Laboratory Testing – Blood
We will often use ‘standard’ blood laboratory testing, especially in new patients.
While there are hundreds of specialized blood tests, there are a handful that are necessary to obtain baseline health information.
Complete Blood Count (CBC)
A CBC is a very commonly ordered test, used for broad health screening purposes. This test examines in detail the two major components of blood; plasma, which is the ‘liquid’ part of blood, and cellular elements, which are the ‘solid’ parts of blood.
Plasma contains several dissolved substances such as proteins, gases (oxygen and carbon dioxide), nutrients and waste products. And of course it helps move the solid parts of blood through our cardiovascular system.
The major solid parts of blood are made up of three main types of cells. White blood cells (WBC) are the cells that make up our immune system. Red blood cells carry oxygen to all the cells of the body. Platelets are cells that help with blood clotting and inflammatory processes.
Each of these 3 groups of cells carries out specific and important functions. A CBC will measure the quantity of all the different types of cells in the blood. CBC results can provide vast detail about a person’s state of health; this is why it is such an important test and is so commonly ordered.
Here’s a lot more detail about a complete blood count.
Chemistry Panel
A chemistry panel is another commonly ordered blood test; oftentimes it’s ordered along with a CBC. This is another broad screening test that can provide a lot of information about a person’s health.
It will relay the state of the body’s electrolyte balance, blood proteins, acid/base balance, and blood sugar. In turn, it can reveal a lot of information about the health of several organs, especially the kidney and liver.
Iron Status
There are several separate tests run when we need to know about a person’s iron status. Iron is an important nutrient; we can’t live without it because it’s used to create hemoglobin, the protein that carries oxygen on our red blood cells. While iron is vital to health, too little and too much of it can lead to serious health problems.
Iron tests look at the actual levels in our blood, the proteins that carry and store it, and how much is stored as well. Each of these tests can provide broad information – not just about the levels of iron in our body, but they can signify several health conditions that may be present before a person has symptoms.
Iron tests can also tell us about inflammation in the body. So while we may not necessarily be concerned directly about iron levels, we may look at it so we can know about any inflammation that may be going on.
Here’s some more detail about iron tests.
Inflammation
While there isn’t a direct test for inflammation, we can use a few different tests to tell us about any inflammatory processes going on in the body.
Ferritin
As noted above, a test that can be used to look at stores of iron can also tell us about inflammation. Ferritin is a protein that controls the storage and release of iron. It can also become elevated in infections, injury, or other inflammatory states.
ESR
An erythrocyte sedimentation rate (ESR or sed rate) is another test used to look at inflammation. When a person has an elevated ESR, we know they have some kind of inflammatory process going on. However, this test can’t tell us where the inflammation is. Because of that, it is typically used with other tests to help detect or track inflammatory illnesses like autoimmune diseases, infections and cancer.
Here’s more detail about the ESR.
High-Sensitivity C-Reactive Protein (hs-CRP)
An hs-CRP is used to detect very small levels of inflammation in the blood vessels. Used with other cardiovascular-specific tests, an hs-CRP can be used to predict a person’s risk for cardiovascular disease. More information can be found here.
There is another version of this test – the CRP. It’s not as sensitive and therefore detects inflammation on a broader scale. Similar to the ESR, it can’t pinpoint exactly where an inflammatory process is coming from, but it can be used to measure and track a general inflammatory process in the body.
Vitamin D
Vitamin D is a very important nutrient that’s easily measured in blood. Vitamin D is important for calcium absorption and performs a number of other important functions in our bodies; new research shows that low vitamin D levels are associated with increased risk of certain cancers, cardiovascular disease and immune system problems.
Like other nutrients, deficiency can cause several far-reaching health problems. Similarly, too much vitamin D is toxic. Vitamin D is made in our skin when exposed to direct sunlight; it’s also found in animal-derived foods. However, most of us don’t get a lot of direct sunlight exposure, and the amount in foods (even vitamin D fortified foods) is often not enough.
We measure vitamin D levels on nearly all of our patients because of its importance in good health.
Thyroid Panel
The thyroid gland regulates our metabolism. When it’s working properly, our cells utilize energy efficiently. But when there’s a problem with the thyroid, major shifts in health can occur.
When a thyroid problem is suspected, it’s important to run several thyroid tests. We like to run a more complete panel than typical conventional doctors will. Detecting thyroid problems can be tricky, and requires looking at more than just one thyroid hormone, namely TSH.
In patients whom we suspect thyroid problems, we’ll run a TSH, free T4, free T3, and thyroid autoantibodies. Thyroid issues can be complex and require looking in depth at thyroid function through blood work.
You can read more about how to correctly diagnose thyroid conditions here.
B12/Methylmalonic acid (MMA)
Other than Vitamin D, the only other nutrient we’ll measure using standard blood tests is B12. However, testing for vitamin B12 in the blood isn’t very accurate in detecting a deficiency by itself; it’s not truly reflective of B12 levels in the tissues.
Because of this, we’ll often run a methylmalonic acid test (MMA) along with B12 and possibly other tests as well. Including methylmalonic acid helps increase the changes of detecting a B12 deficiency. B12 is an important vitamin, especially for the neurological system. Therefore, we want to make sure we’re getting an accurate picture in someone who may be at risk of low B12, and order a MMA test as well.
Here’s more information about MMA testing.
Hemoglobin A1C
This is a protein found in the blood. In one sense, it’s a historical record of how much sugar a person has had in the last 3 months. It indicates how well a person metabolizes sugar. Traditionally a test to monitor therapy in diabetics, we use it to look at possible issues with glucose (blood sugar control) in anyone we suspect of having insulin resistance, type 2 diabetes, or metabolic syndrome.
Here’s more information about Hemoglobin A1c.
Cardiovascular health
There’s more to heart health than just looking at cholesterol! Heart disease is an inflammatory disease that develops over many years. Only looking at cholesterol numbers neglects a whole range of other tests that can shed more light on the inflammatory component of heart disease. Heart disease doesn’t only happen to overweight, sedentary people. Anyone can develop it, with grave consequences.
That’s why we take a much more in-depth look at other cardiovascular factors affecting heart health.
Standard Lipid Panel vs. Lipoprotein Subfractionation:
A standard lipid panel only tells us the total amount of cholesterol, total LDL (low-density lipoprotein, otherwise known as the “bad” cholesterol), total HDL (high-density lipoprotein, otherwise known as the “good” cholesterol) and triglycerides (‘fats’ in your blood).
MANY people have what are considered normal lipid levels, yet have significant heart disease. Why is that? It’s because cholesterol isn’t the most reliable way to detect heart disease through a blood test. We have to take a more detailed look at cholesterol, as well as any inflammation. This is done through a Lipoprotein Subfractionation, which separates out the many different types of cholesterol by density, size and provides an actual count of each cholesterol type (this is more accurate as standard lipid panels only ‘estimate’ how many cholesterol particles there are).
Lp-PLA2
This test measures a chemical that is associated with inflammation in the blood vessels. If elevated, a person may have a higher risk of stroke and heart attack. Higher levels are leaked from unstable plaque in the arteries. Plaque that is unstable is more prone to come loose, blocking a coronary artery (causing a heart attack) or traveling to the brain and blocking a blood vessel there (stroke). This is a key test in looking at vascular-specific inflammation in relation to heart disease.
These are some of the most common blood tests we order; however it isn’t all of them.