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Blood tests 


Children’s profile

This may be requested in your children under 16 years of age. This generalised blood screen for children has been specifically tailored to assess the most common blood tests that will provide your child with a ‘healthy body’.
FBC, Iron, TIBC, Ferritin (see Anaemia profile)– Poor eating habits and lack of adequate weight gain may be related to an Iron deficiency anaemia. This will allow you to assess whether indeed your child is anaemic and whether it is related to an iron deficiency.
U&E’s (see Kidney function test)– This is a general assessment of your child’s health and also looks for signs of dehydration.
ALP, total protein, albumin, globulin (see Liver function tests)– ALP is usually raised in ‘growing bones’ of your children. However, your doctor may use it to assess for other bone diseases (including Vitamin D deficiency). A low total protein, albumin and globulin ratio allows your doctor to assess the nutritional state of your child and assess for any malabsorption conditions (such as Coeliac disease). Low globulins could also indicate an agammaglobulinaemia and an immune deficiency that can leave your child open to multiple infections.
Calcium, Vitamin D (25OH) [see Bone screen]– We are realising that Vitamin D is vital for healthy growing bones and it is now recommended that many children take Vitamin D supplements till the age of 5. Vitamin D is very important to enable the absorption of Calcium from the gut. Lack of Vitamin D in children can cause muscle cramps, seizures and breathing difficulties. In severe deficiency, your child may develop a soft skull/ leg bones, with bowing of their legs and may constantly complain of bone pains, especially in the legs, and muscle pains/ weakness– this condition is called ‘Rickets’. Low Vitamin D may also be associated with poor growth (especially height), tooth delay and irritability.

Comprehensive profile

This may be requested to obtain a generalised blood test for all adults, whatever your age.
U&E’s (see Kidney function test), LFT (see Liver function tests), CK, Bone screen, Uric acid, Cholesterol + Triglyceride + HDL/LDL Cholesterol (see Lipid profile), Fasting glucose + HbA1c (see Diabetes profile), TFT (see Thyroid profile), FBC + ESR + Iron + TIBC + Vitamin B12 + folic acid (see Anaemia profile).

Well Woman (Under 50) profile

This may be requested if you are a woman under the age of 50 and would like a generalised blood test specifically for yourself. It includes all the bloods in the Comprehensive profile plus additional tests.
U&E’s (see Kidney function test), LFT (see Liver function tests), CK, Bone screen, Uric acid, Cholesterol + Triglyceride + HDL/LDL Cholesterol (see Lipid profile), Fasting glucose + HbA1c (see Diabetes profile), TFT ( see Thyroid profile ), FBC + ESR + Iron + TIBC + Vitamin B12 + folic acid (see Anaemia profile).
LH + FSH + Testosterone + DHEAs + SHBG (see Hirsutism/ PCOS profile), Prolactin + Oestrodiol (see Amenorrhoea profile/ infertility)

Well Woman (Over 50) profile

This may be requested if you are a woman over the age of 50 and would like a generalised blood test specifically for yourself. These are exactly the same bloods as in the Comprehensive profile.
U&E’s (see Kidney function test), LFT (see Liver function tests), CK, Bone screen, Uric acid, Cholesterol + Triglyceride + HDL/LDL Cholesterol (see Lipid profile), Fasting glucose + HbA1c (see Diabetes profile), TFT (see Thyroid profile), FBC + ESR + Iron + TIBC + Vitamin B12 + folic acid (see Anaemia profile).

Well Man (Under 45) profile

This may be requested if you are a man under the age of 45 and would like a generalised blood test specifically for yourself. It includes all the bloods in the Comprehensive profile plus additional tests.
U&E’s (see Kidney function test), LFT (see Liver function tests), CK, Bone screen, Uric acid, Cholesterol + Triglyceride + HDL/LDL Cholesterol (see Lipid profile), Fasting glucose + HbA1c (see Diabetes profile), TFT (see Thyroid profile ), FBC + ESR + Iron + TIBC + Vitamin B12 + folic acid (see Anaemia profile).
LH, FSH, Testosterone, free androgen index, prolactin, SHBG (see Male infertility profile).

Well Man (Over 45) profile

This may be requested if you are a man over the age of 45 and would like a generalised blood test specifically for yourself. It includes all the bloods in the Comprehensive profile plus additional tests.
U&E’s (see Kidney function test), LFT (see Liver function tests), CK, Bone screen, Uric acid, Cholesterol + Triglyceride + HDL/LDL Cholesterol (see Lipid profile), Fasting glucose + HbA1c (see Diabetes profile), TFT (see Thyroid profile), FBC + ESR + Iron + TIBC + Vitamin B12 + folic acid (see Anaemia profile).
Total and free PSA (prostate specific antigen) [see Prostate profile].

Full Liver profile

This may be requested if your doctor confirms that you have persistently abnormal Liver function tests (LFT). Each specific component of these tests look for various disorders that can cause an abnormality in your liver function.
Hepatitis A, B and C profile – looking to see if acute viral Hepatitis is causing an abnormality in your liver function.
Iron/TIBC/Ferritin (see Iron status profile)–looking to see if an Iron overload (or Haemochromatosis) may be causing an abnormality in your liver function.
Alpha Feto Protein (AFP)– looking to see if there may be a possibility of Cancer in your Liver that may be causing your liver function abnormality.
Liver Fibrosis Fibrotest– this biomarker test looks for the degree of damage of the liver and it is used for the monitoring for liver fibrosis (irreparable damage to the liver).
Liver autoantibodies– these specific antibodies are sought to see if the cause of your deranged liver function is due to an autoimmune liver disease. The antibodies include Anti-liver/kidney microsomal antibodies, Anti-mitochondrial antibodies, ANA (Anti-Nuclear Antibodies) and Anti-smooth muscle antibodies. In autoimmune diseases, your immune system attacks tissues and organs. The most common autoimmune liver diseases are autoimmune chronic active hepatitis (strongly positive smooth muscle antibodies) and primary biliary cirrhosis (strongly positive anti-mitochondrial antibodies).
CMV (Cytomegalovirus)– this herpesvirus can infect worldwide and is usually asymptomatic. It usually causes a mild diarrhoea, but if immunocompromised, it can cause a pneumonia or attack your retina (eye), brain (encephalitis) or liver (hepatitis). If you have a normal immune system, your liver abnormality will only be transient, usually with a full recovery.
EBV (Epstein Barr Virus) [see Glandular fever antibody/ immunity]– looking to see if glandular fever caused your liver abnormality.
Clotting (see Coagulation profile) – this is checked to assess the severity of your liver disease. Abnormal clotting may suggest significant liver damage has occurred.
Serum copper and ceruloplasmin– Wilson’s disease is a genetic disorder where copper accumulates in the tissues. This manifests as neurological/ psychiatric symptoms and liver disease. It is especially important to check for in younger patients with liver dysfunction. Paradoxically, serum copper is low and ceruloplasmin (a transporter protein) levels are usually low too in Wilson’s disease.

Cardiovascular risk profile

These tests are done to assess your risk of having a heart attack.
Fasting glucose and HbA1c (see Diabetes profile).
Cholesterol, triglycerides, HDL + LDL cholesterol [see Lipid profile].
hsCRP (High-sensitive C reactive protein)– This is a marker of inflammation in your body. If your hsCRP is high, it may suggest that you are at an increased risk of developing heart disease. If your hsCRP is very high, you are at double the risk of having heart disease as those with a low hsCRP. As this is a marker of inflammation, it should not be tested if you have other causes for inflammation (such as an infection or recent surgery).
Apolipoprotein A (Apo A) and Apolipoprotein B (Apo B)– Reduced levels of Apo A together with increased levels of Apo B is associated with an increased risk of coronary heart disease, often with accelerated rates of atherosclerosis (cholesterol build up in your arteries).
Lipoprotein(a)– this is genetically determined and can cause heart disease at a young age. High levels of this increase your risk of having a heart attack or a stroke. It cannot by modified by lifestyle changes or most drugs (however niacin/ nicotinic acid may achieve a 20% reduction). If elevated, your doctor will attempt to treat all other modifiable risk factors.

Blood Group

There are four basic groups of blood types – A, B, AB and O.
There are various reasons you may want to know your blood type. For example, you may want to know what type of blood you can receive if you ever needed a blood transfusion– If you had type A blood, you can receive types A and O blood; If you had type B blood, you can receive types B and O blood; If you had type AB blood, you can receive types A,B,AB and O blood; If you had type O blood, you can only receive type O blood. As you can see, whatever blood type you are, you can receive type O blood.
Blood typing is especially important during pregnancy (see Antenatal profile). If a mother is found to be Rhesus negative, the father should also be tested. If the father has Rhesus positive blood, the mother will need to receive treatment with anti–D gamma globulin at around 28 weeks of pregnancy (some also are given another at 34 weeks of pregnancy). This helps prevent the mother’s immune system from producing antibodies that can attack the baby. Parents to be may also want to check their Rhesus status before conceiving in order to ascertain their Rhesus status early.
If you are Rhesus positive, you can receive Rhesus positive or Rhesus negative blood. But if you are Rhesus negative, you can only receive Rhesus negative blood.

Multivitamin profile

This test may be requested if you wanted to know if you were deficient in any of your Vitamins. Often, especially with generalised malabsorption and nutritional deficiencies, multiple vitamins will be deficient together. Below are the symptoms you will feel if you were deficient in any of the following Vitamins:
Vitamin A and Beta Carotene– Night blindness, dry eyes/ skin/ hair, repeated infections, Anaemia. General malnutrition, Coeliac disease and Crohn’s disease may make you deficient in Vitamin A. Rich sources of Vitamin A include liver, beef, chicken, eggs, fortified milk, carrots and leafy green vegetables.
Vitamin B (B1, B2, B3, B6, B12) [also see B12/Folate]- Rash, inflamed tongue with sores on your lips and mouth with cracks at your mouth corner, numbness with tingling or burning in your hands and feet, anaemia, fatigue and a poor memory or depression. You may be deficient in the B Vitamins if you have general malnutrition, after gastric bypass surgery, if you drink too much alcohol or if you had a chronic disease associated with malabsorption, such as Coeliac disease. Rich sources of Vitamin B include some soy products, some breakfast cereals, some breads and pork.
Vitamin C– Tiredness and weakness, muscle and joint pains and easy bruising and bleeding especially from your gums and nose. You may be deficient in Vitamin C if you have general malnutrition, Crohn’s disease, if you are a smoker or if you are pregnant or breast feeding. Rich sources of Vitamin C include citrus fruits (oranges, grapefruit and lime), berries (blackcurrants, strawberries), watermelon and vegetables (like spinach, tomatoes and broccoli).
Vitamin D ( 25-OH) [see Vitamin D].
Vitamin E– Muscle weakness and loss of muscle mass with unsteady walking, abnormal eye movements and vision problems. Vitamin E deficiency may occur if you have a general nutritional deficiency, Crohn’s disease or Cystic Fibrosis. Rich sources of Vitamin E include Liver, eggs, Nuts (almonds, hazelnuts and walnuts), sunflower seeds, green leafy vegetables (like spinach) and asparagus. Many assertions have been made that Vitamin E supplements aid cognitive decline, cancer and coronary heart disease. However, clinical trials have not supported these assertions.
Red cell folate [see B12/ Folate].

 

Urine tests


Urine dipstick

You may ask for this to be done if you suspect you may have a urinary tract infection (UTI) or cystitis. A Urine dipstick may also be performed to check for the possibility of Diabetes, check for possible Kidney and urinary tract stones and check for possible Kidney or bladder damage.

Urine for microscopy and culture

This may be requested to identify the bacteria causing your urinary tract infection (UTI). UTI’s are more common in women than in men. This may be partly because the female urethra is shorter and closer to the anus, which allows bacteria from the intestines to come into contact more easily with the urethra.
If the urine culture is positive, other tests will be done to help choose which antibiotic will do the best job in treating your infection.
Urine microscopy also helps to identify kidney damage by looking for casts and blood in the urine.

 

Biochemistry

Blood tests


Full Biochemistry profile

This may be requested if you would like a generalised biochemistry blood test.
U&E’s (see Kidney function test), LFT (see Liver function tests), CK, Bone screen, Uric acid, Cholesterol + Triglyceride + HDL/LDL Cholesterol (see Lipid profile), Fasting glucose (see Diabetes profile), Iron + TIBC (see Iron status profile).

Amylase

Usually used to diagnose acute pancreatitis (inflammation of the pancreas). It may be requested if you have signs of a pancreatic disorder- such as abdominal pain, fever, nausea and loss of appetite. In acute pancreatitis, elevated amylase may also parallel another enzyme called Lipase– this can also be used to diagnose acute pancreatitis.
A rapid rise in Amylase occurs within hours of an acute pancreatic attack and declines after about 2 days.
Very high levels of amylase may also indicate cancer of the pancreas, gallbladder disease, perforation of a peptic ulcer, intestinal tract obstruction, mumps or an ectopic pregnancy.

Lipase

Usually used to diagnose acute pancreatitis (inflammation of the pancreas). It may be requested if you have signs of a pancreatic disorder- such as abdominal pain, fever, nausea and loss of appetite. In acute pancreatitis, elevated Lipase may also parallel another enzyme called Amylase – this can also be used to diagnose acute pancreatitis.
A rapid rise in Lipase occurs within hours of an acute pancreatic attack and declines after about 4 days.
Marginally elevated levels of Lipase can also occur in kidney disease, salivary gland inflammation or in peptic ulcer disease.

