Last Updated on January 21, 2025

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. 

The normal range for RBC is:

• Men: approximately 4.7 to 6.1 million cells/ul (microliter).
• Women: range from 4.2 to 5.4 million cells/ul.
• Children: 4.0 to 5.5 million cells/ul.

Haemoglobin

Hemoglobin 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 also may indicate thalassemia, or other blood disorders.

The normal range for haemoglobin is:

• For men, 13.5 to 17.5 grams per deciliter (gm/dl).
• For women, 12.0 to 15.5 gm/dl.
• For Children, 11 to 13 gm/dl.

HCT (Haematocrit)

The hematocrit test, also known as a packed-cell volume (PCV) test, 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 lung or heart disease and even sleep apnea.

Low levels may indicate:

• An insufficient supply of healthy red blood cells (anemia)
• A large number of white blood cells due to long-term illness, infection or a white
• Blood cell disorder such as leukemia or lymphoma
• Vitamin or mineral deficiencies
• Recent or long-term blood loss

Generally, a normal range is considered to be:

• For men, 38.3 to 48.6 percent
• For women, 35.5 to 44.9 percent

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 (as are an elevated Gamma GT and a ratio of AST:ALT of 2:1).

A low result indicates anaemia or thalassemia.

The reference range for MCV is 80-96 fL/red cell in adult.

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.

The reference range for MCH is 27-33 picograms (pg)/cell in adults.

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. It can also indicate Thalassemia. This is an inherited blood disorder in which you have fewer red blood cells and less hemoglobin present in your body.

The reference range for MCHC is 32-36 g/dL in adults.

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.

If anemia is observed, RDW test results are often used together with mean corpuscular volume (MCV) results to determine the possible causes of the anemia.

Normal reference range of RDW in human red blood cells is 11.5-15.5%.

White Blood Cells

White Cell Count

White blood cells are key to your body’s immune or defense system. There are 5 major types of white blood cells and they all play a role in fighting infections and protecting your body from foreign invaders such as harmful germs and bacteria, so it’s important to have an optimal level of each of the 5 types.

A raised white blood cell (WBC) count can indicate recent infection, inflammation, blood cancer, 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.

The specific number for high white blood cell count varies from one lab testing facility to another, but a general rule of thumb is that a count of more than 10,500 leukocytes in a microliter of blood in adults is generally considered to be high, while 4,500-10,500 is considered within the normal range.

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.

The normal range of the percentage of neutrophils is between 50% and 70%.

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.

The normal range is 20 – 40 %.

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.

Normal range is 2 – 9 %.

Eosinophils

Eosinophils are a type of white blood cell whose function is to remove parasitic infections as well as to regulate inflammation. They’re made in the bone marrow and then travel to different body tissues.

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. Eosinophils can also be elevated to certain food allergies, as in the case of allergy to milk and milk proteins like casein.

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

If you take a blood test and the results aren’t in the normal range, your doctor may recommend more tests to figure out the problem. If this happens on a test called a white blood cell differential, you may need to get another blood test called an absolute eosinophil count. You might also get this test if your doctor thinks you have a particular kind of disease.

The serum reference ranges of eosinophils are as follows: Eosinophils blood (%): 0.0-6.0

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.

The Basophils should remain within the normal range, generally between 0% and 2%.

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. A low count can be caused by some drugs or bacterial & viral infections, such as Hepatitis C or HIV. Certain cancers like leukemia or lymphoma can also lower your platelet count.

A normal platelet count ranges from 150,000 to 450,000 platelets per microliter of blood.

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.

A typical range of platelet volumes is 9.4–12.3 fL (femtolitre), equivalent to spheres 2.65 to 2.9 µm in diameter.

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-CRP

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. This marker is also important to check complications from COVID-19 (Coronavirus). However, it does not identify where the inflammation is located.

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

Some types of CLA (Conjugated Linoleic Acid) found in dietary supplements may cause an increase in the levels of C-reactive protein, according to eMedTV. So those with heart disease should not take CLA dietary supplements without first consulting a physician.

CRP reference range is 0.0 – 0.5 mg/dL.

On the other hand, High Sensitivity CRP (hs-CRP) is a test which is used to detect low-level inflammation which is thought to damage blood vessels, and that 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. It helps support bone health and assists in energy production. Magnesium is also involved in protein synthesis and supports your immune system.
Although deficiency is fairly uncommon in otherwise healthy people, it can affect those who take certain medications, have certain health conditions, or consume too much alcohol, according to the National Institutes of Health’s Office of Dietary Supplements.

