Essential Blood Test: What You Have To Know

The Essential Blood Test is a comprehensive, quick and reassuring way of assessing your current state of health. Key tests include full blood count, kidney function, liver health, cholesterol, diabetes, iron status & inflammation.

Who is this test for?

This blood test is ideal for people of all ages. It is an excellent entry-level health screen for people young and old.

What to test?

Complete Blood Count (CBC)

A complete blood count (CBC) is a blood test used to evaluate your overall health and detect a wide range of disorders, including anaemia, infection, immune system disorders, blood cancers, and clotting problems.

Red Blood Cells

RBC
Red blood cell (RBC) count analyses the number of red cells in the blood. Red blood cells carry oxygen from the lungs to the rest of the body. They also carry carbon dioxide back to the lungs so that it can be exhaled.

A high count (thicker blood) means there is a chance that the red blood cells will clump together and block tiny blood vessels. This also makes it difficult for your red blood cells to carry oxygen.

A low count (anaemia) means that your body may not be getting the oxygen it needs and can be caused by nutritional deficiency (lack of iron, folic acid, vitamin B12), over-hydration as well as bleeding, bone marrow disorders and lung cancer. 

Haemoglobin
Haemoglobin carries oxygen and gives the red blood cell its red colour. This test measures the amount of haemoglobin in the blood and is a good measure of the blood's ability to carry oxygen around the body.

A high haemoglobin result can mean increased red cell production to compensate for chronically low oxygen levels in the blood caused by lung disease or living at altitude. While it can also indicate "blood doping" other causes can include dehydration, smoking and bone marrow disorders.

A low haemoglobin result indicates anaemia which can have many causes including pregnancy, blood loss, liver damage, iron deficiency and much more. A low haemoglobin level should be investigated in line with other symptoms and results.

HCT
HCT (haematocrit) measures the amount of space (volume) red blood cells take up in the blood.

Raised levels can result from pregnancy, living at altitude, dehydration as well as low availability of oxygen through chronic lung disease and even sleep apnoea.

Low levels indicate anaemia.

MCV
MCV (mean corpuscular volume) reflects the size of your red blood cells.

A high result may indicate a vitamin deficiency of folate or vitamin B12 and is often seen in excessive alcohol consumption associated with liver inflammation.

A low result indicates anaemia, often caused by iron deficiency.

MCH
MCH (mean corpuscular haemoglobin) is the average amount of haemoglobin contained in your red blood cells.

Together with MCV and MCHC, MCH results can help in the diagnosis of different types of anaemia.

MCHC
MCHC (mean corpuscular haemoglobin concentration) is the average concentration of haemoglobin in your red blood cells.

A high level can indicate the presence of spherocytes (a type of red bood cell with too much haemoglobin) or a deficiency of folic acid or vitamin B12 in the diet.

A low level can indicate chronic blood loss or iron deficiency.

RDW
RDW (red cell distribution width) shows whether the cells are all the same size or different sizes or shapes. Normally cells are fairly uniform, although a raised RDW result (indicating greater variation in cell size and shape than is normally seen) can be caused by deficiency in iron, vitamin B12 or folic acid.

White Blood Cells

White Cell Count
White blood cells are key to your body's immune or defence system. They fight infections and protect your body from foreign invaders such as harmful germs and bacteria.

A raised white blood cell (WBC) count can indicate recent infection, inflammation, trauma and even stress. Your WBC can also be raised when taking certain medications.

A decreased WBC can result from a vitamin deficiency such as folate or vitamin B12, as well as liver disease and diseases of the immune system.

Neutrophils
Neutrophils are a type of white blood cell that are responsible for helping your body fight infection. When neutrophils are low you can be more vulnerable to illness and infection.

Neutrophils can be raised after severe stress on the body from a bacterial infection, recent exercise or sudden kidney failure.

Low neutrophils can be caused by a deficiency in vitamin B12 or folic acid, severe bacterial infection and some autoimmune diseases.

Lymphocytes
Lymphocytes are a type of white blood cell which fight bacterial and viral infections. They include T cells, B cells and natural killer cells.

Lymphocytes can be elevated for many reasons but it is common for them to be raised after recent infection, particularly after the flu. They can also be raised due to autoimmune disorders and some cancers.

The most common cause for lymphocytes to be depleted is the common cold.

Monocytes
Monocytes are a type of white blood cell that engulf and remove pathogens and dead or damaged cells from our blood. The heat and swelling of inflammation is caused by the activities of these cells.

Elevated monocytes can indicate chronic inflammatory disease, chronic infection, parasitic infection and Cushings disease.

Low levels can be due to autoimmune disorders such as lupus and rheumatoid arthritis as well as drugs which affect the bone marrow such as those used in chemotherapy.

Eosinophils
Eosinophils are a type of white blood cell whose function is to remove parasitic infections as well as to regulate inflammation to mark an infected site.

Levels of eosinophils can be elevated if the scale of inflammation is greater than necessary to control the damage (as is the case in asthma and allergic responses) as well as in parasitic and fungal infections, autoimmune diseases and skin disorders.

Low levels of eosinophils are not usually cause for concern and can be caused by the administration of steroids.

Basophils
Basophils are a type of white blood cell that protect your body from bacteria and parasites such as ticks.

An elevated basophil count can be due to inflammatory conditions such as Crohn's disease, ulcerative colitis and dermatitis, recent infection and hormone imbalance (e.g. hypothyroidism).

A low basophil count can be caused by pregnancy, stress and use of steroids.

Clotting Status

Platelet Count
Platelets or clotting cells are the smallest type of blood cell and are important in blood clotting. When bleeding occurs, the platelets swell, clump together and form a sticky plug (a clot) which helps stop the bleeding.

If platelet levels are raised there is an increased risk of blood clots forming in blood vessels.

If platelet levels are too low there is a risk of easy bruising and uncontrolled bleeding.

MPV
MPV (mean platelet volume) is a measurement of the average size of your platelets. New platelets are larger than older ones and a raised MPV result occurs when increased numbers of platelets are being produced. MPV provides an indication of platelet production in your bone marrow.

Inflammation Markers

Erythrocyte Sedimentation Rate (ESR)

Erythrocyte sedimentation rate (ESR or sed rate) is a test that indirectly measures the degree of inflammation present in the body caused by one or more conditions such as infections, tumors or autoimmune diseases; and to help diagnose and monitor specific conditions such as arteritis, endocarditis, systemic vasculitis, Crohn's disease, polymyalgia rheumatica, or rheumatoid arthritis.