Bone Screen

99% of the body’s calcium is locked away in our bony skeleton, but your serum calcium is important to check for if you have kidney stones/ kidney failure, bone disease or neurological (nerve related) disorders. It is important for a doctor to compare your calcium result with your phosphate, albumin and Vitamin D result.
If there is an abnormality, your doctor may suggest that you have your Parathyroid hormone level checked (see under endocrinology bloods).
Very high calcium levels may cause you to feel tired, weak, nauseous or vomit. You may be constipated, have abdominal pain, urinary frequency, increased thirst or lose your appetite.
Very low calcium levels may cause you to have cramps in your abdomen and muscles and tingling in your fingers.
High levels of calcium may suggest Hypeparathyroidism, Cancer, Hyperthyroidism, Sarcoidosis, Tuberculosis, Bone fractures with immobility, or excess Vitamin D intake.
Low levels of calcium may indicate low albumin/ Calcium levels (malnutrition), Hypoparathyroidism, Decreased vitamin D levels, acute pancreatitis, chronic kidney disease, bone disease or alcoholism.

Vitamin D

It may be useful to check your vitamin D if you have generalised widespread bone pain– in adults and in children. The doctor will be able to interpret how low your levels are and as to whether Vitamin D supplementation is actually necessary.
It is advisable to check your vitamin D with calcium levels too (see Bone screen).

BNP (NT–pro BNP)

Used to diagnose and assess the severity of Heart failure. Heart failure may present in you with shortness of breath (especially on exertion or lying flat in bed), fatigue or swelling of your legs. The higher the level of your BNP, the worse your outlook.
If the BNP is raised, your doctor may go on to suggest you have an Electrocardiogram (ECG) +/- an Echocardiogram to confirm the diagnosis of heart failure.
Elevated levels of BNP are also seen in Chronic Kidney Disease.

Chest Pain Profile

This is a comprehensive profile of myoglobin, Troponin T and CK-MB as markers of heart damage in order to check if you have had a heart attack, if you present with central crushing chest pain and is usually used in A&E. If you do have central crushing chest pain, especially worse on walking and possibly associated with shortness of breath, sweating and pain in your jaw/left arm, we would recommend you call the ambulance and go to A&E straight away.
Myoglobin starts to rise within 2 hours of myocardial (heart) damage, reaching a peak in 5 hours and remaining elevated for 12-24 hours after your heart attack.
Troponin T starts to rise within 4 hours of myocardial damage, reaching a peak in 12 hours (which is the optimum time to check for it) and can remain elevated for 1-2 weeks after your heart attack.
CK-MB starts to rise within 3 hours of myocardial damage, reaching a peak in 10 hours and remaining elevated for 24 – 36 hours after your heart attack.
Myoglobin is also found in other muscles. Hence, apart from a heart attack, elevated levels of myoglobin are also found after injections into muscles, after strenuous exercise, in kidney disease and in alcoholism.
Troponin T is the most specific marker of myocardial damage and should not generally be affected by damage to other muscles. Hence muscle injections, drugs and accidents that damage muscles should not normally affect Troponin T levels.
Apart from a heart attack, Troponin T levels may also be elevated in Myocarditis (heart muscle inflammation), Heart failure and kidney disease.
Apart from a heart attack, CK-MB levels can be elevated in muscle diseases, Hypothyroidism and alcoholism.

Troponin T

Usually used in A&E,If you present with central crushing chest pain, to check if you have had a heart attack. It is sometimes used with other markers of heart damage, such as CK MB (see Chest pain profile), but Troponin T is preferred as it is more specific for heart damage and will stay elevated for a longer period of time. If you do have central crushing chest pain, especially worse on walking and possibly associated with shortness of breath, sweating and pain in your jaw/left arm, we would recommend you call the ambulance and go to A&E straight away.
Troponin T levels rise to a peak 12 hours after a heart attack (which is the optimum time to check for it). It can remain elevated for 1-2 weeks after your heart attack.
Troponin T is not generally affected by damage to other muscles, hence muscle injections, drugs and accidents that damage muscle should not normally affect Troponin levels.
Apart from a heart attack, Troponin T levels may also be elevated in Myocarditis (heart muscle inflammation), Heart failure and kidney disease.

CK/CPK

Used to diagnose inflammation of muscle (myositis) or serious muscle damage.
A doctor may ask for a CK/CPK level to help detect muscle damage especially if you are taking a drug such as a statin or other toxin potentially causing muscle damage/pain.
Moderately raised CK/CPK levels may occur after strenuous exercise, contact sports or injections. Levels are also higher in men than in women due to higher muscle mass.

CRP (C Reactive Protein)

This is a non specific test and is used to detect inflammation or infection in the body. It cannot tell where the inflammation is or what condition is causing it. It is used together with other blood tests (such as an Erythrocyte Sedimentation Rate [ESR]) and your symptoms and signs to establish if you have an acute or a chronic inflammatory condition.
The Erythrocyte Sedimentation Rate (ESR) also rises in the presence of inflammation, but CRP rises faster and decreases more rapidly than the ESR.
If a CRP is initially elevated and then falls, it indicates that your inflammation/ infection is subsiding and/ or responding to treatment.

HbA1c

The HbA1c is used to Diagnose and monitor your average glucose control, if you have Diabetes, over the preceding 3 months. The aim is to keep your sugar within the desired range to avoid Diabetes complications (such as vision loss, kidney damage, nerve damage, heart damage).
The current recommendations for diagnosing Diabetes Mellitus are raised levels of HbA1c, one month apart.
However, the HbA1c is not reliable for some people. Hence it is not used for the diagnosis of Diabetes in pregnant women, those with recent/ severe bleeding or those who have had a recent blood transfusion, in chronic kidney/liver disease and certain blood disorders (Iron/ Vitamin B12 deficiency anaemia, sickle cell anaemia or thalassaemia). In these cases, a fasting glucose or an oral glucose tolerance test is used to diagnose Diabetes.
Acute (that is, sudden onset) Diabetes usually presents with increased thirst, increased urination, blurred vision, sweet smelling breath and weight loss. However, most people with Diabetes may not have any symptoms for many years after its onset.
Screening for Diabetes Mellitus is important if you have a high risk of developing it – Family history of Diabetes, Overweight, from the Asian subcontinent or aged more than 45.
Temporary elevations of blood glucose can occur under extreme stress (such as trauma/surgery) or whilst taking certain medication (such as corticosteroids).

Diabetes Profile (Fasting glucose/ HbA1c)

A fasting blood glucose is used to diagnose hyperglycaemia (either Impaired Glucose Tolerance or Diabetes Mellitus) or hypoglycaemia (low blood glucose).
The HbA1c is used to monitor the average glucose control in Diabetics over the preceding 3 months. The aim is to keep your sugar within the desired range to avoid Diabetes complications (such as vision loss, kidney damage, nerve damage, heart damage).
The current recommendations for diagnosing Diabetes Mellitus are raised levels of HbA1c, one month apart.
However, the HbA1c is not reliable for some people. Hence it is not used for the diagnosis of Diabetes in pregnant women, those with recent/ severe bleeding or those who have had a recent blood transfusion, in chronic kidney/liver disease and certain blood disorders (Iron/ Vitamin B12 deficiency anaemia, sickle cell anaemia or thalassaemia). In these cases, a fasting glucose or an oral glucose tolerance test is used to diagnose Diabetes.

Iron Status Profile (Iron, TIBC, Ferritin)

These tests are used together to detect if you have iron deficiency or iron overload.
Iron deficiency may make you feel tired, dizzy or weak. You may look pale, have headaches, chest pain or be short of breath. Iron is low, TIBC is high and ferritin is low.
Anaemia [low haemoglobin] (see Haematology profile / Anaemia Profile) can also be caused by chronic illnesses– Iron is low, TIBC is low and ferritin is normal/high.
Iron overload may cause you to have joint pains, tiredness, abdominal pains and heart problems. Various conditions can cause this, such as Haemochromatosis (Iron high, TIBC low, Ferritin High).
Ferritin is an acute phase reactant and can be elevated in people with inflammation, liver disease, infection, autoimmune diseases or cancer. Hence this may be falsely raised in someone with iron deficiency anaemia.

Kidney Function Tests (U&E’s)

General test to assess your kidney function and is useful to check as part of a general health screen. It is also important to check during treatment for various conditions, such as if you have high blood pressure, heart failure, liver or kidney disease.

Liver Function Tests (LFT’s)

Used to screen for liver damage. Repeated LFT’s and further tests (see Full liver Profile) including a liver ultrasound may be needed to establish the exact diagnosis.
Liver disease may cause you to have weakness, loss of appetite, nausea and vomiting, abdominal swelling/ pain, Jaundice, dark urine/ pale stools or itching symptoms.
Clues to the diagnosis comes from the various components of the tests:
Bilirubin– usually increased if too much is being produced, less is being removed, due to bile duct obstruction or problems with bilirubin processing.
Total protein– is typically normal in liver disease.
ALT/AST– very high levels are often seen in acute Hepatitis (due to infection, drugs and autoimmune diseases). Moderate increases are often seen in chronic hepatitis. Patients with blocked bile ducts, cirrhosis and liver cancer may only have slightly elevated/ near normal ALT levels.
ALP– very high levels may indicate bile duct obstruction or inflammation. ALP can also rise in bone disease. Hence, if other liver enzymes are also raised, it suggests a liver disease, but if they are normal, it may suggest a bone disease (especially if the bone screen is abnormal). ALP is also raised in ‘growing’ bones in children and after fractures.
GGT– often used in conjunction with ALP to detect liver disease and bile duct pathology (as opposed to bone disease if ALP alone is raised). GGT is also raised after alcohol use, heart failure and with concomitant use of various medicines.
Albumin– low albumin levels can indicate liver disease or protein loosing kidney disease. It can also indicate severe inflammation or shock. High albumin usually suggests dehydration.

Liver Fibrosis Fibrotest

Biomarker test generating a score that correlates with the degree of liver damage in a variety of liver diseases (such as Non alcoholic fatty liver disease [NASH], alcoholic liver disease and chronic hepatitis B and C liver disease).
It is used for the monitoring for liver fibrosis (irreparable damage to the liver).

Lipid Profile (Cholesterol test)

This is used to estimate your risk of developing coronary heart disease and other cerebro-vascular diseases (brain and blood vessels).
A high cholesterol test will be judged with other factors– such as your maintenance of a healthy weight, stopping smoking, having regular aerobic exercise, reducing saturated fats in your diet, ensuring a normal blood pressure and having any family history of heart/ vascular disease. The doctor will decide on whether treatment is needed or not.
High triglycerides can occur if you have a high fat diet, increased alcohol intake or in uncontrolled diabetes. When triglycerides are very high, there is a risk of you developing acute pancreatitis (see amylase and lipase).
HDL cholesterol– the higher the level, the lower the risk of you developing heart disease.
LDL cholesterol– high levels carry increased risks of you developing heart disease.

Myeloma screen

Myeloma is a cancer that develops in cells in the bone marrow called plasma cells. Many with this disease have no symptoms for many years. Eventually they may have bone pain, anaemia, kidney failure or bone fractures with resultant hypercalcaemia (high calcium– see bone screen) and a raised ESR.
Protein electrophoresis– this separates the protein in the blood and usually shows an elevated M protein band in myeloma- Other normal immunoglobulins may be reduced.
Urine Bence-Jones protein– may be raised in myeloma.

Uric acid

This is tested when a doctor suspects that you may have Gout clinically on examining you. Levels may be normal during an acute attack of Gout, so the doctor will ask you to test it 2 weeks after the attack has passed.
Gout presents with a sudden swelling, redness and excruciating pain at the base of your big toe, your ankle or your knee.
This may also be requested if you suffer from recurrent kidney stones, to see if this is causing them.
Many medicines can cause your uric acid to rise – such as thiazide diuretics(water tablets for high blood pressure).

The best way to reduce your uric acid is to undertake regular aerobic exercise, modify your diet (avoid organ meats [liver/ kidneys], sardines and anchovies and reduce your alcohol intake).

 

Urine tests


Protein/Creatinine ratio

This can be checked if you have diabetes to assess for kidney disease. Controlling your Diabetes and maintaining a normal blood pressure will minimise this risk. An increased protein/creatinine ratio in Diabetics has also been found to make you more susceptible to heart disease.

24 hour calcium

This may be requested if you have kidney stones, to see if they could be made of calcium. It can also be checked if you have problems with your Parathyroid gland (parathyroid hormone) and your bone screen.

 

Endocrinology

Blood tests


Thyroid Profile

Used to diagnose overactive (hyperthyroidism) and underactive (hypothyroidism) thyroid disease.
If you had hypothyroidism (elevated TSH, decreased T4), you may present with weight gain, dry skin, constipation, cold intolerance, hair loss, fatigue and menstrual irregularity (in women).
If you had hyperthyroidism (decreased TSH, elevated T4), you may present with a fast heart rate, anxiety, weight loss, hand tremor, weakness and diarrhoea.
Occasionally false positive’s (bloods suggest you have a thyroid disease falsely) occur and may be related to concominant medication use, acute illness (even a common cold) or pregnancy. Hence it is important to recheck you thyroid profile at least after 1 month, to ensure that you truly do have a thyroid disease.

Thyroid Profile (including T3)

This is exactly the same as the above Thyroid profile, but it also checks your free T3 level. It is mainly ordered to diagnose hyperthyroidism and may be ordered to monitor treatment of your thyroid disorder. T4 is converted to T3 by the liver and other organs.

Thyroid antibodies

Mainly used to diagnose a thyroid autoimmune disease and to differentiate it from other thyroid diseases. Your doctor may request this after finding an enlarged thyroid gland (goitre) in your neck or after finding abnormalities in your thyroid profile.
Thyroid peroxidise antibody–found in 95% with Hashimoto’s thyroiditis, 90% with primary myxoedema and 18% with Grave’s disease.
Thyroglobin antibody– also present in autoimmune thyroid disease, but mainly tested as part of monitoring of treatment of thyroid cancer.
Thyroid antibodies can also be found in other autoimmune diseases, such as Type 1 Diabetes, pernicious anaemia, rheumatoid arthritis and SLE.

