the other hand, can cause serious liver disease in the majority of patients
infected with the virus.
- Infectious mononucleosis is a viral disease that affects certain Blood cells.
It is caused by the Epstein-Barr virus (EBV), which is a member of the herpes
- This test is sometimes checked to
see if prolonged fevers or fatigue are caused by this difficult virus.
Antibodies are checked to see if there is signs of recent or past
infections. Most people develop
antibodies eventually, but if the early antibodies are present, it may give us a
clue to a recent infection causing symptoms.
HIV Antibody Testing
- This test has remained one of the least expensive, most reliable methods of
diagnosing HIV. HIV antibody testing also allows patients to find out their
status many years before they get sick, allowing them to start medication to
treat HIV. Results of this test cannot be given over the phone and you must sign
a form explaining the HIV test before we can send it.
There are some tests that do not easily fit into any of the other categories. We
group them together here.
There are two often utilized types of thyroid hormones easily measurable in the
Blood, thyroxine (T4) and triiodothyronine (T3). For technical
reasons, it is easier and less expensive to measure the TSH and that usually
tells us what is wrong, if that is off we may also measure FreeT4 level, but T3
is usually not measured on screening tests.
Hormone (TSH) -
This protein hormone is secreted by the pituitary gland and regulates the
thyroid gland. A high level suggests your thyroid is underactive, and a low
level suggests your thyroid is overactive.
This is usually the test used to screen for high or low thyroid and
monitor dosage of medications suchas Synthroid, Levoxyl, Unithroid, etc.
or Thyroid Uptake - This test often causes confusion. This is
NOT a thyroid test, rather a test on the proteins that carry thyroid around in
your Blood stream. Moreover, a high test number may indicate a low level of the
protein. The method of reporting varies from lab to lab. The test is to compute
the free thyroxine index.
(T4) - This shows the total amount of the T4. High levels may
be due to hyperthyroidism, however technical artifact occurs when estrogen
levels are higher from pregnancy, birth control pills or estrogen replacement
therapy. A Free T4 (see below) can avoid this interference.
Free Thyroxine Index
(FTI or T7) - A mathematical computation
allows the lab to estimate the free thyroxine index from the T4 and T3 Uptake
tests. The results tell us how much thyroid hormone is free in the Blood stream
to work on the body. Unlike the T4 alone, it is not affected by estrogen levels.
- This test directly measures the free T4 in the Blood rather than estimating it
like the FTI. It is a more reliable, but a little more expensive test. Some
labs now do the Free T4 routinely rather than the Total T4.
- This test is usually ordered when thyroid disease is being evaluated. T3 is
the stronger and shorter lived version of thyroid hormone. Some people with high
thyroid levels secrete more T3 than T4. In these (overactive) hyperthyroid cases
the T4 can be normal, the T3 high, and the TSH low. The Total T3 reports the
total amount of T3 in the Bloodstream, including T3 bound to carrier proteins
plus freely circulating T3.
- This test measures the amount of thyroid hormone T3 that is "free"
or not bound to carrier proteins.
Blood Sugar / Diabetes
This is a measure of the sugar level in your Blood. High values are associated
with eating before the test, and diabetes. The normal range for a fasting
glucose is 60 to125 milligrams per deciliter of Blood (mg/dL). According to ADA
criteria, diabetes is diagnosed with a fasting plasma glucose of 126 or more. A
precursor, Impaired Fasting Glucose (IFG) is defined as reading of fasting
glucose levels of 110 to 125. Sometimes a glucose tolerance test, which involves
giving you a sugary drink followed by several Blood glucose tests, is necessary
to properly sort out normal from IFG from diabetes.
NOTE: Variations in lab 'normals'
exists, and Europeans tend to use a 'two hour after eating' definition of
diabetes rather than a fasting glucose. Using the European standard tends to
increase the number of people who are classified as having diabetes.
A1 or A1c, HbA1c) - Glycohemoglobin measures the amount of glucose chemically
attached to your red Blood cells. Since Blood cells live about three months, it
tells us your average glucose for the last six to eight weeks. A high level
suggests poor diabetes control. Normal HbA1C is below 5 or so, the goal in
Diabetes care is to keep it below 7. If
this number is above 8 it is definitely time to change medications or treatment
for your sugar.
is a blood test that gives us a look at average blood sugar over a 2 to 3
week period. It allows us to make
changes in medication without waiting the full 3 months before we can test the
HbA1C again. Sometimes this can be
done on a machine n the office, other times it is sent to the lab.
This is a test measured in the urine.
It shows up protein much earlier than the usual urine test done with the
dipstick. If this level is above
normal I a diabetic, it is a sign that they should start taking a special
medication to protect the kidney,called an ACE Inhibitor or alternately an ARB.
Studies have shown that these medications can prevent some of the kidney
damage done by the diabetes.