Magnesium deficiency can cause the development of a number of issues, like loss of appetite, nausea and vomiting, fatigue and weakness, asthma, and even teeth grinding. In more severe cases, it can lead to numbness, muscle & leg cramps, seizures, abnormal heart rhythms, diabetes, osteoporosis, personality changes, or low potassium or calcium levels.

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. Be aware that salt substitutes can potentially increase potassium levels in the blood for some people.

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, excessive sweating, and, sometimes, not enough potassium in the diet, can also cause low potassium levels. Low potassium levels may contribute to the development of insulin resistance, a condition in which the body’s cells become less responsive to insulin’s effects, leading to high blood sugar levels and the development of type 2 diabetes. Again, symptoms may be hard to diagnose: You may experience weakness, fatigue, muscle cramps, tingling and numbness, or constipation, or even an irregular heartbeat.
For patients with low potassium levels, doctors may prescribe potassium supplements. 

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.

Newborns have the highest phosphate levels (4.0 – 8.0 mg/dL) as they require more of this mineral for bone growth and soft tissue development. Levels in children are around 3.0-6.0 mg/dL, and continue to gradually drop toward adulthood.

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. In healthy people, only high loading doses of creatine supplements may slightly increase creatinine levels. If you do a creatinine test while taking high creatine doses (~20 g/day), your doctor could pick up this false positive error and assume you have a kidney disease if unaware of your supplementation regime.
Most athletes have increased creatinine levels, regardless of creatine supplementation. In fact, if creatinine was used as the only measure of kidney function, it would appear as if nearly all athletes are experiencing kidney issues.

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

An increased ratio may be due to a condition that causes a decrease in the flow of blood to the kidneys, such as congestive heart failure or dehydration.

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.

A ratio above the normal range may also be seen with increased protein intake. A ratio below the normal range could mean liver disease or malnutrition.

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. It is often reported automatically when you do a creatinine blood test.

Creatinine is a waste product created from the normal wear and tear of muscles. Kidneys filter (remove) almost all of creatinine from the blood. When kidney function decreases, less creatinine is eliminated and concentrations increase in the blood.

eGFR often helps in early detection of kidney dysfunction, which is important to prevent further kidney damage. It is a better measure of kidney function than creatinine, or other kidney-associated markers such as BUN (blood urea nitrogen), mainly, because it is more sensitive. BUN and creatinine will not usually increase above normal until more than 50% of total kidney function is lost!

For body builders, high muscle mass may lead to underestimation of eGFR. To address this issue, newer equations have been developed linking eGFR to another marker of kidney function, cystatin C. Unlike creatinine, cystatin C can be found in virtually all tissues. Further, some equations include both cystatin C and creatinine – these are the most accurate ones to date.

Understanding eGFR results:

• Normal eGFR: A reading of 90 mL/min/1.73m2 or above is considered normal and indicates healthy kidney function.
• Mild kidney disease: An eGFR between 60 and 89 may be normal unless there is protein in the urine (uACR test) which might suggest early-stage kidney disease.
• Moderate to severe kidney disease: An eGFR between 15 and 59 indicates kidney disease, and you may start experiencing some symptoms like fatigue, high blood pressure, or swelling. Chronic kidney disease is diagnosed when a person has an eGFR less than 60 for more than three months.
• Kidney failure: An eGFR below 15 signifies kidney failure, requiring immediate medical attention.

Important to note:

• eGFR values can vary slightly depending on factors like age, sex, and muscle mass.
• A single eGFR reading might not be conclusive. 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 (uACR test), 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.
• eGFR declines with age, even in people without kidney disease. Values below 60 mL/min/1.73 m2 in those over 70 years old can be normal.

