The Expanded Chemistry Profile

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A Breakthrough in Chemistry Profiling from BioHealth

Expanded Chemistry Profile - BHD #218
Requires Fasting Blood Draw

Over 70 markers offered at a fraction of the cost you would find with other labs.
Sample required: two 10 mL SST (tiger top) decanted serum
one 5 mL EDTA (lavender top) blood
Lab reporting time: 3 - 4 business days

Renal Function/Electrolyte Screen

BUN: Urea is the chief end product of protein metabolism. It is formed almost entirely by the liver from both protein digestion and protein metabolism in the liver. BUN should only be determined on fasting patients since there is an increase in the blood values after ingestion of protein.

CREATININE: This body excretion is formed by the spontaneous decomposition of creatine, an intrinsic substance in the contraction mechanism of muscle. It differs from BUN in that it is unaffected by protein intake or gender.

BUN/CREAT RATIO: Assessing this ratio is critical when the value is 10 or less in antidiuretic hormone (ADH), also known as vasopressin insufficiency.

URIC ACID: This is also a compound which can be found in kidney stones. As the uric acid content of the urine increases the urinary pH will increase as high as 7.0. This causes the uric acid to be converted to sodium urate.

SODIUM: Sodium is the most abundant cation in the extra-cellular fluid. It is of the greatest importance in osmotic regulation of extra-cellular fluid balance, acid balance, and renal, cardiac and adrenal functions. Sodium helps to maintain normal acidity in the urine, is involved in the transmission of nerve impulses and is required for maintenance of the sodium-potassium pump.

POTASSIUM: Potassium is the chief ion found in the intra-cellular fluid. Only a small part of the total body potassium is contained in the serum. Serum potassium values range from 3.5 to 5.0 mmol/L while the levels in intra-cellular fluid are 15 to 20 times this amount. While only a part of total body potassium is found in the serum, proper serum values are critical to normal physiology, especially adrenal, heart, and renal functions. It is essential in the maintenance of pH of blood and urine and maintenance of osmotic pressure preventing edema and general muscle fatigue. Potassium should always be viewed in relation to the other electrolytes.

CHLORIDE: Chloride is an electrolyte. When combined with sodium it is mostly found in nature as "salt." Chloride is important in maintaining the normal acid-base balance of the body and, along with sodium, in keeping normal levels of water in the body. Chloride generally increases or decreases in direct relationship to sodium, but may change without any change in sodium when there are problems with too much acid or base in your body.

CARBON DIOXIDE: CO2 is the amount of base bound as bicarbonate in the blood, which are available for the neutralization of the fixed acids, such as lactic acid and HCl. It should be made clear that CO2 refers only to the base bound as bicarbonate and not the total base of the blood. It represents the reserve alkali readily available for the neutralization of the acids. Conditions involving primary CO2 excess and deficit cannot be determined by CO2 alone. Serum chlorides must be checked for the inverse values when metabolic acidosis or alkalosis is suspect.

Liver Function Screen

BILIRUBIN, TOTAL: Bilirubin is an orange-yellow pigment found in bile. It is formed when hemoglobin, the red-colored pigment of red blood cells that carries oxygen to tissues, breaks down. Small amounts of bilirubin are present in blood from damaged or old red cells that have died.

ALKALINE P-TASE (AP): This enzyme in serum causes hydrolysis of monophosphate at an optimal pH of 9.0 to 10.0. It is commonly elevated in children who are still developing bone. It is abnormally elevated in liver, bone, or intestinal dysfunction and will be elevated in several types of cancer.

SGOT/AST (aspartate aminotransferase): This enzyme is involved in the transfer of D-Amino nitrogen of aspartic acid to Alpha-Ketoglutamic acid, resulting in the synthesis of glutamic acid, alpha-keto acid, and oxaloacetic acid. SGOT/AST acts as a catalyst in amino acid metabolism during glycolysis with resultant energy release. AST levels are also often compared with levels of other liver enzymes, such as alkaline phosphatase (AP), and alanine aminotransferase (ALT), to help determine the form of liver disease present.

SGPT/ALT (alanine aminotransferase): Functionally similar to SGOT. However, it is not increased as much in cardiac problems. In liver dysfunction it is increased more and does not return to normal as fast as SGOT/AST. A SGPT/ALT relationship to the Krebs Cycle is seen in the liver as it releases it from fatty acid storage.

