B Lab Tests

Liver & Kidney Health, General Health & Wellness

Theoretically, direct bilirubin should not be increased in hemolytic anemias, in which bilirubin increase should be in the indirect bilirubin fraction in the absence of complications. In practice, some increase in the direct fraction may be encountered in patients with hemolytic anemia in whom complications have not been proven. Some methods have shown the direct bilirubin to be spuriously high. This may be due to different concentrations of sodium nitrite, which may convert some of the unconjugated bilirubin to conjugated bilirubin.1,2Direct bilirubin is the water soluble fraction. When increased in serum, bilirubin should become positive in the urine. Physiologic jaundice, occurring two to four days after birth, is due to lack of liver glucuronyl transferase.

Liver & Kidney Health, General Health & Wellness

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Allergy Testing

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Allergy Testing

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Autoimmune & Inflammation

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Allergy Testing

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Allergy Testing

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Allergy Testing

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Allergy Testing

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Allergy Testing

Peppercorns are the fruit of the Piper nigrum flowering vine plant. Black peppercorns are dried, unripe fruits that have been cooked.

Allergy Testing

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Allergy Testing

Offered as part of multiple lab tests

Allergy Testing

Offered as part of multiple lab tests

Allergy Testing

Offered as part of multiple lab tests

General Health & Wellness, Liver & Kidney Health

This panel comprises a group of 8 specific tests that provide information on the status of an individual?s blood electrolytes, glucose levels, kidney status, and acid-base balance. The panel is usually ordered as part of a routine health examination or physical [1].The Basic Metabolic Panel is also commonly ordered during hospital and emergency-room admission, and to monitor the metabolism and vital signs of hospitalized individuals with conditions, such as hypertension, who are being treated with diuretics or other appropriate interventions. [1].Significant changes in electrolytes, acid-base balance, renal function, and blood glucose may be associated with kidney failure, respiratory distress, and impaired cognitive status. Changes in sodium, potassium, and calcium alter the excitability of neurons, cardiac, and skeletal muscles that can produce arrhythmias, weakness, and spasms/tremors [1].Basic metabolic panel test results are usually evaluated in conjunction with one another for patterns of results. A single abnormal test result could be indicative of something different than if more than 1 of the test results are abnormal. Many conditions can cause abnormal results, including kidney failure, respiratory distress, and diabetes-related complications [1].The section below outlines the roles of the analytes assessed with this panel [1].Sodium: Plays a central role in maintaining the normal distribution of water and osmotic pressure.Potassium: Essential for proper muscle and nerve function.Chloride: Helps keep the balance of fluids, maintain blood volume, stabilize blood pressure, and balance the pH of body fluids.CO2 (carbon dioxide, bicarbonate): Used to evaluate the total carbonate buffering system and acid-base balance.Glucose: A critical energy source for cells and organs. Used to diagnose diabetes and hypoglycemia.Calcium: Essential for nerve, muscle, and heart functions and bone formation.BUN (blood urea nitrogen): Evaluation of kidney function.Creatinine: Useful for diagnosis of renal insufficiency and estimation of glomerular filtration rate.References1. Rao LV, et al. Laboratory tests. In Rao LV, eds.Wallach's Interpretation of Diagnostic Tests. Pathways to Arriving at a Clinical Diagnosis.11th ed. New York, NY: Wolters Kluwer; 2020, 6-463.

Diabetes & Blood Sugar

The BUN/Creatinine ratio is useful in the differential diagnosis of acute or chronic renal disease. Reduced renal perfusion, e.g., congestive heart failure, or recent onset of urinary tract obstruction will result in an increase in BUN/Creatinine ratio. Increased urea formation also results in an increase in the ratio, e.g., gastrointestinal bleeding, trauma, etc. When there is decreased formation of urea as seen in liver disease, there is a decrease in the BUN/Creatinine ratio. In most cases of chronic renal disease the ratio remains relatively normal.

Allergy Testing

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Allergy Testing

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Allergy Testing

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Autoimmune & Inflammation

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Allergy Testing

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Allergy Testing

Offered as part of multiple lab tests

Allergy Testing

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Allergy Testing

The determination of allergen-specific IgE antibodies is a very sensitive first-order test for allergic disease. The presence of IgE antibodies to black olive is highly predictive of the likelihood that the individual will exhibit immediate hypersensitivity upon exposure to the allergen.

