Fever Panel for Influenza like Illnesses

It gives us a measure of one of the components of the white blood cells , called Neutrophils. While all white blood cells help your body fight infections, neutrophils are important for fighting against bacterial infection.

Blood is made up of different types of cells which are suspended in a fluid called plasma. These include erythrocytes or red blood cells, leukocytes or white blood cells, and platelets. Blood cells are produced by the hematopoietic cells in bone marrow and are then released into circulation. RBCs carry oxygen to the tissues, platelets help in blood clotting at a site of injury, and leukocytes form an integral part of the immune system of the body.

WBCs are of five types, each having a different function and present in different numbers:

1.      Neutrophils: Under normal conditions, the number of neutrophils present is higher than any other type of WBCs.. They provide protection against pathogens, mostly bacteria and sometimes fungi. Neutrophils engulf the pathogens completely and digest them (the process is called phagocytosis). They are usually associated with acute or short-term infections.

2.      Eosinophils: Eosinophils are WBCs that are primarily responsible to fight parasitic infections. They are also involved in allergic reactions and regulation of the extent of immune response.

3.      Basophils: Basophils are WBCs which are present in the lowest numbers in circulation. They are considered to play an important role in allergic response.

[Neutrophils, eosinophils, and basophils are together classified as granulocytes. Granulocytes are the WBCs which contain granules present in their cytoplasm. These granules secrete chemicals during immune response.]

4.      Monocytes: Monocytes are WBCs which are also involved in protection against infectious pathogens by phagocytosis like neutrophils. However, monocytes are more commonly associated with chronic or long-term infections.

5.      Lymphocytes: These are specialized WBCs which are responsible for recognizing and neutralizing foreign (non-self) cells and cancer cells in the body. Lymphocytes are of three types, all of which are differentiated from a common type of lymphocyte progenitor cell:

·         T cells or T lymphocytes are produced in the bone marrow and mature in the thymus gland. They are responsible for differentiating between self and non-self cells of the body. T cells are also responsible for the initiation and extent of immune response, and targeted destruction of cancer cells and virus.

·         B cells or B lymphocytes are control acquired immunity by producing antibodies against antigens found on foreign cells and pathogens like bacteria and viruses.

·         Natural killer cells or NK cells destroy all foreign cells tagged by antibodies, cancer cells and virus-infected cells by phagocytosis.

Depending on various factors like age, gender, health condition, environmental factors, etc., varying amounts of different types of WBCs circulate in the blood. The bone marrow increases production of WBCs in response to an infection or inflammation anywhere in the body, which are then called to the site by a series of chemical signals, where they work to treat the condition. Depending on the condition, the count of one or more types of WBCs remains high in the blood. Once the condition subsides, WBC production by the bone marrow decreases and their count in circulation falls back to normal levels. Elevated amount of one or more types of leukocytes for a long time may be an indication of a chronic condition that is not resolving naturally and might need urgent attention.

Apart from an infection or inflammation, WBC count in blood can also be affected by other conditions like disorders of the immune system, autoimmune conditions, cancer, etc. One or more types of WBC count may be higher or lower than normal in these cases.

Differential Leukocyte Count Test serves as an indication of a condition affecting the body. Further tests are performed to confirm a particular condition and direct treatment.

The hemoglobin test measures the amount of hemoglobin in the blood.

Hemoglobin (Hb) is a protein found in red blood cells (RBCs) that carries oxygen from the lungs to the body tissues, and to exchange the oxygen for carbon dioxide. Hemoglobin then carries the carbon dioxide back to the lungs and where it is exchanged for oxygen. Iron is an essential part of hemoglobin. Most blood cells, including red blood cells, are produced regularly in your bone marrow (present within the cavities of many of large bones). To produce hemoglobin and red blood cells, your body needs iron, vitamin B12, folate and other nutrients from the foods you eat.

A decrease in hemoglobin concentration in blood results in anemia. Anemia is a blood disorder characterized by a decrease in the total amount of red blood cells (RBCs) or hemoglobin in the blood or a lowered ability of the blood to carry oxygen to body organs and tissues. Anemia is the most common blood disorder, affecting about a third of the global population and can cause symptoms like tiredness (fatigue), weakness, shortness of breath etc.

The hemoglobin test is usually performed as a part of complete blood count (CBC) test.

The platelet count measures the number of platelets present in the blood. Platelets are also known as thrombocytes which are tiny fragments of cells. These are formed from large cells which are found in the bone marrow known as megakaryocytes. After the platelets are formed, they are released into the blood circulation.

Whenever there is an injury to a tissue or blood vessel, bleeding starts. At this point, platelets help in stopping the bleeding in three ways:

• The platelets will adhere to the injury site

• The platelets will accumulate at the injury site 

• The platelets will release chemical compounds which stimulate gathering of other platelets

With these steps, a loose platelet connection forms at the site of injury. This process is known as primary hemostasis. The activated platelets start to support the coagulation cascade which involves a series of steps that includes the sequential activation of clotting factors. This process is known as secondary hemostasis which results in the formation of fibrin strands that knit through the loose platelet connection to form a fibrin net. After that, the connection is compressed to form a stable clot so that it remains in place until the injury heals. Once the injury is healed, other factors come into play and break it down so that it gets removed. 

In case the platelets are not sufficient in number or are not functioning properly, a stable clot might not form. These unstable clots can result in an increased risk of excessive bleeding. 

