General Health Panel:
CBC or complete blood count (CBC)
CBC consists of hemoglobin, white blood count and platelets.
Hemoglobin - This is a test to see if a patient has anemia which could be due to several underlying causes, iron deficiency being one of them but the test does not check specifically for iron levels.
WBC or White blood count can be high in case of infection or several chronic diseases and low in case of several neoplastic disorders. Further break down of white cell count does not provide too much information in an out patient setting and should be interpreted in the context only.
Platelets – These small cells perform clotting function in case of bleeding and can be high or low in several health conditions.
The comprehensive metabolic panel (CMP)
CMP This is a frequently ordered panel of 14 tests that gives a healthcare provider important information about the current status of a person's metabolism, including the health of the kidneys and liver, electrolyte and acid/base balance as well as levels of blood glucose and blood proteins. Abnormal results, and especially combinations of abnormal results, can indicate a problem that needs to be addressed.
•The CMP includes the following tests:
Glucose - energy source for the body; a steady supply must be available for use, and a relatively constant level of glucose must be maintained in the blood.
Calcium - one of the most important minerals in the body; it is essential for the proper functioning of muscles, nerves, and the heart and is required in blood clotting and in the formation of bones.
Total Protein - measures albumin as well as all other proteins in serum
Sodium - vital to normal body processes, including nerve and muscle function
Potassium - vital to cell metabolism and muscle function
Chloride - helps to regulate the amount of fluid in the body and maintain the acid-base balance
Kidney Function Tests (BUN and Creatinine)
BUN (blood urea nitrogen) - waste product filtered out of the blood by the kidneys; conditions that affect the kidney have the potential to affect the amount of urea in the blood.
Creatinine - waste product produced in the muscles; it is filtered out of the blood by the kidneys so blood levels are a good indication of how well the kidneys are working.
Liver Test (ALP, ALT, AST, Bilirubin)
ALT (alanine amino transferase, also called SGPT) - enzyme found mostly in the cells of the liver and kidney; a useful test for detecting liver damage
AST (aspartate amino transferase, also called SGOT) - enzyme found especially in cells in the heart and liver; also a useful test for detecting liver damage
Bilirubin - waste product produced by the liver as it breaks down and recycles aged red blood cells
Why is CMP ordered?
•The comprehensive metabolic panel (CMP) is used as a broad screening tool to evaluate organ function and check for conditions such as diabetes, liver disease, and kidney disease. The CMP may also be ordered to monitor known conditions, such as hypertension, and to monitor people taking specific medications for any kidney- or liver-related side effects.In most healthy patients, CMP is expected to be normal and because all tests included in this panel represent a snapshot of metablism at one point in time, slight variations in numbers usually do not mean any serious problem.
Main role of vitamin D is to help regulate blood levels of calcium, phosphorus, and (to a lesser extent) magnesium. Vitamin D is vital for the growth and health of bone; without it, bones will be soft, malformed, and unable to repair themselves normally, resulting in diseases called rickets in children and osteomalacia in adults. Vitamin D has also been shown to influence the growth and differentiation of many other tissues and to help regulate the immune system. These other functions have implicated vitamin D in other disorders, such as autoimmunity and cancer.
•Based on data from the National Health and Nutrition Examination Survey, the Centers for Disease Control and Prevention (CDC) reports that two-thirds of U.S. population has insufficient vitamin D, while roughly one-quarter are at risk of inadequate vitamin D and 80% are at risk of deficiency, as defined by the Dietary Reference Intake (DRI) set by the Institute of Medicine.
C Reactive Protein
C-reactive protein (CRP) is an acute phase reactant, a protein made by the liver and released into the blood within a few hours after tissue injury, the start of an infection, or other cause of inflammation. Markedly increased levels are observed, for example, after trauma or a heart attack, with active or uncontrolled autoimmune disorders, and with serious bacterial infections like sepsis. The level of CRP can rise as much as a thousand-fold in response to inflammatory conditions, and its rise in the blood can precede pain, fever, or other clinical indicators. The test measures the amount of CRP in the blood and can be valuable in detecting inflammation due to acute conditions or in monitoring disease activity in chronic conditions.
