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Calcium (Ca) Test measures the levels of calcium in blood. Calcium is essential for body processes including cell signaling, blood clotting, contraction of muscles, and functioning of nerves. It plays a crucial role in the formation and maintenance of healthy bones. Deficiency of calcium results in Osteoporosis, a disease in which the bones lose their density and become soft and fragile, causing them to fracture very easily.

About 99% of the total amount of calcium received by the body is bound as calcium complex in bones, and the remaining 1% lies in blood circulation. Of the amount of calcium circulating in the blood, about half remains bound to albumin protein or other ions and are metabolically inactive, while the remaining half remains free and metabolically active. Blood Calcium tests can be of two types: Total Calcium Test used to measure the total calcium concentration in blood including both the free and bound forms, and Ionized Calcium Test used to measure the concentration of only the metabolically active form.

Calcium levels in the blood are maintained within a very narrow range by a number of mechanisms. Deviation from the normal range of calcium concentration causes Hypocalcemia (low levels of calcium), or Hypercalcemia (excess of calcium). Both these conditions impact normal body processes in the short term and may give rise to other conditions in the long term.

A blood calcium test cannot be used to check for a lack of calcium in your diet or for osteoporosis (loss of calcium from bones) as the body can have normal calcium levels even in case of dietary deficiency of Calcium. The body can augment mild calcium deficiency by releasing the calcium stored in bones.

Vitamin B12 is a part of B complex of vitamins. Vitamin B12 is also called as Cobalamin. It is a water soluble vitamin. Vitamin B12 plays an important role in formation of normal red blood cells, repair of tissues, DNA synthesis and genetic material in cells. It is not produced in the body and has to be taken in diet. The diet sources include red meat, fish, milk, poultry, yoghurt, eggs, fortified cereals, breads and other grain products. It can also be taken in the form of Vitamin B12 tablets or multivitamin pills. The deficiency of Vitamin B12 results in macrocytic anemia (size of red blood cells larger than normal).

Megaloblastic anemia is a type of macrocytic anemia, in which large size red blood cells called as macrocytes are produced. These red blood cells are fewer in number. There is a decrease in white blood cell count and platelet count. Megaloblastic anemia occurs due to acquired deficiency of Vitamin B12. The reason can be an inadequate dietary intake of Vitamin B12 or any problem in the absorption of Vitamin B12 from the intestines.

In case of problem in the absorption of Vitamin B12 from intestines, it is known as Pernicious anemia. It occurs due to lack of intrinsic factor which is present in secretions of the stomach.

Vitamin B12 is also important for nerve health and is taken as a nutritional supplement for the treatment of nerve damage.

Vitamin B12 binds with intrinsic factor (protein secreted by cells in the stomach). After binding, a complex is formed which is absorbed by the small intestine. In case of any disease interfering in this process can cause weakening of absorption of Vitamin B12.   

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.

The Vitamin B9 test measures the levels of Vitamin B9 in the blood. Vitamin B9 also known as folate is a part of the B complex of vitamins. It is important for the formation of normal red blood cells, tissue and cell repair, and synthesis of DNA. This vitamin cannot be produced in the body, and hence it has to be taken in the diet. 

Folate is the naturally occurring form of the vitamin, while folic acid is referred to as a supplement which is added to food and drinks. This vitamin is found in food sources such as green leafy vegetables, citrus fruits, peas, dry beans, yeast, and liver. Apart from these food sources, Vitamin B9 can be found in fortified cereals (in which minerals are added), bread, and other grain products.

The deficiency of Vitamin B9 can lead to macrocytic anemia in which the size of red blood cells becomes larger than normal. Such type of macrocytic anemia includes Megaloblastic anemia which is characterized by the production of fewer but larger red blood cells. These red blood cells are known as macrocytes. Along with this, white blood cells may also get reduced and low platelet count can be seen.

Vitamin B9 is important for cell division such as in the case of developing a fetus. The deficiency of this vitamin during early pregnancy can expose the growing fetus to the risk of neural tube defects such as spina bifida. 

The cause of Vitamin B9 deficiency can be due to not taking supplements or diet rich in Vitamin B9, inadequate absorption of this vitamin or at the time of pregnancy when the requirement of this vitamin increases.

Antinuclear antibody (ANA) test screens for the presence of ANA in blood. The immune system of the body is responsible for differentiating between the body’s own cells and foreign cells, like pathogens. Once the foreign cells are identified, they are then targeted and destroyed. In autoimmune disorders, the immune system of the body is unable to recognize certain cells as the body’s own cells and starts an immune response against them which results in their destruction. The recognition of ‘self’ and ‘non-self’ cells is mediated by certain proteins present on the surface of cells or inside them. When the immune system identifies a cell as foreign or ‘non-self’, it produces antibodies against these cells to destroy them. Antibodies produced in an autoimmune disease are called autoantibodies.