Pituitary Function Profile

The pituitary gland is situated in the brain and is important in regulating various hormones. Pituitary disorders are characterised by an excess or a deficiency in one or more of these hormones. A tumour of the pituitary may cause headaches and visual disturbances.
Your doctor will usually decide, depending on your symptoms, and other blood tests results, as to whether a check of your anterior pituitary function is necessary:
TSH– stimulates the thyroid gland to produce thyroid hormones, which regulates the rate at which your body uses energy.
FSH/LH– needed for the development of sexual characteristics in puberty.
Prolactin– stimulates breast milk production after childbirth.
Growth Hormone– regulates bone growth and muscle mass.
ACTH– regulates your body’s response to stress by stimulating the production of cortisol from the adrenal glands.

Prolactin

This is requested to:
– check your pituitary function (see Pituitary function profile)
– to diagnose prolactinomas (prolactin producing tumour of pituitary gland)- will need an MRI of your pituitary gland in your brain.
– to diagnose the cause of galactorrhoea (breast milk production without being pregnant),
– to diagnose the cause of headaches with visual disturbances
– to investigate infertility in both sexes
– to investigate low sex drive, erectile dysfunction and/or low testosterone (see Male infertility profile) in men.
High prolactin levels can also occur with various medications (such as antidepressants), hypothyroidism, kidney disease, nipple stimulation and polycystic ovarian syndrome.

Parathyroid Hormone (PTH)

This is checked if your calcium level is elevated or too low (see Bone screen), to help distinguish between parathyroid and non parathyroid related causes.
A high blood calcium can be caused by a condition called Hyperparathyroidism (Raised PTH levels).
Primary hyperparathyroidism is mainly caused by a parathyroid gland tumour (usually benign) which constantly produces parathyroid hormone and thus high blood calcium. Hence the PTH level will be high and the calcium level will be high too.
A high blood calcium can cause you to have kidney stones and thirst (STONES), bone pain/ fractures/ osteoporosis/ osteomalacia (BONES), constipation/ indigestion/ gastritis/ pancreatitis (ABDOMINAL GROANS) and fatigue/ depression/ memory loss/ psychosis (PSYCHIATRIC MOANS).
There are various causes for secondary hyperparathyroidism, such as kidney failure, malabsorption and Vitamin D deficiency. In these cases, PTH level will be high and the calcium level will be normal or low. Rarely, secondary hyperparathyroidism patients develop a high calcium with persistently elevated PTH levels (this is called tertiary hyperparathyroidism).
A low blood calcium level may occur due to hypoparathyroidism (parathyroid gland malfunction). Hence there will be a low PTH level and a low calcium level.
A low blood calcium can cause you to have muscle cramps and tingling fingers.

 

Haematology

Blood tests


Haematology Profile (FBC/ ESR)

The Full blood count (FBC) is a very common screening test. It can assess if you have anaemia [see anaemia profile] ( you will have fatigue, weakness or shortness of breath on exertion), and suggest causes of your infection/ inflammation (White cells and differential), or your bruising and bleeding disorder (Platelets).
The doctor will look at various aspects of your FBC and decide if anything else needs to be checked.
The Erythrocyte Sedimentation Rate (ESR) assesses you for acute and chronic inflammation including infections, cancers and autoimmune diseases. The ESR is very non specific as it cannot tell you where the inflammation is and is often used in conjunction with the CRP. In the presence of any acute inflammation, the CRP rises faster and decreases more rapidly than the ESR.

Full Blood Count (FBC)

The Full blood count (FBC) is a very common screening test. It can assess if you have anaemia [see anaemia profile] (you will have fatigue, weakness or shortness of breath on exertion), and suggest causes of your infection/ inflammation (White cells and differential), or your bruising and bleeding disorder (Platelets).
The doctor will look at various aspects of your FBC and decide if anything else needs to be checked.

ESR

The Erythrocyte Sedimentation Rate (ESR) assesses you for acute and chronic inflammation including infections, cancers and autoimmune diseases. The ESR is very non specific as it cannot tell you where the inflammation is and is often used in conjunction with the CRP. In the presence of any acute inflammation, the CRP rises faster and decreases more rapidly than the ESR.

Anaemia Profile

Anaemia occurs when the amount of red blood cells/ haemoglobin falls below normal. Poor nutrition and various illnesses may cause your anaemia.
If you have anaemia, you may have no symptoms if it is mild. But in more moderate/ severe anaemia you may have fatigue, feel short of breath and look pale. You may feel dizzy or have headaches, cold extremities, palpitations or chest pain, especially when you exert yourself.
Your doctor will look at various aspects of your ‘Anaemia Profile’ to ascertain what may be causing your anaemia:
Iron deficiency anaemia (Iron is low, TIBC high, ferritin usually low) [see Iron status profile]– this could be caused by blood loss, a poor iron containing diet or malabsorption of iron.
Pernicious anaemia and Vitamin B12/ Folic acid deficiency anaemia (low Vitamin B12/Folate) [see B12/Folate]– this could be caused by an intrinsic factor deficiency, poor Vitamin B12/folic acid in your diet or malabsorption of these vitamins due to bowel diseases.
Aplastic anaemia (low haemoglobin, white cells and platelets)–this occurs when there is a generalised reduction in bone marrow production of cells and can occur with Cancer, autoimmune diseases, viral infections and after exposure to toxic substances.
Haemolytic anaemia– this may be inherited (such as sickle cell and thalassaemia) or acquired (such as transfusion reactions or autoimmune diseases). If suspected, your doctor will ask for other tests, such as Haemoglobin electrophoresis, reticulocyte count and direct Coombs test.
Anaemia of chronic disease – over time, many diseases can cause a low haemoglobin. These include autoimmune diseases, chronic kidney diseases, diabetes and chronic infections.

B12/ Folate

This is mainly requested to find the cause of your macrocytic anaemia (low haemoglobin and high MCV in your Full blood count) [see Haematology profile / Anaemia profile]. Vitamin B12 and/or folate deficiency may occur if you have malnutrition or gut malabsorption– including if you suffer from alcoholism, Coeliac disease and Crohn’s disease.
Sometimes, especially in the elderly, Vitamin B12/folate deficiency may cause irritability, confusion, depression +/- paranoia. Other symptoms of deficiency include dizziness, weakness, lethargy and a sore mouth. B12 deficiency may also cause you to have tingling/ burning/ numbness in your arms/ legs/ fingers/ toes.
Often, if your B12/Folate level is found to be low, without you being symptomatic or your Full blood count showing a macrocytic anaemia, your doctor will ask you to maximise your ‘green vegetable’ diet and repeat your levels in 3 months.
If your doctor suspects you may suffer from Pernicious anaemia, they may request Intrinsic factor binding antibodies and gastric parietal cell antibodies to try to ascertain the diagnosis. The old fashioned Schilling test has recently gone out of favour.

Blood Film Examination

If your Full blood count (see Haematology profile) shows abnormal white blood cells, red blood cells or platelets, the blood film examination is important to look for immature and abnormal cells.
Your doctor will inform you that this needs to be requested if there is a suspicion of a disorder affecting blood cell production- such as Anaemia, decreased or abnormal production of cells in the bone marrow or increased cell destruction, including leukaemia.

Coagulation profile

These may be tested if you have excessive bruising or bleeding. It can also be used to assess the severity of your liver disease. APTT may be used if you have a thrombotic (blood clotting) episode and is often used in the investigation of recurrent miscarriages (see Recurrent miscarriage profile).
If your APTT is prolonged, it is mixed with normal ‘pooled’ plasma to see if it corrects. If it does, specific coagulation factor testing is done to see which factors are deficient. If it does not correct, then other specific inhibitors are looked for.
The doctor will assess your PT with your APTT to make a decision on a possible diagnosis:
Prolonged PT + Normal APTT– possible Liver disease, decreased Vitamin K, decreased or defective factor VII.
Normal PT + Prolonged APTT– possible decreased/defective factor VII,IX, XI or XII, von Willebrand disease or lupus anticoagulant present.
Prolonged PT + Prolonged APTT– possible decreased or defective I, II, V, X, liver disease or disseminated intravascular coagulation (DIC).
Normal PT + Normal APTT– decreased platelet function, thrombocytopenia, factor XIII deficiency, mild deficiency in other factors, mild form of von Willebrand’s disease, weak collagen.
Your fibrinogen assesses your ability to form and break down blood clots. It is a useful addition if there is prolongation of your PT and/or APTT. It is also useful if your doctor suspects a Disseminated intravascular coagulation (you may have bleeding gums, nausea, vomiting, severe muscle and abdominal pain, seizures and reduced urination)- Your doctor is looking to see if you have a reduced fibrinogen level.
Various foods, medication and alcohol can affect your clotting profile. Fibrinogen is an acute phase reactant and can be elevated if inflammation/infection is present.

INR

This is similar to your PT (see Coagulation profile), but is the specific test requested to monitor your levels if you take Warfarin tablets. Your doctor will advice you, in between what range you need to keep your INR, for your specific condition.

D-Dimer

This may be requested if your doctor suspects a blood clot in your calf/ leg (deep vein thrombosis [DVT]) or a blood clot in your lung (Pulmonary embolus [PE]). It is also requested if you doctor suspects a Disseminated intravascular coagulation (see Coagulation profile).
A DVT will cause you to have leg/calf pain, tenderness, swelling and discolouration. It is more common after long distance travel (seated in the same position for a long time), after surgery and with combined oral contraceptive use.
A PE will cause you to be breathless, have a cough, chest pain and possibly blood in your sputum. This usually occurs after a clot breaks off from a DVT and travels up to the lungs.
An elevated D-Dimer can be suggestive of an acute clot, but further testing such as leg dopplers and spiral CT Chest/ VQ testing are needed for an exact diagnosis.
A D-dimer can be artificially low in someone taking anticoagulants and can be falsely raised in the elderly, those with rheumatoid arthritis and those with high bilirubin levels.

Thrombotic Risk Profile

These tests can be ordered if you have a recurrent venous thrombosis [blood clots] (such as deep vein thrombosis and pulmonary embolus [see D-Dimer]) or an initial venous thrombosis occurring at an unusual site (such as your brain, kidneys, eye, etc), especially if you are under the age of 50. You may also have a family history of recurrent venous thrombosis. These tests are also done if you have had recurrent miscarriages (see recurrent miscarriage profile).
These tests can only be done after your blood clot has been treated and resolved, as both the clot and your clot treatment can affect the results of this test.
Persistently low Antithrombin III levels can increase the risk of recurrent miscarriages and can increase the risk of clots after surgery (so preventative anticoagulation may be advised).
Factor V leiden mutation can be heterozygous (when patients are asked to reduce their risks of clotting [such as reducing weight, stop the combined contraception pill], but, if asymptomatic, may be treated the same way as the normal population) or homozygous (high risk of recurrent venous thrombosis and may need lifelong anticoagulation treatment).
Lupus anticoagulant is checked for the above and also if you have a prolonged APTT (see Coagulation profile). If found, it will be repeated after many weeks, to ensure it was not raised temporarily. If your anticardiolipin antibody is also raised, it raises the possibility of antiphospholipid syndrome (recurrent arterial and venous thrombosis and recurrent miscarriages). Anticardiolipin antibodies can develop in the future in patients with autoimmune diseases, such as Systemic Lupus Erythematosus (see SLE screen).
Protein C or Protein S deficiency causes a high risk of recurrent venous thrombosis and may need lifelong anticoagulation treatment. However, levels can fall temporarily in many conditions (such as liver disease, severe infections, kidney disease, during pregnancy,etc), and so should be repeated after many weeks. Furthermore, the severity of clotting risk is very dependent on how abnormal and how deficient the protein is.
If any of the above are found, it would be advisable for you to have a discussion with a Haematologist to assess ongoing treatment and testing your close family members, to check if they have the same.

Haemoglobin Electrophoresis

This looks for different types of haemoglobin and is mainly done to check for inherited haemoglobin variants such as Sickle cell disease (most common in those of African descent) and Thalassaemia (most common in those of Mediterranean and South Asian descent).
This is checked for routinely during pregnancy (see Antenatal profile) or if the doctor suspects that your anaemia may be caused by one of the above (see Anaemia profile).

 

Immunology

Blood tests


Full Polyarthritis screen

This is a full screen for all possible causes of your inflammatory arthritis (multiple inflamed/ swollen/ painful/ stiff joints).
Rheumatoid factor and Anti CCP antibody (see Rheumatoid arthritis screen) attempts to diagnose rheumatoid arthritis.
ANA, dsDNA and ENA’s attempt to diagnose a Systemic Lupus Erythematosus (see SLE screen).
HLAB27 attempts to ascertain if your arthritis may be related to a seronegative (that is rheumatoid factor negative) cause– essentially looking for ankylosing spondylitis (usually a young man with stiffening of the lumbar and cervical spine and possible arthritis in small joints of his hands/ feet/ wrists/ knees). It can also be positive if you have a Psoriatic arthritis (arthritis related to skin psoriasis), an Inflammatory bowel disease related arthritis and a reactive arthritis (especially related to sexually transmitted infections and gastrointestinal infections).
Uric acid (done 2 weeks after the acute event) attempts to diagnose gout.
FBC, ESR and CRP help assess the activity of your arthritis.

Reduced polyarthritis screen

This is the same as the Oligoarthritis screen, but without the HLAB27.
This screen should be sufficient if you present with arthritis (inflamed/ swollen/ painful/ stiff joints) and your doctor is not very suspicious that you have Systemic lupus erythematosus (see SLE screen) or Ankylosing spondylitis.