LDH: Lactic Dehydrogenase represents a group of enzymes involved in carbohydrate metabolism. LDH enzymes participate in lactate and pyruvate utilization. With heart attacks, LDH values will be the highest on the second and third days after the damage occurs.

GGTP (gamma glutamyl transpeptidase): The GGTP test is a more rapid, sensitive and specific indicator of liver problems than AP and in certain conditions than SGPT-ALT. It is elevated in all common forms of liver dysfunction/disease and is even more elevated in bile duct disease and alcoholism.

TOTAL PROTEIN: The sum of the total albumin and total globulin.

ALBUMIN: Produced almost entirely in the liver, albumin is responsible for about 80% of the colloid-osmotic pressure between blood and tissue fluids.

GLOBULIN: Total globulin is valuable in assessing degenerative inflammatory and infectious processes. It also can indicate the need for digestive HCL support. Total globulins are a combination of alpha 1, alpha 2, beta, and gamma fractions.

A/G RATIO: The value of the A/G ratio is not precise due to the countless number of variables in the fractions (Total Globulins and Albumin) associated with various metabolic states. Abnormal A/G ratios usually reflect a general index of liver dysfunction.

Bone and Mineral Screen

PHOSPHORUS: Essential to the physiology of bone, and the formation of active compounds such as phospholipids, nucleic acids, ATP, creatine phosphate, and compounds required for the utilization of glucose. Phosphorus level is often indicative of digestive function.

CALCIUM: Calcium is absorbed from the upper part of the small intestine. The amount of absorption depends upon the acidity of the intestinal contents and the amount of phosphate present. Calcium relates to bone metabolism, the drawing of the fats through the intestinal wall, muscle contraction, transmitting nerve impulses and protein absorption. The amount of protein in the blood affects the calcium level. Calcium provides a mobilizing factor in trauma, infections, and stress and is used rapidly for the repair of tissue in conjunction with Vitamin A and C, Magnesium, Phosphorus and unsaturated fatty acids. Calcium exists in the ionized form (about 55 percent) and the non-diffusible portion (about 45 percent) that is bound to protein, chiefly albumin.

CALCIUM IONIZED: Calcium is one of the most important minerals in the body. About 99% of it is found in the bones, and most of the rest circulates in the blood. Roughly half of the calcium is referred to as free or ionized, and is metabolically active; the remaining half, referred to as "bound" calcium, is attached to protein and other compounds and is inactive.

MAGNESIUM: Magnesium is one of the most frequently encountered intracellular metallic ions, only potassium occurs in larger amounts. It plays an important role in numerous enzyme systems. It exists in the plasma where about 75 to 85 percent in the unbound (ionic) state and the remainder in the protein-bound form. When attempting to increase or decrease magnesium levels supplementally, the five parts of calcium to one part of magnesium in the blood, should be observed.

Thyroid Screen

T-3 UPTAKE: In spite of its name, this measurement has nothing to do with actual serum T-3 levels. It is done by measuring the in vitro partition of 125/1-labeled triiodothronine (T-3) between the patient's serum and a specifically treated resin previously charged with the radio-active T-3. In this test the unsaturated thyroid binding globulin (TBG) competes with resin for the radio-active T-3. The binding of labeled hormone to the resin beads is thus inversely proportional to the unsaturated thyroxine-binding globulin (hyperthyroidism) show an increase in T-3 binding to the resin; conversely, a relative increase in the unsaturated thyroxine-binding (hypothyroidism) results in a low T-3 uptake by the resin.

T-4 RIA: This measurement is done by radio-immune assay (RIA). In this analysis T-4 and 125/1-labeled thyroxine compete for binding sites on a specific antibody. After an appropriate incubation period, the antigen-antibody complex is precipitate by the addition of polyethylene glycol. The presence of unlabeled T-4 causes a decrease in the percent labeled T-4 bound to the antibody (isotope dilution). The T-4 content of the serum is determined by comparing its isotope diluting ability to series of standards containing known concentrations of T-4.