Antinuclear antibodies (ANA) are autoantibodies that are produced against protein markers present in the nucleus of certain cells of the body. They are produced in a number of autoimmune diseases but are most commonly produced in Systemic Lupus Erythematosus (SLE).

The Antinuclear Antibody Test can be performed either by Immunoassay method (ELISA) or Indirect Fluorescent Antibody (IFA) method to detect ANA in blood. Both these tests may be used by some laboratories together: the Immunoassay method (ELISA) screens for the presence of antinuclear antibodies, and IFA method subsequently confirms the positive or equivocal Immunoassay results.

ANA by Immunoassay method (ELISA) utilizes a mixture of known anti-nuclear antigens and is fairly simple to perform, can be automated and provides fairly objective results.

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Blood Stag 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

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 of variation (RDW CV)is a measurement of the variability of the red blood distribution curve and their mean size. 

The creatinine - spot test measures the levels of creatinine in the urine. Creatinine is a waste product that is produced by the muscles due to the breakdown of a compound called Creatine. Creatinine is produced during the cycle of energy production which is required to contract muscles. Kidneys remove creatinine from the body by filtering it from the blood and then releasing it into the urine.

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 on the muscle mass and general physique (size) of an individual. That is why levels of creatinine are higher in men as compared to women and children. 

Glucose - Fasting Blood Test is done to measure the levels of glucose in blood during period of fasting.

Glucose is the main source of energy for body. Carbohydrates consumed in the diet are broken down in the body to glucose, which is absorbed by the intestines and transported by the blood to various organs. The cells of these organs utilize the glucose to produce energy when required, and the excess is stored either as glycogen in the liver for short-term storage or in fat tissues as triglycerides for long-term storage. The uptake, utilization, and storage of glucose after it is absorbed in the intestines is facilitated by the hormone- insulin which is secreted by the pancreas. Insulin influences the transport of glucose to the organs like heart, brain, working muscles, etc. It also directs storage of excess glucose. The action of insulin reduces sugar levels in the blood.

After a meal, sugar levels increase in blood and insulin is secreted in response to reduce sugar levels until it becomes normal. If glucose levels fall too low in blood, another pancreatic hormone called glucagon is released, which directs the liver to convert stored glycogen into glucose and releases it into the blood. The insulin and glucagon hormones create a feedback mechanism to keep blood glucose levels within the normal range. Imbalance in their activity causes an excess or shortage of blood sugar.

Glucose - Fasting blood Test helps to determine if the body is able to utilize or store glucose efficiently. High levels of sugar in blood indicates diabetes or resistance to insulin. Type 1 Diabetes is caused when insulin is not produced or produced in very little quantity. Type 2 Diabetes is caused when insulin produced is not utilized effectively by the body. In both these cases, blood sugar level rises, while cells are deprived of nutrition.

Magnesium is a mineral micronutrient which plays essential roles in body processes including enzyme functions, energy production by metabolism, contraction of muscles, and nerve functioning. It also helps in the metabolism of calcium and hence helps in the maintenance of healthy bones. Magnesium is supplied to the body from dietary sources and is absorbed in the small intestine and colon. It is subsequently absorbed into the bones and tissues. Only about 1% of the total amount of magnesium absorbed remains in the blood within a narrow normal range. The normal range of magnesium concentration is maintained in the body by utilizing the amount absorbed from food and excreting the excess through urination.

Deviation from the normal range of magnesium concentration causes Hypomagnesia (shortage of magnesium), or Hypermagnesia (excess of magnesium). Both these conditions impact normal body processes in the short term and may give rise to other conditions in the long term.

The Homocysteine Test measures the levels of homocysteine in the blood.

Homocysteine is an amino acid which is an intermediate in the production of cysteine from methionine. Methionine is obtained from dietary sources, mainly fish, meat, and dairy products, and is converted to homocysteine, and then to cysteine in the body. This conversion from methionine to cysteine is regulated by various enzymes which require Vitamin B6, B12, and folic acid to work. Deficiency of these vitamins causes an increase in the levels of homocysteine in the body. Increased homocysteine levels in the blood can be due to a rare genetic disease called homocystinuria, where the enzymes needed for methionine metabolism are dysfunctional.

Increased levels of homocysteine in the blood are associated with an increased risk of cardiovascular diseases including atherosclerosis, thrombosis (formation of blood clots) in blood vessels, heart attack, and stroke. It has also been implicated in some studies with an increased risk of Alzheimer’s disease.

The Lipid Profile Test typically measures the levels of total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides. Other results that may be reported include VLDL cholesterol, non-HDL cholesterol, and total cholesterol to HDL cholesterol ratio.