Allergy Testing

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Allergy Testing

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Allergy Testing

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Allergy Testing

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Infectious Diseases, General Health & Wellness

Sequential blood cultures in nonendocarditis patients using a 20 mL sample resulted in an 80% positive yield after the first set, a 90% yield after the second set, and a 99% yield after the third set. Volume of blood cultured seems to be more important than the specific culture technique being employed by the laboratory. The isolation of coagulase-negativeStaphylococcusposes a critical and difficult clinical dilemma. Although coagulase-negativeStaphylococcusis the most commonly isolated organism from blood cultures, only a few (6.3%) of the isolates represent “true” clinically significant bacteremia.2Conversely, coagulase-negativeStaphylococcusis well recognized as a cause of infections involving prosthetic devices, cardiac valves, CSF shunts, dialysis catheters, and indwelling vascular catheters.3Ultimately, the physician is responsible for determining whether an organism is a contaminant or a pathogen. The decision is based on both laboratory and clinical data. Frequently this determination includes patient data (ie, patient history), physical examination, body temperatures, clinical course, and laboratory data (ie, culture results, white blood cell count, and differential). The number of positive cultures as defined by a venipuncture is the most relevant criterion to use in determining whether an isolate is a contaminant. Clinical experience and judgment may play a significant role in resolving this clinical dilemma.4In patients who have received antimicrobial drugs, four to six blood cultures may be necessary. Any organism isolated from the blood is usually tested for susceptibility. It is not recommended to culture blood while antimicrobials are present unless verification of an agent's efficacy is needed. This is confirmed with a single culture.The diagnosis of bacterial meningitis is accomplished by blood culture, as well as culture and examination of the cerebrospinal fluid.5Most children with bacterial meningitis are initially bacteremic.6See tables.Blood Culture CollectionClinical Disease SuspectedCulture RecommendationRationalSepsis, meningitis osteomyelitis, septic arthritis, bacterial pneumoniaTwo sets of cultures—one from each of two prepared sites, the second drawn after a brief time interval, then begin therapy.Assure sufficient sampling in cases of intermittent or low level bacteremia. Minimize the confusion caused by a positive culture resulting from transient bacteremia or skin contamination.Fever of unknown origin (eg, occult abscess, empyema, typhoid fever, etc)Two sets of cultures—one from each of two prepared sites, the second drawn after a brief time interval (30 minutes). If cultures are negative after 24 to 48 hours obtain two more sets, preferably prior to an anticipated temperature rise.The yield after four sets of cultures is minimal. A maximum of three sets per patient per day for three consecutive days is recommended.EndocarditisAcuteObtain three blood culture sets within two hours, then begin therapy.95% to 99% of acute endocarditis patients (untreated) will yield a positive in one of the first three cultures.SubacuteObtain three blood culture sets on day one, repeat if negative after 24 hours. If still negative or if the patient had prior antibiotic therapy, repeat again.Adequate sample volume despite low level bacteremia or previous therapy should result in a positive yield.Immunocompromised Host (eg, AIDS)Septicemia, fungemia mycobacteremiaObtain two sets of cultures from each of two prepared sites; consider lysis concentration technique to enhance recovery for fungi and broth systems for recovery of mycobacteria.Low levels of fungemia and mycobacteremia frequently encountered.Previous Antimicrobial TherapySepticemia, bacteremia; monitor effect of antimicrobial therapyObtain two sets of cultures from each of two prepared sites; increased volume >10 mL/set.Recovery of organisms is enhanced by dilution and increased sample volume.Interpretation of Positive Blood Cultures**Adapted from Flournoy DJ, Adkins L. Understanding the blood culture report.Am J Infect Control.1986 Feb; 14(1):41-46.Virtuallyanyorganism, including normal flora,cancause bacteremia.A negative culture result does not necessarily rule out bacteremia; false-negative results occur when pathogens fail to grow.A positive culture result does not necessarily indicate bacteremia; false-positive results occur when contaminants grow.Gram-negative bacilli, anaerobes, and fungi should be considered pathogens until proven otherwise.The most difficult interpretation problem is to determine whether an organism that is usually considered normal skin flora is a true pathogen.