FREE THYROXINE INDEX: T-7 is an estimate (index) related to free T-4 levels in serum calculated as the product of T-4 and a T-3 test result. The T-3 uptake result is inversely proportional to unsaturated thyroid binding globulin (UTBG) in serum, and that free T-4 varies directly with total T-4 and inversely with UTBG levels. It is quite possible to obtain a normal T-7 with an abnormal T-3 uptake or T-4 findings. Also, aberrant results may occur in patients whose TBG is abnormal.

TSH-ULTRA SENSITIVE: Simply stated, a reduction of T-3 and T-4 causes an increase in TSH; and increase in both causes TSH to decrease.

FREE T-3: Measures the free fraction form of T-3 in serum. T-3 and T-4 are involved in the negative feedback mechanism affecting TSH response.

FREE T-4: Measures the free fraction form of T-4 in serum. T-3 and T-4 are involved in the negative feedback mechanism affecting TSH response.

Coronary Risk Screen

CHOLESTEROL: A white crystalline substance, C27H45OH, found in animal tissues and various foods, that is normally synthesized by the liver and is important as a constituent of cell membranes and a precursor to steroid hormones. Its level in the bloodstream can influence the pathogenesis of certain conditions, such as the development of atherosclerotic plaque and coronary artery disease

TRIGLYCERIDES: Triglycerides are esters of glycerol and fatty acids. Since they and cholesterol travel in the blood stream together, they should be assessed together.

HDL: A complex of lipids and proteins in approximately equal amounts that functions as a transporter of cholesterol in the blood. High levels are associated with a decreased risk of atherosclerosis and coronary heart disease.

LDL (Direct): A complex of lipids and proteins, with greater amounts of lipids than proteins, which transports cholesterol in the blood. The direct LDL method is the gold standard. The calculated method results in errors and misclassifications. The direct LDL liquid-select cholesterol assay is a homogeneous method for directly measuring LDL levels in serum or plasma without the need for any off-line pretreatment or centrifugation steps.

VLDL: Apolipoproteins are an essential part of lipid metabolism. They are component parts of lipoproteins - molecules that the body uses to transport lipids from ingested food in the intestines, throughout the bloodstream, to the liver, and to the body's cells. Apolipoproteins provide structural integrity to lipoproteins and protect the hydrophobic lipids (non-water absorbing lipids) at their center. They are recognized by receptors found on the surface of many of the body's cells and help bind lipoproteins to those cells to allow the transfer (uptake) of cholesterol and triglyceride from the lipoprotein into the cells.

CHOL/HDL RATIO: A ratio of lipids for determining possible cardiac risk factors.

HOMOCYSTEINE: The amino acid participates in essential metabolic pathways of some vitamins. The problem with Homocysteine is that even though 70% is bound to plasma proteins in the blood stream, it is a potent toxin to cells that line blood vessels (endothelial or intimal cells) and interacts with specialized proteins and cells in the blood causing blood to easily clot. The toxicity directed at the endothelial cell when combined with blood clot promotion is a lethal marriage capable of producing heart attacks, strokes, pulmonary embolism. In addition, Homocysteine worsens blood vessel narrowing in those with kidney diseases and diabetes mellitus

LIPOPROTEIN (a): Lipoprotein (a), which is expressed verbally as "lipoprotein little a", is an LDL-like particle found in the circulation of all individuals. Like all lipoproteins it is made up of cholesterol, triglycerides, protein and phospholipids. The size and composition of this particle are very similar to LDL with the exception that it contains an additional protein which is known as apolipoprotein (a) ("apolipoprotein little a"). The levels of Lp (a) in the circulation are largely genetically determined and higher levels are associated with an increased risk of cardiovascular disease.

CRP: C-reactive protein is an acute phase reactant. CRP is released by the body in response to acute injury, infection, or other inflammatory stimuli. Recent development of a high sensitivity assay for CRP (hs-CRP) has enabled investigation of this marker of systemic inflammation. CRP is a powerful predictor of first and recurrent cardiovascular events.

CPK: Also known as Creatine Kinase (CK), CPK is an enzyme catalyzing the breakdown of phosphocreatine to phosphoric acid and creatine. Skeletal muscle necrosis results in elevated values. CPK acts in the cell by liberating high energy phosphate from creatine phosphate and attaching it to ADP for creatine and ATP. This reaction furnishes energy for muscle contraction and for nerve tissue function.

