D Lab Tests

Allergy Testing

See Thermo Scientific.

Allergy Testing

See Thermo Scientific.

Allergy Testing

See Thermo Scientific.

Heart Health & Cardiovascular

Be sure the patient is not on digitoxin instead of digoxin. Digitoxin is also an active component of digitalis leaf. The 2013 ACCF/HCA Guidelines for Management of Heart Failure suggest a therapeutic range of 0.5 -0.9 ng/mL for digoxin. Ninety percent of nontoxic patients have levels ≤2.0 ng/mL, 87% of toxic patients have levels >2.0 ng/mL. Levels >3.0 ng/mL in adults are strongly suggestive of overdosage. However,digitalis levels must always be interpreted in light of clinical and chemical data. Older, smaller patients require less digoxin. Proportionally lower loading doses are advocated in the elderly.1The primary cause of digoxin toxicity in the aged is decreased renal function. Maintenance doses should be adjusted to the glomerular filtration rate.1Renal failure, hypercalcemia, alkalosis, myxedema, hypomagnesemia, recent MI and other acute heart disease, hypokalemia, and hypoxia may increase sensitivity to the toxic effects of digoxin.Quinidinemay cause elevation of digoxin level by decreasing its excretion.2,3It is recommended that serum digoxin concentration be measured before initiation of quinidine therapy and again in four to six days.When confronted with unexpectedly low digoxin levels, consider thyroid disease, malabsorption, cholestyramine, colestipol, kaolin, pectin, neomycin, sulfasalazine, anticholinergic drug effects, and reduced intestinal blood flow from mesenteric arteriosclerosis. Consider as well congestive failure when low digoxin levels are encountered.Patients withdigitalis resistancemay require larger doses and higher than usual serum levels (eg, patients with hyperthyroidism).The probability that a patient will take a drug exactly as the physician has prescribed it has been shown to be hardly better than half. The probability is less among elderly patients getting a large number of medications. Measure trough, because of variability of peak interval.FAB fragments of digoxin-specific sheep antibodies are available for the treatment of digoxin toxicities but should be limited to potentially life-threatening overdoses.Compounds with “digoxin-like” immunoreactivity are present in a variety of clinical states associated with salt and fluid retention (eg, renal failure, pregnancy third trimester, congestive heart failure) and are also present during the first two weeks of neonatal life. These compounds (DLF−digoxin-like factors, etc) cross react with digoxin-specific immunoassays and give falsely elevated plasma digoxin levels. Laboratories must evaluate new antibody preparations for cross reactivity with the factors.

Anti-Aging

DHEA-S is a steroid hormone which is produced from the precursor cholesterol in the zona reticularis and broad fascia of the adrenal cortex.1The determination of elevated DHEA-S values is an important aid in the diagnosis of hirsutism and virilism.2,4In addition to a differential diagnosis of hirsutism and virilism, further indications for this parameter are all forms of androgenization, hyperprolactinemia, polycystic ovarian syndrome, and the exclusion of an androgen-producing tumor of the adrenal cortex.2DHEA-S exhibits only a weak androgenic activity but can be metabolized to more active androgens, such as androstenedione and testosterone, which can indirectly cause hirsutism and virilism.2,5From 7 years of age onwards, an increase in DHEA-S levels is observed which then gradually after the age of 30 begins to fall again.6Only elevated DHEA-S concentrations are of clinical importance; other factors which can be responsible for DHEA-S excess production are genetic enzyme defects of the adrenal cortex (adrenogenital syndrome),7hyperplasia of the adrenal cortex, as well as androgen-producing tumors.2The rate of secretion of DHEA-S into the blood stream is only slightly more than the rate observed for DHEA. As a consequence of the DHEA-S half-life of approximately one day, the DHEA-S level is, however, about a thousand-fold greater.8DHEA-S is relatively strongly bound to albumin, only a small portion is nonprotein bound, and none appears to be bound to sex hormone-binding globulin (SHBG).9Due to its high concentration and low inter- and intra-day variability, DHEA-S is an excellent indicator of adrenal cortex androgen production.8,10Together with testosterone, DHEA-S assays represent the assay of choice for initial screening tests to determine whether androgen values are elevated in hirsutism. Approximately 84% of the women suffering from hirsutism exhibit elevated androgen levels.11The main purpose of this is to exclude the presence of androgen-producing tumors (from the adrenal cortex or the ovaries).7

Diabetes & Blood Sugar

Offered as part of multiple lab tests

Heart Health & Cardiovascular, Diabetes & Blood Sugar

LDL cholesterol is a key factor in the pathogenesis of atherosclerosis and Coronary Artery Disease (CAD), while HDL cholesterol has often been observed to have a protective effect. Even within the normal range of total cholesterol concentrations, an increase in LDL cholesterol can produce an associated increased risk for CAD. LDL cholesterol binds to receptor sites on macrophages in blood vessel walls inciting several changes to the blood wall which enhance atherosclerotic plaque development.

