INSURANCE TEST AND TUBE INFORMATION

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1 HIV Cotinine TPHA RPR and VDRL Hep. B s Antigen Hep. C Antibodies Cholesterol Triglyceride HDL Cholesterol Creatinine Urea Uric acid This is a screening test to detect HIV infection. The test does not confirm HIV infection. If reactive, further confirmatory tests will be required. Cotinine is an unique degradation product of nicotine. Detection of cotinine in serum will indicate the presence of primary or secondary cigarette smoke inhalation over a long period of time. This is a screening test for antibodies in the serum of patients with possible syphillus. If test is positive, confirmatory tests will be requiered. A number of other disease disorders can produce a false positive result. This is a screening test for antibodies in the serum of patients with possible syphillus. If test is positive, confirmatory tests will be requiered. A number of other disease disorders can produce a false positive result. Idenitify antibodies to the Hepatitis B antigen, which will be an indication of past or present infection with the Hepatitis B virus, which is tranferred by fluids Identify present of part infection with the Hepatitis C virus, which causes jaundice and are transmitted via body fluids. Identify hypercholesterolaemia, which can be used to identify the risk of heart attck or heart failure. A high Cholesterol level is a risk factor for blood vessel disease, in particular the coronary arteries and therefore heart disease. Used in conjunction with Cholesterol and HDL Cholesterol to identify the risk of cardiovascular diseases. Used in conjunction with Cholesterol and fasting Triglycerides to identify the risk of cardiovascular diseases. Can be used in the diagnosis of muscular disease or damage as well as used in the assessment of renal (kidney) function Urea is a waste product, soluble in water and excreted solely by the kidney. It can be used to identify a high protein diet, the administration of cortisol like steroids, stressful situations, and prerenal, renal, and postrenal factors as described for creatinine increase the concentration of urea-n. Uric acid is a purine compound that circulates in plasma a sodium urate and is excreted by the kidney. It is increased during conditions associated with gout, renal diseases, and after increased breakdown of nucleic acid or nucleoproteins (in leukemia, polycythemia, toxemia of pregnancy, resolving pneumonia, and after irradiation of x-ray-sensitive carcinomas). Its concentration can be decreased during conditions associated with the administration of ACTH or cortisol-like steroids, certain drugs that decrease the reabsorption of urate by renal tubules (aspirin, probenicid, penicillamine), by Fasting hours prior Fasting hours prior Fasting hours prior Page 1 of 5

2 drugs (allopurinol) that block a step in the formation of uric acid, or by defective renal tubular absorption of uric acid. Gamma GT Alkaline Phosphatase Gamma-GT is located primarily on cell membranes and may assist in amino acid transport into cells. The enzyme is present in relatively high concentrations in kidney, pancreas, liver, and prostate. Usually elevated in both hepatocellular disease and obstructive liver diseases. The estimation of g-gt is most helpful in the following situations: 1. In detecting hepatic injury caused by alcoholism. 2. Hepatic metastasis in the anicteric patient. 3. In the management of patients with infectious hepatitis. 4. In chronic obstruction of the bile ducts. 4.1 Extra hepatic cholestasis (e.g. gallstones, pancreas head carcinoma) 4.2 GGT is usually very high with markedly increased ALP and bilirubin. 4.3 Intrahepatic cholestasis 4.4 GGT is mildly to moderately increased and bilirubin not as high as in extra hepatic cholestasis. ALP is widely distributed in the body and is present in high concentration in bone (osteoblasts, the cells of growing bones), intestinal mucosa, and renal tubule cells and in lower concentration in the liver, leukocytes, and placenta. One must thus always exclude the possibility of osteoblastic activity (like in growing children) when using the ALP test for liver disease. ALP activity rises in both hepatocellular disease and cholestasis, but the rise is usually greater in the latter. It is also elevated in space occupying lesions of the liver. The increase in ALP activity is usually great in space occupying lesions of the liver, such as carcinoma, amebic abscess, amyloidosis, and granulomatous lesions (sarcoidosis, tuberculosis of the liver). Serum ALP activity is increased in all bone disorders, accompanied by increased osteoblastic activity. Such disorders include Paget's disease (osteitis deformers), osteoblastic tumors with metastases, hyperparathyroidism when mobilization of Ca and P from bone exists, rickets, and osteomalacia. Serum ALP activity is also increased in liver disease, particularly in disorders of the hepatic biliary tree and during the third trimester of pregnancy owing to the contribution of a placental isoenzyme of ALP that is absorbed into the maternal bloodstream. Low levels of ALP are found in hypophosphatasia, a rare congenital defect in dwarfs resulting from depressed osteoblastic activity, in hypothyroidism, and in pernicious anemia. Deficiencies of thyroid hormone in hypothyroidism and of vitamin B12 in pernicious anemia are responsible for the lowered serum ALP activity. Page 2 of 5