Lipids are fatty acids which store energy for the body and play essential roles in cellular structure and cell signaling. Cholesterols and triglycerides are essential lipids, carried in the blood by lipoprotein particles made up of cholesterol, triglycerides, proteins and phospholipid molecules. The lipoprotein particles are classified according to their densities into High Density Lipoproteins (HDL), Low Density Lipoproteins (LDL), and Very Low Density Lipoproteins (VLDL).

Cholesterol is a fat-like substance formed in the liver, as well as obtained from dietary sources. It is found in all the cells and is an essential part of the structural framework of the cells apart from performing various vital body processes. However, excess cholesterol is harmful. Increased cholesterol in blood can cause it to get deposited on the inner walls of the blood vessels forming plaque.

Triglycerides are the commonest type of fat in the body. Triglycerides are obtained from dietary sources and form the stored fat in adipose tissues. Increase in triglyceride concentration can also give rise to cardiovascular diseases.

High Density Lipoproteins or HDLs are high density particles which help to reduce the chances of cardiovascular diseases by picking up and carrying lipoprotein particles of lower density to the liver for disposal.

Low Density Lipoproteins or LDLs are lipoprotein particles of low density which carry cholesterol to the tissues. Cholesterol carried by LDLs easily comes out of blood and get deposited on the inner walls of the blood vessels, increasing the chances of cardiovascular diseases.

Very Low Density Lipoproteins or VLDLs are lipoprotein particles of very low density which carry triglycerides to the tissues. Excess triglycerides in blood causes increase in VLDL particles which in turn again increases the chance of developing cardiovascular diseases.

Plaque deposition makes the lumen of the blood vessels narrower thereby preventing proper flow of blood and may stop the flow completely. Excessive plaque deposition can also cause the arteries to harden, giving rise to a condition called Atherosclerosis. Improper flow of blood prevents the supply of nutrients and oxygen to the vital organs and may cause heart attack or stroke.

Thyroxine (T4) Total test measures the total levels (both free and bound forms) of Thyroxine hormone (T4) in the blood.

The thyroid gland secretes the following hormones:

• Triiodothyronine (T3)

• Thyroxine (T4)

Thyroid Stimulating Hormone (TSH), also called Thyrotropin is a hormone secreted into the blood by the pituitary gland (a gland present in the brain). It directs the thyroid gland to produce and release the thyroid hormones (T3 & T4) into your blood. The iodine from the food stimulates the thyroid gland to make the thyroid hormones.

The thyroid hormones regulate growth and metabolism. If the thyroid gland produces very high amounts of these hormones (T3 and T4), symptoms of weight loss, rapid heartbeat, tremors, sweating, anxiety, increased sensitivity towards heat, etc occurs. This is known as Hyperthyroidism.

The decreased production of thyroid hormones (T3 and T4) results in Hypothyroidism which may lead to weight gain, fatigue, slow heart rate, increased sensitivity towards cold, depression, dry and thin hair, etc.

There is a feedback system in the body to maintain stable amounts of the thyroid hormones (T3 and T4) in the blood. When the levels of thyroid hormones decrease, the pituitary gland is stimulated to release TSH. High TSH, in turn, increases the release of thyroid hormones (T3 & T4) from the thyroid gland and vice-versa.

T4 hormone constitutes about 90% of thyroid hormones and circulates in the blood in two forms:

1) Bound form - It is bound to the proteins present in blood and this prevents it from entering the body tissues. The three main proteins in the blood that the T4 hormone is bound to are albumin, transthyretin and Thyroxine-binding globulin (TBG). TBG is also called Thyroid hormone Binding Globulin (THBG).

2) Free form - It enters the body tissues where it is needed and this is the active form.

Hence, the T4 hormone can be measured as Free T4 or Total T4. The total T4 includes both bound and free forms circulating in the blood and can be affected by the amount of protein available in the blood to bind to them.

While the total T4 test is a useful indicator of T4 levels in the presence of normal binding proteins, it is not useful when levels of binding proteins are increased or decreased. For example, increased total T4 levels can be seen despite normal levels of free T4 levels and normal thyroid function due to an increase in thyroxine-binding proteins.

Thyroxine (T4) Total test is also done as a part of the Thyroid profile Total test which includes two more tests: Thyroid Stimulating Hormone (TSH) and Triiodothyronine (T3) Total.

Iron is an essential micronutrient that is required by the body in trace amounts. Iron plays an essential role in a number of body activities. The most important role of iron is that it regulates the formation and functioning of red blood cells or RBCs. Iron is an integral part of a protein called hemoglobin present in the RBCs. RBCs transport oxygen from the lungs to other body tissues.

