Basic Laboratory Tests Basic Blood Chemistry Tests Examples of conditions in Alternative Usual which abnormal values Test Names Units Normal Range occur Albumin, serum Albumin g/dL 3.8-5.2 g/dL Low levels may occur with malnutrition, liver disease, malabsorption, kidney disease. Elevated levels are uncommon but may be seen in dehydration. Bilirubin, Total Bili. Total mg/dL 0.2-1.5 mg/dL Liver dysfunction, biliary tract disease/obstruction, Gilbert’s syndrome (isolated), hemolysis (isolated) Blood Urea Nitrogen BUN mg/dL 9-25 mg/dL Kidney (renal) disease Creatinine, serum Creatinine mg/dL 0.7-1.5 mg/dL Kidney (renal) disease Lactate Dehydrogenase LDH (LD) U/L 50-150 U/L Tumors, hemolysis, liver, heart, lung and kidney diseases Protein, Total Tot Protein g/dL 6.1-8.2 g/dL See Albumin and Globulin Aspartate Aminotransferase AST (SGOT) U/L 0-33 U/L Viral hepatitis, fatty liver, alcohol abuse, cirrhosis, muscle injury, drug reactions, macroenzyme (isolated) Alanine Aminotransferase ALT (SGPT) U/L 0-45 U/L Viral hepatitis, fatty liver, alcohol abuse, cirrhosis, drug reactions Alkaline Phosphatase Alk. Phos. U/L 30-125 U/L Biliary tract disease, gallstones, tumors, drug reactions, bone disease/injury, pregnancy, growing children/adolescents Gammaglutamyl GGT (GGTP) U/L 0-65 U/L Biliary tract disease, Transpeptidase alcohol abuse, fatty liver, drug reactions Globulin Globulin g/dL 2.1-3.9 g/dL Elevated levels can occur with infections, inflammation, autoimmune diseases and various cancers. Low levels can occur with liver disease, inherited abnormalities in globulin production, and in kidney disease. Glucose Glucose mg/dL 60-109 mg/dL Diabetes mellitus, hypoglycemia Fructosamine Fructosamine mg/dL 1.2-2.0 mg/dL Diabetes mellitus Hemoglobin A1c HbA1c, % 3.0-6.0% Diabetes mellitus Glycosylated Hemoglobin (GHb) Total Cholesterol Cholesterol mg/dL 140-199 mg/dL Familial hyperlipidemia, HDL Cholesterol HDL mg/dL 35-80 mg/dL hypothyroidism, liver disease, LDL Cholesterol LDL mg/dL 0-129 mg/dL kidney disease, diabetes, Total Cholesterol/HDL Chol/HD No units <5.0 medications, obesity, cigarette Cholesterol ratio L ratio smoking, alcohol consumption LDL Cholesterol/HDL LDL/HD No units 0.9-5.3 Cholesterol ratio (LDLHDL L ratio ratio) Triglycerides Triglycerides mg/dL 0-15 mg/dL Uric Acid UA mg/dL 2-7 mg/dL Gout, renal failure, malignancy Prostate specific antigen PSA nanograms per 0-4 ng/mL Prostate cancer, milliliter (ng/mL) benign prostate hypertrophy, prostatitis Carbohydrate deficient CDT % 0-2.5% Excessive alcohol transferrin consumption, liver disease, Hemoglobin associated HAA micromoles per <10.5 ìmol/L inherited conditions and in acetaldehyde liter (ìmol/L) normal individuals NTproBNP Pro-Brain picograms per <125 pg/mL Various types of heart disease naturetic milliliter (pg/mL) peptide, N terminal fragment C-reactive protein CRP mg/L Low risk <1,2 mg/L Coronary disease, vascular Mod risk 1-2-1.9 disease mg/L High risk >2 mg/L HIV antibody, serum Non-reactive HIV infection HIV antibody, urine Non-reactive HIV infection Hepatitis B surface antigen HBsAg Non-reactive Hepatitis B infection Hepatitis B surface antibody HBsAb Non-reactive Previous Hepatitis B infection, Hepatitis B vaccination Hepatitis B core antibody HBcAg Non-reactive Current or previous Hepatitis B infection Hepatitis B “e” antigen HBeAg Non-reactive Current Hepatitis B infection Hepatitis C antibody HCVAb Non-reactive Hepatitis C infection Blood Chemistry Tests Indicators of Carbohydrate Metabolism: Glucose, Glycosylated Hemoglobin (Hemoglobin A1c) and Fructosamine Glucose measurements are made to determine if there is a disorder of carbohydrate metabolism. Such disorders include diabetes mellitus and various forms of hypoglycemia. Diabetes usually results in elevated glucose levels while disorders associated with hypoglycemia may result in low glucose levels. However, normal glucose values do not exclude the possibility that abnormal carbohydrate metabolism may exist. Glucose level rise after meals and fall with fasting so it is important to note when the blood samples were obtained in relation to the last meal. The degree of blood glucose elevation may be an indicator of the severity of diabetes or of how well the diabetes is being controlled. But since glucose levels often vary considerably throughout the day, fructosamine or glycosylated hemoglobin levels may give a better indication of longer-term diabetes control. Improper preparation or delays in analyzing blood samples can result in erroneously low glucose values, a condition termed glycolysis. Glycolysis not only may result in erroneously low glucose values but may also cause laboratory measurements of creatinine to be erroneously high. Glycosylated hemoglobin (Hemoglobin A1c). Hemoglobin is the