This test works by measuring how long it takes for red blood cells to fall to the bottom of a test tube. The quicker they fall, the more likely it is there are high levels of inflammation.

The ESR is not diagnostic; it is a non-specific test that may be elevated in a number of these different conditions. It provides general information about the presence or absence of an inflammatory condition. For this reason ESR is typically used in conjunction with other tests.

Women tend to have a higher ESR, and menstruation and pregnancy can cause temporary elevations.

A low ESR can be seen with conditions that inhibit the normal sedimentation of red blood cells, such as a high red blood cell count (polycythemia), significantly high white blood cell count (leukocytosis), and some protein abnormalities. Some changes in red cell shape (such as sickle cells in sickle cell anemia) also lower the ESR.

ESR test results are measured in mm/hr, or millimeters per hour. The following are considered normal ESR test results:

  • Women under age 50 should have an ESR under 20 mm/hr in 1st hr.
  • Men under age 50 should have an ESR under 15 mm/hr in 1st hr.
  • Women over age 50 should have an ESR under 30 mm/hr in 1st hr.
  • Men over age 50 should have an ESR under 20 mm/hr in 1st hr.
  • Newborns should have an ESR under 2 mm/hr inn 1st hr.
  • Children who haven’t reached puberty yet should have an ESR between 3 and 13 mm/hr in 1st hr.

CRP-hs

C-Reactive Protein (CRP) is an inflammation marker produced in the liver and used to assess whether there is infection in the body. High CRP levels will fall when the infection is under control. When CRP remains high, it is an indication of chronic inflammation-related disorders, including cardiovascular disease, cancer, diabetes, obesity, rheumatoid arthritis, Crohn’s disease, lupus and more. However, it does not identify where the inflammation is located.

Heavier people usually have higher CRP levels, as abdominal fat provides fertile ground for over-production of deadly pro-inflammatory cytokines that cause CRP to increase. Obese individuals are often in a chronic pro-inflammatory state that sharply increases their risk of all degenerative diseases.

CRP interferes with the protein synthesis in the muscle cells, hence contributing to the loss of muscle mass.

High Sensitivity CRP (CRP-hs) is a test which is used to detect low-level inflammation which is thought to damage blood vessels which can lead to a heart attack or stroke.

If you're having an hs-CRP test to evaluate your risk of heart disease, current risk levels used include:

  • Lower risk. You have an hs-CRP level of less than 2.0 mg/L.
  • Higher risk. You have an hs-CRP level greater than 2.0 mg/L.

Optimal CRP levels for everyone to strive for are under 0.55 mg/L in men and under 1.0 mg/L in women.

Electrolytes

Electrolytes are minerals that are found in body tissues and blood in the form of dissolved salts. As electrically charged particles, electrolytes help move nutrients into and wastes out of the body's cells, maintain a healthy water balance, and help stabilize the body's acid/base (pH) level.

The main electrolytes to measure are:

  • Sodium (discussed under 'Kidney Function')
  • Calcium (discussed under 'Bone Health')
  • Magnesium
  • Potassium
  • Chloride
  • Phosphorus
  • Bicarbonate (HCO3-; sometimes reported as total CO2)

Magnesium
Magnesium is both a mineral and an electrolyte. It carries an electrical charge as it transports other electrolytes, potassium and calcium, through your cell membranes. The nutrient serves a wide range of purposes in your body, including regulation of your blood sugar, blood pressure and heart rate. Magnesium is also involved in protein synthesis and supports your immune system. Because the mineral is crucial to your body's most basic functions, maintaining normal levels in your body is important.

The normal adult value for magnesium is 1.5 - 2.5 mEq/L (0.75 - 1.25 mmol/L).

Potassium
In the right amounts, the mineral potassium helps your nerves and muscles “talk” to each other, moves nutrients into and waste out of your cells, and helps your heart function.
Your kidneys help regulate the amount of potassium in your body. Kidney disease is a common cause of a high potassium level (hyperkalemia). It’s important to be aware of your potassium levels, as hyperkalemia can cause an irregular heartbeat, nausea, muscle weakness, paralysis, and even death.

Of course, low levels of potassium (hypokalemia) can also have a significant impact on your health. The most common cause is prescription medication that increase urination, which leads to the body expelling too much potassium in the urine. Other causes could include alcoholism, trauma, or surgical procedures. Vomiting, diarrhea, and, sometimes, not enough potassium in the diet, can also cause low potassium levels. Again, symptoms may be hard to diagnose: You may experience weakness, fatigue, muscle cramps, or constipation, or even an irregular heartbeat.
For patients with low potassium levels, doctors may prescribe potassium supplements. Also make sure to ask your doctor before trying salt substitutes, as these can potentially increase potassium levels in the blood for some people.

A normal potassium range is about 3.6 - 5.2 (mmol/L), while levels higher than 6 mmol/L are considered dangerous. A very low potassium level (less than 2.5 mmol/L) can be life-threatening and requires urgent medical attention.

Chloride
Chloride is an electrolyte which helps maintain the bodies acid-base balance and fluid levels. Chloride is also vital in maintaining healthy blood pressure, blood volume, and pH levels in bodily fluids. Most of the chloride in the body comes from the salt you eat. Low chloride levels can be caused by conditions such as dehydration or illnesses which cause excessive vomiting. People whose diet includes too much or too little sodium may suffer from irregular Chloride levels. If your levels are too high, it often means your kidneys aren’t working properly.

The normal blood reference range of chloride for adults is 96 - 106 mEq/L (96 - 106 mmol/L).

Phosphorus
Phosphorus deficiencies (hypophosphatemia) may be seen with malnutrition, malabsorption, acid-base imbalances, hypercalcemia, and with disorders that affect kidney function.
Phosphorus excesses (hyperphosphatemia) may be seen with increased intake of the mineral, hypocalcemia (low-calcium levels), and with kidney dysfunction.
High phosphorus levels may lead to cardiovascular disease, osteoporosis, and organ damage due to calcification.
Soft drinks and pre-packaged food items are high in phosphorus content, which some nutritionists believe contributes to over-consumption of phosphorus.