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: A: Urine albumin-to-creatinine ratio (uACR) test: It measures the amount of albumin, a protein normally found in your blood, and creatinine, a waste product eliminated from your body by your kidneys, in your urine. The spot urine collected on awakening (before breakfast or exercise) is the most recommended test for uACR. The presence of albumin in the urine is called albuminuria or sometimes proteinuria. If albumin in the urine is detected, it should be confirmed by retesting twice within a 3-6 month period. Albuminuria, along with a low eGFR (glomerular filtration rate) and a high BUN (blood urea nitrogen), are signs that the kidneys are not functioning well. People at risk of kidney disease and increased ACR are those with: Diabetes High blood pressure Heart disease A family history of kidney disease. They should all check their ACR regularly. Normal uACR levels vary depending on your age and sex. Here’s a general guideline: A ratio of albumin to creatinine of less than 30 mg/g (3 mg/mmol) is normal to mildly increased – category A1. A ratio of 30-300 mg/g (3-30 mg/mmol) signifies microalbuminuria, referred to as moderately increased – category A2. Values above 300 mg/g (30 mg/mmol) are considered as macroalbuminuria, termed severely increased – category A3. Note: The normal uACR in young adults is <10 mg/g (<1 mg/mmol). Nephrotic range is considered >2200 mg/g (>220 mg/mmol). 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. How to calculate ACR? The formula for ACR is: ACR = Albumin in mg/dL / Creatinine in g/dL Albumin’s unit is usually displayed in mg/dL. If you get the Albumin value in mg/L, you can convert to mg/dL by multiplying by 0.1. mg/dL = mg/L × 0.1 For example, if you have 90 mg/L, it would be: 9 mg/dL Whereas you might get mg/dL or mmol/L for creatinine. We can convert creatinine to mmol/L or mg/dL. Here are the conversion factors: 1 mmol/L = 0.056 mg/dL; and 1 mg/dL = 18 mmol/L. To calculate ACR: 1- Find the albumin level in urine – e.g., 9 mg/dL. 2- Write down the creatinine concentration in g/dL – e.g., 133 mg/dL = 0.133 g/dL. 3- From the equation: ACR = Albumin in mg/dL / Creatinine in g/dL, which translates to: 9 / 0.133 4- Here’s the result: your ACR is equal to 67.66 mg/g. This value is classified as moderately increased – category A2. Here is an online calculator to calculate ACR.   B: 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.

You may also need an ALP test if you’re taking a medication that has the potential to damage your liver, such as acetaminophen (Panadol). Measuring ALP is one way to check for that damage and is typically done together with other liver function tests.

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.

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. 

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.

The normal range of AST is 10 to 45 U/L.

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.

Creatine supplementation also increase creatine kinase activity.

Although higher CK levels are found in athletes, conversely, high CK levels are also found in obese and overweight people.

In a healthy adult, the serum CK level varies with a number of factors (gender, race and activity), but normal range is 22 to 198 U/L (units per liter).

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.

The indirect bilirubin level in the bloodstream is the total bilirubin minus the direct bilirubin.

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.

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. 
Low levels of thyroid hormone, also known as hypothyroidism, and low levels of anabolic hormones such as DHEA – the precursor to testosterone, and growth hormones also cause low levels of albumin.

Raised levels are usually caused by dehydration.

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

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.

Signs of severely low calcium include muscle cramps and abnormal heart rhythms.

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.

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

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

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 bones. Symptoms of vitamin D deficiency include bone pain, muscle aches or weakness, fatigue, increased blood pressure, and depression. If it goes on long term, a vitamin D deficiency can lead to softening of the bones. 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%! Furthermore, Vitamin D plays an essential role in the immune system. Vitamin D inhibits the production of pro-inflammatory cytokines and increases the production of anti-inflammatory cytokines. This is important with regard to COVID-19 (Coronavirus) as case-fatality rates (CFRs) surge with age when Vitamin D levels are low.

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.

Hint: 1 nmol/liter = 0.4 ng/mL

How much to take Vitamin D from supplements? For every 1 ng/mL increase, you’ll need to get an additional 100 IU of vitamin D per day (obese individuals may require double the amount). For example, if your blood level is 18 ng/mL, taking 400 IU of vitamin D daily (or 800 IU if you are obese) should get you to about 22 ng/mL. It can take 6 weeks to reach the peak. Keep taking the vitamin D to stay at that level. If your level is above 35 ng/mL, taking a Vitamin D supplement may be doing more harm than good, so consider cutting back. 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.

 

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. Uric acid levels are best tested 6 weeks after symptoms appear as they may not be raised at the onset of a gout attack.
Excess uric acid can also be deposited in tissues such as the kidney, leading to kidney stones or kidney failure.

Normal Uric acid levels are 2.4-6.0 mg/dL (female) and 3.4-7.0 mg/dL (male).

Uric Acid and the Heart Uric acid, when elevated, can play a role in oxidizing LDL particles. The process of oxidized fats binding to LDL is one of the big accelerating risk factors for heart disease. Uric acid is an inhibitor of nitric oxide synthesis (the creation of nitric oxide via genes like NOS3), which leads to hypertension as the heart needs to pump harder to get blood to the various regions of the body. Nitric oxide is a vasodilator, we need it to relax blood vessels so they can receive blood. At high levels, uric acid disrupts this process.

 

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.

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

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

Scored 7.0 or above? You are at the verge of developing diabetes-related complications.