Infectious Diseases

Patients with acute infection develop IgG, IgM, and IgA antibodies to fimbrial agglutinogens, and IgM and IgA antibodies are probably diagnostic. Following vaccination, IgG and IgM antibodies can be demonstrated. IgG antibodies can only be used to diagnose acute infection when paired sera are available and a rise in antibody level can be demonstrated.

Digestive Health, Liver & Kidney Health

The concentration of bile acids in serum is elevated in patients with many structural liver diseases, due to the inability of the liver to extract bile acids efficiently from portal blood. Metabolic liver diseases such as Gilbert disease, Crigler-Najjar syndrome, or Dubin-Johnson syndrome do not appear to cause elevated bile acid concentrations. Bile acid levels may be altered even when other liver function tests are normal and may serve as a sensitive and specific indicator of liver disease.Intrahepatic cholestasis of pregnancy (ICP) is a temporary condition caused by maternal liver dysfunction during pregnancy. It is characterized by intense generalized pruritus (itchiness) which usually begins in the third trimester. ICP is also known as cholestatic jaundice of pregnancy, cholestatic hepatosis, icterus gravidarum, and obstetric cholestasis.There are several laboratory tests which can be done to confirm a diagnosis of cholestasis of pregnancy, including bile acids. Maternal blood levels of bile salts are often at least three times the normal level in ICP; however, the levels may be 10 to 100 times normal. Blood tests can also reveal increased levels of other liver enzymes that indicate general liver dysfunction, such as ALT, AST, and alkaline phosphatase. While ALT/AST levels may be normal or slightly elevated, alkaline phosphatase levels are almost always higher than normal (though this may be due, in part, to the alkaline phosphatase added to the mother's blood from the placenta). However, if the liver enzymes are extremely elevated, other causes, such as viral hepatitis, should be considered. In the absence of bile acid tests, elevated ALT, AST and/or alkaline phosphatase levels in the setting of intense pruritus are generally adequate to diagnose cholestasis of pregnancy.Though it may cause extreme discomfort, cholestasis of pregnancy is regarded as benign to the mother; however, it has been widely established that ICP poses a significant increased risk to the fetus and is associated with an increased incidence of stillbirth. Fetal death in ICP is a real risk and the primary objective of treatment is to make certain that the baby is born before stillbirth occurs. While the fetal death rate for untreated patients is around 10%, studies in which patients are induced before term have found fetal mortality rate to be 0% to 2%. The danger from ICP is eliminated when the child is safely delivered and labor is induced when the fetus' lungs are mature, regardless of any other test results.After delivery, the symptoms in the mother usually decrease within 48 hours of delivery and disappear completely within four weeks postpartum. Cholestasis of pregnancy does not cause permanent liver impairment to the mother and the liver returns to normal function, once the baby is delivered.

Infectious Diseases

Offered as part of multiple lab tests

Diabetes & Blood Sugar

In diabetics, the measurement of B-hydroxybutyrate as well as blood glucose is needed for the assessment of the severity of diabetic coma and is essential for the exclusion of hyperosmolar non-ketotic diabetic coma. A specific enzymatic assay for Beta-hydroxybutyrate is extremely important in the assessment of ketosis.

Liver & Kidney Health

Beta-2-Microglobulin (B2M) is a low molecular weight protein that forms the light chain component of the histocompatibility antigen. It is synthesized by all nucleated cell types. It is an integral part of the class I MHC antigens and is present in all body fluids. B2M is filtered through the glomeruli of the kidney and is then reabsorbed and catabolised by the proximal tubular cells. In normal patients only trace amounts of B2M appear in the urine. Elevated urine B2M is seen in tubulo-interstitial disorders. Increased urine B2M is seen in cadmium exposure, diatrizoate, exercise, fever, nephrectomy, semen. There is evidence that monitoring B2M levels in HIV-infected individuals offers an independent predictor of progression to AIDS, leukemia and lymphoma.