According to Mayo Medical Laboratories, a normal range for adults is generally 2.5 to 4.5 mg/dL (0.80 - 1.45 mmol/L).

Bicarbonate (HCO3-; Total CO2)
Bicarbonate is a form of carbon dioxide (CO2), a gas waste left when your body burns food for energy. Bicarbonate belongs to a group of electrolytes, which help keep your body hydrated and make sure your blood has the right amount of acidity. Too much or too little bicarbonate can be a sign of a number of conditions, including diarrhea, liver failure, kidney disease, and anorexia.

Normal bicarbonate levels are 23 to 30 mEq/L (23 - 30 mmol/L) in adults.

Kidney Function

Sodium
Sodium is both an electrolyte and a mineral. It helps regulate the water and electrolyte balance of the body and is important in the operation of nerves and muscles. Sodium levels in the blood are regulated by the kidneys.

Excess sodium in the blood is often due to dehydration but can also indicate that the kidneys are not working properly.

Too little sodium is often caused by fluid retention (oedema) or reflects loss due to vomiting, diarrhoea or excessive sweating.

The normal range for blood sodium levels is 135 to 145 mEq/L (135 - 145 mmol/L).

Urea (Blood Urea Nitrogen - BUN)

Urea is waste product produced as the body digests protein and is carried by the blood to the kidneys, which filter the urea out of the blood and into the urine.
The blood urea nitrogen or BUN test is primarily used, along with the creatinine test, to evaluate kidney function in a wide range of circumstances, to help diagnose kidney disease, and to monitor people with acute or chronic kidney dysfunction or failure.
If your kidneys are not able to remove urea from the blood normally, your BUN level rises. Heart failure, dehydration, or a diet high in protein can also make your BUN level higher.

Low amounts of urea in the blood may indicate a low protein diet, excess hydration, malnutrition or liver disease.

Normal BUN values tend to vary depending on gender and age. It’s also important to note that each laboratory has different ranges for what’s normal.
It is widely accepted that there is an age-related increase in plasma/serum urea concentration but this is not well defined and there is uncertainty as to whether it simply reflects an age-related decline in renal function as some studies suggest, or occurs despite normal renal function as others seem to suggest. The results suggest that healthy elderly individuals (without any apparent loss of renal function), may have BUN levels as high as 40-50 mg/dL (14.3-17.8 mmol/L).

In general, normal BUN levels fall in the following ranges:

  • Adult men: 8 to 24 mg/dL (2.8 to 8.5 mmol/L)
  • Adult women: 6 to 21 mg/dL (2.1 to 7.5 mmol/L)
  • Children 1 to 17 years old: 7 to 20 mg/dL (2.5 to 7.1 mmol/L)

Hint: BUN mg/dL multiplied by 0.357 = BUN (mmol/L)

Creatinine
Creatinine is a chemical waste molecule that is generated from muscle metabolism. Measurement of this is an indicator of the levels of other waste products in the body. Creatinine is an accurate marker of kidney function.

Elevated creatinine can be caused by high intake of animal protein, taking creatine supplements and vigorous exercise. If your lab tests show you have a high BUN level and elevated creatinine level, your doctor will do further test to make sure whether it is caused by the kidneys that are not functioning as well as they should. This can be due to kidney disease related to diabetes or high blood pressure or can be caused by another condition such as autoimmune disease.

Low creatinine can be caused by a low protein diet, reduced muscle mass or liver disease.

A normal level of creatinine depends on how much muscle mass you have. A normal level for a man is higher than it is for a woman. Children have lower levels than both men and women. Here are the normal values by age:

  • 0.7 to 1.2 mg/dL for adult males
  • 0.6 to 1.1 mg/dL for adult females
  • 0.5 to 1.0 mg/dL for children ages 3 to 18 years
  • 0.3 to 0.7 mg/dL for children under age 3

BUN/Creatinine Ratio

Doctors will look at the ratio between a person’s BUN and blood creatinine to to see if dehydration is the cause of an increased BUN. If the BUN-creatinine ratio is high, it usually indicates dehydration. Levels that are high or low may not be a cause of concern and should be rechecked.

In people taking high doses of steroid medications such as prednisone, the BUN can be elevated, causing a high calculated BUN/creatinine ratio. And if there is a bleeding ulcer or bleeding of any type anywhere in the stomach or intestines, the BUN will rise disproportionately from the creatinine causing a high BUN/creatinine ratio.

Healthy BUN/creatinine ratio is usually 10:1 to 20:1 when both are expressed as mg/dl (men and older individuals may be a bit higher).

Here is an online calculator to calculate BUN/creatinine ratio: https://www.miniwebtool.com/bun-to-creatinine-ratio-calculator/

Estimated Glomerular Filtration Rate (eGFR)

Glomerular filtration rate (GFR) is a measure of the function of the kidneys. This test measures the level of creatinine in the blood and uses the result in a formula to calculate a number that reflects how well the kidneys are functioning, called the estimated GFR or eGFR.

The eGFR is a calculation based on a serum creatinine test. Creatinine is a muscle waste product that is filtered from the blood by the kidneys and released into the urine at a relatively steady rate. When kidney function decreases, less creatinine is eliminated and concentrations increase in the blood. With the creatinine test, a reasonable estimate of the actual GFR can be determined.

Early detection of kidney dysfunction can help to minimize the damage. This is important as symptoms of kidney disease may not be noticeable until as much as 30-40% of kidney function is lost.

An eGFR may be repeated if the initial result is abnormal to see if it persists.

A normal eGFR for adults is greater than 90 mL/min/1.73m2, according to the National Kidney Foundation. (Because the calculation works best for estimating reduced kidney function, actual numbers are only reported once values are less than 60 mL/min/1.73m2).

An eGFR below 60 mL/min/1.73m2 suggests that some kidney damage has occurred. The test may be repeated to see if the abnormal result persists. Chronic kidney disease is diagnosed when a person has an eGFR less than 60 mL/min/1.73m2 for more than three months.

A person may have some kidney damage even with an eGFR greater than 90 mL/min/1.73m2. Other evidence, such as increased urine albumin, may indicate some degree of kidney damage. Thus, a person's eGFR should be interpreted in relation to the person's clinical history and presenting conditions.

Another method of evaluating kidney function and potentially estimating GFR involves the measurement of the blood level of cystatin C. There is increasing interest in the use of this test for these purposes and several studies have been performed comparing calculations of eGFR using creatinine, cystatin C, or both.