Oligoarthritis screen

This is usually requested if you present with a monoarthritis (only 1 joint is inflamed/ swollen/ painful/ stiff) or an oligoarthritis (less than 4 joints are inflamed/swollen/painful/ stiff).
Uric acid (done 2 weeks after the acute event) attempts to diagnose gout.
Rheumatoid factor and Anti CCP antibody (see Rheumatoid arthritis screen) attempts to diagnose rheumatoid arthritis.
ANA attempts to diagnose a Systemis Lupus Erythematosus (see SLE screen).
HLAB27 attempts to ascertain if your arthritis may be related to a seronegative (that is rheumatoid factor negative) cause– essentially looking for ankylosing spondylitis (usually a young man with stiffening of the lumbar and cervical spine and possible arthritis in small joints of his hands/ feet/ wrists/ knees). It can also be positive if you have a Psoriatic arthritis (arthritis related to skin psoriasis), an Inflammatory bowel disease related arthritis and a reactive arthritis (especially related to sexually transmitted infections and gastrointestinal infections).
FBC, ESR and CRP help assess the activity of your arthritis.

Rheumatoid arthritis screen

The rheumatoid factor helps to diagnose rheumatoid arthritis and differentiate it from other forms of arthritis that causes joint pain, stiffness and swelling. Rheumatoid arthritis mainly causes pain and swelling in your wrists, knuckles,balls of your feet and joints in the middle of your fingers and toes. The stiffness you feel will be in these joints mainly in the morning and can last more than ½ an hour, before getting better.
However, a negative rheumatoid factor does not mean you don’t have rheumatoid arthritis, especially if your doctor feels that clinically you do.
Rheumatoid factor can also be positive in a number of other conditions, such as Sjogrens (very dry eyes and mouth), infections and other autoimmune diseases (like thyroid disorders).
The anti CCP antibody is a newer test which is much more specific for a diagnosis of Rheumatoid arthritis– so if it is positive, you are very likely to have rheumatoid arthritis. But anti CCP is not as sensitive as the rheumatoid factor– meaning that many with rheumatoid arthritis will not be anti CCP positive. Hence it is important to do a rheumatoid factor as well. Anti CCP positivity also confers a worse prognosis– that is, there is a greater chance of the rheumatoid arthritis eroding into your joints and causing permanent damage.
The CRP is a non specific test and is used to detect inflammation in the body. It cannot tell where the inflammation is or what condition is causing it. It is used together with other blood tests (such as an Erythrocyte Sedimentation Rate [ESR]) and symptoms/ signs to establish if you have an acute or a chronic inflammatory condition. It is useful to test in rheumatoid arthritis as it will inform the doctor as to whether your rheumatoid arthritis is active or not.
Your doctor will go on to ask for XRays or Ultrasound scans of affected parts to further assist in making the diagnosis of rheumatoid arthritis.

Anti CCP antibody

The anti CCP antibody is a newer test which is much more specific for a diagnosis of Rheumatoid arthritis– so if it is positive, you are very likely to have rheumatoid arthritis. But anti CCP is not as sensitive as the rheumatoid factor (see Rheumatoid arthritis screen)– meaning that many with rheumatoid arthritis will not be anti CCP positive. Hence it is important to do a rheumatoid factor as well. Anti CCP positivity also confers a worse prognosis– that is, there is a greater chance of the rheumatoid arthritis eroding into your joints and causing permanent damage.

SLE Screen

This is done if your doctor suspects you may have a Systemic lupus erythematosus (SLE). The various tests done are to both try and establish the cause as SLE and to exclude your arthritis from being caused by Rheumatoid arthritis (Rheumatoid factor, Anti CCP antibody– see Rheumatoid arthritis screen).
SLE usually affects middle aged women with variable symptoms such as joint arthritis, a photosensitive rash (especially a butterfly rash on the nose and cheeks), fever, fatigue, mouth ulcers, muscle pain and hair loss. It can also affect multiple organs, including the kidneys, lungs, heart and central nervous system.
ANA, dsDNA and ENA’s are used to establish the diagnosis of SLE. dsDNA, C3/C4 complement levels, ESR and CRP are used to assess the activity level of SLE. The FBC is used to assess for anaemia (low haemoglobin) and thrombocytopenia (low platelets) in SLE.
The anticardiolipin antibody is measured to assess for an increased risk of thrombotic disorders in those with SLE (see Thrombotic risk profile).

ANA

This is mainly used to diagnose SLE (Systemic lupus erythematosus) and a drug induced SLE like syndrome (see SLE screen).
However, the ANA can be raised in many other conditions, such as scleroderma (you have tight hands and face and swallowing difficulties), Sjogrens (you have very dry eyes and mouth), Raynauds (In the cold, your hands/ feet turn white, then purple/ blue and after coming into the warmth, they become red, swollen, hot and itchy), rheumatoid arthritis (see Rheumatoid arthritis screen), autoimmune hepatitis and other disorders. It can also be raised in healthy people, especially the elderly and those who are pregnant.
Hence, as SLE is difficult to diagnose, other tests, such as ENA’s and dsDNA is requested by your doctor to help elucidate the diagnosis.

ENA’s (extractable nuclear antigens)

These are requested by your doctor if you have features suggesting an autoimmune connective tissue disorder (see SLE symptoms under SLE screen) and a positive ANA.
Each ENA may be suggestive of a specific disorder:
Anti- RNP– usually found in mixed connective tissue disease (an overlap of symptoms of SLE, scleroderma [you have tight hands and face and swallowing difficulties] and polymyositis [you have marked muscle weakness in your shoulders and thighs]), but may also be positive in SLE and scleroderma by themselves.
Anti- Sm– very specific for SLE, but only raised in some.
Anti-SS-A (Ro)– usually suggestive of Sjogrens (you have very dry eyes and mouth), but can be positive in SLE and scleroderma.
Anti-SS-B (La)– usually suggestive of Sjogrens (you have very dry eyes and mouth), but can be positive in SLE and scleroderma.
Anti-Jo-1– may be positive in polymyositis and pulmonary fibrosis (lung condition causing shortness of breath).
Scl-70– often positive in patients with scleroderma.

dsDNA (double stranded DNA)

This test is used to support a diagnosis of SLE (see SLE screen) and distinguish it from other autoimmune disorders. It is usually done after a positive ANA result, when there are other features of SLE and ENA’s are also done to aid diagnosis.
dsDNA can also be used in monitoring the disease activity in SLE. Hence, the higher the level, the more active the disease. C3/C4 complement levels are also used to monitor SLE disease activity. Hence, the lower the C3/C4 levels are, the higher the disease activity of SLE.
dsDNA may also be raised in other autoimmune disorders, including Sjogrens and Mixed Connective Tissue Disorders (see ENA’s). It may also be raised in chronic hepatitis and primary biliary cirrhosis.

C3/C4 Complement levels

This is requested to ascertain if their deficiencies may be contributing to the disease being tested for. It may be requested by your doctor if you have unexplained infections, inflammation or symptoms of an autoimmune disorder, such as SLE (see SLE screen). It may also be done to ascertain the cause of unexplained swellings (angioedema)– If C4 is low, then C1 esterase inhibitor deficiency is tested for to diagnose a hereditary angioedema.
This is also used to monitor SLE disease activity. Hence, the lower the C3/C4 levels are, the higher the disease activity of SLE. dsDNA can also be used in monitoring disease activity in SLE. Hence, the higher the level, the more active the disease.
C3/C4 complement levels may fall in various illnesses and will not tell your doctor what is wrong, but it can give an indication that the immune system is involved with your condition.

ANCA (Anti-Neutrophil Cytoplasmic Antibody)

These are requested if your doctor suspects a small vessel vasculitides. These disorders include Wegener’s granulomatosis, microscopic polyangiitis, Churg-Strauss syndrome and drug induced vasculitis.
They all have variable presentations and if suspected by your doctor, especially with positive ANCA levels, you will be referred to a rheumatologist for specific diagnostic testing.

ACE Level (Angiotensin Converting Enzyme)

This is requested to diagnose and monitor sarcoidosis.
Sarcoidosis is a multisystem granulomatous disease which can cause you to present with a chronic cough, shortness of breath, red tender spots on swollen legs, red/ watery eyes and joint pains. Your doctor may request other tests to ensure you don’t have Tuberculosis (see TB Quantiferon–TB gold), which may present the same way.
ACE levels are high in most with sarcoidosis, but may be low/ normal. An Xray of the chest will also be needed to aid in the diagnosis of Sarcoidosis.

Immunoglobulins (IgG, IgA, IgM)

These measure the levels of certain antibodies that fight particular antigens, such a bacteria, viruses and toxins.
IgG– this is the main antibody and is found in all your bodily fluids and protects you against bacterial and viral infections.
IgA– this is found in high concentrations in your mucous membranes, especially the respiratory tract, gastrointestinal tract and saliva and tears.
IgM– this is mainly found in your blood and lymph fluid and is the first to be made by your body to fight a new infection.
They may be requested to ensure that your immune system is functioning normally, especially in relation to infections or autoimmune diseases.

Immunoglobulin E

This antibody is present mainly in your skin and mucous membranes (like the respiratory tract) and rises in response to environmental antigens and plays a role in allergic reactions characterised by skin eruptions.
It may be requested by your doctor if it is felt that you may be reacting with a type I (immediate) allergic response to specific antigens.

Coeliac disease screen

This may be requested if you have symptoms of Coeliac disease (gluten sensitivity) or Irritable Bowel Syndrome type symptoms. It may also be requested if you have Anaemia (especially B12/folate deficiency), osteoporosis or neurological symptoms. It can also be tested if you have a family history of coeliac disease.
Coeliac disease symptoms include diarrhoea, abdominal pain, bloating, weakness, fatigue, weight loss and failure to thrive in kids.
If your antibody tests are positive for Coeliac disease, it is important to see a gastroenterologist to perform a gastroscopy and biopsy of the small intestine to confirm or exclude the diagnosis of Coeliac disease.

C1 esterase inhibitor

This may be done if you have unexplained swellings in your face/ tongue (angioedema) and the doctor suspects that you may have a hereditary angioedema (see also C3/C4 complement levels).

ASOT titre

This antibody rises if you are infected with a streptococcal bacteria, which can cause rheumatic fever and scarlet fever. It is only significant if it is dramatically raised.

 

Stool Tests


Calprotectin

This may be requested if you doctor suspects you may have an inflammatory bowel disease (such as Ulcerative colitis or Crohn’s disease). It is often difficult to separate irritable bowel syndrome symptoms from inflammatory bowel disease symptoms and hence this is a useful test to perform to distinguish between the two.
Inflammatory bowel disease can present with cramping abdominal pain, diarrhoea (sometimes with blood) +/- vomiting, weight loss and anaemia.
Faecal Calprotectin can also be raised in infective colitis and in bowel cancer.
If calprotectin is raised, your doctor will send you for a colonoscopy and biopsy to confirm the diagnosis.

 

Microbiology / Infections

Blood tests


Malaria Parasites

This rapid antigen detection test can detect malaria parasites quickly.
Malaria is a mosquito born protozoan infectious disease. Within 8-30 days of an infected Mosquito’s bite, you may have a fever, headache, joint pains, vomiting, convulsions and in severe cases progress into a coma and death. It is widespread in Tropical and subtropical regions, especially sub Saharan Africa, Asia and the Americas.
Your doctor will be very suspicious of malaria if you have any of the above symptoms, especially if you have recently returned from the above stated countries and did not take/ forgot to take your malaria prophylaxis tablets.

TB Quantiferon– TB Gold

This is a blood test which is used to aid in the diagnosis of Latent Tuberculosis infections and active Tuberculosis (TB) disease. You should wait for 6 weeks after exposure to a person with active TB to do this blood test (as it takes about 6 weeks for the test to become positive after exposure).
TB is a very infectious disease that can affect many body areas, but primarily affects the lungs. It spreads from person to person by coughing, sneezing and breathing. Most of those who become infected manage to confine it to a few cells in their body, where it stays alive in an inactive form– this is called Latent TB (it does not make you feel sick and you are not infectious and in many, does not progress to active TB– but in some, it does).
However in a few, especially those who are immunocompromised, it may proceed directly to active progressive TB, which can be very dangerous. In classical active lung TB, you may have a chronic cough (sometimes with bloody sputum), a fever, weight loss and weakness. If TB affects other organs, you may have back pain, joint pains, anaemia, urinary tract pain, abdominal pain, heart chest pain or a headache/ confusion. Sputum for TB culture may also be requested.
The disadvantage with this test is that it is not suitable to check for in children under 17 years of age and those who are immunocompromised. It may also give a false positive if the patient has another type of mycobacterial infection.
After this, an Xray of the chest may be requested by your doctor to look for active TB or latent TB.
If you are worried that you may have been in contact with someone with ‘open chest TB’ (that is has TB and was coughing around you), if you are over 35 years of age, you can ask for an Xray of your chest to check if you have contracted it. If you are under 35 years of age, your doctor will refer you to the TB clinic to have a mantoux skin prick test.

 

Sputum tests


Sputum for routine culture

This is done to diagnose bacterial infections of your chest, such as a bacterial pneumonia.
Your doctor will ask for this sample if you have a suspicion of a chest infection/pneumonia. Symptoms you may feel include a cough, productive phlegm (thick and discoloured), fever, muscle aches, fatigue, shortness of breath, chest pain and occasionally confusion (especially if you are elderly).
The most common infections include Streptococcus pneumonia (Pneumococcus), Staphylococcus aureus and Haemophilus influenzae.
If suspected, your doctor may also advise that you have an Xray of your chest.

Sputum for TB culture

This is used to diagnose Tuberculosis (TB) of the respiratory tract. Ideally, 3 sputum specimens are collected first thing in the morning on 3 consecutive days. This is then examined under a microscope after being stained with a special stain to look for acid fast bacteria. The sputum is then cultured and can take many weeks to confirm the diagnosis of TB.
For symptoms of TB and for the blood test to check for latent and active TB– see TB Quantiferon– TB gold
After this, an Xray of the chest may be requested by your doctor to look for active TB or latent TB.