Iron is not produced by the body and its only source is diet. Only a minute quantity of iron is required by the body. Most of the iron obtained from the food is found in hemoglobin present inside the RBCs. Excess iron absorbed from food is stored as ferritin, and a small amount is present in myoglobin and enzymes. Ferritin is stored in the liver, spleen, bone marrow, and skeletal muscles. When the iron level in the blood drops, it is recovered from these stored iron reserves.

The protein transferrin is produced by the liver and transports iron to different parts of the body for utilization or storage. Low levels of transferrin can impair the transport of iron for utilization or storage and may give rise to symptoms of iron deficiency or overdose. Transferrin is a negative acute phase reactant which means that its level decreases in case of inflammation in the body. It is the primary iron-transporting protein in the body and most of the free iron remains bound to it.

The following tests are performed apart from the Total Iron Binding Capacity Test to measure the iron levels of the body and results are interpreted accordingly:

·         Serum Iron Test measures the levels of iron present in the blood.

·         Transferrin Test measures the levels of transferrin present in blood both bound and unbound with iron.

·         Unsaturated Iron Binding Capacity (UIBC) Test measures the transferrin reserve of the body, or the amount of transferrin not saturated with iron.

·         Transferrin Saturation Test is performed to determine the amount of transferrin that is saturated with iron. In normal conditions, approximately one-third of transferrin is bound to and saturated with iron.

·         Ferritin Test measures the amount of the protein ferritin in blood. Ferritin is the primary iron storage protein of the body.

Triiodothyronine (T3) Total Test measures the total levels (both free and bound forms) of Triiodothyronine (T3) hormone in the blood.

The thyroid gland secretes the following hormones:

• Triiodothyronine (T3)

• Thyroxine (T4)

Thyroid Stimulating Hormone (TSH) is a hormone secreted into the blood by a gland present in the brain (Pituitary gland) and it tells your thyroid gland to make and release the thyroid hormones (T3 & T4) into your blood. The thyroid gland uses iodine from food to make the thyroid hormones.

The thyroid hormones are essential for growth and metabolism. If the thyroid gland produces very high amounts of these hormones (T3 and T4), you may experience symptoms of weight loss, rapid heartbeat, tremors, sweating, anxiety, increased sensitivity to heat etc. and this is known as Hyperthyroidism.

Also, the decreased production of thyroid hormones (T3 and T4) results in Hypothyroidism which may cause symptoms like weight gain, fatigue, slow heart rate, increased sensitivity to cold, depression, dry and thin hair etc.

There is a feedback system in the body to maintain stable amounts of the thyroid hormones (T3 and T4) in the blood. When thyroid hormone levels decrease, the pituitary gland is stimulated to release TSH. This high TSH in turn leads to the release of more thyroid hormones (T3 & T4) from the thyroid gland and vice-versa.

Majority of the T3 hormone is formed from T4 hormone and a smaller fraction is produced directly by the thyroid gland. T3 hormone circulates in the blood in two forms:

1) Bound form - It is bound to proteins present in blood and this prevents it from entering body tissues. The two main proteins in the blood that the T3 hormone is bound to are albumin and Thyroxine-binding globulin (TBG), also called Thyroid hormone Binding Globulin (THBG).

2) Free form - It enters the body tissues where it is needed and this is the active form. Free Triiodothyronine (FT3) constitutes only 0.3% of the total T3 hormone.

The total T3 includes both bound and free forms circulating in the blood and can be affected by the amount of protein available in the blood to bind to them. The T3 hormone can be measured as Free T3 or Total T3. Triiodothyronine (T3) Total Test measures the total levels (both free and bound forms) of Triiodothyronine (T3) hormone in the blood and is usually done as a part of the Thyroid Profile Total test which includes two more tests: Thyroid Stimulating Hormone (TSH) and Thyroxine Total (T4) hormone.

Vitamin D Test measures the levels of Vitamin D in the blood. Two forms of vitamin D can be measured in the blood, 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D. The 25-hydroxyvitamin D is the major form found in the blood and is the relatively inactive precursor to the active hormone, 1,25-dihydroxyvitamin D. Because of its long half-life and higher concentration, 25-hydroxyvitamin D is commonly measured to assess and monitor vitamin D status in individuals.

The 25-hydroxyvitamin D test is done to determine the level of Vitamin D in your blood, whether it is low or higher than normal. Low levels can be seen if a person is not getting enough exposure to sunlight or enough dietary vitamin D to meet his or her body's demand or if there is a problem with its absorption from the intestines (cystic fibrosis, crohn’s disease, who have undergone gastric bypass surgery). Sometimes, medicines used to treat seizure (Phenytoin) can cause Vitamin D deficiency by interfering with transformation to 25-hydroxyvitamin D in the liver. Severe liver and kidney diseases can also cause vitamin D deficiency. High levels reflects excess supplementation of the vitamin.