Could I calculate my own eGFR?

If you have had a recent creatinine or cystatin C measurement, you can calculate the eGFR by using one of the calculators for people 19 years of age or older on the National Kidney Foundation (NKF) web site (https://www.kidney.org/professionals/KDOQI/gfr). If you have questions about the interpretation of your results, it is best to consult with your doctor. For children and teens younger than 19, see the pediatric eGFR calculator on the NKF website.

Other tests that may be done at the same time to help detect kidney damage and/or evaluate kidney function are:

Urine albumin (microalbumin) and albumin/creatinine ratio (ACR): The albumin-creatinine ratio (ACR) in early morning spot urine collected on awakening (before breakfast or exercise) is the most recommended test for albumin excretion in urine. 

Albumin is a protein that is present in high concentrations in the blood. Virtually no albumin is present in the urine when the kidneys are functioning properly.

Creatinine, a byproduct of muscle metabolism, is normally released into the urine at a constant rate and its level in the urine is an indication of the urine concentration.

If albumin in the urine is detected, it should be confirmed by retesting twice within a 3-6 month period. Albumin is one of the first proteins to be detected in the urine with kidney damage. 

A ratio of albumin to creatinine of less than 30 µg/mg (3 mg/mmol) is normal to mildly increased - category A1; a ratio of 30-300 µg/mg (3-30 mg/mmol) signifies microalbuminuria, referred to as moderately increased - category A2. And values above 300 µg/mg (30 mg/mmol) are considered as macroalbuminuria, termed severely increased - category A3.

The normal urine ACR in young adults is <1 mg/mmol. Nephrotic range is considered >220 mg/mmol.

Note: In addition to diabetic & hypertensive people, microalbuminuria is common, also in a non-diabetic, non-hypertensive population, and is an independent indicator of cardiovascular risk factors and cardiovascular morbidity. These findings suggest that urinary albumin measurements may be useful in early risk profiling and prevention of cardiovascular disease in the population at large.

Here is an online calculator to calculate ACR.

Urinalysis: May be used to help detect signs of kidney damage, such as the presence of blood or casts in the urine.

Liver Function

ALP

Alkaline Phosphatase (ALP) test may be performed to determine how well your liver and gallbladder are functioning or to identify problems with your bones. Elevated ALP is assessed in conjunction with other liver function tests to determine whether the problem lies in the liver or the bones. 

The normal range runs higher in children and decreases with age. Pregnant women typically have higher alkaline phosphatase values due to contributions from the placenta.

Normal values can vary slightly among testing laboratories. Normal values from the laboratory performing the test should be used when interpreting the test results.
ALP results are reported in units per liter (U/L). For men and women older than 18, an ALP level between 37 and 116 U/L is considered normal.

AST (previously called SGOT)

Aspartate Aminotransferase (AST) is an enzyme that can be elevated in heart and muscle diseases and is not liver specific. Any injury to the heart or liver, and other bodily tissues, will cause AST to be released into the bloodstream. Levels can be raised following a heart attack or from liver damage (fatty liver) caused by alcohol, viruses (hepatitis) or drugs, such as painkillers, chemotherapy drugs, and statins (reduce blood pressure).

Your doctor may look at your AST and ALT together to see if the result of your AST is specifically related to your liver.

AST can also be elevated after vigorous exercise. The normal range of AST is 0 to 45 U/L.

Note: Overall, low AST levels in the blood are normal and should not be a cause for concern. Vitamin B6 deficiency may cause low AST (under 10 U/L), and this individual should be supplemented with vitamin B6.

ALT (previously called SGPT)
Alanine Aminotransferase (ALT) is an enzyme which is produced by the liver and can indicate liver damage caused by alcohol, drugs or viruses (hepatitis). Small amounts of ALT are normal, but raised levels may indicate that your liver is inflamed. 

ALT is used as a surrogate marker for nonalcoholic fatty liver disease (NAFLD), which is frequently observed among obese subjects. ALT concentrations have a strong association with visceral fat accumulation.

Elevated levels of ALT can also be caused by recent vigorous exercise. The normal range of ALT is 0 to 45 U/L.

CK or CPK

Creatine kinase (CK), also knows as creatine phosphokinase (CPK) is an enzyme found specifically in muscle cells. One form of CK is found in heart muscle cells, another in the skeletal muscle cells. CK is also found in brain cells.
When these cells are damaged for any reason, the CK is released into the blood and can be measured by a blood test. If the heart CK (CPK-MB) is elevated it can mean that the heart is damaged which can occur in a heart attack or in conditions in which the heart muscle is inflammed such as viral myocarditis. Skeletal muscle can be damaged in trauma such as in severe injury to the muscles, or after intense exercise causing an increase in the skeletal muscle form of CK (CPK-MM). Certain drugs such as cholesterol lowering drugs (statins) can damage muscle and elevate CK. Other causes are alcohol, viruses & hereditary conditions. Also, CK can be elevated in certain autoimmune diseases that cause inflammation in the muscle such as polymyositis or dermatomyositis.

If CK continues to rise it indicates that muscle damage is not being repaired.
CK levels tend to be higher in people with greater muscle mass. If you have been to the gym the day before your blood test you may well exhibit raised levels of CK.

Newer guidelines recommend further evaluation in white men whose level is greater than 500 U/L and black men if greater than 1,200 U/L.

Gamma GT
Gamma GT, also known as gamma glutamyltransferase, is an enzyme primarily found in the liver that assists in carrying peptides and amino acids into your cells.

Elevated Gamma GT may be an indicator of heart disease and fatty liver disease, and predicts increased risk of mortality.

Gamma GT test is used in conjunction with ALP to distinguish between bone or liver disease. If GGT and ALP are both elevated, doctors will suspect that you have problems with your liver or the bile ducts. If GGT is normal and ALP is elevated, this could indicate bone disease.
Gamma GT is also used to diagnose alcohol abuse as it is raised in 75% of long term drinkers. Smoking can also increase your GGT level. And it is also influenced by body mass index (BMI), certain drugs and supplements.

The elevation of GGT may also be temporary, perhaps due to medications that you are taking or alcohol ingested within 24 hours of the test.

