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Lactate dehydrogenase is an enzyme which plays an essential role in the production of energy from glucose. It is present in all the cells of the body, with the highest concentrations being in the cells of heart, lungs, muscles, liver, kidneys, and RBCs. Normally, only a small amount of the enzyme is found in the serum outside blood cells. However, in certain conditions of damage to the cells, lactate dehydrogenase is secreted out of the cells into the serum, where its concentration rises. Thus, the Serum Lactate Dehydrogenase Test is a nonspecific test that helps to determine the presence of conditions causing tissue damage somewhere in the body. Further tests are performed to identify the exact cause and location of these conditions.

The total lactate dehydrogenase in the body consists of five different forms of the enzymes (isoenzymes) named LDH-1 to LDH-5. The isoenzymes are present in different concentrations in different organs of the body. For example, LDH-1 and LDH-2 are most abundant in the cells of the heart, while LDH-5 is most abundant in the liver. Although the total LDH levels indicate tissue damage somewhere in the body, testing for the different isoenzymes can help identify the location of such damage.

Lactate dehydrogenase is also secreted into other body fluids in case of damage to the body tissues. It is also produced by bacteria and can be thus used to help identify bacterial meningitis.

The serum electrolyte test measures the following electrolytes:

• Sodium (Na+)

• Potassium (K+)

• Chloride (Cl-)

Electrolytes play an important role in a number of body functions like metabolism, neuromuscular functioning, maintaining hydration and pH (acid-base balance). Electrolytes also help in the entry of nutrients into the cells and removal of waste products from the cells. Electrolytes carry an electrical charge, either negative or positive and exist as dissolved salts in blood and body tissues. The Serum Electrolyte test measures the following important electrolytes:

Sodium (Na+)

Sodium is an essential body electrolyte which, along with potassium, chloride, bicarbonate, etc., helps to maintain the normal fluid and pH balance of the body. It is also vital for cellular metabolism, and in the activity of nerves and muscles and transmission of impulses between them. Sodium is present in all the body fluids. The highest concentration of sodium is found in blood and extracellular fluid.

Sodium is supplied to the body principally through dietary salt (sodium chloride or NaCl), and a small portion of sodium is absorbed through other food items. The required portion is absorbed by the body and the remaining is excreted by the kidneys through urine. The body maintains a very narrow range of sodium concentration by three mechanisms:

·         Secretion of hormones natriuretic peptides and aldosterone to control sodium elimination through urine

·         Secretion of antidiuretic hormone (ADH), also called Vasopressin, to control the volume of water eliminated through urine

·         Induction of thirst

Any disruption in the above mentioned mechanisms gives rise to an imbalance in the concentration of sodium in the blood to produce Hyponatremia (low blood sodium concentration), or Hypernatremia (high blood sodium concentration). Both these conditions produce a number of symptoms and may even lead to death.

Potassium (K+)

Potassium is one of the essential body electrolytes along with sodium, chloride, bicarbonate, etc. As an electrolyte, potassium helps to regulate the amount of fluids present in the body and to maintain a correct pH balance. It performs a vital role in cellular metabolism and transport of nutrients and waste products in and out of cells. It is also essential in the transmission of nerve impulses to muscles and muscle activity.

Sufficient amount of potassium required by the body is absorbed from dietary sources, and the remaining unabsorbed potassium is excreted by the kidneys. The hormone called aldosterone maintains the body potassium level within a small normal range. Aldosterone acts on the nephrons present in the kidneys and activates a sodium-potassium pump which helps the body to reabsorb sodium and excrete potassium. This helps to maintain the potassium concentration in the blood within its normal range. Deviation of potassium concentration from its normal range gives rise to Hyperkalemia (high potassium level in blood), or Hypokalemia (low potassium level in blood). Both these conditions may produce a number of symptoms, and may even be fatal if not controlled.