Thyroid Stimulating Hormone (TSH) test measures the amount of TSH in your blood which helps to find out if the thyroid gland is working normally or not. Low TSH levels indicate hyperthyroidism and high TSH levels indicate hypothyroidism.

In case of hyperthyroidism, the thyroid gland produces very high amounts of thyroid hormones (T3 and T4) and you may experience symptoms of weight loss, rapid heartbeat, tremors, sweating, anxiety, increased sensitivity towards heat, etc. In case of Hypothyroidism, there is a decrease in the production of thyroid hormones (T3 and T4) which may cause weight gain, fatigue, slow heart rate, increased sensitivity towards cold, depression, dry and thin hair, etc.

There is a feedback system in the body to maintain stable amounts of the thyroid hormones (T3 and T4) in the blood. TSH signals the thyroid gland to make and release the thyroid hormones (T3 & T4) into the blood when the level of thyroid hormones is low and can also signal the thyroid gland to lower the production of thyroid hormones when the level of thyroid hormones is very high. So, when the thyroid hormone (T3 and T4) levels decrease, the pituitary gland is stimulated to release TSH and this high TSH level, in turn, stimulates thyroid gland to release more thyroid hormone (T3 & T4) from the thyroid gland and the vice-versa happens when the thyroid hormone levels are very high.

Zinc is a mineral which is a micronutrient (required by the body in small amounts). It has a number of essential roles in the body. Zinc is a structural component of a number of proteins. It is essential in the synthesis of proteins and DNA, for cell division, and is necessary for proper enzymatic activity. It is also essential in the proper functioning of the immune system and in wound healing. Zinc is essential for proper physical and mental growth and development of children. It is also essential for the senses of taste and smell.

Zinc is absorbed primarily from dietary sources. It is transported in the serum bound to proteins, namely, albumin and alpha-macroglobulin. Excess zinc is disposed out of the body primarily through the feces, and a small amount through urine and sweat. The absorbed amount of zinc is utilized by almost all the cells of the body but is not stored anywhere in particular.

Lipase is an enzyme, which helps in the breakdown and digestion of dietary triglycerides (fats) into simple fatty acids for absorption. Lipase is secreted primarily by the pancreas, and in small amounts by the stomach, intestines, and the liver. The pancreas secretes lipase into the pancreatic duct, which flows into the duodenum (anterior portion of the small intestine). Normally only a small amount of lipase is secreted into the blood and is maintained at this low level. However, in the case of conditions like pancreatitis, blockage of the pancreatic duct, pancreatic cysts or tumors, etc., the levels of lipase in the blood get increased.

The Lipase Test may be performed together with Amylase Test to help in the diagnosis of pancreatitis or other conditions. Amylase levels also increase in case of pancreatitis. In Pancreatitis, Lipase rises almost at the same time as amylase (4-8 hrs) but the elevation lasts much longer (7-14 days) as compared to amylase.

Anti cyclic citrullinated peptide antibodies are autoantibodies which are produced by the immune system that attack against the cyclic citrullinated peptide. Due to these attacks, inflammatory symptoms are produced in the body which is most commonly seen in rheumatoid arthritis. The Anti CCP antibodies can be present in patients prior to the start of symptoms of rheumatoid arthritis. The presence of positive Anti CCP antibodies in rheumatoid arthritis patients is said to be due to the combination of genetics and environmental factors. These patients have a common sequence of amino acids which is called as shared epitope that is encoded in specific genetic markers called human leukocyte antigens (HLA) which are responsible for producing proteins to control immune responses. The shared epitope attaches to these proteins to produce Anti CCP antibodies.

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 of 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 all body fluids and is found in highest concentration in the blood and extracellular fluid (fluid present outside the cells).

Most of the chloride intake is through dietary salt (sodium chloride or NaCl), and a small portion through other food items. The body absorbs the required amount and the kidneys excrete the remaining through urine. The concentration of chloride in blood is maintained within a very narrow range by the body and usually increases or decreases in direct correlation with sodium levels.

High-sensitivity CRP (Hs-CRP) test measures lower levels of CRP in the blood to predict the risk of Cardiovascular diseases and stroke.

Hs-CRP can implicate low level of inflammation. A persistent low level of inflammation can result in a build-up of cholesterol and other lipids and can cause atherosclerosis and narrowing of blood vessels, which is often associated with Cardiovascular diseases (CVD). The hs-CRP test accurately measures low levels of C-reactive protein to identify low but persistent levels of inflammation and thus helps predict a person's risk of developing CVD. High-sensitivity CRP along with lipid profile can be a useful test for screening the risk of CVD, heart attacks, and strokes. Studies have suggested that this test is best suited for people who have a moderate risk of heart attack over the next 10 years.

Therefore, Hs-CRP is generally advised along with other tests such as lipid profile and lipoprotein-associated phospholipase A2 (Lp-PLA2) to provide added information about the risk of heart disease.