The normal biologic role of GGT is to reconstitute glutathione, the body’s master antioxidant. Glutathione (or GSH) provides natural protection against harmful oxidative stress. When GGT concentrations are above “low-normal” ranges, excess GGT can catabolize (degrade) glutathione causing critical depletion of this very important antioxidant. When glutathione is depleted, and only insufficient amounts remain to protect the body’s organs from oxidative stress, damage & disease starts to occur.

Below is a table that summarizes normal Gamma GT levels

Bilirubin

Bilirubin is a product of haemoglobin breakdown. It is removed from the body via the liver, stored and concentrated in the gallbladder and excreted into the bowel. Elevated levels can cause the skin and whites of eyes to become yellow (jaundice) as the liver is unable to remove enough bilirubin from the blood. This can indicate liver damage or disease. Low levels of bilirubin are usually not a concern and may be due to certain medications and increased vitamin C levels.

Bilirubin not attached to glucuronic acid is called indirect, or unconjugated, bilirubin. All the bilirubin in your blood together is called total bilirubin. A comprehensive bilirubin blood test will get an accurate count of all three bilirubin levels in your blood: direct, indirect, and total.

Higher than normal levels of direct bilirubin in your blood may indicate your liver isn't clearing bilirubin properly.

Elevated levels of indirect bilirubin may indicate other problems.

Total bilirubin (direct and indirect) normal range from about 0.2 to 1.2 mg/dL.
Normal values of direct bilirubin range from 0 to 0.4 mg/dL.
The indirect bilirubin level in the bloodstream is the total bilirubin minus the direct bilirubin.

Proteins

Total Protein

Total Protein represents the sum of albumin and globulin.
A low total protein level can suggest a liver disorder, a kidney disorder, or a disorder in which protein is not digested or absorbed properly. Low levels may be seen in severe malnutrition and with conditions that cause malabsorption, such as celiac disease or inflammatory bowel disease (IBD).
A high total protein level may be seen with chronic inflammation or infections such as viral hepatitis or HIV. It also may be associated with bone marrow disorders such as multiple myeloma.

Normal range is 60 to 80 g/L or 6 to 8 g/dL.

Albumin
Albumin is made mainly in the liver and helps to keep the blood from leaking out of blood vessels. It also helps carry some medicines and other substances through the blood and is important for tissue growth and healing.

Low albumin levels can indicate liver disease and can also be a marker for chronic ill-health, malnutrition and inflammation. It can also occur in kidney conditions such as nephrotic syndrome and diabetes.

Normal range is 38 to 55g/L or 3.8 to 5.5g/dL.

Raised levels are usually caused by dehydration.

Globulin

Globulin consists of different proteins and is made by the liver and the immune system. Certain globulins bind with haemoglobin while others transport metals, such as iron, in the blood and help fight infection.

Elevated levels of globulin proteins in the blood usually mean excessive inflammation in the liver and/or immune system. Very high levels may be seen in some types of cancers. You may have low levels if your diet is low in protein, or if you have liver or kidney disease.

In some cases of low globulin count, underlying causes have to be treated first before trying to raise globulin count.
One of the ways to improve globulin level is to consume high protein foods rich in globulin such as soy, hemp seeds, green leafy vegetables, whole grains, eggs, seafood and red meat. And depending on the clinical report of your blood profile, your doctor may prescribe globulin supplements and medication to raise globulin count to its normal range.

Normal range is 20 to 32g/L or 2 to 3.2g/dL.

Albumin/Globulin Ratio (calculated)

The albumin to globulin (A/G) ratio has been used as an index of disease state, however, it is not a specific marker for disease because it does not indicate which specific proteins are altered.

If the ratio is too low or too high, additional testing must be done to determine the cause and diagnosis.

The AG ratio may be elevated in:

  • Hypothyroidism
  • High protein/high carbohydrate diet with poor nitrogen retention
  • Hypogammaglobulinemia (low globulin)
  • Liver disease
  • High alcohol consumption/overweight
  • Adrenal gland disease
  • Leukemia

If the ratio is low, it can suggest:

  • Autoimmune disease
  • Multiple myeloma
  • Liver Cirrhosis
  • Kidney disease

The normal A/G ratio is 0.8 - 2.2 for unisex gender and for All age groups.

Bone Health

Calcium
Calcium is the most common mineral in the body and one of the most important. The body needs it to build and repair bones and teeth, help nerves and muscles to function, blood to clot and also help the heart to work. Vitamin D is essential to absorb calcium.

There are several tests to measure blood calcium. The total calcium test is the test most frequently ordered to evaluate calcium status.

There are several different forms of calcium in your blood. These include ionized calcium (free calcium not attached to proteins), calcium bound to other minerals called anions, and calcium bound to proteins like albumin.

When an abnormal total calcium result is obtained, it is viewed as an indicator of an underlying problem. To help diagnose the underlying problem, additional tests are often done to measure ionized calcium, urine calcium, phosphorus, magnesium, vitamin D, parathyroid hormone (PTH) and PTH-related peptide (PTHrP).

Some conditions where ionized calcium should be the test of choice include: critically ill patients, those who are receiving blood transfusions or intravenous fluids, patients undergoing major surgery, and people with blood protein abnormalities like low albumin.
An ionized calcium test may also be ordered when someone has numbness around the mouth and in the hands and feet and muscle spasms in the same areas. These can be symptoms of low levels of ionized calcium.

Normal values for calcium levels range from 8.5 to 10.2 mg/dl (2.12 - 2.54 mmol/L).

Note: Blood calcium levels do not indicate levels of bone calcium but rather how much calcium is circulating in the blood.

Vitamin D - 25(OH)D
The 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.

Two forms of vitamin D can be measured in the blood, 25-hydroxyvitamin D (simply called the 25(OH)D test) 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.

1,25-dihydroxyvitamin D may be ordered when kidney disease or abnormalities of the enzyme that converts 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D is suspected.

Vitamin D comes from two types: vitamin D2 (ergocalciferol, which comes from plants) and vitamin D3 (cholecalciferol, which comes from animals). Vitamin D3 is the form produced in the body. Vitamin D2 and D3 are equally effective when they are converted by the liver and the kidney into the active form, 1,25-dihydroxyvitamin D.

Some tests do not distinguish D2 and D3 forms of the vitamin and report only the total result. Newer methods, however, may report levels of both D2 and D3 and then add them together for a total level.