Anemia Screen

IRON: A common mistake is to run a red blood count and indices without running a serum iron. Without the serum iron value, the amount of iron (inorganic) available to convert to hemoglobin (organic iron) is unknown. Therefore, anytime the HGB, HCT or RBC levels are found to be abnormal, with a normal or increased serum iron, an iron utilization problem must be investigated; i.e. the need for folic acid, B12, B6 or copper.

IRON BINDING CAPACITY: Transferrin carries 2 iron atoms per molecule. Transferrin is normally 30% bound to iron. Iron binding capacity reflects a measurement of serum Transferrin.

PERCENT OF IRON SATURATION: Measurement of iron in serum.

FERRITIN: Ferritin is a protein in the blood that stores iron for later use by your body. The amount of ferritin stored reflects the amount of iron stored. Iron is stored mainly in ferritin, but also as hemosiderin. Ferritin and hemosiderin are present primarily in the liver, but also in the bone marrow, spleen, and skeletal muscles. Small amounts of ferritin also circulate in the plasma. In healthy people, most iron is stored as ferritin (an estimated 70% in men and 80% in women and smaller amounts women) and smaller amounts are stored as hemosiderin.

When iron begins to disappear from your system, over the long term, iron stores are depleted before iron deficiency begins.

TRANSFERRIN: Transferrin is a protein that attaches iron molecules and transports iron to the blood plasma. Transferrin is largely made in the liver and regulates your body's iron absorption into the blood.

VITAMIN B-12: Pernicious anemia is the megaloblastic anemia caused by malabsorption of Vitamin B12. This is usually caused by decreased production of intrinsic factor, a substance essential to Vitamin B12 absorption, in the stomach. This test may also be performed as part of the testing to determine the cause of nervous system disorders.

FOLIC ACID: Folic acid (folate) is one of the "B" vitamins needed to metabolize homocysteine. Vitamin B12, another B vitamin, helps keep folate in its active form, allowing it to keep homocysteine levels low.

Complete Blood Count

WBC: Leukocytes of the peripheral blood are divided into two groups, the granulocytes and the non-granulocytes. An increase or decrease in the total number of white blood cells is the result of an increase or decrease in one or more of the above fractions; hence, it is essential that a differential count be taken in addition to the total white blood count to ascertain where the increase or decrease is occurring. White blood cells are much fewer in number than red blood cells and have lower specific activity. The total white blood count (total WBC) is valuable in screening the system's defense mechanism against infection and virus (inflammation). Serious abnormal findings in the total WBC or any segment is justification to conduct a serum protein electophoresis (SPE).

RBC: Red Blood Cells are increased in nephritis, kidney stones, urinary tract infection, benign prostate hypertrophy, renal hypertension, renal free radical problems, sickle cell anemia, hemophilia, rheumatic fever, congestive heart failure, diverticulitis of the colon, S.L.E, heavy metal body burdens, toxic effects of non-medicinal gases.

HGB (Hemoglobin): There are considerable physiological variations in the hemoglobin levels of healthy individuals. Caution is advised when interpreting values somewhat above or below the average as pathological. The infant has higher hemoglobin which soon declines to a level somewhat lower than the adult levels. Low values persist through childhood with a tendency to low values in the elderly. Hemoglobin should be evaluated with HC, RBC and the indices to determine anemia and the type of anemia. Serum iron as well as total globulin, uric acid, ceruloplasmin and ferritin should also be evaluated if possible. Hemoglobin is the most abundant protein found within the red blood cell. The hemoglobin indicates the amount of intracellular iron; hence its value in determining anemia.

HCT (Hematocrit): The packed cell volume (HCT) is the percentage of total volume occupied by packed red blood cells when a given volume of whole blood is centrifuged at a constant speed for constant period of time. The HCT is one of the most precise methods of determining the degree of anemia or polycythemia.

MCV (Mean Corpuscular Volume): This measurement indicates the volume in cubic micron occupied by an average single red blood cell. MCV increase or decrease along with an increase or decrease in MCH is a significant finding for folic acid and/or B12 need (increase) or iron, copper or B6 need (decrease). MCV and MCH should always be viewed together.