The CRP test is not diagnostic, but it provides information to a health practitioner as to whether inflammation is present. This information can be used in conjunction with other factors such as signs and symptoms, physical exam, and other tests to determine if someone has an acute inflammatory condition or is experiencing a flare-up of a chronic inflammatory disease. The health practitioner may then follow up with further testing and treatment.
Prostate specific antigen (PSA) is a protein produced primarily by cells in the prostate, a small gland that encircles the urethra in males and produces a fluid that makes up part of semen. Most of the PSA that the prostate produces is released into this fluid, but small amounts of it are also released into the bloodstream. This test measures the amount of PSA in the blood.
The PSA test is used as a tumor marker to screen for and to monitor prostate cancer. It is a good tool but not a perfect one, and most experts agree that screening should be done on asymptomatic men only after thorough discussions with their healthcare providers on the benefits and risks and after informed decisions are made to undergo screening. Elevated levels of PSA are associated with prostate cancer, but they may also be seen with prostatitis and benign prostatic hyperplasia (BPH). PSA levels tend to increase in all men as they age, and men of African American heritage may have levels that are higher than other men, even at earlier ages.
Hemoglobin A1c, also called A1c or glycated hemoglobin, is hemoglobin with glucose attached. The A1c test evaluates the average amount of glucose in the blood over the last 2 to 3 months by measuring the percentage of glycated (glycosylated) hemoglobin.
What does the test result mean?
Pre-diabetes: A1c result 5.7% (39 mmol/mol)
Diabetes: A1c level is 6.5% (48 mmol/mol) or higher
For monitoring glucose control, A1c is currently reported as a percentage and, for most people with diabetes, it is recommended that they aim to keep their hemoglobin A1c below 7%. The closer they can keep their A1c to the American Diabetes Association (ADA)'s therapeutic goal of less than 7% without experiencing excessive low blood glucose (hypoglycemia), the better their diabetes is in control. As the A1c increases, so does the risk of complications.
A lipid panel typically includes:
High-density lipoprotein cholesterol (HDL-C) — often called "good cholesterol" because it removes excess cholesterol and carries it to the liver for removal.
Low-density lipoprotein cholesterol (LDL-C) — often called "bad cholesterol" because it deposits excess cholesterol in walls of blood vessels, which can contribute to atherosclerosis.
Optimal, Borderline High and High Values for different components of lipid panel are given below:
Desirable: Less than 200 mg/dL (5.18 mmol/L)
Borderline high: 200-239 mg/dL (5.18 to 6.18 mmol/L)
High: 240 mg/dL (6.22 mmol/L) or higher
Non HDL Cholesterol
Optimal: Less than 130 mg/dL (3.37 mmol/L)
Near/above optimal: 130-159 mg/dL (3.37-4.12mmol/L)
Borderline high: 160-189 mg/dL (4.15-4.90 mmol/L)
High: 190-219 mg/dL (4.9-5.7 mmol/L)
Very high: Greater than 220 mg/dL (5.7 mmol/L)
Optimal: Less than 100 mg/dL (2.59 mmol/L); for those with known disease (ASCVD or diabetes), less than 70 mg/dL (1.81 mmol/L) is optimal
Near/above optimal: 100-129 mg/dL (2.59-3.34 mmol/L)
Borderline high: 130-159 mg/dL (3.37-4.12 mmol/L)
High: 160-189 mg/dL (4.15-4.90 mmol/L)
Very high: Greater than 190 mg/dL (4.90 mmol/L)
Low level, increased risk: Less than 40 mg/dL (1.0 mmol/L) for men and less than 50 mg/dL (1.3 mmol/L) for women
Average level, average risk: 40-50 mg/dL (1.0-1.3 mmol/L) for men and between 50-59 mg/dl (1.3-1.5 mmol/L) for women
High level, less than average risk: 60 mg/dL (1.55 mmol/L) or higher for both men and women
Desirable: Less than 150 mg/dL (1.70 mmol/L)
Borderline high: 150-199 mg/dL(1.7-2.2 mmol/L)
High: 200-499 mg/dL (2.3-5.6 mmol/L)
Very high: Greater than 500 mg/dL (5.6 mmol/L)
Should you take medicine for high cholesterol?
Calculate your risk at www.cvriskcalculator.com
•A risk of < 7.5% suggests that there is no need to treat cholesterol with a pharmacologic agent. However, a shared decision must be made based upon each individual’s unique circumstances and preferences.