Blood is made up of different types of cells suspended in a fluid called plasma. These include erythrocytes or red blood cells, leukocytes or white blood cells, and platelets. Blood cells are produced by the hematopoietic cells in bone marrow and are then released into circulation. RBCs carry oxygen to the tissues, platelets help in blood clotting at a site of injury, and leukocytes form a part of the immune system of the body. WBCs are of five primary types: neutrophils, basophils, eosinophils, monocytes, and lymphocytes. Lymphocytes are further of three types: B-Lymphocytes, T-Lymphocytes, and natural killer (NK) cells. Neutrophils, basophils, eosinophils are collectively called granulocytes since they contain granules in cytoplasm.

Depending on various factors like age, gender, health condition, environmental factors, etc., varying amounts of different types of WBCs circulate in the blood. The bone marrow increases the production of WBCs in response to an infection or inflammation anywhere in the body. These WBCs are called to the site by a series of chemical signals, where they work to treat the condition. During this time, the total leukocyte count remains high in blood. Once the infection or inflammation subsides, WBC production by bone marrow decreases and WBC count in circulation falls back to normal levels. A continuously elevated WBC count may thus be an indication of a chronic condition that is not resolving naturally and might need urgent attention.

Apart from an infection or inflammation, WBC count in blood can also be affected by other conditions like disorders of the immune system, autoimmune conditions, cancer, etc. WBC count may be higher or lower than normal in these cases.

WBC count test serves as an indication of a condition affecting the body. Further tests are performed to confirm a particular condition and direct treatment.

The absolute eosinophil count measures the number of eosinophils present in the blood. Eosinophils, a  type of white blood cells, helps in fighting the disease. These come into action for are said to be linked with certain infections and allergic diseases. The eosinophils are produced and mature in the bone marrow. They usually take about 8 days to mature and then are moved to blood vessels.

The eosinophils have varied functions which include the physiological role in organ formation such as the development of post-gestational mammary gland. Other functions include its movement to the areas of inflammation, trapping substances, killing cells, bactericidal and anti-parasitic activity. It also helps the treatment of immediate allergic reactions and modulation of inflammatory responses.

Human blood is made up of erythrocytes or red blood cells, leukocytes or white blood cells, and platelets suspended in a fluid called plasma. Each of the component of blood performs a specific function. The packed cell volume or hematocrit is a ratio of the volume occupied by the RBCs to the total volume occupied by all the blood components or whole blood.

The RBCs transport inhaled oxygen from the lungs to all the cells of the body, and also a small amount of carbon dioxide from the cells to the lungs to be exhaled. The majority of carbon dioxide is transported in solution in plasma as bicarbonate ions. They contain a protein called hemoglobin which binds to oxygen for transport.

RBCs are produced in the erythropoietic cells of the bone marrow in response to the hormone Erythropoietin secreted by the kidneys when oxygen saturation of blood is detected to be low (hypoxia). The average lifespan of RBCs in circulation is 120 days. Hence, the bone marrows continuously produce RBCs to maintain a steady concentration in blood. The Packed Cell Volume Test depends on the count as well as the average size of the RBCs (Mean Corpuscular Volume or MCV). Higher than normal amount of RBCs produced by the bone marrow can cause the hematocrit to increase, leading to increased blood density and slow blood flow. Lower than normal hematocrit can be caused by low production of RBCs, reduced lifespan of RBC in circulation, or excessive bleeding, leading to reduced amount of oxygen reaching the cells.

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The Glucose - fasting urine test measures the levels of glucose in urine during the period of fasting. The most common cause of high levels of glucose in the urine is diabetes. In diabetes, the way the body processes the glucose gets affected. The insulin hormone is responsible for controlling the metabolism of glucose in the blood. In diabetic patients, the body is either not able to make enough insulin or the body is not able to utilize the insulin produced. Due to this, the glucose starts to build up in the blood and the kidneys are not able to control it to release it into the urine.

The presence of glucose in the urine is termed as glycosuria or glucosuria. This could be due to side effects caused by certain medicines or problems in the kidney, such as renal glycosuria. 

The Protein, Urine measures the excessive protein excreted in the urine. The urine protein tests measure the protein which is released into the urine. Normally, the urine protein elimination is less than 150 mg/day and less than 30 mg of albumin/day. Temporarily raised levels may be seen in conditions such as stress, infections, pregnancy, cold exposure, diet, or heavy exercise. 

The appearance of persistent protein discharge in the urine suggests possible kidney damage or the requirement of additional tests to know the cause.

In a normal functioning kidney, the filtered proteins are retained or reabsorbed and sent back to the blood. Whereas, if any damage is caused to the kidneys then it may affect their functioning which may cause detectable amounts of protein extracted into the urine.

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.

This is a test panel done to evaluate the kidney functions. It contains a group of tests integrated to collectively analyze any malfunction related to the kidney.

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 formed by 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. Although indirectly but uric acid test helps in estimating the proper functioning of the kidneys, .

The presence of excess amounts of uric acid in the blood is called hyperuricemia. This accumulation of uric acid crystals in the synovial fluid between joints lead to the formation of gouts. 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 improper kidney function.

The levels of creatinine in the blood can rise 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 the blood to the levels of creatinine in the blood. This ratio serves as a more accurate representation of kidney function. An increase in the ratio can be seen in case of 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.

Electrolytes: 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 which can be 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 similar to 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 an essential role in metabolism by producing hydrochloric acid (HCl) in the stomach for digestion. 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.