MCH (Mean Corpuscular Hemoglobin): Indicates the weight of hemoglobin in a single red blood cell. MCH increase or decrease along with an increase or decrease in MCV is a significant finding for folic acid and/or B12 needed. A decrease in MCH with a decrease in MCV indicates an iron, copper, or B6 needed.

MCHC (Mean corpuscular hemoglobin concentration): Indicates the average hemoglobin concentration per volume (100ml) of packed red blood cells.

PLATELETS: Platelets are concerned with the clotting of the blood and also clot retraction.

SEG %: A type of neutrophil, its primary function is in phagocytosis.

BANDS: Non-segmented neutrophils (metamylocytes) are the youngest forms that are normally found in the peripheral blood. These forms increase in the presence of acute infections with or without an absolute increase in the total WBC.

LYMPH %: Lymphocytes help to destroy the toxic products of protein metabolism. Lymphocytes originate from lymphoblasts in the spleen, lymph glands, tonsils, thymus, bone marrow, and possibly the appendix.

MONO %: Monocytes phagocytize some bacteria, particulate matter, and protozoa. In the inflammatory process neutrophils predominate for about three days, then they break up and the monocytes remain to phagocytize fragments of cells, etc; hence, the reason for an elevation of the monocytes during the recovery phase of infection.

EOS %: Eosinophils have an important role in detoxification, disintegration and removal of protein. Eosinophils are commonly elevated in allergy sensitivity and parasites.

BASO %: With inflammation, basophils deliver heparin to the effected tissue to prevent clotting.

Celiac/Gluten Sensitive Enteropathy Screen

TOTAL SERUM IgA: Total serum IgA qualifies the IgA levels to anti-gliadin and anti-transglutaminase. Individuals with Selective IgA deficiency may have a clinical or sub-clinical gluten sensitive enteropathy (GSE) with anti-gliadin IgA and anti-transglutaminase IgA reported within normal ranges.

ANTI-GLIADIN ANTIBODY, IgA: Gliadin IgA is an enzyme-linked immunosorbent assay (ELISA) for the detection of Gliadin IgA antibodies in human serum. Detection of these antibodies is an aid in the diagnosis of certain gluten sensitive enteropathies such as celiac disease and herpetiformis. Celiac disease or gluten sensitive enteropathy is a chronic condition with features including inflammation and characteristic histological "flattening" of intestinal mucosa resulting in malabsorption of nutrients.

ANTI-GLIADIN ANTIBODY, IgG: Gliadin IgG is an enzyme-linked immunosorbent assay (ELISA) for the detection of Gliadin IgG antibodies in human serum. Detection of these antibodies is an aid in the diagnosis of certain gluten sensitive enteropathies such as celiac disease and herpetiformis. Celiac disease or gluten sensitive enteropathy is a chronic condition with features including inflammation and characteristic histological "flattening" of intestinal mucosa resulting in a malabsorption of nutrients.

Measuring both Anti-gliadin IgA & IgG provides a significantly higher degree of detection.

ANTI-TRANSGLUTAMINASE ANTIBODY, IgA: Human tissue transglutaminase is an enzyme-linked immunosorbent assay (ELISA) for the detection of IgA antibodies to tissue transglutaminase (endomysium) in human serum. Detection of these antibodies is an aid in diagnosis of certain gluten sensitive enteropathies such as celiac disease and dermatitis herpetiformis. Celiac disease and dermatitis herpetiformis, two recognized forms of gluten sensitive enteropathy (GSE) are characterized by chronic inflammation of the intestinal mucosa and flattening of the epithelium or positive "villous atrophy". Intolerance to gluten (gliadin), the protein found primarily in grains such as wheat, rye and barley causes GSE. Patients with celiac disease may suffer from diarrhea, gastrointestinal problems, anemia, fatigue, psychiatric problems and other diverse side effects or they may be asymptomatic. Dermatitis herpetiformis is a skin disease associated with GSE. All GSE patients have an increased risk of lymphoma. A gluten-free diet controls GSE and substantially reduces the associated risks.

Glycemic Control Screen

HEMOGLOBIN A1C: The hemoglobin A1c test (also called HbA1c) is a simple lab test that shows the average amount of sugar (also called glucose) that has been in a person's blood over the last 3 months. The hemoglobin A1c test shows if a person's blood sugar is close to normal or too high. Sugar in the bloodstream can become attached to the hemoglobin (the part of the cell that carries oxygen) in red blood cells. This process is called glycosylation. Once the sugar is attached, it stays there for the life of the red blood cell, which is about 120 days. The higher the level of blood sugar, the more sugar attaches to red blood cells. The hemoglobin A1c test measures the amount of sugar sticking to the hemoglobin in the red blood cells. Results are given in percentages.