 

Stool tests


Faecal Occult Blood (FOB)

This is mainly used as a screening test for early bowel cancer. It looks for microscopic traces of blood in your stool. FOB testing is automatically tested in those over the age of 60 in the UK, as part of the national screening programme.
Blood in the stool does not automatically mean you have cancer of the bowel. There are other causes, like haemorrhoids and diverticulitis that can cause it and further testing, such as a sigmoidoscopy/ colonoscopy will be needed. There is also a blood tumour marker, called CEA, which may be requested by your doctor to assess your risk of having bowel cancer.
Many factors may cause FOB’s to come back positive, when there is no blood in the stools. This includes bleeding from elsewhere (such as your gums, or aspirin causing bleeding from your stomach), other sources of haemoglobin (such as eating red meat within 3 days of testing) and substances reacting with the FOB test (such as eating fish, turnips, horseradish and various medications).

Stool for Ova/Cysts/ Parasites + Culture

This may be requested if you have prolonged diarrhoea, abdominal pain and/or blood and mucus in your stool. This can help diagnose the cause of a food poisoning or prolonged diarrhoea after returning from abroad.
This can ascertain if there are parasites present in your gastrointestinal tract. The stool culture identifies if there are any pathogenic bacteria in your stool.
Parasitic infections are especially common if you have travelled outside the UK, drunk lake or stream water whilst camping or have been exposed to someone with a parasitic infection.

Rotavirus in Stool

Rotavirus is the most common cause of severe diarrhoea in children. It produces frequent watery stools and may be accompanied by abdominal pain, nausea and tiredness. There may occasionally be blood and mucus in the stool. Often the diarrhoea only lasts a few days, but if it is protracted and profuse, you/ your child may become very dehydrated with an electrolyte imbalance and may require hospital admission for an Intravenous infusion.
The main aim is to keep yourself/ your child hydrated as much as possible with fluids and a bland diet.

Giardia antigen

This is a parasitic infection of your upper small intestine. You may have no symptoms or it may cause you to have acute or chronic diarrhoea, abdominal pain, bloating, nausea, vomiting or a loss of appetite.
Giardia is the commonest parasite in Europe and is especially common in children. It is especially common if you have travelled outside the UK, drunk lake or stream water whilst camping or have been exposed to someone with the parasitic infection.

Helicobacter Pylori Stool Antigen

This is a stool test for Helicobacter Pylori bacteria, which may cause you to have peptic (stomach) ulcer disease.
It is important to check for Helicobacter Pylori if you have symptoms of a peptic ulcer– Indigestion, feeling of fullness/ bloating, nausea or belching and regurgitation. There is evidence to suggest that undiagnosed Helicobacter Pylori infection increases the risk of gastric cancer by three to sixfold.
Once Helicobacter Pylori has been isolated and treated by your doctor, you may want to repeat the stool test to ensure it has actually been killed, as it is such a resistant organism.

 

Skin tests


Mycology/ Skin scrapings

This is used by the doctor to help diagnose fungal infections either of your skin, hair, scalp or mucous membranes.
Superficial fungal infections can cause itchy red areas on your skin, white patches in your mouth (thrush), vaginal itching and discharge (yeast infection) or white macerated areas in between your toes (athletes foot).
Fungi thrive in moist environments, such as public swimming pools, in gym lockers, inside sweaty shoes and in skin folds. Fungi can be avoided by wearing flip flops (to minimise direct exposure), by changing socks regularly and keeping moist areas of the body clean and dry.

Nail clippings

This is used to look for fungal infection in your nails (usually toenails, but also fingernails), before the doctor can start you on oral antifungal medication.
If you have a fungal nail infection, your nail(s) will look discoloured, thickened, brittle and possibly deformed.
Topical treatment (creams) are not very effective on fungal nail disease. Hence the doctor will want to make sure that your discoloured nail is actually fungal (and not related to a psoriatic nail disease or trauma or onychogryphosis), before giving you oral antifungal treatment (which can affect your liver).

Swab for culture (any site)

A doctor or nurse may recommend that you have a swab (cotton bud sample) of various sites around your body, if they are suspicious of either a bacterial or viral infection.
These samples will be sent off to the laboratory, so that they can look at it under the microscope and then culture it, to see which organism has grown and what treatment will work best on it.

 

Joint fluid tests


Synovial fluid (for crystals)

Synovial fluid is the fluid produced within your joints to provide it with lubrication and free movement.
If acute Gout or Pseudogout (usually a solitary joint, which is acutely inflamed, red, hot, swollen and painful) is suspected, your doctor may ask if you were willing for them to remove some of this fluid from your joint (for example your knee/ ankle/ wrist) to help them diagnose the condition definitively.
The laboratory technician will then inspect the fluid under a polarised light microscope to confirm the diagnosis, if crystals are indeed present.
This test is more accurate in making a diagnosis of Gout than the blood test (see Uric acid).

 

Virology / Immunity Check

Blood tests


Hepatitis A Immunity(IgG)

This is to check if you are Immune/ had previous exposure to the Hepatitis A virus.
Once you have had your initial booster, you should be immune to the Hepatitis A virus for at least 10 years (see Travel Vaccinations).

Hepatitis B Immunity (HBsAb)

This is to check if you are immune to the Hepatitis B virus. It also can indicate if you have had previous exposure to the Hepatitis B virus, but the virus is no longer present and cannot be passed on to somebody else (that is, you are not infectious).
Booster doses of Hepatitis B may be suggested for some every 5 years (see Travel Vaccinations)– it is best to discuss this with your nurse.

Measles, Mumps and Rubella Immunity (IgG)

These are part of your childhood immunisation schedule (unless you/your parents opted out of it). This checks that you are immune to the Measles, Mumps and Rubella viruses. You will also be immune to some/ all of these viruses, if you have contracted the virus in the past.
Once immunised, you don’t need any additional boosters (see All Other Vaccinations).

Measles Antibody (IgM)

This is used to check if the rash and upper respiratory tract symptoms (cough and cold) that you/ your child has may be related to the Measles virus. You can only get measles if you have not been immunised to it before and if you have not had it before.
The Measles virus causes you to have a cough, cold, red eyes, koplik spots (white spots in your mouth) and a red blotchy rash (commences behind your ears and spreads to your head and neck before covering the rest of your body). It is spread by coughing and sneezing and is highly contagious. The incubation period (the period between you getting infected with the virus and you becoming symptomatic) is about 2 weeks. The time when you are contagious to others is about 5 days before the onset of the rash till the complete resolution of the rash.
But, timing is crucial. As the IgM antibody rises about 10 days after exposure and may be undetectable within 30 days of the rash onset.
Once contracted, you don’t need any additional boosters (see All Other Vaccinations).

Measles Immunity (IgG)

This is part of your childhood immunisation schedule (unless you/your parents opted out of it). This checks that you are immune to the Measles virus.You are also immune to Measles if you have contracted the virus in the past.
Once immunised, you don’t need any additional boosters (see All Other Vaccinations).

Mumps Antibody and Immunity (IgM and IgG)

Mumps IgM is requested if you doctor thinks that your fever, headache and painful swollen salivary gland (typically the Parotid gland in your posterior cheek) may be due to the Mumps virus. Mumps can also occasionally cause a painful testicular swelling (in teenagers, this may cause subfertility) and a rash. You can only get Mumps if you have not been immunised to it before and if you have not had it before.
Mumps is contagious and is spread by coughing and sneezing.The incubation period (the period between you getting infected with the virus and you becoming symptomatic) is about 2 – 3 weeks. The time when you are contagious to others is about 6 days before the onset of your symptoms till about 9 days after your symptoms start.
Mumps is part of your childhood immunisation schedule (unless you/your parents opted out of it). The Mumps IgG checks that you are immune to Mumps.You are also immune to Mumps if you have contracted the virus in the past.
Once contracted/immunised, you don’t need any additional boosters (see All Other Vaccinations).

Rubella Antibody (IgM)

This is requested if you have a mild rash (red rash on your face which usually spreads to the trunk and limbs and fades within 3 days) with a cough and cold. Other symptoms include swollen glands (behind your neck and scalp), joint pains, headaches and red eyes. Especially if you are pregnant, your doctor will want to ensure that this is Rubella, as Rubella can be very dangerous for your unborn child (especially if contracted within the first 20 weeks of pregnancy).
Rubella is contagious and is spread by coughing and sneezing. The incubation period (the period between you getting infected with the virus and you becoming symptomatic) is about 2 – 3 weeks. The time when you are contagious to others is about 7 days before the onset of your symptoms till about 4 days after the onset of your rash.
Once contracted, you don’t need any additional boosters (see All Other Vaccinations).

Rubella Immunity (IgG)

This is part of your childhood immunisation schedule (unless you/your parents opted out of it). This checks that you are immune to the Rubella virus.You are also immune to Rubella if you have contracted the virus in the past.
Once immunised, you don’t need any additional boosters (see All Other Vaccinations).

Chicken Pox Antibody (Varicella Zoster IgM)

This can be requested if you/ your doctor suspects that you have chicken pox, but are not entirely certain. It starts with a fever, aching muscles and a headache, followed by the rash (red dots which progress over 12 hours to become small bumps, blisters and pustules, followed by umbilication and the formation of scabs) on the body and head which then becomes itchy and usually heals without scarring.
Varicella Zoster IgM becomes positive shortly after the onset of the rash and reaches a peak within 1 to 4 weeks. It normally declines to undetectable levels after 3 months.
Chicken Pox can seriously affect your unborn child if contracted within the first 28 weeks of your pregnancy. It can also affect your baby if contracted within 7 days of the delivery (before and after).
Chicken Pox is contagious and is spread by coughing and sneezing. The incubation period (the period between you getting infected with the virus and you becoming symptomatic) is about 2 – 3 weeks. The time when you are contagious to others is about 2 days before the onset of the rash till all the lesions have crusted over (about 7 days after the onset of rash).
Chicken Pox can be more severe in adult men, non immune pregnant women and those with immunosuppression.
Shingles (Herpes Zoster) is the reactivation of the Chicken Pox virus. It can occur many years after you have had Chicken Pox. You can contract Chicken Pox after exposure to the Shingles virus, but it is unlikely that you will contract shingles after exposure to the Chicken Pox virus.
Once contracted, you don’t need any additional boosters. There are Chicken Pox and Shingles Immunisations available if you have not had Chicken Pox or Shingles before (see All Other Vaccinations).

Chicken Pox Immunity (Varicella Zoster IgG)

This checks that you are immune to the Chicken Pox virus. You are also immune to Chicken Pox if you have contracted the virus in the past.
Shingles (Herpes Zoster) is the reactivation of the Chicken Pox virus. It can occur many years after you have had Chicken Pox. You can contract Chicken Pox after exposure to the Shingles virus, but it is unlikely that you will contract shingles after exposure to the Chicken Pox virus.
Once contracted, you don’t need any additional boosters. There are Chicken Pox and Shingles Immunisations available if you have not had Chicken Pox or Shingles before (see All Other Vaccinations).

Glandular Fever Antibody / Immunity (EBV IgM/ IgG)

This can be requested if your doctor suspects that you may have glandular fever. Usually symptoms are mild and self limiting. You may have a fever, sore throat (with enlarged, pussy tonsils) and swollen lymph glands behind your neck/ throughout the body. It may occasionally cause intense fatigue, headaches, abdominal pains (with jaundice and spleen and liver enlargement), nausea and vomiting. Symptoms usually resolve in 3 weeks, but the fatigue and generalised feeling of being unwell may last for months.
The Ebstein Barr Virus (EBV) is transmitted via saliva (hence called the kissing disease) and has an incubation period (the period between you getting infected with the virus and you becoming symptomatic) of 4 – 7 weeks. It seems you are most contagious in the first 6 weeks following the infection.
About 90% of adults will have acquired an immunity to EBV by the age of 40. Hence it is very difficult to pick up an IgM positive (that is an acute glandular fever) person. This is because symptoms may recur, even if you had previously contracted the virus.
EBV IgM usually peaks 4 – 8 weeks after the onset of symptoms of Glandular fever and remains elevated usually for 6 months after this. Hence, if you are EBV IgM positive (or EBV IgM and IgG positive), you have probably contracted Glandular fever recently. If you are EBV IgM negative and EBV IgG positive, it usually indicates that you have had Glandular fever more than 6 months previously and your current illness is not related to Glandular fever.
There is no vaccine for EBV.

Parvovirus antibody/ Immunity (IgM/ IgG)

This may be requested by your doctor if there is suspicion that you/ your child has Parvovirus B19 infection (also called Fifth disease or Slapped Cheek Syndrome). It usually starts with a high fever and malaise, followed by a bright red rash on your cheeks (with relative sparing around the mouth). After this a red lace like rash develops on the trunk or extremities, made worse by sunlight.
Parvovirus B19 is important as it can cause :
Joint Inflammation and pain– sometimes significant and your doctor may check for Parvovirus B19 if you present with painful/swollen joints.
Aplastic crisis– Those with Sickle Cell anaemia or hereditary spherocytosis, may become very anaemic as the virus attacks red blood cell production.
Risk of foetal abnormality/ foetal loss– If the virus is contracted before 20 weeks of your pregnancy, there may be a significant risk to your unborn child.
Parvovirus B19 is contagious and is spread by coughing and sneezing. The incubation period (the period between you getting infected with the virus and you becoming symptomatic) is about 1 – 2 weeks. The time when you are contagious to others is before you become symptomatic, but you are probably not contagious after that. The illness lasts about 1 week.
Once contracted, you are immune for life. There is no Vaccine for Parvovirus B19.

Please see below for how parvovirus results will be reported and what the result means:

IgM +ve IgG +ve Interpretation
Negative Negative No previous infection. Patient may be susceptible to Parvovirus infection.
Negative Positive Previous exposure/infection with Parvovirus – minimal risk of Parvovirus infection.
Equivocal Positive or negative May indicate current or recent Parvovirus infection – retest in 1 to 2 weeks.
Positive Positive Implies current or recent Parvovirus infection.
Positive Negative or equivocal May indicate current Parvovirus infection – retest in 1 to 2 weeks.

