Pollution Elements and Whole Body Checkup

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 Thyroid Profile Total test measures the levels of the following three hormones in the blood:
Thyroid Stimulating Hormone (TSH)
Thyroxine (T4) - Total
TriIodothyronine (T3) - Total

The thyroid gland (a small, butterfly-shaped gland located in front of the neck) 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 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. and 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 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 hormone decrease, the pituitary gland is stimulated to release TSH.  High TSH in turn increases the release of T3 and T4 thyroid hormones from the thyroid gland and vice-versa.

T3 and T4 circulate in the blood in two forms:

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

2) Free form - It enters the body tissues where it is  needed

The total T3 or total T4 includes both bound and free forms circulating in the blood. Hence, thyroid hormones can be measured as Free T3, Total T3, Free T4, and Total T4.

The total T3 and total T4 levels can be affected by the amount of protein available in the blood to bind to them.

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.

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.

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.

Apolipoprotein B/ Apolipoprotein 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).  

Lipoprotein B is a marker that has been proven to indicate a person's chance of having a cardiovascular event such as a heart attack or stroke. 

Apolipoprotein B is ordered along with an apo A-I or other lipid tests, when a healthcare practitioner is trying to evaluate 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.
 

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.

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 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.

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.

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.

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.

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.