People at higher risk of deficiency include the elderly or obese people, people who don't get enough sun exposure, people with darker skin, and people who take certain medications for long periods of time. Adequate sun exposure is typically estimated to be two periods per week of 5-20 minutes. People who do not have adequate sun exposure may obtain the vitamin D that they need from food sources or supplements. There is evidence that vitamin D deficiency may increase the risk of some cancers, immune diseases, and cardiovascular disease. Research suggests that women with low levels of vitamin D have a higher risk of breast cancer. The right vitamin D levels may reduce your risk of breast cancer by 83%!

The Endocrine Society defines vitamin D deficiency as a 25-hydroxyvitamin D blood level below 20 ng/mL (50 nmol/liter) and vitamin D insufficiency as a level between 21–29 ng/mL (52.5–72.5 nmol/liter).

The optimal range should be between 30–40 ng/ml (75–100 nmol/liter). With vitamin D levels in this range, your body is absorbing calcium well and you should have the right levels of parathyroid hormone. This means strong and healthy bones. In some research studies, vitamin D levels in this range have been shown to reduce your risk of developing cancer and improve your immune system, which fights infection.

Several studies now show potential adverse effects among people with levels above 40 ng/mL (100 nmol/liter), including increased risk for breast, pancreatic and prostate cancer; cardiovascular disease; falls and bone fractures in the elderly; and death from any cause.

Hint: 1 nmol/liter = 0.4 ng/ml

Gout

Uric Acid

Uric acid is a waste product from the digestion of protein. Most uric acid is removed from the body by the kidneys and is eliminated from the body in the urine, with the remainder eliminated in the stool.

If too much uric acid is produced or not enough is removed, it can accumulate in the body, causing increased levels in the blood (hyperuricemia). The presence of excess uric acid can cause gout, a condition characterized by inflammation of the joints due to the formation of uric acid crystals in the joint (synovial) fluid. Excess uric acid can also be deposited in tissues such as the kidney, leading to kidney stones or kidney failure.

Uric acid levels are best tested 6 weeks after symptoms appear as they may not be raised at the onset of a gout attack.

Diabetes

Blood Glucose

High levels of glucose most frequently indicate diabetes, but many other diseases and conditions can also cause elevated blood glucose.

In a person with signs and symptoms of diabetes or hyperglycemia, a non-fasting glucose level (random blood sample) that is equal to or greater than 200 mg/dL (11.1 mmol/L) indicates diabetes.

The following information summarizes the meaning of other test results.

Fasting Blood Glucose:

  • From 70 to 99 mg/dL (3.9 to 5.5 mmol/L) - Normal fasting glucose
  • From 100 to 125 mg/dL (5.6 to 6.9 mmol/L) - Prediabetes (impaired fasting glucose)
  • 126 mg/dL (7.0 mmol/L) and above on more than one testing occasion - Diabetes

HbA1c
HbA1c or Haemoglobin A1c is also known as glycosylated haemoglobin and is a longer term measure of glucose levels in your blood than a simple blood glucose test. Glucose attaches itself to the haemoglobin in your red blood cells, and as your cells live for around 8-12 weeks it provides a good indication of the level of sugar in your blood over a 2-3 month period.

This is an important measure for diagnosing type 2 diabetes and prediabetes, as well as understanding how well blood sugar levels are being controlled in people who have already been diagnosed with diabetes.

The HbA1c test result is reported as a percentage. The higher the percentage, the higher your blood glucose levels have been.

HbA1c results and what the numbers mean:

  • Normal: below 5.7 percent
  • Prediabetes: 5.7 to 6.4 percent
  • Diabetes: 6.5 percent or above

Note: Any test used to diagnose diabetes requires confirmation with a second measurement, unless there are clear symptoms of diabetes.

Iron Status

Iron
This test measures how much iron is in your blood with the aim of identifying iron deficiency anaemia or iron overload syndrome (haemochromatosis)

The symptoms of too much or too little iron can be similar - fatigue, muscle weakness, moodiness and difficulty concentrating.

A raised result can mean that you have iron overload syndrome, an inherited condition where your body stores too much iron, or that you are over-supplementing or that you have a liver condition.

A low result can mean that you are anaemic or are suffering from gastro-intestinal blood loss (or other blood loss). Anaemia is also very common in pregnant women.

Generally men have higher levels of serum iron than women. The amount of circulating iron bound to transferrin is reflected by the serum iron level. The serum iron reference range is 65–176 µg/dL (0.65 - 1.76 mg/L) in men and 50–170 µg/dL (0.5 - 1.7 mg/L) in women.

T.I.B.C or Transferrin

A total iron-binding capacity (TIBC or transferrin) test is used to measure the amount of the protein transferrin in your blood. When your body's stores of iron run low, your liver produces more transferrin in order to get more iron into your blood. Higher values mean you may have iron-deficiency anemia. As transferrin is produced by the liver, lower values may also indicate liver disease.

Normal values for the TIBC test are 240 to 450 µg/dL (43 - 80.5 µmol/L).

Ferritin
Ferritin is a protein which stores iron in your cells for your body to use later. Measuring ferritin levels gives us a good indication of the amount of iron stored in your body.

Low levels of ferritin can indicate anaemia which can be caused by excessive or chronic bleeding, poor absorption of iron or too little iron in the diet.

Raised ferritin levels can indicate iron overload syndrome (haemochromatosis) or any kind of liver damage. It is also a marker of infection and inflammation.

The results may vary slightly among laboratories, but in general, normal ferritin levels range from 12 to 300 ng/mL for males and 12 to 150 ng/mL for females.

Cholesterol Status

Cholesterol
Cholesterol is an essential body fat (lipid). It is necessary for building cell membranes and for producing a number of essential hormones. Cholesterol is manufactured in the liver and also comes from the food we eat. On average, humans make 10 mg of cholesterol per day per kg of body weight. The production depends on the needs of the person. If you eat foods high in cholesterol, less needs to me made in the body. Elevated cholesterol is a risk factor for heart disease. It can also contribute to other problems, such as liver disease and Alzheimer’s disease.

Total cholesterol is measured using a method called a blood fat (lipid) profile test. The test measures up to 4 parameters:

  • Total cholesterol
  • High-density lipoprotein (HDL) cholesterol
  • Low-density lipoprotein (LDL) cholesterol
  • Triglycerides

Cholesterol, however, is made up of both good (HDL) and bad (LDL) cholesterol, so it is important to investigate a raised total cholesterol result to determine the cause. High levels of HDL cholesterol can cause a raised total cholesterol result but may actually be protective against heart disease.