Chloride (Cl-)

Chloride is an essential mineral which acts as an electrolyte along with potassium, sodium, bicarbonate, etc. It helps to maintain the normal fluid and electrolyte balance in the body. It also acts as a buffer to help maintain the pH balance of the body. It also plays essential roles in metabolism. Chloride is used by the stomach to produce hydrochloric acid (HCl) for digestion. Chloride is present in every body fluid. The highest concentration of chloride is found in blood and extracellular fluid (fluid present outside the cells).

Most of the chloride is supplied to the body through dietary salt (sodium chloride or NaCl), and a small portion is absorbed through other food items. The required portion is absorbed by the body and the remaining is excreted by the kidneys through urine. The concentration of chloride in blood is maintained within a very narrow range by the body. Its increase or decrease is directly correlated with the sodium levels.

Creatinine is a waste product which is produced by the muscles due to the breakdown of a compound called Creatine. During the cycle of energy production which is required to contract muscles, creatine is produced. Kidneys remove creatinine from the body by filtering it from the blood and then releasing it into the urine. This test measures the amount of creatinine in the blood.

The body produces creatine and creatinine at a relatively same rate. Since kidneys filter most of the creatinine from the blood and release it into the urine, the blood levels can be used as an indicator to know how well the kidneys are functioning. The amount of creatinine produced depends upon the size of the person as well as their muscle mass. That is why levels of creatinine are higher in men as compared to women and children.

CRP Test measures the levels of CRP in blood to detect the presence of an inflammation or to monitor the treatment and progress of an inflammatory condition. C-reactive Protein or CRP is an acute phase reactant protein which is produced and secreted by the liver in response to an inflammation in the body, which may be caused by tissue injury, infection, or autoimmune diseases. CRP levels increase in patients with trauma, heart attack, autoimmune diseases, bacterial infections, sepsis, post surgery, cancer, etc. CRP levels are often increased before the onset of other symptoms of inflammation such as pain, fever, etc. CRP levels in blood fall as the inflammation subsides.

It is a non-specific test. It can neither diagnose a condition by itself nor can it determine the location of a particular inflammation or disease. Other tests along with physical examination are performed to diagnose a particular condition and determine the location.

A variant of the CRP test is the High Sensitivity C-reactive Protein Test (hs-CRP) which is more sensitive for CRP levels and can detect blood CRP levels at a lower concentration than the standard CRP Test. The hs-CRP Test is performed usually to determine the risk of development of cardiovascular diseases in otherwise healthy individuals.

The ESR test measures the rate at which red blood cells (erythrocytes) settle (sediment) at the bottom of a tube that contains a blood sample in one hour. The test result is expressed in millimeters per hour (mm/hr).

In the presence of inflammation, certain proteins mainly fibrinogen increase in blood. This high proportion of fibrinogen in the blood causes the red blood cells to form a stack (rouleaux formation) which settle quickly due to their high density.

The ESR test is a non-specific measure of inflammation. An ESR can be affected by conditions other than inflammation also. Although a high ESR can detect the presence of inflammation, it cannot provide any information regarding the cause and site of inflammation. Hence, an ESR test is done along with other tests.

The Procalcitonin Test helps to detect infection in the early stages so that it can be treated effectively. It also helps to differentiate between bacterial and non-bacterial infections so that the treatment may be provided appropriately.

Procalcitonin is secreted by most cells of the body in response to bacterial infections or tissue injuries. It is a messenger of the enzyme calcitonin which is secreted by the thyroid gland. A significant increase in the level of procalcitonin can be observed in case of a large-scale bacterial infection and sepsis.

The immune system of the body responds quickly in case of bacterial infection by producing inflammation which limits bacterial growth. In order to destroy the bacterial pathogens, the white blood cells arrive at the site. The immune system localizes (restricts) the bacterial infection. However, if the infection is not controlled, sepsis starts to occur. If sepsis is left untreated, it may become fatal.