Carbohydrates consumed in the diet are digested and converted into the simple sugar, glucose. Glucose is absorbed by the cells for the production of energy, or stored in other forms like fats. Insulin is the hormone responsible for the uptake of glucose by the cells from blood for utilization and storage. It thus helps to maintain blood glucose levels within a normal range. Insulin also plays an essential role in the metabolism of lipids.

Levels of blood glucose and levels of insulin in blood maintain a balance with each other. A rise in blood sugar stimulates insulin production by the pancreas. This causes insulin levels to rise in blood. Insulin stimulates the uptake of glucose by cells, leading to a fall in blood glucose, and insulin levels in turn. Disruptions in this mechanism due to low insulin production by pancreas or inability of cells to respond to insulin (insulin resistance) cause a rise in blood sugar levels or hyperglycemia. Hyperglycemia is associated with diabetes. Diabetes Type 1 is an inherited condition where insulin is produced in insufficient quantities. Diabetes Type 2 occurs due to insufficient insulin production, or due to the development of insulin resistance. When cells are unable to respond to insulin, they cannot take up glucose from the blood effectively. The cells are deprived of glucose for energy, while glucose levels become high in the blood.

Insulin resistance increases with time. Increased glucose levels in blood stimulate the pancreas to produce excess insulin, leading to hyperinsulinemia (high insulin levels in the blood) along with hyperglycemia. Insulin resistance can also be seen in cases other than diabetes, such as prediabetes, polycystic ovarian syndrome (PCOS), pituitary or adrenal gland diseases, etc.

High insulin levels in the blood may also occur in patients suffering from tumors in the beta cells of pancreatic glands, or in cases of insulin overdose. Since excess insulin in these cases is not caused due to excess blood sugar levels, hyperinsulinemia in these cases can cause hypoglycemia (low blood sugar), leading to energy deprivation in all cells of the body.

The Sodium test measures the concentration of sodium in the blood.

Sodium is an essential body electrolyte which, along with potassium, chloride, bicarbonate, etc., helps to maintain the normal fluid and pH balance in 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 body fluids and is found in highest concentration in the blood and extracellular fluid.

Sodium is supplied to the body principally through dietary salts (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 abovementioned 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.

Urine Routine and Microscopy test involve the three-part evaluation of the urine sample.

1. Gross Examination - It involves the visual examination of the urine sample for color and appearance.

2. Chemical Examination - It is done by urine dip-stick method which involves the use of reagent test strips. These test strips are dipped into the urine sample and the colors that develop are matched with the control for analysis. It is done to examine the urine sample for glucose, protein, pH, specific gravity, blood, nitrites, ketones, leukocyte esterase, bilirubin, and urobilinogen.

3. Microscopic Examination - It involves the examination of the urine sample under the microscope for casts, crystals, cells, bacteria, and yeast. 

Amylase is an enzyme that helps in the breakdown of complex dietary carbohydrates into simple carbohydrates for absorption. Digestion of carbohydrates begins in the mouth since amylase is secreted by the salivary glands. However, most of the amylase is produced by the pancreas and secreted into the duodenum of the small intestine. Amylase is also found in small quantities in blood, urine and peritoneal fluid.

The levels of amylase in blood rise either due to its increased secretion into the blood or decreased clearance by the kidneys or due to both these reasons. High levels are commonly seen in acute pancreatitis (inflammation of the pancreas) where the amylase levels rise rapidly (in 6 to 48 hours). In mild cases of pancreatitis, amylase levels slowly return to normal within a few days. Higher levels for longer periods indicate other complications.

Testosterone is a sex hormone which is mainly found in men. It can also be found in women but in small amounts. The appearance of male physical characteristics is due to testosterone hormone. Testosterone Total measures the levels of testosterone in the blood. 

In men, testosterone is produced by the Leydig cells present in the testicles. It is also produced by the adrenal glands in both males and females. In females, small amounts of testosterone are produced by the ovaries. 

The function of testosterone is to develop secondary sex characteristics which include enlargement of the penis, body hair growth, development of muscle, and deepening of the voice. During puberty, it is produced in large amounts in males. In adult males, its function is to regulate the sex drive and to maintain muscle mass. In adult females, the testosterone gets converted to estradiol, which is the main sex hormone in females.

The testosterone hormone production is regulated by luteinizing hormone (LH), which is produced by the pituitary gland. As the levels of testosterone rise, the production of LH decreases which in turn slows down the production of testosterone. Similarly, when the levels of testosterone fall, it leads to an increase in production of LH which stimulates testosterone production.

The levels of testosterone are highest in the early morning and lowest in the evening. With exercise, the levels of testosterone increase and with age the levels decrease. 