Every person over the age of 45 should get a fat profile test. People under the age of 45, but with a family history of heart disease, diabetes, or chronic kidney disease, should be tested earlier.

For adults, in a routine setting where testing is done to screen for risk, the test results are grouped in three categories of risk:

  • Desirable: A cholesterol below 200 mg/dL (5.18 mmol/L) is considered desirable and reflects a low risk of heart disease.
  • Borderline high: A cholesterol of 200 to 239 mg/dL (5.18 to 6.18 mmol/L) is considered to reflect moderate risk. If the cholesterol test was done by itself, a healthcare practitioner may decide to order a lipid profile to see if the high cholesterol is due to the amount of bad cholesterol (high LDL-C) or good cholesterol (high HDL-C). Depending on the results of the lipid profile (and any other risk factors), a decision will be made about whether treatment, including lifestyle changes, is necessary.
  • High risk: A cholesterol greater than or equal to 240 mg/dL (6.22 mmol/L) is considered high risk. A health care provider may order a lipid profile (as well as other tests) to try to determine the cause of the high cholesterol. Once the cause is known, an appropriate treatment will be prescribed.

Low Range

Although an unhealthy lower level of total cholesterol has not been fully validated, it is thought that < 140 mg/dL of cholesterol will produce negative effects. There are links between lowered cholesterol and psychiatric disorders.

For children and adolescents:

  • A cholesterol below 170 mg/dL (4.40 mmol/L) is acceptable.
  • A result of 170-199 mg/dL (4.40-5.16 mmol/L) is borderline.
  • A total cholesterol reading greater than or equal to 200 mg/dL (5.17 mmol/L) is considered high.

For young adults:

  • A cholesterol below 190 mg/dL (4.92 mmol/L) is acceptable.
  • A result of 190-224 mg/dL (4.92-5.80 mmol/L) is borderline.
  • A total cholesterol greater than or equal to 225 mg/dL (5.82 mmol/L) is considered high.

Cholesterol should be measured when a person is not ill. Blood cholesterol is temporarily low during acute illness, immediately following a heart attack, or during stress (like from surgery or an accident). Wait at least six weeks after any illness to have cholesterol measured.
Cholesterol is typically high during pregnancy. Women should wait at least six weeks after having a baby to have cholesterol measured.

HDL Cholesterol
HDL cholesterol (high density lipoprotein) removes cholesterol from the bloodstream and transports it to the liver where it is broken down and removed from the body in bile. HDL cholesterol is commonly known as "good cholesterol".

Raised levels are believed to be protective against heart disease, while low levels are associated with increased risk of a heart attack.

Typically, doctors recommend an HDL level of 60 milligrams per deciliter (mg/dL) of blood or higher. Having HDL under 40 mg/dL increases your risk of developing heart disease.

Here is the adult range for normal HDL cholesterol:

  • 40 to 65 mg/dL for men
  • 40 to 80 mg/dL for women

LDL Cholesterol (LDL-C)
LDL cholesterol (low density lipoprotein) carries cholesterol, triglycerides and other fats to various tissues throughout the body. Too much LDL cholesterol, commonly called "bad cholesterol", can cause fatty deposits to accumulate on artery walls, potentially leading to atherosclerosis and heart disease.

  • LDL level can be evaluated as follows:
  • Less than 100 mg/dL (2.59 mmol/L) — Optimal
  • 100-129 mg/dL (2.59-3.34 mmol/L) — Near optimal, above optimal
  • 130-159 mg/dL (3.37-4.12 mmol/L) — Borderline high
  • 160-189 mg/dL (4.15-4.90 mmol/L) — High
  • Greater than 189 mg/dL (4.90 mmol/L) — Very high

According to the American Academy of Pediatrics, the LDL level can be evaluated for youth with no other risk factors as follows:

For children and teens:

  • Less than 110 mg/dL (2.85 mmol/L) — Acceptable
  • 110-129 mg/dL (2.85-3.34 mmol/L) — Borderline high
  • Greater than 130 mg/dL (3.36 mmol/L) — High

For young adults:

  • Less than 120 mg/dL (3.10 mmol/L) — Acceptable
  • 120-159 mg/dL (3.10-4.11 mmol/L) — Borderline high
  • Greater than 160 mg/dL (4.12 mmol/L) — High

Triglycerides
Triglycerides are a type of fat (lipid) that circulate in the blood. After you eat, the body converts excess calories into triglycerides which are then transported to cells to be stored as fat. Your body releases triglycerides to be used for energy.

Raised triglycerides are thought to be a risk factor for peripheral vascular disease (affecting the blood vessels which supply your arms and legs as well as organs below the stomach) as well as microvascular disease, affecting the tiny blood vessels around the heart. 

Low triglyceride levels can also be harmful as they are associated with heart and autoimmune diseases.

For adults, triglyceride test results are categorized as follows:

  • Low: Less than 100 mg/dL (1.13 mmol/L)
  • Desirable: Less than 150 mg/dL (1.7 mmol/L)
  • Borderline high: 150 to 199 mg/dL (1.7-2.2 mmol/L)
  • High: 200 to 499 mg/dL (2.3-5.6 mmol/L)
  • Very high: Greater than 500 mg/dL (5.6 mmol/L)

For children, teens and young adults:

From newborn to age 9

  • Acceptable: Less than 75 mg/dL (0.85 mmol/L)
  • Borderline high: 75-99 mg/dL (0.85-1.12 mmol/L)
  • High: Greater than 100 mg/dL (1.13 mmol/L)

For ages 10-19 years

  • Acceptable: Less than 90 mg/dL (1.02 mmol/L)
  • Borderline high: 90-129 mg/dL (1.02-1.46 mmol/L)
  • High: Greater than 130 mg/dL (1.47 mmol/L)

For young adults older than 19

  • Acceptable: Less than 115 mg/dL (1.30 mmol/L)
  • Borderline high: 115-149 mg/dL (1.30-1.68 mmol/L)
  • High: Greater than 150 mg/dL (1.7 mmol/L)

Note: These values are based on fasting triglyceride levels.

When triglycerides are very high (greater than 1000 mg/dL (11.30 mmol/L)), there is a risk of developing pancreatitis in children and adults. Treatment to lower triglycerides should be started as soon as possible.