Urea is a byproduct of protein metabolism. Proteins consumed in the diet are digested and converted into amino acids, which are utilized by the body. This metabolic process creates toxic byproduct ammonia. This byproduct is rapidly converted by the liver to form urea, which is less toxic and is transported relatively safely in blood. Following this, urea is transported by the blood to the kidneys. The kidneys then filter it out of the blood and excrete it out of the body in a solution called urine. This process continues and the body keeps producing and excreting urea, hence maintaining a low and steady level of urea in the blood.

The BUN test measures the amount of urea present in the urea. The levels of BUN test in the blood are affected due to impairment of kidney function, or due to large scale liver conditions. Primarily, BUN Test results are used to evaluate kidney functioning. Results are often interpreted together with results of Creatinine Tests that measure the levels of another metabolic waste (creatinine), which is also excreted in the urine.

Glycosylated Hemoglobin Test measures the percentage of glycosylated hemoglobin in blood which reflects the average blood glucose over a period of past two to three months (8 - 12 weeks).

Hemoglobin is the protein found in Red Blood Cells and is responsible for transporting oxygen. Of the different types of hemoglobin, Hemoglobin A is predominant. With the elevation of blood sugar levels, some glucose binds spontaneously to Hemoglobin A (this binding is called Glycosylation or Glycation) and remains bound for the complete lifetime of the RBC, which is 120 days normally. Higher the level of glucose in the blood, greater is the amount of it binding to Hemoglobin A. Hemoglobin A1c is the dominant form of Glycated Hemoglobin. As RBCs die and are replaced, Hemoglobin A1c is cleared and slowly replaced with non-glycosylated hemoglobin. Measurement of HbA1c level over a period of time gives an indication of the level of glucose in the blood over the specified period of time. This helps in the diagnosis of Diabetes and is useful for monitoring the effectiveness of measures taken to reduce blood sugar levels.

D-dimer testing is usually ordered when someone goes to the hospital with symptoms such as chest pain and difficulty in breathing. A D-dimer test may be ordered when someone has symptoms of deep vein thrombosis, such as:
-Leg pain or tenderness, usually in one leg
-Leg swelling, edema
-Discoloration of the leg

This test may also be ordered when someone has symptoms of pulmonary embolism such as:

-Rapid heart rate
-Sudden shortness of breath, forced breathing
-Coughing hemoptysis (blood present in sputum)
-Lung-related chest pain

A low ferritin level, indicates iron deficiency, while an excess build up of ferritin can be suggestive of a condition called hemochromatosis that can cause organ and tissue damage. Higher than the normal levels can also indicate other serious medical conditions such as liver disease and cancer.

Iron is an essential micronutrient that is required by the body in trace amounts. It plays an essential role in the formation and functioning of red blood cells or RBCs. RBCs transport oxygen from the lungs to other body tissues.

Ferritin is stored in the liver, spleen, bone marrow, and skeletal muscles. When iron levels in the blood drop, it is recovered from these stored iron reserves.

Iron deficiency may occur due to insufficient dietary consumption of iron, excessive loss of blood from injuries, bleeding during periods, during pregnancy, etc. Iron deficiency could also be because of diseases like Celiac disease which prevent absorption of nutrients from food.

 Increased ferritin levels in the blood may occur due to excess iron consumption through diet or iron supplements, multiple blood transfusions within a short duration, liver damage, alcoholism, or due to conditions like hemochromatosis where the body absorbs excessive iron from food. 

Ferritin Test is performed in combination with other iron measurement tests like Iron Test, Total Iron Binding Capacity (TIBC) Test, and Unsaturated Iron Binding Capacity (UIBC) Test. The results are interpreted accordingly.

Aspartate aminotransferase (AST) is an enzyme which is found in most of the body cells but mainly in the heart and liver. It is also present in kidneys and muscles but in smaller amounts. Normally, the levels of AST are low, but the levels rise when there is an injury to cells of the liver or muscle. 

The function of the liver is to process the nutrients of the body. It also produces bile which helps in digesting fats along with the production of other important proteins such as blood clotting factors and albumin. The liver breaks the potentially toxic substances into harmless products which can be used or eliminated by the body. 