Heart Health & Cardiovascular

B-type natriuretic peptide (BNP), also referred to as brain natriuretic peptide, is a member of a family of structurally similar peptide hormones that includes atrial natriuretic peptide.1BNP is a 32-amino-acid peptide that contains a 17-amino-acid ring structure that is formed as the result of an internal disulfide bond. BNP is predominantly secreted by the ventricles of the heart in response to increased pressure. BNP acts as a vasodilator and has diuretic and natriuretic properties. BNP suppresses both sympathetic tone and the renin-angiotensin system. These physiologic effects serve to reduce intraventricular pressure and improve the symptoms of congestive heart failure (CHF).BNP levels increase with age and can be transiently increased by vigorous exercise.1,2BNP levels correlate with end-diastolic pressure and tend to be increased in patients with diminished left ventricular ejection fraction.1,3BNP levels have been shown to be useful in the diagnosis of patients with symptoms that are consistent with CHF. Maisel and coworkers4found that a BNP cutoff of 75 pg/mL could be used to predict systolic and/or diastolic abnormalities accurately in symptomatic patients referred to echocardiology for left ventricular function studies. They found that this cutoff identified patients with abnormal function from a population of 200 patients with a sensitivity of 95.9%, specificity of 86%, positive predictive value of 98%, and a negative predictive value of 89%. The overall accuracy of the diagnosis with a cutoff of 75 pg/mL was 93%. These results were similar to those found by Dao and coworkers.5They found that BNP levels could be used to accurately identify patients with CHF from a population of patients presenting at the emergency room with shortness of breath (dyspnea). They found that a BNP value >80 pg/mL could be used to identify patients with CHF from this population with a sensitivity of 97%, specificity of 98%, positive predictive value of 92%, and a negative predictive value of 98%.6

Cancer Screening

Beta-2-microglobulin normally passes through the glomerulus into the proximal tubule where much of it is reabsorbed. Serum levels are therefore an index of glomerular function. When impaired, serum levels rise in inverse ratio to glomerular filtration rate. Increased amounts of beta-2-microglobulin are excreted in several renal disorders, e.g., Balkan nephropathy, heavy metal poisoning and renal tubular disease due to therapeutic agents. Serial levels of beta-2-microglobulin in serum and urine are used to evaluate transplant viability and anticipate rejection. Following a successful graft, serum levels decline toward normal. Increasing serum levels provide an early sign of rejection. Elevated levels are also noted in lymphproliferative disorders, neoplasms (malignant and benign), inflammatory disease, and autoimmune diseases such as systemic lupus erythematosus (SLE) and Sjögren's disease.

Infectious Diseases

Antibody levels above the reference range are highly suggestive of recent infection or vaccination.

Heart Health & Cardiovascular

BNP is increased in congestive heart failure, left ventricular hypertrophy, acute myocardial infarction, coronary angioplasty, and hypertension. Elevations are also observed in pulmonary hypertension (indicating right ventricular dysfunction), acute lung injury, hypervolemic states, chronic renal failure and cirrhosis. Decreasing levels indicate therapeutic response to anti-hypertensive therapy.