IgM antibodies indicate recent infection. IgG antibodies only is indicative of past exposure. IgG and IgM may become positive very soon after exposure and usually reach peak levels within 30 days of the onset of illness.

Toxoplasma Antibody/ Immunity (IgM/ IgG)

This is a parasitic protozoan mainly hosted in the Cat family. Cat Faecal contamination and handling raw meat are significant risk factors for contracting this. It usually presents with mild flu like symptoms and enlarged lymph glands around your neck (unless you are immunosuppressed).
The main problem is if you contract it while pregnant, it can cause serious abnormalities (brain and eyes) of your unborn child.
This is not routinely screened for in pregnant women in the UK. Your best strategy is to avoid cats and raw meat during your pregnancy. There is no Vaccination available for Toxoplasma.

A positive Toxoplasma IgG indicates infection with the organism occurred at some time. If Toxoplasma IgM is negative, then this excludes a recent infection. However, a positive IgM test is difficult to interpret because Toxoplasma IgM antibodies may be detected for as long as 18 months after an acute acquired infection.

If the patient is pregnant, and IgG/IgM positive, an IgG avidity test should be performed. A high avidity result in the first 12 to 16 weeks of pregnancy usually rules out an infection acquired during gestation. A low IgG avidity result cannot be interpreted as indicating recent infection, because some individuals have persistent low IgG avidity for many months after infection.

IgG +ve IgM +ve Interpretation
Negative Negative No serological evidence of infection with Toxoplasma.
Negative Equivocal Possible early acute infection or false positive IgM. Obtain a new specimen for IgG and IgM testing. If results for the second specimen remain the same, you are probably not infected with Toxoplasma.
Negative Positive Possible acute infection or false positive IgM. Obtain a new specimen for IgG and IgM testing. If results for the second specimen remain the same, the IgM reaction is probably a false-positive.
Equivocal Negative Indeterminate – obtain a new specimen for testing.
Equivocal Equivocal Indeterminate – obtain a new specimen for both IgG and IgM testing.
Equivocal Positive Possible acute infection with Toxoplasma. Obtain a new specimen for IgG and IgM testing. If results for the second specimen remain the same or if the IgG becomes positive, both specimens should be sent to a reference laboratory with experience in diagnosis of toxoplasmosis for further testing.
Positive Negative Previous infection with Toxoplasma. Should now be immune.
Positive Equivocal Infected with Toxoplasma for probably more than 1 year or false-positive IgM reaction. Obtain a new specimen for IgM testing. If results with the second specimen remain the same, both specimens should be sent to a reference laboratory with experience in the diagnosis of toxoplasmosis for further testing.
Positive Positive Possible recent infection within the last 12 months, or false-positive IgM reaction. Send the specimen to a reference laboratory with experience in the diagnosis of toxoplasmosis for further testing.

If you are pregnant and your Toxoplasma IgM is equivocal or positive, you will need to contact your midwife straight away. She will confirm the results on your ‘booking in’ bloods and contact your Obstetric Consultant straight away to organise regular scans on your baby.

CMV (Cytomegalovirus) Antibody/ Immunity (IgM/ IgG)

This is a herpesvirus infection. Infection is worldwide and usually asymptomatic. However, it can cause severe congenital infections if contracted when you are pregnant or if you are immunocompromised (such as CMV pneumonia). After an initial CMV infection, the virus remains in your body in a suppressed state. Unless, you become immunocompromised, it should not cause any significant problems to you.
CMV is the most commonly acquired congenital infection in infants and can cause significant complications (such as learning difficulties and neurological abnormalities). Placental infection usually occurs if you first contract CMV during your pregnancy. 50-80% of all adults are infected with CMV and the infection is passed on by bodily fluids. Hence some women check their CMV immunity status when considering pregnancy. This is not routinely screened for in pregnant women in the UK. There is no vaccination against CMV.

 

Allergy Testing

Blood tests


UK Profile

These are a group of allergens that more commonly cause type 1 allergies in the UK population.
These allergens are very subjective, and we would encourage you to look through the lists of allergens under each sub-heading and choose the profile most suited to yourself.

Mediterranean Profile

These are a group of allergens that more commonly cause type 1 allergies, in those of Mediterranean origin.
These allergens are very subjective, and we would encourage you to look through the lists of allergens under each sub-heading and choose the profile most suited to yourself.

Middle East Profile

These are a group of allergens that more commonly cause type 1 allergies, in those of Middle East origin.
These allergens are very subjective, and we would encourage you to look through the lists of allergens under each sub-heading and choose the profile most suited to yourself.

Immunocap ISAC Panel

These are a group of more than 50 preselected allergens. This is the most comprehensive list of allergens that you can check for.

Eczema Provoking Profile

These are a group of allergens that more commonly cause type 1 allergies, in those suffering from Atopic eczema. These agents can exacerbate your eczema.
These allergens are very subjective, and we would encourage you to look through the lists of allergens under each sub-heading and choose the profile most suited to yourself.

Rhinitis Provoking Profile

These are a group of allergens that more commonly cause type 1 allergies, in those suffering from rhinitis (constantly running nose). These agents can exacerbate your rhinitis.
These allergens are very subjective, and we would encourage you to look through the lists of allergens under each sub-heading and choose the profile most suited to yourself.

Food and Inhalants Profile

These are a comprehensive group of allergens that more commonly cause type 1 allergies, in those suffering from inhaled respiratory and food gastrointestinal tract allergies.
These allergens are very subjective, and we would encourage you to look through the lists of allergens under each sub-heading and choose the profile most suited to yourself.

Inhalants Profile

These are a comprehensive group of allergens that more commonly cause type 1 allergies, in those suffering from inhaled respiratory tract allergies.
These allergens are very subjective, and we would encourage you to look through the lists of allergens under each sub-heading and choose the profile most suited to yourself.

Food Profile

These are a comprehensive group of allergens that more commonly cause type 1 allergies, in those suffering from food gastrointestinal tract allergies.
These allergens are very subjective, and we would encourage you to look through the lists of allergens under each sub-heading and choose the profile most suited to yourself.

Nuts and Seeds Profile

These are a comprehensive group of Nut and Seed allergens that more commonly cause type 1 allergies.
These allergens are very subjective, and we would encourage you to look through the lists of allergens under each sub-heading and choose the profile most suited to yourself.

Stone Fruit, Rosacea Family Profile

These are a comprehensive group of Stone Fruit allergens that more commonly cause type 1 allergies.
These allergens are very subjective, and we would encourage you to look through the lists of allergens under each sub-heading and choose the profile most suited to yourself.

Children’s Profile

These are a group of allergens that more commonly cause type 1 allergies in Children.
These allergens are very subjective, and we would encourage you to look through the lists of allergens under each sub-heading and choose the profile most suited to yourself.

Shellfish Profile

These are a comprehensive group of Shellfish allergens that more commonly cause type 1 allergies.
These allergens are very subjective, and we would encourage you to look through the lists of allergens under each sub-heading and choose the profile most suited to yourself.

Finfish Profile

These are a comprehensive group of Finfish allergens that more commonly cause type 1 allergies.
These allergens are very subjective, and we would encourage you to look through the lists of allergens under each sub-heading and choose the profile most suited to yourself.

Combined Shellfish/ Finfish Profile

These are a comprehensive group of Shellfish and Finfish allergens that more commonly cause type 1 allergies.
These allergens are very subjective, and we would encourage you to look through the lists of allergens under each sub-heading and choose the profile most suited to yourself.

Cereal Profile

These are a comprehensive group of Cereal allergens that more commonly cause type 1 allergies.
These allergens are very subjective, and we would encourage you to look through the lists of allergens under each sub-heading and choose the profile most suited to yourself.

Milk and Milk Proteins Profile

These are a comprehensive group of Milk and Milk Protein allergens that more commonly cause type 1 allergies.
These allergens are very subjective, and we would encourage you to look through the lists of allergens under each sub-heading and choose the profile most suited to yourself.

Antibiotics profile

These are a specific group of Antibiotic allergens that more commonly cause type 1 allergies.
These allergens are very subjective, and we would encourage you to look through the lists of allergens under each sub-heading and choose the profile most suited to yourself.

Insect Profile

These are a comprehensive group of Insect allergens that more commonly cause type 1 allergies.
These allergens are very subjective, and we would encourage you to look through the lists of allergens under each sub-heading and choose the profile most suited to yourself.

 

Tumour Markers

Blood tests


Alpha Feto Protein (AFP)

This is requested by your doctor if there is a suspicion of Cancer of your Liver or Testes. AFP is also used to monitor response to treatment of these cancers. If you have Chronic Hepatitis or Cirrhosis of the Liver, your doctor may check this periodically to look for signs of an impending Cancer.
The higher the AFP, the bigger the tumour or spread of Cancer.
A negative AFP does not mean that you do not have cancer of your Liver/ testes.

BRCA1/ BRCA2 Full screen

These 2 genes are examined to find any mutations in them. Different mutations in these genes are associated with the development of Breast and Ovarian Cancer.
There are 2 types of BRCA1/2 testing:
Diagnostic BRCA1/2 testing – done if you have already had Breast/ Ovarian Cancer (usually with a strong family history). It gives you information about your chances of further cancers and provides your family members with vital information in order to have predictive testing.
Predictive BRCA1/2 testing – done on the unaffected relative of someone who is known to have the BRCA1/2 gene mutation. This may allow you to take steps to avoid breast/ ovarian cancer from developing. You may want to speak to a Geneticist.
A negative BRCA1/2 test does not mean that you have a low risk of developing Breast/ Ovarian Cancer, especially if you have a strong family history of it.

CA 15-3

This is used to monitor your response to Breast Cancer treatment and to watch for Breast Cancer recurrence. The higher the CA 15-3, the larger and more advanced the Breast Cancer.
Mild elevations of CA 15-3 can be seen in Liver and Pancreatic Cancer, cirrhosis and benign breast disorders.
A negative 15-3 does not mean that you do not have a Breast Cancer.

CA 19-9

This is used to help identify a Cancer of the Pancreas and bile ducts and differentiate it from non cancerous conditions, such as pancreatitis (benign conditions of the Liver and Pancreas can cause mild elevations in CA 19-9). CA 19-9 can also monitor the response to Pancreatic Cancer treatment and monitor for its recurrence.
Pancreatic Cancer presents with abdominal pain, nausea, weight loss and Jaundice.
A negative CA 19-9 does not mean that you do not have a Pancreatic Cancer.

CA125

This is mainly used to monitor treatment of Ovarian Cancer, and to monitor for recurrence. CA 125 is recommended in women more than 50 years of age (together with a pelvic ultrasound), if you have persistent, continuous or worsening abdominal pain/bloating/ feeling full and/or loss of appetite or problems with urination.
A High CA 125 may be suggestive of Ovarian Cancer, but needs verification with a pelvic ultrasound. A high CA 125 can also occur in normal and benign conditions (such as pregnancy, menstruation, endometriosis and pelvic inflammatory disease).

Ovarian Tumour Early Detection

HE4 is found in high levels in Ovarian Cancer. Serum levels are less affected by menstruation, ovulation and other benign ovarian conditions such as endometriosis (unlike CA 125).
In pre-menopausal women, HE4 is more sensitive/specific for even an early stage ovarian cancer.
In post-menopausal women the non specific CA 125 is more suitable for assessing Ovarian Malignancy (as benign ovarian conditions occur less frequently). But CA 125 can rise in pulmonary embolus, liver cirrhosis and pleural/pericardial/peritoneal effusions.
The Risk of Ovarian Malignancy Algorithm (ROMA) is a calculation combining the CA 125 and HE4 and classifies women as being at low or high risk of having an Ovarian cancer.

CEA (Carcino Embryonic Antigen)

This is mainly used to monitor for bowel cancer, but it can be elevated in other cancers. It may be done if you have symptoms suggestive of bowel cancer, such as blood in your stools, weight loss, new onset constipation and feeling of incomplete emptying of your bowel.
However, the CEA does not correlate accurately with the tumour size. CEA levels can also rise in Liver disease and inflammatory bowel disease.

 

Sexual Health

Blood tests


Hepatitis (acute) screen

This is requested if you have symptoms of an acute hepatitis. Symptoms of acute hepatitis include jaundice, dark urine, pale stools, a fever and loss of appetite.
The acute viral hepatitis markers are checked– Hepatitis A IgM (see Hepatitis A profile), HBsAg (see Hepatitis B profile) and Hepatitis C Ag/Ab (see Hepatitis C antigen and Hepatitis C antibodies).

Hepatitis A, B and C profile

This comprehensive viral hepatitis profile checks your liver function tests as well as for acute and chronic markers of each viral hepatitis (see Hepatitis A profile, Hepatitis B profile and Hepatitis C antigen / Hepatitis C antibodies).

Hepatitis A profile

This is requested by your doctor if you have acute hepatitis symptoms (see Hepatitis [acute] screen) or are likely to have been exposed to the virus. The Hepatitis A virus is found in contaminated water and faeces. Eating raw fruit or vegetables handled by an infected person or eating raw/ poorly cooked seafood from contaminated waters can transmit this to you.
The IgM antibody appears first after being exposed to the Hepatitis A virus. It appears 2-3 weeks after your infection and disappears within 2-4 months.
The IgG antibody appears later, continues to rise for several months and usually persists for life and protects you from getting infected again by the Hepatitis A virus. It is also raised if previously vaccinated (see Travel vaccinations).