LDL Particle Testing (LDL-P)

Traditional lipid testing measures the amount of LDL cholesterol (LDL-C) present in the blood. This is total amount of LDL. However, whilst a high reading is a potential issue, there is a much more effective reading for heart disease risk and that is LDL-P, which is the number of LDL particles not the volume of LDL particles as in LDL-C.

LDL particle number (LDL-P) is a much more accurate predictor of CV disease risk than either LDL-C or total cholesterol.

As well as measuring LDL-P we can also measure Apolipoprotein B. Apolipoprotein B is the major apolipoprotein in LDL. It binds with triglycerides and cholesterol to form LDL, and it is also the receptor that binds with cells so LDL can deliver it’s fats and cholesterol. So in scientific studies Apolipoprotein B levels act as a proxy for LDL-P.

VLDL Cholesterol

VLDL stands for very low density lipoprotein. VLDL is considered one of the "bad" forms of cholesterol, along with LDL cholesterol and triglycerides.
An elevated level of VLDL cholesterol like elevated LDL cholesterol, is considered a risk factor for heart disease and stroke. The presence of high VLDL in addition to high LDL may affect the choice of therapy used to lower a person's cholesterol, such as lifestyle changes or drug treatment.

Normal VLDL levels are from 2 to 30 mg/dL.

Heart Disease Risk (Cholesterol Ratios)

There are three indicators that describe your heart disease risk with high accuracy. They are all built as ratios of the aforementioned blood results and are therefore called cholesterol ratios.

- HDL percentage of Total Cholesterol
HDL percentage of Total Cholesterol is considered to be more indicative of your risk of cardiovascular disease than total cholesterol alone.

Your cholesterol ratio is calculated by dividing your total cholesterol by your HDL number. For instance, if your total cholesterol is 180 mg/dl and your HDL is 82 mg/dl, your cholesterol ratio is 2.2. According to the American Heart Association (AHA), you should aim to keep your ratio below 5, with the ideal cholesterol ratio being 3.5.

- Non-HDL Cholesterol
Many doctors now believe that determining your non-HDL cholesterol level may be more useful than calculating your 'HDL percentage of Total Cholesterol' ratio for predicting your risk of heart disease.
Non-HDL cholesterol, as its name implies, simply subtracts your HDL cholesterol number from your total cholesterol number. So it contains all the "bad" types of cholesterol, not just the LDL cholesterol.
An optimal level of non-HDL cholesterol is less than 130 mg/dl. Higher numbers mean a higher risk of heart disease.

- LDL/HDL ratio
LDL/HDL ratio is simply the LDL level divided by the HDL level. It's one of the most popular measures of a heart disease risk.

  • Ideal: below 2.0
  • Good: below 5.0
  • Too high: above 5.0

Additional Blood Tests for the Elderly

Prostate-specific antigen (PSA)
PSA is a protein only made by the prostate gland. Some of it will leak into your blood. How much depends on your age and the health of your prostate. PSA levels should be meausured for men over the age of 50.
The most frequent benign prostate conditions that cause an elevation in PSA level are prostatitis (inflammation of the prostate) and benign prostatic hyperplasia (BPH) (enlargement of the prostate). There is no evidence that prostatitis or BPH leads to prostate cancer, but it is possible for a man to have one or both of these conditions and to develop prostate cancer as well.

Before having the test, you shouldn't have:

  • Ejaculated in the last 48 hours
  • Exercised heavily in the last 48 hours
  • A urinary infection
  • Had a prostate biopsy in the last 6 weeks

If you're aged 50 to 69, a raised PSA is 3 ng/mL or higher.

Vitamin B12
Vitamin B12 deficiency is quite common in older adults, and can be related to common problems such as fatigue, memory problems, and walking difficulties.
Depending on the situation, if an older adult is found to have low vitamin B12 levels, additional testing may be pursued, to determine the underlying cause of this vitamin deficiency.
Methylmalonic acid levels in the body are related to vitamin B12 levels, and can help confirm a vitamin B12 deficiency. Low vitamin B12 levels are associated with higher-than-normal methylmalonic acid levels.

A normal level of vitamin B12 in your bloodstream is between 200 and 900 ng/mL.

Homocysteine
Homocysteine is an amino acid and breakdown product of protein metabolism that, when present in high concentrations, has been linked with a wide range of health disorders including heart disease, stroke, macular degeneration, migraine, dementia, cancer, and osteoporosis.

B vitamins such as folic acid, vitamin B12, and vitamin B6 help the body maintain homocysteine levels within a healthy range.

A normal level of homocysteine in the blood is less than 15 mcmol/L. Higher levels of homocysteine are split into three main categories:

  • Moderate: 15-30 mcmol/L
  • Intermediate: 30-100 mcmol/L
  • Severe: greater than 100 mcmol/L

In most cases, doctors will not consider testing for homocysteine and could therefore be treating their patients without success. Most health-conscious people know their cholesterol level but few know their equally important homocysteine number.

Note: A rare inherited condition called homocystinuria (also called cystathionine beta synthase deficiency) can also greatly increase homocysteine in the blood and urine.

Thyroid Function Tests
The TSH test and the T4 test are the two most common thyroid function tests.

The TSH test measures the level of thyroid-stimulating hormone in your blood. The TSH has a normal test range between 0.4 and 4.0 mIU/L.

The T4 test is known as the thyroxine test. A high level of T4 indicates an overactive thyroid (hyperthyroidism). Symptoms include anxiety, unplanned weight loss, tremors, and diarrhea.

An easy way to remember how the thyroid works is to think about supply and demand. As the T4 level falls, the TSH rises. As the T4 level rises, the TSH falls.

Note: Both the TSH and T4 tests are routinely performed on newborn babies to identify a low-functioning thyroid gland. If left untreated, this condition, called congenital hypothyroidism, can lead to developmental disabilities.

 

Reference:
https://www.medichecks.com/health-checks/essential-blood-test
https://www.lalpathlabs.com/blog/what-is-esr-in-blood-test/
http://www.healthcaremagic.com/questions/ESR-in-Blood-Test-is-this-normal/128180
https://labtestsonline.org/
https://www.healthline.com/health/gamma-glutamyl-transpeptidase
http://www.healtheiron.com/about-ggt
https://emedicine.medscape.com/article/2087891-overview

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