Nutrition & Vitamins

Offered as part of multiple lab tests

Infectious Diseases

This antibody panel helps diagnose infections withBartonella henselaeandBartonella quintana.This panel includes IgM and IgG antibodies with reflexes to titers for positive results.B henselaecauses cat scratch disease, a self-limiting bacterial infection transmitted via exposure to cats or cat fleas.B quintanacauses trench fever, a febrile bacteremic illness transmitted via body lice.B henselaeandB quintanaare the 2Bartonellaspecies that most frequently cause blood culture-negative endocarditis. In immunocompromised individuals, infections withB henselaeand B quintanamay present as bacillary angiomatosis, a vasculoproliferative disease of the skin [1-4].Because of the fastidious nature ofB henselaeand B quintana, recovery of these bacteria is rarely successful, especially from blood. Serology is commonly used for diagnosingBartonellainfections [1,3]. Confirmation of recent or current infection with eitherB henselaeorB quintanamay require testing of serial specimens to demonstrate a 4-fold increase of IgG titers or the presence of IgM. AB henselaeorB quintanaIgG titer of 1:800 has been proposed as a major criterion for diagnosingBartonellaendocarditis [4].IgG cross-reactivity betweenB henselaeandB quintanaoften occurs [1,3]. Qualitative real-time polymerase chain reaction is a highly specific and sensitive method to detect the presence ofBartonellaspecies DNA in clinical specimens and can differentiate betweenB henselaeandB quintana.The results of this test should be interpreted in the context of pertinent clinical history and physical examination findings.References1. Dumler JS, et al.Bartonella. In: Carroll KC, et al, eds.Manual of Clinical Microbiology.12th ed. ASM Press; 2019.https://www.clinmicronow.org/doi/book/10.1128/9781683670438.MCM.ch502. Centers for Disease Control and Prevention.Bartonellainfection (cat scratch disease, trench fever, and Carrion's disease). Last reviewed December 18, 2019. Accessed January 28, 2022.https://www.cdc.gov/bartonella/clinicians/index.html3. Miller JM, et al.Clin Infect Dis. 2018;67(6):813-816.4. Okaro U, et al.Clin Microbiol Rev. 2017;30(3):709-746.

Heavy Metals & Toxins

Offered as part of multiple lab tests

Diabetes & Blood Sugar

Measurement of the levels of bilirubin is used in the diagnosis and treatment of liver, hemolytic, hematologic, and metabolic disorders, including hepatitis and gall bladder obstruction. The assessment of direct bilirubin is helpful in the differentiation of hepatic disorders. The increase in total bilirubin associated with obstructive jaundice is primarily due to the direct (conjugated) fraction. Both direct and indirect bilirubin are increased in the serum with hepatitis.

Sexual Health & STDs, Women's Health

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Heavy Metals & Toxins

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Heavy Metals & Toxins

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Infectious Diseases

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Heavy Metals & Toxins

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Heavy Metals & Toxins

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Mental Health & Neurological

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Drug & Alcohol Testing

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Nutrition & Vitamins

This panel of LC/MS/MS assays measures Beta-Amyloid 42/40 Ratio and ApoE Isoform and Total ApoE in CSF. Test results are further analyzed by an algorithm that calculates a risk assessment score. Based on this score, patients are categorized as low, intermediate, or high risk of having AD.

Nutrition & Vitamins

Biotin, vitamin B7, or vitamin H, is a water soluble vitamin. The vitamin plays a role in the transferring of carbon dioxide in the metabolism of fat, carbohydrate and protein by functioning as an enzyme cofactor. It is involved in multiple biochemical reactions including niacin metabolism, amino acid degradation, and the formation of purine, which is an integral part of nucleic acids. It interacts with histone by the action of biotinyl-transferase. Sometimes the vitamin is used in weight reduction programs. It may be prescribed as a supplement for diabetic patients due to its role in carbohydrate metabolism. Biotin is commonly found in vitamin B complex and many food sources, such as milk, yeast, egg yolk, cereal, and mushrooms. The reference daily intake [RDI of 101.9(c) (8) (IV)] for vitamin B7 is 300 micrograms. Deficiency in the vitamin may result in seborrheic dermatitis, alopecia, myalgia, hyperesthesia, and conjunctivitis. Disorders of biotin metabolism can be acquired or congenital. Biotinidase and holocarboxylase synthethase deficiency are the two better known forms of disorders. The lack of biotin-dependent pyruvate carboxylase, propionyl-CoA carboxylase, methylcrotonyl-CoA carboxylase, and acetyl-CoA carboxylase can lead to the life-threatening disorder of multiple carboxylase deficiency. Treatment involves a daily dose of approximately 10 mg biotin/day. Irreversible mental or neurological abnormalities may result from delayed clinical intervention.