The rise in levels of AST can be due to conditions causing liver damage such as hepatitis, drugs which are toxic to liver, cirrhosis, or alcoholism. The AST test is not specific for the liver. Its levels may also rise in conditions which affect other parts of the body.

This test is done with alanine aminotransferase (ALT) test. Both the enzymes are found in the liver and their levels rise in case of liver damage. The ratio of AST/ALT helps in differentiating between the causes of liver damage in case of injury to heart or muscle. 

Blood is composed of blood cells suspended in blood plasma (yellowish colored liquid). The blood cells include red blood cells (also called RBCs or erythrocytes), white blood cells (also called WBCs or leukocytes) and platelets (also called thrombocytes).

Red blood cells (RBCs) are the most abundant blood cells. RBCs contain hemoglobin which helps in the transportation of oxygen to the tissues. RBC count is the measurement of the number of RBCs in a given volume of blood.

Packed Cell Volume (PCV) or Hematocrit (Hct) is the measurement of the blood volume occupied by RBCs. It is expressed in percentage.

White blood cells (WBCs) are key components of the immune system and thus protect the body from various infections and cancers. Total Leucocyte count (TLC) is the measurement of the total number of leukocytes (WBCs) in a given volume of blood.

There are five types of WBCs:

1. Neutrophils

2. Basophils

3. Eosinophils

4. Lymphocytes

5. Monocytes

Neutrophil to lymphocyte ratio (NLR) is used as a marker of subclinical inflammation. It is calculated by dividing the number of neutrophils by number of lymphocytes, from peripheral blood sample.

Differential Leucocyte Count (DLC) determines the percentage of different types of WBCs.

Neutrophils, Basophils, and Eosinophils are called Granulocytes because of the presence of granules inside these cells.

Absolute count of different types of WBCs is the measurement of their absolute numbers in the given volume of blood.

Platelet count - Platelets (also called thrombocytes) are disc-shaped cell fragments without a nucleus that help in blood clotting. Platelet count is the measurement of the number of platelets in a given volume of blood.

Mean Platelet Volume (MPV) is a measurement of the average size of platelets.

PDW or platelet distribution width refers to the variation of platelet size distribution

Hemoglobin (Hb) -  Hemoglobin (Hb) is a protein found in red blood cells (RBCs) that carries oxygen from the lungs to the body tissues, exchanges the oxygen for carbon dioxide, and then carries the carbon dioxide back to the lungs where it is exchanged for oxygen.

Mean Corpuscular Volume (MCV) is the average volume of a red blood cell.

Mean Corpuscular Hemoglobin (MCH) is the average amount of hemoglobin in the average red blood cell.

Mean Corpuscular Hemoglobin Concentration (MCHC) is the average concentration of hemoglobin in a given volume of red cells.

Red Cell Distribution Width Coefficient variation (RDW CV)is a measurement of the variability of red blood cell size and their mean size.

Alanine Transaminase test measures the levels of alanine transaminase in the blood.  Alanine Transaminase is an enzyme which is found in liver and kidney cells. However, this enzyme, in less quantity, can be found in the muscles and the heart. Its function is to convert alanine (an amino acid found in proteins) to pyruvate (intermediate in cellular energy production). 

Generally, these levels of alanine transaminase in the blood remain low in healthy individuals. However, if there is any damage to the liver, alanine transaminase is released in the blood. This process helps in early detection of any damage to the liver. 

The function of the liver is to process the nutrients of the body. It also produces bile which helps in digesting fats along with the production of other important proteins such as blood clotting factors and albumin. The liver breaks the potentially toxic substances into harmless products which can be used or eliminated by the body. 

This test is done with another liver enzyme, aspartate aminotransferase (AST) as a part of the liver panel. In case of damage to the liver, there is a sudden rise in levels of both enzymes. However, alanine transaminase is more specific for the liver. In some cases, it is possible that only one of them is increased. The AST/ALT ratio can be calculated to differentiate between various causes and severity of the liver injury. This can also help to distinguish whether the injury is from damage to the liver or heart or muscles.