Hepatitis B profile

This is requested by your doctor if you have acute hepatitis symptoms (see Hepatitis [acute] screen) or are incidentally found to have abnormal liver function tests. The Hepatitis B virus is contracted via exposure to blood or bodily fluids containing blood– such as sexual contact, blood transfusions, re-use of contaminated needles or vertical transmission from mother to child.
There are various Hepatitis B virus tests that are done to assess whether you have an acute (new) or chronic (for many months/ years) Hepatitis B virus infection. It also helps to detect a past Hepatitis B infection which has now cleared or just to see if your vaccination has been successful (see Hepatitis B Immunity [HBsAb]). It can take about 2-3 months to become positive after an exposure.
HBsAg (surface antigen)– Used to screen/ detect for a Hepatitis B virus infection. It is the first indication of an acute infection being present. It is also positive in people with chronic infections.
HBsAb (surface antibody)– Indicates a previous exposure to the Hepatitis B virus, but the virus is no longer present and cannot be passed on. It also protects against a future infection by the Hepatitis B virus. These antibodies are also acquired via vaccination.
HBcAb [IgG/IgM] (anti core antibodies)– Used to detect an acute (IgM) and chronic (IgG) Hepatitis B virus infection. It usually persists for life. It is also used to detect for a past infection but you are now immune, in combination with HBsAb.
HBeAg– The ‘e’ antigen is only found in the blood when the Hepatitis B virus is actively replicating. This is used as a marker to see how infectious the person is (that is how quickly the person can spread it to another person).
HBeAb– present in those who have recovered from a recent Hepatitis B infection. HBcAb and HBsAb will also be present.
Here are some common scenarios:
Acute infection and contagious– Positive HBsAg and HBeAg; Positive or negative HBcAb; negative HBsAb and HBeAb.
Chronic infection but low risk of liver damage (carrier state)– positive HBsAg, HBcAb (IgG) and HBeAb; negative HBsAb, HBcAb (IgM) and HBeAg.
Active chronic infection and liver damage possible– positive HBsAg, HBcAb (IgG) and HBeAg; negative HBsAb, HBcAb (IgM) and HBeAb.

No active/ past infection and not immune, so can have Hepatitis B vaccination– negative HBsAg, HBsAb and HBcAb
Acute infection, now resolving– negative HBsAg, HBsAb and HBeAg; positive HBcAb and HBeAb.
Infection resolved, immunity due to natural infection– negative HBsAg, HBcAb (IgM) and HBeAg; positive HBsAb, HBcAb (IgG) and HBeAb.
Immunity due to vaccination– negative HBsAg and HBcAb; positive HBsAb.
If a chronic Hepatitis B virus is confirmed, your doctor will refer you on to the gastroenterologist / liver specialist for further testing +/- a liver biopsy.

Hepatitis C antigen

This is requested by your doctor if you have acute hepatitis symptoms (see Hepatitis [acute] screen) or are incidentally found to have abnormal liver function tests. The Hepatitis C virus is contracted via exposure to blood or bodily fluids containing blood– such as sexual contact, blood transfusions, re-use of contaminated needles or vertical transmission from mother to child. Hepatitis C is a common cause of chronic liver disease. 70% of those infected will develop chronic hepatitis and 25% of those will go on to develop cirrhosis of the liver. There is also an increased risk of developing Hepatocellular carcinoma.
The Hepatitis C antigen is a rapid non specific test to assess for the presence of an acute Hepatitis C infection. It can take about 2 months to become positive after exposure.
If a Hepatitis C virus is suspected, your doctor will refer you on to the gastroenterologist/ liver specialist for further testing +/- a liver biopsy.

Hepatitis C antibodies

This is requested by your doctor if you have acute hepatitis symptoms (see Hepatitis [acute] screen) or are incidentally found to have abnormal liver function tests. The Hepatitis C virus is contracted via exposure to blood or bodily fluids containing blood– such as sexual contact, blood transfusions, re-use of contaminated needles or vertical transmission from mother to child. Hepatitis C is a common cause of chronic liver disease. 70% of those infected will develop chronic hepatitis and 25% of those will go on to develop cirrhosis of the liver. There is also an increased risk of developing Hepatocellular carcinoma.
The Hepatitis C antibody is a non specific test to assess for the presence of an acute Hepatitis C infection. It cannot tell you if you have had a previous infection or have a current infection. It can take about 2 months to become positive after exposure.
If a Hepatitis C virus is suspected, your doctor will refer you on to the gastroenterologist / liver specialist for further testing +/- a liver biopsy.

HIV/ HBV/ HCV (Early Detection Screen)

This is an early detection screen on bloods for HIV, Hepatitis B and Hepatitis C after 10 days of exposure to the viruses either sexually or via infected needles.
HIV 1&2 RNA–this detects for active HIV infection in your blood.
HBV DNA– this detects an active Hepatitis B infection in your blood.
HCV RNA– this detects an active Hepatitis C infection in your blood.

HIV 1&2/p24Ag

This test is done to detect HIV. It may not detect HIV immediately after exposure (sexual or needlestick injury) and can take between 10 days and 3 months to become positive. Hence, if checking, you are asked to repeat the HIV test again at least 3 months after exposure.
The p24 antigen test can become positive earlier than the HIV antibody test, if exposure to the infection is recent.
This combination HIV/p24Ag becomes positive 1 month after exposure to HIV. If your exposure is over 10 days ago only, please do the Early Detection Screen above.

Syphilis

This is used to diagnose an infection with syphilis. Syphilis may present with a chancre (ulcer on your genitals or throat) or a non itchy rash on your trunk and extremities.
The syphilis antibodies indicate that you have a current (IgM) or past (IgG) infection. It may take up to 3 months after exposure to become positive. The antibodies can also remain positive many years after being treated for a previous syphilis infection.
Positive tests do not necessarily mean that you have syphilis. Further, more specific testing may be necessary.
If you are positive for Syphilis, it would be best to get a comprehensive STD (sexually transmitted disease) check from your local GUM clinic as many other STD’s can co-exist.

 

Urine tests


7 STD Profile by PCR

This Urine test can be used to have a near comprehensive sexually transmitted disease check.
However, for a comprehensive STD check, you will have to also do your blood testing for HIV/ HBV/ HCV (early detection screen) [10 days after unprotected sexual encounter] and Syphilis.

Chlamydia/ Gonorrhoea

This urine test can be used to assess for Chlamydia or Gonorrhoea.

 

Internal swabs


Chlamydia/ Gonorrhoea

These endocervical swabs are taken to assess for the sexually transmitted bacteria, Chlamydia or Gonorrhoea. They are suspected if a woman has a vaginal discharge and abdominal pain or a man has an unusual discharge from his penis or pain on urinating. However, many have no symptoms at all and continue to infect their partners without knowing.
If found, it is important to seek out and treat everyone you have been in sexual contact with. It is also important to look for other STD’s (such as HIV) as they can also co-exist.

Herpes Simplex Virus I/II

This swab may be taken by your doctor/nurse of lesions they suspect may be related to Herpes Simplex Virus (HSV) I or II. Both types are contagious and periodically cause small blisters that break open to form open lesions that can be swabbed.
HSV 1 mainly causes blisters or ‘cold sores’ around or inside your mouth, whereas HSV 2 is often a sexually transmitted disease. However, HSV1 can also be transmitted via oral sex and appear on your genital region. Painful blisters may appear at the site of first infection, usually 2 weeks after being exposed to it. The blisters usually heal in 2-4 weeks and can appear in your vaginal area, on your penis, around your anus or on your buttocks or thighs.
Recurrent outbreaks may occur and you may want to discuss regular medication with your doctor if this occurs.

Vaginitis/ Bacterial vaginosis profile

This swab can be taken by your nurse if you have symptoms of a vaginal discharge (sometimes foul smelling), itching and pain. There may be a vulval irritation and pain during intercourse. The 3 main culprits causing this are tested for with this swab test:
Candida (thrush)– this yeast/ fungal infection causes a watery, white, cottage cheese like vaginal discharge. It can be very itchy.
Gardnerella vaginalis (Bacterial vaginosis) – this causes a fish like odour vaginal discharge. It too can be very itchy but does not cause pain during intercourse.
Trichomonas vaginalis– this causes a profuse fish like odour vaginal discharge, pain on urinating, pain during intercourse and redness/ swelling of external genitals.
It is best to treat these infections, especially if pregnant, as non treatment can lead to premature delivery of your baby.
Thrush and Bacterial vaginosis are NOT sexually transmitted, but there is evidence that there is increased risk of getting thrush after intercourse and people with Bacterial vaginosis have increased risk of contracting other STD’s (sexually transmitted diseases) such as pelvic inflammatory disease and HIV.

 

Gynaecology – Female Health

Blood tests


Pregnancy Test (beta-hCG)

This can be requested to confirm that you are pregnant. This informs you of the level of beta hCG in your blood and may also be used to help diagnose an ectopic pregnancy, to help diagnose and monitor a pregnancy that may be failing and to monitor you after a miscarriage.
This can be requested as early as 10 days after a missed menstrual period in order to confirm that you are pregnant. In a normal early pregnancy, the amount of beta hCG doubles every 2-3 days.
If your doctor is concerned about an ectopic pregnancy, they will refer you as soon as possible to the hospital– however, several beta hCG levels over several days (usually every 48 hours) may be requested to ensure you do not have an ectopic pregnancy. In an early ectopic pregnancy, the beta hCG doubling time is usually much more prolonged than a normal pregnancy.
In a failing pregnancy, the beta hCG doubling time may also be prolonged, or may even fall.
Beta hCG levels will dramatically fall after a miscarriage. If levels do not fall to undetectable levels, it may indicate that you have remaining hCG producing tissue in your womb that may need to be removed.
Beta hCG levels may also be used to diagnose trophoblastic disease (hydatidiform mole) or germ cell tumours of your testes or ovary. If this is detected, your doctor will send you to the appropriate specialist.

Antenatal Profile

These are the blood tests that are routinely done by your midwife in the antenatal clinic when you are around 12 weeks pregnant. These can be done before becoming pregnant if wanted.
Full Blood Count (FBC)– this is mainly to check for haemoglobin (the protein in red blood cells that gives blood its red colour). Its main job is to carry oxygen from the lungs to the rest of the body. In pregnancy, the haemoglobin also provides oxygen to your unborn child. It is normal to be slightly anaemic (that is, have a low haemoglobin) in pregnancy, but your doctor will inform you if it is too low and may suggest you take iron supplements.
Blood group and Rhesus status ( see Blood group )– This is to check for the maternal blood type (either A, B, AB or O ) and whether she is Rhesus positive or negative. If a Rhesus negative mother is pregnant with a Rhesus positive baby, the mother’s immune system may produce antibodies that attack the baby. In order to reduce this risk, all Rhesus negative mothers are given an injection, by their midwife, of anti–D gamma globulin at around 28 weeks of pregnancy (some also are given another at 34 weeks of pregnancy and shortly after the birth of a Rhesus positive baby). Additional anti-D injections may be given if there is suspicion that the mother’s blood has come into contact with a Rhesus positive baby– such as an amniocentesis or a threatened miscarriage.
Atypical antibody screen– other than Rhesus status, there are various other antibodies that can harm your baby.
Haemoglobin electrophoresis– this is used to screen as to whether you are a carrier for sickle cell, thalassaemia or another haemoglobin disorder. If the test is positive, your baby’s father will also be offered the test. If he is positive as well, you will be sent to speak to a genetic counsellor.
Syphilis– This bacterial sexually transmitted disease can lead to miscarriage or infect your baby prior to or during the delivery.
Fasting glucose (see Diabetes profile)– this is to assess the risk of you having Type 2 Diabetes, which can affect your baby (risk of congenital abnormalities, having a larger baby and risk of miscarriage and still birth).
Thyroid profile– This is to assess if you have an underactive or an overactive thyroid gland which can affect both yourself and your baby (anaemia, heart failure, pre-eclampsia, miscarriage, premature birth, low birth weight baby, and stillbirth).
Rubella Immunity– this is to assess if you are immune (and so cannot get) the Rubella virus. If you are not immune and you become infected with the rubella virus during the first 3 months of your pregnancy, there is increased risk of your baby having serious birth defects or dying. If you are not immune, you will have to wait till the birth of your baby before getting vaccinated with the Rubella vaccine.
Toxoplasma antibody/ immunity–This is to assess if you are infected with/ immune to the Toxoplasma protozoa. If you contract this while pregnant, it can cause serious abnormalities (brain and eyes) of your unborn child. This is not routinely screened for in pregnant women in the UK. There is no Vaccination available for Toxoplasma.
Hepatitis B [HBsAg] (see Hepatitis B profile)– this is to see if you may be infected with the Hepatitis B virus. Hepatitis B can infect your baby.
Hepatitis C antibodies– this is to see if you may be infected with Hepatitis C, which also can infect your baby.
Varicella Zoster (Chicken Pox immunity)–This is to check if you are immune (that is cannot get it again) to the chicken pox virus. If you are not immune and you contract chicken pox during your pregnancy, it can affect you and your unborn child. The chicken pox virus can affect you much more aggressively and can cause a pneumonia, a brain infection (encephalitis) or another serious infection affecting many organs. If you contract chicken pox before 20 weeks of pregnancy, there is a risk of your child being born with serious abnormalities. If you contract chicken pox within 7 days of giving birth (either before or after), your newborn baby may develop a severe form of chickenpox. See your doctor immediately if you are exposed to (if not immune) or contract chicken pox in your pregnancy. This is not routinely screened for in pregnant women in the UK.
HIV 1&2/p24Ag– this is to assess your risk of having HIV, which can infect your baby.

