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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.

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. 

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

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

The serum electrolyte test measures the following electrolytes:

• Sodium (Na+)

• Potassium (K+)

• Chloride (Cl-)

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

Sodium (Na+)

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

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

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

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

·         Induction of thirst

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

Potassium (K+)

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

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

Chloride (Cl-)

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

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

The random blood glucose test is done to measure the levels of glucose at any point of the time. This test provides speedy diagnosis of diabetes. Also, it is helpful for diabetic patients who require a supplementary dose of insulin in case of emergency. 

Glucose is the main source of energy for the body. Carbohydrates consumed in the diet are broken down in the body to form 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 intestine is facilitated by a hormone called 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 the storage of excess glucose. The action of insulin reduces sugar levels in the blood.

After a meal, the levels of sugar increase in blood and insulin is secreted in response until they become normal. If glucose levels fall too low in blood, another pancreatic hormone called glucagon is released. This hormone 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.

The random blood glucose test helps to determine the levels of glucose at any point of the time. To confirm the diagnosis, follow-up tests are required which include Glucose - Fasting Blood and Oral glucose tolerance test.

High levels of sugar in the blood indicate 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 levels rise, while cells remain deprived of nutrition.

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 Uric acid test measures the levels of uric acid in the blood. Uric acid is a nitrogenous compound produced by the metabolic breakdown of purine. Purines are nitrogenous bases in DNA forming parts of the structural framework of the cells. Breakdown of purines occurs when cells become old and die, forming uric acid. Uric acid is also formed from the metabolic breakdown of some types of food like red meat, seafood, beans, etc.

Most of the uric acid in the blood is filtered and eliminated by the kidneys and a small remaining amount in the stool. The concentration of uric acid in the blood can increase due to overproduction of uric acid or improper elimination of uric acid, and this condition is called Hyperuricemia. Hyperuricemia can also be caused due to cancer treatment by chemotherapy or radiotherapy. These treatment methods kill the cancer cells, which may leak the uric acid into the blood.

Excess uric acid can form crystals in the synovial fluid between the joints causing inflammation and pain. This condition is called gout and can severely damage the joints if left untreated. The Uric Acid Test can indicate the presence of gout, or risk of formation of gout. However, it is not a definitive test for gout. Confirmatory test for gout is performed by analysis of synovial fluid (joint fluid) for monosodium urate crystals. Chronic Hyperuricemia can cause the formation of tophi, which are hard lumpy deposits of uric acid crystals formed under the skin, in the joints, and at the top of the ears. Tophi cause severe damage to the joints and may compress nerves causing chronic pain and disfigurement. The excess uric acid may also deposit and crystallize in the kidneys causing kidney stones and acute renal failure.

The alkaline phosphatase, serum test measures the alkaline phosphatase levels in the blood. Alkaline phosphatase (ALP) is an enzyme which is found in various tissues throughout the body. The maximum concentrations of ALP are present in cells of bone and liver. Usually, raised levels of ALP are caused due to liver disease or bone disorders.

ALP is found in the liver on the cell edges that join to form bile ducts. The bile ducts are the tiny tubes which drain bile from the liver to the bowels. The bile juice formed is required by the small intestine to help digest fat in the diet.

ALP is produced by osteoblasts cells in the bone which are involved in bone formation. The various tissue types produce distinct forms of ALP which are known as isoenzymes.

The levels of ALP generally increase to a great extent if one or more bile ducts get blocked. The reason could be inflammation of the gallbladder which is known as cholecystitis or the presence of gallstones. The small amount of increase of ALP in the blood can be seen in liver cancer and cirrhosis. These high levels can also be observed if there is intake of medications toxic to the liver and hepatitis.

In conditions, where there is formation of excessive bones such as Paget’s disease one can also have increased levels of ALP. Along with that, higher blood ALP levels can be seen in children and adolescents, as they are in the growing stage and so are their bones.

Cholesterol is essential for life, as it is required by the body to work properly. It plays a role in the formation of cell membranes in all organs and tissues in the body. It is associated with the formation of hormones which are important for development, growth, and reproduction. It forms bile acids, which help to absorb nutrients from food. 

In the blood, a small amount of cholesterol circulates in the form of lipoproteins which contains protein, cholesterol, triglyceride, and phospholipid molecules. These are classified according to their density into HDL (high-density lipoproteins), LDL (low-density lipoproteins), and VLDL (very low-density lipoproteins). HDL cholesterol is also known as good cholesterol, as it carries excess cholesterol away for disposal while LDL cholesterol is also known as bad cholesterol, as it deposits cholesterol in tissues and organs. 

It is important to maintain and monitor the levels of cholesterol for a healthy lifestyle. The source of cholesterol is diet as well. If a person is taking too much of cholesterol-rich foods, it can cause a rise in levels of cholesterol in the blood. The amount of cholesterol which is not required by the body starts to deposit in the form of plaques on the walls of blood vessels. These plaques can narrow or block the blood vessels opening which can lead to the hardening of arteries known as atherosclerosis. Also, with an increase in cholesterol levels, there is an increased risk of various conditions such as heart disease and stroke. 

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. 

The Blood Urea Nitrogen test measures the amount of urea nitrogen in the blood. Urea is a waste product which is formed in the liver. It is formed when protein is metabolized into amino acids. This leads to the production of ammonia which is further converted into urea which is a less toxic waste product. 

Both ammonia and urea have nitrogen as their component. The liver releases urea into the blood which is then carried out to the kidneys. Here, it is filtered out of the blood and then released into the urine. Since this is a continuous process, a small and stable amount of urea nitrogen always remains in the blood.

In case of kidney or liver diseases, there is a change in the amount of urea present in the blood. If the liver produces urea in increased amounts or if there is any problem in the functioning of the kidneys, there can be difficulty in filtering out wastes of the blood which will lead to rising in urea concentrations in the blood. If due to liver damage or disease there is less production of urea, the concentration of BUN will fall.

The BUN test is done along with creatinine test to evaluate kidney function to diagnose kidney disease and to monitor patients undergoing treatment of kidney disease.