Iron Status

Iron

Iron is necessary to produce red blood cells, which carry oxygen throughout your body.

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.

Low iron levels interfere with immune function and can skew the immune response away from Th1 (pro-inflammatory) and towards Th2 (anti-inflammatory), which lowers the body’s ability to fight off viral infection like COVID-19 (Coronavirus).

Generally men have higher levels of serum iron than women. The amount of circulating iron bound to transferrin is reflected by the serum iron (SI) level.

The serum iron reference range is:

• Men: 65–180 µg/dL
• Women: 50–170 µg/dL

Pediatric ranges for serum iron:

• 0 – 4 months: 100-270 μg/dL
• 5 months – 23 months: 30-70 μg/dL
• 24 months – 35 months: 20-124 μg/dL
• 3 years – 11 years: 50-120 μg/dL
• 12 years and older: Use adult ranges above 

Hint: Iron level in µmol/L = Iron level in μg/dL × 0.179

Vitamin C & Iron Absorption The availability of iron depends on its absorption rate. Iron from a plant source is different than iron from an animal source. According to the National Institutes of Health (NIH): Overall, 10 – 15% of dietary iron is absorbed by healthy adults. The body absorbs 15 – 35 % of heme iron (animal sources), and this is not significantly influenced by other nutrients in your diet. The body absorbs 2 – 20% of non-heme iron (plant sources). This rate can be greatly influenced by other nutrients you eat. Several food components can decrease your absorption of iron: Tannins and polyphenols found in tea, coffee, and cocoa. Calcium found in dairy products and fortified foods. Phytates found in legumes and whole grains. There are ways to increase your iron absorption: When non-heme iron (plant-based) is eaten with a source of heme iron (animals), this improves the absorption rate of the non-heme iron. According to the NIH, this will increase non-heme iron absorption up to three times. Vitamin C and other organic acids in fruits and vegetables boost the absorption rate of non-heme iron, according to the American Dietetic Association. Adequate vitamin C intake is especially important for vegetarians who do not consume heme iron.

 

Transferrin, Total Iron Binding Capacity (TIBC), and The Unsaturated Iron Binding Capacity (UIBC)

Iron moves through the blood attached to a protein called Transferrin. Your body makes transferrin in relationship to your need for iron. When iron stores are low, transferrin levels increase, and when iron levels are high, transferrin levels decrease. Usually about one third of the transferrin is being used to transport iron. Because of this, your blood serum has considerable extra iron-binding capacity, which is the UIBC. UIBC represents the portion of iron binding sites on transferrin that are not carrying iron.

The TIBC is the total iron-binding capacity; it equals the unsaturated iron binding capacity (UIBC) plus the serum iron measurement. TIBC [µg/dL] = UIBC [µg/dL] + Iron [µg/dL]

Some laboratories measure Transferrin, some measure UIBC, and some measure TIBC.

• Transferrin normal values are 170 to 370 mg/dL. A higher level means that you may have iron-deficiency anemia.
• UIBC normal values are 155 to 355 µg/dL.
• TIBC normal values are 240 to 450 µg/dL.

Transferrin Saturation Another measurement, called Transferrin Saturation, tells us how much iron in the blood is bound to transferrin. Percentage transferrin saturation is calculated by dividing serum iron by TIBC and multiplying the result by 100. Normal values are 20% to 50%. In severe cases of iron-deficiency and anemia, this number may fall below 10%.

 

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 200 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.

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.

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.

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.

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.

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.

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”.

A series of studies shows that the relationship of HDL levels to heart disease and overall mortality forms a U-shaped curve: too little and too much of this blood lipid are, on average, associated with an elevated risk of heart disease, cancer and premature death.

Dr. Marc Allard-Ratick of Emory University School of Medicine in Atlanta who studied the link between HDL cholesterol levels and the risk of having a heart attack or dying of cardiovascular disease, says: “A level above 70 milligrams can be an added risk for people who already have heart disease or an increased likelihood of developing it”.
“In our study of 5,500 high-risk patients, there was a positive association with all-cause mortality in people with HDL levels of 80 or above,” Dr. Allard-Ratick said.

Here is the adult range for normal HDL cholesterol:

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

Less than 40 mg/dL is a major risk factor for heart disease.

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 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

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

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. 

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.

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.

VLDL Cholesterol (Calculated)

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.

You can calculate VLDL levels using the following formula:

VLDL Cholesterol (mg/dL)  = Triglycerides (mg/dL) / 5

Example: If your Triglycerides level is 150 mg/dL, then your VLDL Cholesterol reading is 30 mg/dL.

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

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.