Infectious Diseases

This test is intended for the qualitative detection of Borrelia DNA in whole blood, CSF, synovial fluid, or ticks.Borreliaare spirochetes and are commonly classified into two categories: those that cause Lyme disease(Lyme borreliosis)and those that cause relapsing fever. This test detects species in both categories.Borrelia are typically transmitted to humans via the bite of an infected tick, including hard-bodied ticks of the generaAmblyommaandIxodesand soft-bodied ticks of the generaOrnithodoros.Lyme disease, the most common tick-borne infection in the United States, is marked by three stages: 1) local infection, which can include an erythema migrans or "bull's eye" skin lesion and/or flulike symptoms; 2) disseminated infection, which is typically marked by cardiac, neurological and/or skin manifestations; and 3) persistent infection, which can include Stage 2 manifestations as well as rheumatological involvement, most commonly joint pain.Relapsing fever is marked by febrile periods lasting about three days that alternate with afebrile periods include muscle and joint pain, headache, vomiting and dizziness.Diagnosis of Borrelia infections is normally based on clinical findings and serological assays. PCR testing can serve as an adjunct to serology, especially during the early stages of infection before antibodies have developed.

Digestive Health, Autoimmune & Inflammation

Disorders of the lower gastrointestinal tract in adults and children are among the most common conditions and may pose a difficult diagnostic problem. They account for 1 in 20 of all general practitioner consultations and their symptoms are frequently ill-defined.1Those disorders include a wide range of pathologic conditions, including irritable bowel syndrome (IBS), inflammatory bowel disease (IBD) that includes Crohn's disease (CD), ulcerative colitis (UC), and indeterminate colitis; microscopic colitis, infectious colitis, small intestinal bacterial overgrowth, celiac disease, and colon neoplasia (including colon cancer).2The most prevalent condition is IBS. Its prevalence in Europe and North America is estimated to be 10% to 15%.3Prevalence of celiac disease increased at least four times during the last 50 years and approaches 0.9%.4The incidence rate of Crohn’s disease increased from 0.1 (three decades ago) to 4.6 (in 2003) per 100,000 children and the incidence of UC from 0.5 to 3.2 per 100,000 children.5The prevalence of IBD in the adult population is approaching 0.3%.6Recently another condition termed “gluten sensitivity” emerged as an important and often underdiagnosed and undertreated disease.7-11It is reported that as many as 12% of the healthy population may have serological evidence of gluten sensitivity.9Difficulties in differential diagnosis of those conditions often prompt clinicians to use an exclusion approach by performing tests to rule out the alternative etiologies.2Interestingly, one study shows that most of the celiac disease serological test requests are now from general practitioners rather than gastroenterologists.12Another study reports that 72% of general practitioners endorsed IBS as a diagnosis of exclusion.2Endoscopy with biopsies for histological examination remains the gold standard for the diagnosis of many of these conditions.13In recent years, however, introduction of a number of new and improved serological tests may allow for reduction in the number of intestinal biopsies.14The cascade includes three testing steps:Step 1: Celiac Disease Screen:The cascade begins with a celiac screen that includes testing for tTG IgA and DGP IgG.10When any or both of the results are positive, the testing stops and the interpretive comment on the report would read: “Suggestive of celiac disease or other gluten-sensitive enteropathies. Subsequent testing forEndomysial Antibody, IgA [164996]and/or genetic testing forCeliac Disease HLA DQ Association [167082]may be indicated for further patient evaluation.” When the result is negative, the testing reflexes to the second step.Step 2: Inflammatory Bowel Disease Screen:Inflammatory bowel disease screen includes testing for IgG antibodies to anti-Saccharomyces cerevisiae(ASCA) and atypical perinuclear antineutrophil cytoplasmic antibodies (pANCA). This profile of tests aids in the serological identification of patients with IBD and in differentiation among its three clinical forms: CD, UC, and indeterminate colitis. When the marker for CD (ASCA IgG) is positive, the clinical sensitivity for CD is reported to be as high as 74.4% and specificity for IBD as high as 94.4%.15When atypical pANCA (a marker of UC) is positive, the clinical sensitivity for UC is reported to be as high as 70% and specificity as high as 80%.16It must be emphasized that neither of the markers negatively rules out IBD. Similarly, the presence of these antibodies does not strictly confirm the diagnosis of IBD.17Testing for Step 2 is described below and (depending on the combination of results) the interpretive comment on the report would be one of the following: When ASCA IgG is positive and atypical pANCA is negative, testing stops and the comment would read: “Suggestive of Crohn's disease. Subsequent testing with theCrohn's Disease Prognostic Profile [162020]that includes antiglycan antibodies AMCA, ALCA, ACCA, and gASCA may aid in the differentiation of clinical forms of CD and prognosis of disease progression.” When ASCA IgG is negative or equivocal and atypical pANCA is positive testing stops and the comment would read: “Suggestive of ulcerative colitis.” When both ASCA IgG and atypical pANCA are positive testing stops and the comment would read: “Suggestive of IBD. Subsequent testing with theCrohn's Disease Prognostic Profile [162020]that includes antiglycan antibodies AMCA, ALCA, ACCA, and gASCA may aid in the differentiation of clinical forms of IBD and prognosis of disease progression.” When all results are negative, then the testing reflexes to the third step.Step 3: Nonceliac Gluten Sensitivity Screen:The nonceliac gluten sensitivity screen includes testing for IgG antibodies to gliadin with reported clinical sensitivity as high as 87% (for untreated clinically defined celiac disease patients) and specificity as high as 91%.18Recent reports show that there is a significant subset of patients who have normal histology for celiac disease, negative for antibodies to DGP and tTG, positive for antigliadin antibodies and clinically indistinguishable from those with celiac disease. Those patients constitute the so-called “nonceliac gluten sensitivity” group, and many of them will benefit from a gluten-free diet. This group of patients is also reported to have increased mortality.7-10,14When the result is positive, the testing stops and the interpretive comment on the report would read: “Suggestive of nonceliac gluten sensitivity. The patient may benefit from a gluten-free diet.” When all results are negative, the testing stops and the interpretive comment on the report would read: “Suggestive of irritable bowel syndrome (IBS). Careful evaluation of the patient's history, physical examination, and application of Rome III diagnostic criteria may help to rule in or rule out the diagnosis of IBS. Subsequent testing forCalprotectin, Fecal [123255]may be recommended. If IBD is strongly suspected, subsequent testing with theCrohn's Disease Prognostic Profile [162020]that includes antiglycan antibodies AMCA, ALCA, ACCA, and gASCA may aid in differential diagnosis.”