In the blood, about two-thirds of testosterone hormone is bound to sex-hormone binding globulin (SHBG) and about one-third is bound to albumin. A small amount is present as free testosterone. 

The kidneys are a pair of bean-shaped organs located on either side of the spinal column in the abdomen towards the back. The kidneys perform a number of important functions. The most important of these is that they filter the blood and separate the waste products generated out of regular metabolic activities of the body, primarily urea. Following the separation, the kidneys excrete the waste products out of the body through urine. They help in maintaining the normal pH level and water balance of the body. The kidneys also play essential roles in the synthesis of Vitamin D and Red Blood Cells (RBCs).

The Kidney Function Test includes the following tests to monitor kidney function:

·  Blood Urea Nitrogen (BUN)/ Urea:

Blood Urea Nitrogen is a test to measure the amount of urea nitrogen present in the blood. Urea is a nitrogenous by-product of the metabolism of protein, and its level in blood serves as an indication of the amount of nitrogen present in blood as urea. In simpler terms, BUN is the measure of the amount of nitrogen present in blood in the form of urea. High BUN levels in the blood can be caused as a result of kidney diseases, dehydration and obstruction in the urinary tract due to kidney stones, prostate gland enlargement, etc.

Urea test measures the level of urea in the blood. Urea is a final waste product formed from the breakdown of proteins. Urea is filtered out of the blood by the kidneys to excrete excess nitrogen present in the blood through urine. Excess of urea in blood is called uremia and can be caused by a number of conditions including kidney diseases.

·  Uric Acid:

This test measures the level of uric acid in the blood. Uric acid is a waste product formed from the breakdown of purines, which are essential building blocks of DNA. It is also produced by the metabolism of proteinaceous food, especially red meat. Uric acid is excreted from the body by the kidneys through urine and a small portion through stool. The uric acid test indicates the level of uric acid in the blood and serves as an indirect estimation of the proper functioning of the kidneys.

The presence of excess amounts of uric acid in the blood is called hyperuricemia, and causes gout due to the accumulation of uric acid crystals in the synovial fluid between joints. Hyperuricemia also causes the formation of hard lumps of uric acid crystals called tophi under the skin and at the top of the ears. Uric acid crystals can also accumulate in the kidneys and cause kidney stones.

·  Creatinine:

This test measures the level of Creatinine in blood. Creatinine is a waste product formed from the normal breakdown of muscles in the body. Creatinine is almost completely excreted by the kidneys, so their levels in the blood serve as an indication of kidney function.

Excess creatinine in the blood can be found due to decreased elimination from the kidneys as well as due to increased creatinine production by muscular breakdown, eating cooked meat, protein supplements, etc.

·  BUN/Creatinine Ratio:

BUN/Creatinine Ratio compares the levels of nitrogen as urea in blood to the levels of creatinine in the blood. This ratio serves as a more accurate representation of kidney function. It is also used to check for dehydration since the BUN level increases in dehydration while creatinine levels remain the same. Low BUN to creatinine ratio can be caused due to a low protein diet, liver cirrhosis, rhabdomyolysis (muscle disease), syndrome of inappropriate antidiuretic hormone secretion (SIADH) as well as during pregnancy.

LFT measures the level of liver enzymes, proteins, and bilirubin in the blood.

The liver is a wedge-shaped organ located in the right upper part of the abdomen. The liver helps in the synthesis of certain proteins, produces bile (an alkaline compound which helps in the breakdown of fat), process the bilirubin (a yellowish substance produced from the breakdown of hemoglobin) and helps in removing ammonia and other toxins (harmful substances) from the body. It plays an important role in the metabolism of fats, protein, and carbohydrates. It stores glycogen, vitamins, and minerals as well as helps in the metabolism (breakdown) of certain drugs.

Many diseases affect the health of the liver like hepatitis A, hepatitis B, hepatitis C, alcoholic hepatitis, autoimmune hepatitis, cirrhosis, non-alcoholic fatty liver disease (NAFLD), bile duct obstruction, liver or bile duct cancer and many others. Liver function can also be affected by various risk factors like alcohol abuse, certain drugs, sedentary lifestyle, and obesity. Regular monitoring of liver function is essential for early detection of any liver abnormality.

LFT is a group of tests that measure the levels of Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), Alkaline Phosphatase (ALP), Total protein, Bilirubin and Gamma Glutamyltransferase (GGT) in blood. Each component has its own significance and helps to understand a particular aspect of the liver function.

Alanine Aminotransferase (ALT)

 Alanine Aminotransferase (ALT) is an enzyme and this test measures the level of this enzyme in the blood. ALT is also known as serum glutamic-pyruvic transaminase (SGPT) and is mainly found in the liver, but also in smaller amounts in the kidneys, heart, pancreas and muscles. This enzyme is released into the bloodstream in case of liver disease or damage leading to increased ALT blood levels, a specific indicator of liver injury. However, this test cannot determine the extent or severity of the liver damage.