This test is particularly useful for individuals with a personal or family history of heart disease. High LDL-P levels can indicate a higher risk of developing cardiovascular disease, even if LDL-C levels are normal.

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.

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.

A. 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.

B. 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.

C. 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

Aging also affects PSA Levels. Even without any prostate problems, your PSA level can go up gradually as you age. “At age 40, a PSA of 2.5 is the normal limit,” says John Milner, MD, a urologist in the Chicago area. “By age 60, the limit is up to 4.5; by age 70, a PSA of 6.5 could be considered normal.”

Vitamin B12

Vitamin B12 is essential for building blood cells and maintaining healthy nerve cells in the body. Harvard Health Publishing says that vegans may be at particular risk for vitamin B12 deficiency because plants don’t make the nutrient, as are people who’ve had weight loss surgery, because the procedure makes it difficult for the body to extract B12 from food.

Vitamin B12 deficiency is also quite common in older adults and can lead to anemia. Symptoms of severe B12 deficiency include numbness in the legs, hands, or feet; problems with walking and balance; anemia; fatigue; weakness; constipation; weight loss, and loss of appetite; a swollen, inflamed tongue. Deficiency is also damaging to the nervous system and can cause depression, confusion, and dementia.

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 – 900 ng/L (nanograms per liter), 200 – 900 pg/mL (picograms per milliliter), or 148 – 644 pmol/L (picomoles per liter).

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.

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.

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

Thyroid Function Tests

Thyroid hormones control the rate of your metabolism. They affect your cholesterol levels and insulin sensitivity. An underactive or overactive thyroid can cause issues with weight, energy levels, and mood.

The TSH test and the total T4 test are the two most common thyroid function tests.

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.

Alternatively, you can take a whole thyroid panel, containing a combination of these biomarkers: TSH, total or free T4, total or free T3, T3 uptake, and free T4 Index.

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.

The TSH test measures the level of thyroid-stimulating hormone in your blood. A higher-than-normal level of TSH could mean your thyroid is underactive (hypothyroidism), while a lower-than-normal level could mean it’s overactive (hyperthyroidism).

The TSH has an optimal test range between 0.4 and 3.0 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.

The reference range of total T4 (Thyroxine) is 4.5-12.5 µg/dL.

Testosterone Test

In males, the testosterone test can help find the reason for sexual problems, like reduced sex drive or erectile dysfunction. If you’re having a hard time getting your partner pregnant, the test can tell if your blood testosterone level is low. It can also screen for problems with the hypothalamus or pituitary gland. This controls how much testosterone your body makes.

In females, this test can find the reason you’re missing periods, not having periods, or having a hard time getting pregnant. Doctors can also use it to diagnose polycystic ovary syndrome (PCOS). That’s a hormone problem that can cause irregular periods and make it hard to get pregnant. A testosterone test can also reveal if you might have a tumor in your ovaries that affects how much of the hormone your body produces.

Testosterone travels through your blood in two ways:

• Attached to the proteins albumin and sex hormone binding globulin (SHBG)
• Free (not attached to any proteins)

Usually you’ll get a total testosterone test that measures both attached & free testosterone. But numbers from this test can be misleading since it doesn’t account for how much testosterone is actually available for use by the body. (It should also be noted that false Total T readings are more likely in older or obese patients.) Free T, therefore, is the more useful number when there is a reason to suspect that there may be a problem. In any case, Free T numbers, although better than Total T numbers, can still wildly miss the mark since they don’t differentiate between albumin bound testosterone, which is easily available for use by your body, and SHBG bound testosterone, which is not. So once again, the number we truly want is the level of bioavailable testosterone. Bioavailable testosterone refers to the non-SHBG bound testosterone. In other words, it is the combination of free testosterone and albumin bound testosterone.

Note: Free and bioavailable testosterone are not usually measured but, rather, calculated from the total testosterone results and from formulaic estimates as to how much SHBG and albumin are in the blood.

The normal range of total testosterone levels is:

• Men age 18 to 69: 250 to 1,100 nanograms per deciliter (ng/dL)
• Men age 70 to 89: 90 to 890 ng/dL

The normal range for free testosterone is:

• Men age 18 to 69: 46 to 224 ng/dL
• Men age 70 to 89: 6 to 73 ng/dL

Bioavailable testosterone should measure:

• Men age 18 to 69: 110 to 575 ng/dL
• Men age 70 to 89: 15 to 150 ng/dL

Testosterone levels in women vary. However, women create lower levels and are more sensitive to androgens than men. Normal measurements for total testosterone in women range from 15 to 70 ng/dL.

 

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