Nutrition & Vitamins

This test is used to determine the presence of BK Virus DNA in patients' specimens. Detection of the virus in these specimens may be indicative of an active infection, as PCR detects the presence of the virus, and not the host's reaction to the virus. Polyomavirus BK DNA detection in urine is associated with an increased risk of graft rejection in renal transplant recipients.

Nutrition & Vitamins

This test detects and quantitates BK Virus DNA in urine specimens of kidney transplant recipients who are at risk of developing BKV-associated nephropathy (BKVAN) and associated hemorrhagic cystitis leading to kidney failure. Prospective viral load monitoring of BKV DNA in urine (and plasma) is useful to exclude a diagnosis of BKVAN and to monitor the course of BKV infection. The assay is calibrated to the First World Health Organization International Standard for BKV DNA with a Reportable Range of 200-100,000,000 IU/mL (2.30-8.00 log IU/mL).

Infectious Diseases

Offered as part of multiple lab tests

Infectious Diseases

Offered as part of multiple lab tests

Infectious Diseases

Offered as part of multiple lab tests

Infectious Diseases

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Infectious Diseases

BartonellaDNA PCR is a highly specific and sensitive method to detect the presence ofBartonellaspecies DNA in clinical specimens. This assay can differentiate betweenBartonella henselaeandBartonellaquintana. The diagnosis ofBartonellainfection should not rely solely on the result of a PCR assay. A negative PCR result indicates only the absence ofBartonellaspecies DNA in the sample tested and does not exclude the diagnosis of the disease. Patients with a positive PCR result should be evaluated with other tests to further establish the diagnosis of the disease. A positive result should be considered in conjunction with clinical presentation and additional established clinical tests.

Cancer Screening, Blood Disorders

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Autoimmune & Inflammation, Blood Disorders

Monoclonal antibody-based therapies block available CD20-binding sites and, therefore, the antibody used for this flow cytometric assay cannot recognize the CD20 molecule on B cells. The concomitant use of the CD19 marker provides information on the extent of B-cell depletion when using this particular treatment strategy. This Flow Cytometry panel is also useful for confirming the complete absence of B cells in suspected primary humoral immunodeficiencies.