INSULIN LEVEL, FASTING: Insulin and glucose levels must be in balance. Hyperinsulinemia, an excess amount of insulin most often seen with insulinomas (insulin-producing tumors) or with an excess amount of administered insulin, can be dangerous. It causes hypoglycemia, low blood glucose levels, which can lead to sweating, palpitations, hunger, confusion, visual problems, and seizures. Since the brain is totally dependent on blood glucose as an energy source, glucose deprivation due to hyperinsulinemia can lead fairly quickly to insulin resistance, insulin shock and death.

GLUCOSE, FASTING: Hyperglycemia and hypoglycemia, caused by a variety of conditions, are both hard on the body. Severe, acute high or low blood glucose levels can be life threatening, causing organ failure, brain damage, coma, and, in extreme cases, death. Chronically high blood glucose levels can cause progressive damage to body organs such as the kidneys, eyes, cardiovascular system, and nerves. Untreated hyperglycemia that arises during pregnancy, in the form of gestational diabetes, can cause mothers to give birth to large babies who may have low glucose levels. Chronic hypoglycemia can lead to brain and nerve damage.

SERUM CORTISOL, FASTING: Cortisol is a hormone, produced by the adrenal glands, that helps break down nutrients, increases in times of stress, and is the primary hormone regulating the immune system. Heat, cold, infection, trauma, exercise, obesity, debilitating disease and numerous other factors influence cortisol secretion. The hormone is secreted in a daily pattern, rising in the early morning, peaking around 8 a.m., and declining in the evening. This pattern changes if you work irregular shifts (such as the night shift) and sleep at different times of the day.

AMYLASE, FASTING: Used as a marker for pancreatic function, helps to identify pancreatic dysfunction, including possible pathology.

Auto-Immune Screen

ANA SCREEN: (Antinuclear antibody) In general, the higher the titer of certain ANA patterns known to be associated with SLE (systemic lupus erythematosus), the more likelihood that the patient has SLE. Possible fluorescent ANA test patterns include solid (homogeneous), speckled, nucleolar, and centrome.

RHEUMATOID FACTOR: This test detects evidence of rheumatoid factor (RF), which is a type of autoantibody. An antibody is a protective protein that forms in the blood, typically in response to a foreign material, usually another protein known as an antigen. Auto-antibodies, however, are antibodies that are capable of targeting one's own proteins rather than those of an outside agent, such as bacterial protein. Rheumatoid factors are auto-antibodies directed against a fragment of the class of immunoglobulins known as IgG and are members of a class of proteins that become elevated in states of inflammation. Rheumatoid factor is elevated in almost all patients with inflammation and is, therefore, a sensitive test for monitoring the level of inflammation associated with rheumatoid arthritis.

Candida Screen

D-ARABINITOL: The five-carbon sugar alcohol D-Arabinitol (DA) is a metabolite of most pathogenic Candida species in vivo and in vitro including; Candida albicans, Candida tropicalis, Candida parapsilosis, Candida pseudotropicalis, Candida kefyr, Candida lusitaniae and Candida guilliermondii. (Please note that strains of Candida glabrata, Candida krusei and Candida neoformans do not produce D-Arabinitol in vitro.) The D-Arabinitol level is determined on serum by gas chromatography or enzymatic analysis. Positive DA results have been obtained several days to weeks before positive Candida blood cultures and the normalization of DA levels has been correlated with the therapeutic response in both humans and animals. By looking at DA, the direct metabolite of pathogenic Candida species listed above, it is possible to assess whether a person has invasive Candidiasis. D-Arabinitol is also essential in monitoring the efficacy of therapy.

Logical Sequence of Testing

The logical sequence of using this test as an initial or a follow-up test is determined by a variety of individual considerations, including the patient's chief complaint, the array of signs and symptoms, the chronicity of the condition, the tests previously taken, and the judgment of the practitioner. Technical assistance is available from BioHealth Diagnostics' support staff.