Which
blood tests
do I need
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First time basics
Thyroid
• FT3 (triiodothyronine, free)
• FT4 (thyroxine, free)
• RT3 (reverse T3)
• Thyroid antibodies
TPO (thyroid peroxidase antibody) and
TgAb (anti thyroglobulin antibody also known as ATA)
Iron
• Serum iron (sometimes called total iron)
• TIBC (total iron binding capacity) -or- Transferrin
• Saturation (this is a calculation of the first two)
• Ferritin
Plus
• BMP or CMP (basic or comprehensive chemistry panel)
• CMP may be called Chemistry Panel; Chemistry Screen; Chem,
SMA, SMA or SMAC followed by number 12, 14, 20
• BMP may be called Chem, SMA or SMAC followed by number 7
• Panel will vary from lab to lab
• Basic panel always includes:
• Glucose
• Electrolytes
• Calcium |
• Sodium |
• Potassium |
• CO2 (carbon dioxide, bicarbonate) |
• Chloride |
• Kidney Tests
• BUN (blood urea nitrogen) |
• Creatinine |
Comprehensive panel adds:
• Proteins
• Albumin |
• Total Protein |
• Liver Tests
• ALP (alkaline phosphatase) |
• ALT (alanine amino transferase, also called SGPT) |
• AST (aspartate amino transferase, also called SGOT) |
• Bilirubin |
• Vitamin B12/folate
• Vitamin D 25(OH)D3 (calcifediol)
The actual substance that is used in the body is 1,25(OH)2D3
(calcitriol). However it has a very short half life (possibly only a few
hours) and circulates in serum at only 0.1 percent of its immediate
precursor 25(OH)D3 (calcifediol) which has a half life of two to four
weeks. Thus, it is 25(OH)D3, the most abundant and stable vitamin D
metabolite in human serum that is used to evaluate vitamin D status.
Tests specific to related health issues
Symptoms of electrolyte imbalance with good serum levels
• RBC potassium
• RBC magnesium
Glucose control
• HbA1c
Provides a measure of the average level of blood glucose over the |
previous two to three months |
• C Peptide
• more accurate measure of insulin production than a direct blood |
test for insulin as much of insulin is broken down very quickly after it |
is released by the pancreas |
• Glucose Tolerance Test (or GTT)
• challenges the body with a large dose of liquid glucose |
• a healthy body will respond with enough insulin to bring glucose |
levels back into a healthy range within, usually, two hours |
• often used during pregnancy to diagnose gestational diabetes |
• may result in reactive hypoglycemia (a protein snack can be |
carried for immediately after the test; patient should be driven home) |
Inflammation
• H.pylori
• Homocysteine
• CRP (C-reactive protein)
• hsCRP (cardiac specific)
• Sed rate (sedimentation rate)
• Galectin 3
Low aldosterone symptoms
• Aldosterone
• Renin Activity
• BMP or CMP for Sodium and Potassium
Sex hormone imbalance
• Progesterone
• Estrogens
• Estradiol (E2) |
• Estrone (E1) particularly important post meno |
• Estriol (E3) elevated in pregnancy; blood testing is not sensitive |
enough to measure low levels at other times |
• Testosterone
• Free Testosterone |
• Bioavailable Testosterone |
• Total Testosterone |
• SHBG (sex hormone binding globulin)
• LH (luteinizing hormone)
• FSH (follicle stimulating hormone)
• Free and bioavailable testosterones can be calculated from Total
• The most effective estrogen testing, and also the most expensive, is
24-hour urine testing. Its primary advantage is accurate testing for E3
estriol, the protective estrogen as blood serum testing for estriol is
designed for the very high levels in pregnancy and are not generally
sensitive enough to accurately measure the very low non-pregnant
levels
• Prior to supplementation, saliva testing can be utilized to evaluate
levels. Once supplementing, saliva test results are not accurate and
testing should be done in blood serum. Because of this there is an
advantage to starting out with blood serum testing
The range of normal day-by-day levels of
progesterone, estradiol, lutenizing hormone and
follicle stimulating hormone can be seen here
Note: Once supplementing sex hormones, blood serum is more accurate than
saliva. 24 hour urine testing is the most accurate and also the most expensive
Low ferritin and low iron not responsive to treatment
• CBC (complete blood count)
• Reticulocyte count (when hemoglobin and/or red blood cells are low)
Combination of high ferritin and low iron without inflammation
• Serum Copper
• Ceruloplasmin
• Plasma zinc
• Molybdenum
Hyperthyroid
• TSI (thyroid stimulating immuneglobulin also called TSH receptor
antibody, TRab or TRAK)
• ANA (anti-nuclear antibody)
Pernicious Anemia
• MMA (methylmalonic acid)
H.pylori
• Urea breath test
• detect infection in the stomach (not intestines or elsewhere) |
• capsule, liquid, or pudding containing urea “labeled” with a |
radioactive carbon atom is ingested |
• exhalation is evaluated |
• Serum blood test
• reflects untreated infection at any time |
• does not prove a current, active infection |
• measures specific antibodies |
• Stool test looks
• measures H.pylori antigens (foreign proteins) |
• present in active infection |
Atrophic Gastritis
• Antibody tests for Parietal cells and Intrinsic Factor
Celiac disease
Celiac can only be absolutely confirmed with a biopsy, but there are
antibodies that are usually present in someone suffering from Celiac:
immunoglobulin gamma A and/or G (IGa, IGg) subtypes of anti-gliadin.
A sensitive testing protocol includes testing for both IgA and IgG
anti-gliadin antibodies. This combined IgA and IgG anti-gliadin antibody
assay has an overall sensitivity of 95% with a specificity of 90%. There
is also a TTG stool antibody test offered by EnteroLabs
Repeat blood tests during treatment
Natural desiccated thyroid hormone (at 6 weeks, then as needed)
• FT3 (triiodothyronine, free)
• FT4 (thyroxine, free)
• RT3 (reverse T3)
T3-only thyroid hormone
• FT3 (triiodothyronine, free) (at 4 weeks, then as needed)
During iron supplementation (every 5-6 weeks)
• Serum iron (sometimes called total iron)
• TIBC (total iron binding capacity) -or- Transferrin
• Saturation (this is a calculation of the first two)
• Ferritin
Hydrocortisone replacement (2 weeks, then every 4-5 weeks)
• BMP or CMP to monitor sodium and potassium
Fludrocortisone (before each increase to fludrocortisone dose and/or
until potassium is stable, then every 4-5 weeks)
• BMP or CMP to monitor sodium and potassium