Amenorrhoea Profile/ Infertility

This can be requested if you are under 40 years of age and have missed your period on more than 2 consecutive occasions and you have done a urine pregnancy test to ensure that you are not pregnant. It can also be requested if you are having irregular periods (but you may want to do the Hirsutism/ PCOS profile instead, especially if your irregular periods are associated with increased acne, facial hair, infertility +/- obesity) or having infertility problems (that is, trouble conceiving). This can also be requested to check if you have reached your menopause.
LH and FSH levels– High levels suggest a primary ovarian failure (ovaries themselves are malfunctioning). This can occur with genetic causes or due to damage by radiation/ autoimmune diseases or anovulation causes (ovaries fail to ovulate– such as polycystic ovarian syndrome, adrenal disease, thyroid disease or ovarian tumour). High FSH levels are also seen when a woman enters the menopause. Low LH and FSH levels suggest a secondary ovarian failure (disorder of pituitary or hypothalamus gland in the brain).
In young children, high LH and FSH levels and the development of secondary sexual characteristics at an unusually young age indicate precocious (early) puberty. This is much more common in girls.
Oestrodiol– low levels may be seen if you are going through the menopause (irregular, heavy periods, hot flushes, night sweats and irritability).
Prolactin– high levels are seen in pregnancy and after childbirth while you are breastfeeding. High levels are also seen in brain pituitary tumours, underactive thyroid disorders and in polycystic ovarian syndrome. Very low prolactin levels may suggest a more generalised brain pituitary disorder.
These tests should not be done when you are taking the oral contraceptive pill as the results will not be valid.

Hirsutism/ PCOS profile

This can be requested if you are concerned regarding having increased facial and body hair (hirsutism). There are many causes for hirsutism, but the commonest is Polycystic Ovarian Syndrome (PCOS). PCOS is common, affecting up to 10% of women of childbearing age. If you have PCOS, you may have some or all of– hirsutism, irregular/ absent periods, acne, obesity and infertility issues. There is also an increased risk of developing Type 2 Diabetes and cardiovascular (heart) disease.
LH and FSH Levels– in PCOS, both can be increased, but often LH may be 3 times more raised than FSH. High levels suggest a primary ovarian failure (ovaries themselves are malfunctioning). This can occur with genetic causes or due to damage by radiation/ autoimmune diseases or anovulation causes (ovaries fail to ovulate– such as polycystic ovarian syndrome, adrenal disease, thyroid disease or ovarian tumour). Low LH and FSH levels suggest a secondary ovarian failure (disorder of pituitary or hypothalamus gland in the brain).
Testosterone– high testosterone levels cause hirsutism. Levels can rise due to tumours arising from the ovary or adrenal gland or because of other conditions, such as PCOS.
DHEAs– high levels may suggest an adrenal cancer or adrenal hyperplasia (benign). Increased levels can be ambiguous and are not diagnostic of any specific condition, and further evaluation by your doctor is necessary. There are often normal concentrations of DHEAs in PCOS. Low levels of DHEAs may suggest an adrenal malfunction or an underactive pituitary gland (see Pituitary function profile).
SHBG (sex hormone binding globulin)– If levels are low, there may be more of the total testosterone available to the tissues and can lead to hirsutism. Hence, often a free androgen index (total testosterone/SHBG) is used to assess the total free available testosterone.
These tests should not be done when you are taking the oral contraceptive pill as the results will not be valid.

Ovarian reserve profile

This may be requested to assess the capacity of your ovaries to provide eggs that are capable of fertilisation, resulting in a healthy and successful pregnancy. The higher your maternal age, the less the number of eggs available for fertilisation. These tests are best done after seeing your infertility/ IVF specialist.
FSH– (see amenorrhoea profile)– this allows you to assess if there is any Ovarian failure.
Antimullerian Hormone (AMH)– low levels suggest that you may respond less well to ovarian stimulation by your IVF specialist and an alternative protocol may be required. High levels suggest that you may have an excessive response to ovarian stimulation and again, an alternative protocol may be needed.
Day 3 Inhibin B test– This protein produced by your ovaries blocks FSH (which is needed to help your ovarian follicles develop). Inhibin B decreases with age and indicates your egg quality and quantity. Low levels are associated with reduced ovulation, reduced success with IVF, lower pregnancy rates and an increased risk of miscarriage.

Antimullerian Hormone (AMH)

This may be requested to assess the capacity of your ovaries to provide eggs that are capable of fertilisation, resulting in a healthy and successful pregnancy. The higher your maternal age, the less the number of eggs available for fertilisation. This test is best done after seeing your infertility/ IVF specialist. A more comprehensive screen is done via the Ovarian reserve profile.
Low levels of Antimullerian hormone suggest that you may respond less well to ovarian stimulation by your IVF specialist and an alternative protocol may be required. High levels suggest that you may have an excessive response to ovarian stimulation and again, an alternative protocol may be needed.

Progesterone

This may be requested to check if you have ovulated (that is, released an egg from your ovary). Progesterone levels start to rise when an egg is released from the ovary and continues to rise for several days and then either continues to rise with early pregnancy or rapidly falls to start menstruation.
If levels do not rise (usually checked at Day 21 or Day 23 of your cycle– depending on your cycle length), you may not be ovulating properly. If concentrations do not rise normally during early pregnancy, the pregnancy may be an etopic or a failing pregnancy.
Progesterone levels should not be done when you are taking the oral contraceptive pill as the results will not be valid.

Recurrent miscarriage profile

This may be requested if you have had more than 2 recurrent miscarriages. Each of the tests have been carefully selected to assess if any of the below could be associated with you having recurrent miscarriages.
FBC, Coagulation, antithrombin III, Factor V leiden, Protein C/S, Lupus anticoagulant (see Thrombotic risk profile).
Chromosome analysis– This is the test for genetic abnormalities in your DNA which could be causing your recurrent miscarriages. A chromosome analysis will only show up a genetic abnormality in 4% of couples. The most common chromosome abnormality is a translocation (balanced rearrangement of chromosomes). Male and female carriers of balanced translocations may have infertility, recurrent pregnancy loss or live born children with problems due to missing and/or extra genetic material (an unbalanced translocation). This is why chromosome analysis should be done in both the male and female partners.

Menopause profile

This may be requested if you feel you may be going through your menopause. The usual age of Menopause in the UK is 50, but can occur at any time after the age of 42. Menopausal symptoms include irregular heavy periods, hot flushes, night sweats, disturbed sleep and an irritable mood.
LH, FSH, Oestrodiol (see Amenorrhoea profile)- the menopause is suggested by raised FSH +/- LH levels and a low oestrodiol level.
TSH/ free T4 (see Thyroid profile)– both underactive and overactive thyroid disorders can cause menstrual irregularities or menopause like symptoms, hence it is important to check for this too.

 

Internal swabs


Group B streptococcus

This low vaginal plus rectal swab can be taken antenatally (before delivery of your baby) to check for the presence of Group B streptococcus (GBS). It is best done after 35 weeks of pregnancy. GBS is present in up to 30% of the normal population and usually does not need to be treated if you are not pregnant or before delivery.
However, it is important to know if you do have carriage of GBS in pregnancy. This is because GBS vaginal colonisation can cause a severe infection of the baby during delivery.
If labour occurs (that is your waters break) before 37 weeks of pregnancy, early antibiotic therapy will be considered by your obstetrician. If labour occurs after 37 weeks of pregnancy, and your waters have been broken for more than 18 hours, or you develop a fever, your obstetrician may again consider early antibiotic treatment.

 

Smear test


Cervical smear

This could be requested if you wanted to check for HPV (Human Papilloma Virus) infection and cervical cells that are abnormal or even potentially cancerous.
A Negative result means that the cells obtained appear normal. Rarely, the sample may be reported as inadequate (insufficient cells for reliable evaluation).
Borderline changes– cells present that may indicate HPV infection. Most borderline changes return to normal without treatment.
Mild dyskaryosis– low grade changes often associated with HPV and return to normal without treatment.
Moderate dyskaryosis– indicates that abnormal cells are present and may need treatment.
Severe dyskaryosis– indicates abnormal cells are present, suggesting high grade pre-cancer (CIN) is probably present and usually requires treatment.
If you have any abnormal bleeding (for example, after intercourse, between periods or after the menopause), you may want to ensure you have had your smear done.

 

Male Health

Blood tests


Male Infertility profile

This can be requested if there are infertility issues for you and your partner.
LH and FSH levels– LH controls the production of testosterone from your testes and FSH controls the production of your sperm. High LH and FSH levels are due to a primary testicular failure (failure of the testicles themselves). This may be caused by developmental abnormalities of the testes at birth or from damage later on (such as a mumps infection, alcoholism, anabolic steroid use, trauma, autoimmune disorders or a testicular tumour). Low levels of FSH suggest a brain pituitary or hypothalamic disorder.
In young children, high LH and FSH levels and the development of secondary sexual characteristics at an unusually young age indicate precocious (early) puberty. This is much more common in girls.
Testosterone– a low testosterone level may be due to a brain hypothalamic or pituitary disease (there will be a reduced LH and FSH) or may be due to a primary testicular failure (as above). Increased testosterone levels may indicate a testicular tumour.
Sex hormone binding globulin (SHBG)– this is used together with testosterone to help discover the cause of your infertility. The Free Androgen Index (Total testosterone/ SHBG) estimates the amount of free active testosterone. When SHBG levels are raised, there is likely to be less free testosterone available and may be the cause of your infertility (for example, from a low sex drive).
Prolactin– Raised levels associated with a low testosterone level suggest a brain pituitary cause (such as a prolactinoma) for your infertility.

Erectile dysfunction/ Impotence profile

This may be requested if you are having issues related to a reduced sex drive and/ or erectile dysfunction (lack of morning erections, lack of initiation or maintenance of erections).
Testosterone– low testosterone levels can cause erectile dysfunction and impotence. It may be due to a brain hypothalamic or pituitary disease (there will be reduced LH and FSH levels) or may be due to a primary testicular failure (failure of the testicles themselves– due to developmental abnormalities of the testes at birth or from damage later on [such as a mumps infection, alcoholism, anabolic steroid use, trauma, autoimmune disorders or a testicular tumour]). Increased testosterone levels may indicate a testicular tumour.
Sex hormone binding globulin (SHBG)– this is used together with testosterone to help discover the cause of a reduced sex drive and erectile dysfunction. The Free Androgen Index (Total testosterone/ SHBG ) estimates the amount of free active testosterone. When SHBG levels are raised, there is likely to be less free testosterone available and this may be the cause of your poor libido.
Prolactin– Raised levels associated with a low testosterone level suggest a brain pituitary cause (such as a prolactinoma) for your erectile dysfunction.
Lipid screen (see Lipid profile), fasting glucose/ HbA1c (see Diabetes profile) and TSH (see Thyroid profile) are all conditions that can exacerbate/ cause a reduced sex drive and erectile dysfunction. They need to be actively looked for and controlled if diagnosed.
PSA (Prostate specific antigen)– see Prostate profile. This checks for the possibility of a prostate cancer which can also cause an erectile dysfunction.

Prostate profile

This may be requested to help detect and monitor the progress of a prostate cancer.
Routine Prostate specific antigen (PSA) testing is not recommended as often the PSA detects early cancers that are extremely slow growing and may never cause life threatening disease. Those at an increased risk of prostate cancer (Afro-Carribean men and those with a family history of it) may wish to be screened after the age of 45.
Free PSA levels can help to differentiate between prostate cancer and other non cancerous conditions, such as benign prostatic hypertrophy (BPH), especially in borderline raised total PSA levels. The lower the free PSA to Total PSA ratio, the greater the risk of prostate cancer (that is, higher free PSA ratios are more reassuring).
If your PSA is raised, your doctor will go on to perform a rectal examination of your prostate gland to assess whether there is a true risk of prostate cancer, or whether the raised PSA was a false positive (that is, inaccurately raised). If concerned, your doctor will refer you to an Urologist to perform a prostate biopsy to confirm the diagnosis.
Increased PSA levels may also be caused by an infection of your prostate gland (prostatitis). Ejaculation and vigorous physical activity affecting the prostate (such a bicycle riding) may also cause a temporary increase in your PSA levels.

Chromosome analysis

This is the test for genetic abnormalities in your DNA which could be causing recurrent miscarriages in your partner. A chromosome analysis will only show up a genetic abnormality in 4% of couples. The most common chromosome abnormality is a translocation (balanced rearrangement of chromosomes). Male and female carriers of balanced translocations may have infertility, recurrent pregnancy loss or live born children with problems due to missing and/or extra genetic material (an unbalanced translocation). This is why chromosome analysis should be done in both the male and female partners.

 

Semen tests


Comprehensive Semen Analysis

This may be done to check if you may be infertile (unable to get a woman pregnant). If abnormal, your doctor will ask you to repeat the test 1 month later.Your semen can also be analysed after you have had a vasectomy to count if there are any remaining sperm. The test will need to be repeated till there are no sperm remaining in your sample.
The fertility semen test checks for semen volume, sperm concentration, motility, progression and morphology. It also tests for fructose in the semen and antisperm antibodies.
In order to maximise your chances of having a fertile semen analysis, we would recommend, for at least 3 months beforehand, you stop smoking and drinking alcohol, have regular aerobic exercise, wear ‘airy’ boxer shorts and take vitamin supplements containing Vitamins A,C,D,E and Zinc and Selenium. Peanuts are meant to help too.

 

Drug Screening

Blood tests


Drugs of Abuse from Bloods

Amphetamines, Barbiturates, Tricyclic Antidepressants, Benzodiazepine, Cannabinoids, Opiates.

NO Chain of custody – We DO NOT provide a chain of custody drugs of abuse screen.

Alcohol profile

This may be requested to provide short term information useful for detecting excessive alcohol use. The test checks you for abnormal Liver function tests (LFT). It also checks your CDT (Carbohydrate Deficient Transferrin) test which is a protein that transports iron around your body, which is affected by excessive alcohol consumption. A positive reading is consistent with an increased alcohol intake longer than 2 to 4 weeks. An Alcohol level is also checked as well as your MCV (the size of your red blood cells- which are bigger with persistently increased alcohol use).

 

Urine tests


Drugs of Abuse from Urine

Random Urine – HAVE to produce ON-SITE. Amphetamines, Barbiturates, Benzodiazepine, Cannabinoids, Cocaine, Codeine (opiate), Dihydrocodeine (opiate), Ephedrine, MDMA, Methadone, Metamphetamines, Morphine (opiate).

NO Chain of custody – We DO NOT provide a chain of custody drugs of abuse screen.