oxygen carrying protein within red blood cells. When hemoglobin comes into prolonged contact with glucose, some glucose may become chemically attached to the hemoglobin molecule resulting in what has become known as glycosylated hemoglobin (GHb) or hemoglobin A1c (HbA1c). Glycosylated hemoglobin levels rise and fall in direct proportion to blood glucose levels. Glycosylated hemoglobin levels reflect average blood glucose levels over the life span of the red blood cell, about 120 days. Therefore glycosylated hemoglobin concentrations are more useful indicators of long-term diabetes control than are individual blood glucose measurements. The American Diabetes Association recommends that a glycosylated hemoglobin values be kept at 7% or less. Fructosamine Similar to the way glycosylated hemoglobin is formed, blood glucose may become chemically attached to the protein, albumin, to form fructosamine. As with glycosylated hemoglobin, fructosamine levels rise and fall in direct proportion to blood glucose levels. But because the life-spam of the albumin molecule is shorter than that of the hemoglobin molecule, fructosamine levels reflect average blood glucose concentrations over a shorter period of time, usually thought to be the preceding 3 to 6 weeks. Indicators of Lipid Metabolism: Total Cholesterol, HDL Cholesterol, LDL Cholesterol, TC/HDL ratio Cholesterol, Total Cholesterol Cholesterol is a lipid (fat) that is an essential component of cell membranes and is required for the synthesis of various hormones. Cholesterol is both absorbed from food and synthesized by the liver. Excess amounts of cholesterol may be deposited in arteries resulting in atherosclerosis and predisposing to the risk of heart attack and stroke. Cholesterol circulates in the body bound to various forms of protein. The size and composition of these “lipo- protein” particles determine their potential for causing atherosclerosis. HDL Cholesterol, LDL Cholesterol, Cholesterol/HDL Ratio The forms of cholesterol commonly measured at the time of insurance underwriting include total cholesterol, high density lipoprotein cholesterol (HDL cholesterol or “HDL”) and low density lipoprotein cholesterol (LDL cholesterol or “LDL”). LDL particles transport cholesterol to the tissues and result in the deposition of cholesterol in arterial walls resulting in atherosclerosis. HDL particles transport cholesterol back to the liver for further metabolism and thereby reduce the risk of atherosclerosis. The total cholesterol/HDL cholesterol ratio (TC/HDL) has been shown to be an important predictor of the risk of atherosclerosis, with lower cholesterol/HDL ratios being associated with less risk. Conversely, elevated LDL levels and lower HDL/LDL ratios are associated with an increased risk of atherosclerosis. In some studies, low total cholesterol levels and total cholesterol levels that are falling without treatment have also been associated with increased mortality risk, primarily cancers and other non-cardiovascular diseases. Total cholesterol, HDL and LDL concentrations vary from day-to-day by up to 13% in a given individual. Ideally, lipid measurements should be made after a 12-hour fast since HDL levels may decrease slightly after meals. However, eating has little effect on total cholesterol levels. Lipid Normal/Optimum/Desirable Borderline Increased Risk Total Cholesterol <200 mg/dL 200-239 mg/dL >240 mg/dL HDL Cholesterol >60 mg/dL 40-59 mg/dL < 40 mg/dL LDL Cholesterol <100 mg/dL 100-159 mg/dL >160 mg/dL Total Cholesterol/HDL ratio <3.5 >5 Triglycerides <150 mg/dL 150-199 mg/dL > 200 mg/dL Modified from Hunninghake DB, Pasternak RC, Smith SC, et al: Third Report of the Expert Panel on Detection, Evaluation and Treatment of the High Blood Cholesterol in Adults (Adult Treatment Panel III) Circulation 2004; 110: 227-239 Triglycerides Triglycerides are a major transportation and storage form for lipids. Triglycerides are produced in the intestine after meals and by the liver. Elevated triglyceride concentrations are risk factors for coronary disease and may be a marker for insulin resistance and pre-diabetes. Triglyceride concentrations above 1,000 mg/dL may cause acute pancreatitis. Triglyceride levels can be markedly elevated after meals. Therefore triglycerides should be measured after a minimum of a 9 hour fast. Indicators of Kidney (Renal) Function: Glomerular Filtration Rate (GRF), Creatinine, and BUN (Blood Urea Nitrogen) The kidneys’ main functions are to regulate salt and water balance in the body and to filter waste products from protein metabolism. Blood entering the kidneys travel through a myriad of branching arteries until reaching structures called glomeruli that consist of portions of capillaries twisted into what resemble microscopic tufts, each