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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.   

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.

A Diabetes Screening (HbA1C & Fasting Sugar) test includes a glycosylated hemoglobin test and a glucose-fasting blood test. The glycosylated hemoglobin test measures the percentage of glycosylated hemoglobin in the blood, while a glucose-fasting blood test measures the glucose level during fasting. Glucose is the main form of sugar utilized by the body to release energy; it is absorbed by the intestine and distributed to all organs through blood. These tests help your doctor to monitor your blood sugar levels and manage your diabetes well. 

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.

Ph, Serum measures the levels of inorganic phosphates in blood. It is critical in the production and storage of energy as it forms a part of the energy currency of cells (Adenosine tri, di, and monophosphates). It is also a structural component of DNA. It is essential in the functioning of nerves and muscles, and in the growth and maintenance of healthy bones. In blood, phosphates act as buffers to maintain the pH and electrolyte balance of the body.

The main source of phosphorus comes from diet. Once consumed, it is quickly absorbed by the digestive system. In the body, most of the phosphates are bound to calcium in the bones and teeth. Some of it is found in muscles and nerves, and a small amount is present in cells, where it forms a structural component of DNA. Very small amounts of phosphates are normally found in circulation, and these levels are measured with blood phosphorus levels.

Phosphate levels in the blood are maintained within its very narrow normal concentration range by excretion of excess phosphorus through kidneys. Phosphate levels are also dependent on the levels of calcium, Vitamin D and parathyroid hormone in blood.

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.

Rheumatoid factor (RF) attacks healthy body tissues as it mistakes them for foreign body tissues. It is not found in healthy persons. The presence of RF means that the body has an autoimmune disease such as Rheumatoid arthritis. Symptoms of Rheumatoid arthritis include stiffness of joints especially in morning, pain in joints, underlying skin nodules, loss of bone and swelling of joints.   

The thyroid gland secretes the following hormones:

• Triiodothyronine (T3)

• Thyroxine (T4)

Thyroid Stimulating Hormone (TSH) is a hormone secreted into the blood by the pituitary gland (a gland present in the brain) which tells your thyroid gland to make and release the thyroid hormones (T3 & T4) into your blood. The thyroid gland uses the iodine gained 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 T3 and T4 hormones, you may experience symptoms like weight loss, rapid heartbeat, tremors, sweating, anxiety, increased sensitivity to heat, etc. This is known as hyperthyroidism.

The decreased production of thyroid hormones (T3 and T4) results in hypothyroidism which may cause 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 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 the 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), also called Thyroid hormone binding globulin (THBG).

2) Free form - This is the active form which enters the body tissues where it's needed. Free Thyroxine (FT4) constitutes only 0.3% of the total T3 hormone.

Hence, the T4 hormone can be measured as Free T4 or Total T4. Total T4 includes both the bound and the free forms, circulating in the blood and can be affected by the amount of protein available in the blood to bind to them. Therefore, Thyroxine (T4) Free Test is a useful indicator of the T4 levels in the blood when binding proteins are increased or decreased.

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

The Free Triiodothyronine (T3) Test measures the levels of the Free form of the T3 hormone.

The thyroid gland secretes the following hormones:

• Triiodothyronine (T3)

• Thyroxine (T4)

• Calcitonin

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 absorbed from the food stimulates the thyroid glands to make the thyroid hormones.

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

The decreased production of thyroid hormones results in Hypothyroidism 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. When the levels of thyroid hormone decrease, the pituitary gland is stimulated to release TSH. This high TSH, in turn, leads to an increase in the release of thyroid hormones (T3 & T4) from the thyroid gland and vice-versa.

T3 hormone circulates in the blood in two forms:

1) Bound form - It is bound to the proteins present in the blood which prevents it from entering the body tissues.

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

The total T3 includes both the bound and the free forms circulating within the blood and can be affected by the amount of protein available in the blood to bind to them.

Majority of the T3 hormone is formed from T4 hormone and a smaller fraction is produced directly by the thyroid gland. Free Triiodothyronine (FT3) constitutes of only 0.3% of the total T3 hormone. The two main proteins in the blood that the T3 hormone binds itself to are albumin and Thyroxine-binding globulin (TBG), also called Thyroid hormone Binding Globulin (THBG).

Hence, the T3 hormone can be measured as Free T3 or Total T3. Free Triiodothyronine (T3) Test is also a part of the Thyroid profile Free test which includes two more tests: Thyroid Stimulating Hormone (TSH) and Free Thyroxine (FT4).

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.

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. Ionized calcium provides a more physiologically accurate assessment of calcium, especially in the presence of high protein concentrations, hyperparathyroidism and hypoparathyroidism.

The anti-thyroglobulin antibody test measures the levels of antibodies produced against thyroglobulin in the body. Thyroglobulin is a protein which is made by the thyroid gland. The thyroid gland is small-sized and butterfly-shaped and is located near the base of the throat above the collar bone. The thyroid gland makes T3 and T4 hormones. The role of hormones is to regulate the metabolism of the body. In addition to that, these hormones affect the body’s energy levels, weight, and mood.

In case of conditions where autoantibodies are produced against thyroid gland such as s Hashimoto’s thyroiditis and autoimmune thyroid disease, the anti-thyroglobulin antibody test is carried out. 

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.

Following tests are a part of the Advanced cardiac risk markers package:

Apolipoprotein A-I (apo A-I) is a protein that plays an important role in the transportation and metabolism of lipids and is the main protein component in high-density lipoprotein. Apo A-I is ordered in someone who has a personal or family history of abnormal lipid levels and/or premature cardiovascular disease. It may be ordered when your doctor is trying to determine the cause of a person's high cholesterol.

The Homocysteine Test measures the levels of homocysteine in the blood. Homocysteine is an amino acid which at increased levels in the body can damage the inner lining of the blood vessels that increases the chances of blood clot formation. The Homocysteine Test measures the levels of homocysteine in the blood. The Homocysteine Test is performed to screen for heart attack and stroke, especially in people with no known risk factors but with a family history of cardiovascular diseases. This test also detects and diagnoses an inherited disease called homocystinuria in newborns and infants and even detects deficiency of Vitamin B6, B12, or Folic acid.

Apolipoprotein B/ A1 Ratio helps in evaluating your risk of developing cardiovascular disease (CVD); It is also used to monitor treatment for high cholesterol. This test is not widely used for a screening test but may be ordered if a person has a family history of heart disease and/or high cholesterol and triglycerides (hyperlipidemia).

High sensitive CRP: High sensitive C reactive protein is a test that measures the amount of C reactive protein in the blood. The level of this marker is elevated in cases of inflammation in the body. This test can evaluate your risk of heart diseases such as coronary artery disease.

Lipoprotein-A: This test measures the amount or activity of Lipoprotein in the blood. It helps in determining your risk of developing cardiovascular disease (CVD), including your risk of coronary heart disease (CHD) and ischemic stroke.

Apolipoprotein-B is ordered, when a healthcare practitioner is evaluating someone's risk of developing CVD and when a person has a personal or family history of heart disease and/or abnormal lipid levels, especially when the person has significantly elevated triglyceride levels.