Aspartate Aminotransferase (AST)

This test measures the level of the enzyme AST in your blood. It is also known as serum glutamic-oxaloacetic transaminase (SGOT). AST is found in the liver and is released in the blood in large amounts in case of any liver injury. AST levels are usually measured along with ALT as AST is not specific for liver (also found in the heart, skeletal muscle and other organs). Your doctor may also recommend an ALT/AST ratio to help in the diagnosis.

Alkaline phosphatase (ALP)

This test measures the blood levels of the enzyme ALP which is found in the liver (one of the main source), bile ducts, bones, intestine, pancreas and kidney. ALP helps to break down proteins in the body. Diseases that mainly harm or damage the cells of the liver and bile duct, leading to overproduction and release of this enzyme into the bloodstream. This causes increased blood ALP levels.

Total Serum Protein

This test measures the total amount of protein in the blood, which includes two major types of proteins: albumin and globulin. The test report mentions separate results for total protein, albumin, globulin and albumin/globulin ratio (A/G ratio).

The level of proteins in the blood indicates the biosynthetic capacity of the liver. Hepatocytes (liver cells) are unable to synthesize this protein in certain liver diseases leading to a fall in protein levels in the blood.

Albumin is synthesized only in the liver. It helps to transports minerals, enzymes, hormones, bilirubin and some medicines throughout your body. It prevents the fluid from leaking out of your blood vessels into the tissues.

Globulin is synthesized in the liver and by the cells of the immune system. It plays a key role in fighting infections and transports many enzymes, hormones, minerals and some medicines in the body.

Bilirubin

This test measures the amount of bilirubin in the blood. Bilirubin is a waste product formed by the breakdown of red blood cells and is processed by the liver.

Bilirubin blood test report includes separate values for direct (conjugated) bilirubin, indirect (unconjugated) bilirubin, and total bilirubin.

When heme is released from the hemoglobin, it is converted to bilirubin. This is called unconjugated (indirect) bilirubin which is carried to the liver by some proteins.

In the liver, bilirubin gets attached (conjugated) to modified sugars (glucuronic acid) and form conjugated (direct) bilirubin.

Both these forms can be measured or estimated by laboratory tests, and a total bilirubin result (includes both direct and indirect bilirubin) is also measured.

A damaged liver can’t properly process bilirubin, leading to abnormally high levels of bilirubin in the blood. Increased unconjugated bilirubin in the blood results due to its overproduction or improper uptake by the liver. Increased conjugated bilirubin results can be seen in diseases that reduce the rate of secretion of conjugated bilirubin into the bile or the flow of bile into the intestine resulting in a backward flow of conjugated bilirubin into the blood.

Gamma-glutamyltransferase (GGT)

This test measures the level of the enzyme GGT in your blood which is present in large amounts in the liver. It is a transport molecule and it helps the liver to metabolize many drugs and toxins. GGT is a very sensitive test for detecting any liver disease especially due to alcohol abuse and is also one of the first enzymes to rise in patients with bile duct obstruction like tumor or stones.

The Vitamin B6 test measures the levels of Vitamin B6 in blood. Vitamin B6 belongs to the Vitamin B complex group. Generally, this vitamin is found in the diet, but its deficiency can be found in people who are deficient in other B complex vitamins. The chances of vitamin B6 deficiency are more in people having liver, kidney, digestive, or autoimmune diseases. Along with that, people who are smokers, overweight, alcoholics, and pregnant women can also have a deficiency of this vitamin. 

Vitamin B6 plays a role in the processing of protein, carbohydrates, and fats in the body. It is also important for the proper functioning of the nervous system and the immune system. It is also said to have antioxidant and anti-inflammatory properties which help in preventing chronic conditions such as heart disease and cancer. 

Vitamin B6 is found in food sources like poultry, fish, meat, eggs. potatoes, bananas, chickpeas, cereal grains and flour, vegetables (e.g., peas, spinach, and carrots), seeds and nuts, legumes, milk, and cheese. It is also found in fortified cereals and nutrition bars. The recommended daily amount of Vitamin B6 required for adults is around 1.7 mg. People eating only plant-based food require additional foods to meet the required amount of Vitamin B6 intake in the body.

Vitamin A is also called as Retinol. It is an essential nutrient required for healthy vision, skin growth and integrity, bone formation, immune function, and embryonic development.
Vitamin A toxicity is typically due to the overuse of supplements but may also be caused by diets which include large amounts of foods which are high in Vitamin A. Deficiency of Vitamin A may occur in people who do not get enough meat, fruits and vegetables in their diet. The most common symptom of Vitamin A deficiency is night blindness.