3 Alanine aminotransferase Asparate aminotransferase Total bilirunin The concentration of ALT is not nearly as great as that of AST. ALT is present in moderately high concentrations in liver, but is low in cardiac and skeletal muscles and other tissues. Its use for clinical purposes is primarily for the diagnosis of intracellular hepatic disease. ALT is the more specific transaminase for the liver, and is elevated in the presence of hepatocellular necrosis. Measurement can be helpful in distinguishing hepatocellular jaundice from obstructive jaundice, as ALT shows marked elevations in hepatocellular jaundice and only mild elevations in obstructive jaundice. The rise in serum aminotransferase activity in viral hepatitis begins early in the disease and reaches a maximum during the acute stage of the disease when destruction of hepatic cells is at its height. Peak rises in aminotransferase after acute chemical toxicity occurs within 24 hr and decline rapidly by the second day. Moderate elevations occur in cholestasis, cirrhosis, hepatic tumors, infections and infectious mononucleosis. AST is found in practically every tissue in the body, including red blood cells, and is in particularly high concentrations in cardiac muscle and liver, intermediate in skeletal muscle and kidney, and in much lower concentrations in other tissues. The measurement of AST levels is most helpful in the diagnosis and monitoring of hepatocellular disease. Levels are increased because of intracellular liver damage (hepatitis, cirrhosis, hepatotoxins), after myocardial infarction, in trauma to or diseases affecting skeletal muscle, after renal infarct, and in various hemolytic conditions. Prolonged myocardial ischaemia may be accompanied by a rise in serum AST. Congestive heart failure is also associated with an increased activity of AST because of the hepatic ischaemia and anoxia that are pronounced. Bilirubin, the principal pigment of bile, is derived from the breakdown of hemoglobin when senescent red blood cells are phagocytized. Increased concentrations can develop because of a magnitude of causes such as the following: Bile pigment metabolism disorders ( excessive load of bilirubin presented to the liver such as in the case of hemolytic disease; defective transport into the hepatocyte such as in Gilbert s syndrome; congenital deficiency of the UDPG transferase enzyme system such as the Crigler-Najjar syndrome; impairment in the esterification of bilirubin such as physiologic jaundice of the newborn or HDN; disturbances in the excretion of bilirubin such as cholestasis); Hepatic dysfunction - Viral hepatitis, alcoholic liver disease, hepatic drug toxicity, cholestasis, and hepatic encephalopathy (hepatic coma). Page 3 of 5

4 Fasting Tolerance Test Random tube tubes x 4 at intervals Can be used to determine possible glucoe intolerance or insulin deficiency. The glucose level is increased in diabetes mellitis. This is a common disorder which is associated with potential complications, in particular heart, kidney and eye relating to damage of blood vessels. Used to diagnose diabetic conditions. Helpful in confirming or excluding the diagnosis of diabetes mellitis. An appointment is needed Can be used to determine possible glucoe intolerance or insulin deficiency. The glucose level is increased in diabetes mellitis. This is a common disorder which is associated with potential complications, in particular heart, kidney and eye relating to damage of blood vessels. HbA1c EDTA Measurements of glycated proteins are affective in monitoring long-term glucose control in people with diabetes mellitus. It provides a retrospective index of the integrated plasma glucose values over an extended period of time and is not subject to the wide fluctuations observed when assaying blood glucose concentrations. Glycated protein concentrations, therefore, are a valuable and widely used adjunct to blood glucose determinations in the assessment of glycemic control. However, these analytes are not reliable for the diagnosis of diabetes mellitus. Fructosamine In selected patients with diabetes mellitus there may be a need for assays that are more sensitive than glycated hemoglobin to shorter-term alterations in average blood glucose levels. Because serum proteins turn over more rapidly than hemoglobin, the concentration of glycated albumin reflects glucose control over a period of 2 to 3 weeks. Fasting hours prior An appointment is needed. The patient will be at the laboratory\ depot for +/- 2.5 hours. Fasting for hours prior A blood specimen will be taken on arrival prior to a glucose drink. 2 Further specimen will be taken at 1 hour intervals. The patient is required to be at rest for the full duration of the test. Full blood count and platelets EDTA Fructosamine is the generic name for plasma protein ketoamines. Analogous to glycated hemoglobin, measurement of fructosamine may be used as an index of the average blood glucose concentration over an extended period of time. The full blood count can be used to identify several abnormalities in the body including any type of anaemia, inflammation, infection, allergy or malignancies to mention a few. The platelet count is a useful indication for malaria infestiation as well as coagulation disease that has to do with platelet aggregation, but not with clotting factor abnormalities. Page 4 of 5

5 Erythrocyte sedimentation rate Transferrin Urine Biochemistry & Microscopy Urine albumin (Protein) EDTA Clean catch urine\ Urine bottle Random or timed urine \ Urine bottle This test depends on the forces between red blood cells, which can be influenced by specific proteins. These proteins are produced during inflammation, infection and certain types of malignancies. It is only an indication (screening test) that there is some or other abnormality, it can not be used to identify specific abnormalities. Transport of iron from one organ to another is accomplished by a plasma iron transport protein called apotransferrin. Transferrin concentration on its own is of no clinical importance and should always be evaluated as part of the total iron binding capacity or transferrin saturation. It is increased in iron overload states (haemochromatosis, hemosiderosis), hemolytic anaemias, acute hepatitis, and pernicious anemia in relapse. The saturation is decreased in iron deficiency anemia, late pregnancy, infection, neoplasia, and after acute hemorrhage. It is a valuable tool in the identification of urinary tract infections The amount of protein normally excreted in urine is not detectable by these methods. Proteinuria usually indicates injury to the glomerular membrane. Excessive albumin loss through the kidneys, into the urine can be one of the earliest indicators of kidney disease. It must however be differentiated from transient proteinuria (high fever conditions), or orthostatic proteinuria (extremely active people). 2 to 4 days Clotting tube \ = Yellow top tube EDTA tube = Purple top tube Sodium Floride tube = Grey top tube Page 5 of 5