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

Allergy Testing

Offered as part of multiple lab tests

Allergy Testing

This allergen-specific IgE antibody test quantifies an individual’s IgE response to duck feathers. It is an in vitro quantitative assay that is intended to be used in conjunction with other clinical information to aid in the diagnosis of allergic diseases [1].While allergen-specific serum IgE testing is considered comparable to skin testing in many instances, both the American Academy of Allergy, Asthma, and Immunology and the American College of Allergy, Asthma, and Immunology recognize that allergen-specific serum IgE testing may be preferred in some clinical situations. These include 1) the presence of widespread skin disease, 2) the recent use of antihistamines or other medications that can affect the results of allergy skin tests, 3) uncooperative patients, and 4) medical history suggesting that allergen skin testing would pose a significant risk for a serious allergic reaction [1].A definitive clinical diagnosis of allergy should not be based on the results of any single diagnostic method, but should be made by a trained healthcare provider after all clinical and laboratory findings have been evaluated.More specific information about this allergen can be found athttp://www.phadia.com/en/Products/Allergy-testing-products/ImmunoCAP-Allergen-Information/Epidermals-and-Animal-Proteins/Allergens/Duck-feathers/Reference1. Bernstein IL, et al.Ann Allergy Asthma Immunol.2008;100(Suppl 3):S1-S148.

Heart Health & Cardiovascular

Coagulation activation results in the cleavage of fibrinogen to fibrin monomer.7,8The fibrin monomers spontaneously aggregate to fibrin and are cross-linked by factor XIII; this produces a fibrin clot. In response to the coagulation process the fibrinolytic system is activated resulting in the conversion of plasminogen into plasmin, which cleaves fibrin (and fibrinogen) into the fragments D and E. Due to cross-linkage between D-domains in the fibrin clot, the action of plasmin releases fibrin degradation products with cross-linked D-domains. The smallest unit is D-dimer. Detection of D-dimers, which specifies cross-linked fibrin degradation products generated by reactive fibrinolysis, is an indicator of coagulation activity. Fibrin degradation products are not consistently "D-dimer" but are a mixture of fragments and complexes of different molecular weight. The presence of D-dimer confirms that both thrombin and plasmin have been generated since it can only be produced as the result of the plasmin degradation of cross-linked fibrin. The in vivo half-life of D-dimer is approximately eight hours.11Elevated D-dimer levels are observed in all diseases and conditions with increased coagulation activation, eg, thromboembolic disease, DIC, acute aortic dissection, myocardial infarction, malignant diseases, obstetrical complications, third trimester of pregnancy, surgery, or polytrauma.12-17However, in the context of venous thromboembolism, symptoms being present since a certain period of time, eg, longer than a week, may produce normal D-dimer values.18For the diagnosis of DIC a scoring system has been suggested, in which elevated D-dimer levels represent the major indicator of DIC.12While increased levels of D-dimer are not specific for DVT or PE, low D-dimer levels may be used to rule out these conditions. The negative predictive values for DVT and PE are approaching 100% for the Innovance D-dimer assay employing a cutoff of <0.5 mg/L FEU. The negative predictive value is further enhanced through the use of a clinical probability model along with D-dimer in the decision process.12-15Values less than 0.5 mg/L FEU in an individual with a low clinical risk of venous thrombosis can serve as the basis for not performing more expensive diagnostic tests for DVT and PE. Patients with results greater than this cutoff require further diagnostic testing to establish the diagnosis.D-dimer levels are known to increase with age; eg, median D-dimer levels in apparently healthy men aged 75 to 79 are about twice as high as in men aged 60 to 64.19This increase in the basal D-dimer concentration is responsible for the decrease in the specificity of D-dimer measurements for exclusion of VTE in the elderly. Several studies on D-dimer for exclusion of venous thromboembolism (VTE) have been reëvaluated using an age-specific cutoff.20-23The aim was to improve the effectiveness of D-dimer testing in ruling out VTE.20-23The cutoff provided with the patient result is the manufacturer-determined value for exclusion of VTE; however, it has been determined that D-dimer values increase with age, and this can make VTE exclusion of an older population difficult. To address this, the American College of Physicians, based on best available evidence and recent guidelines, recommends that clinicians use age-adjusted D-dimer thresholds in patients greater than 50 years of age with:(a)a low probability of PE who do not meet all "pulmonary-embolism-rule-out criteria," or(b)in those with intermediate probability of PE.21The formula for an age-adjusted D-dimer cutoff is "age/100." For example, a 60-year-old patient would have an age-adjusted cutoff of 0.6 mg/L FEU, and an 80-year-old patient would have an age-adjusted cutoff of 0.8 mg/L FEU.

Hormone Testing, Anti-Aging

DHEA-S is the sulfated form of DHEA and is the major androgen produced by the adrenal glands. This test is used in the differential diagnosis of hirsute or virilized female patients and for the diagnosis of isolated premature adrenarche and adrenal tumors. About 10% of hirsute women with Polycystic Ovarian Syndrome (PCOS) have elevated DHEA-S but normal levels of other androgens.

Allergy Testing

This allergen-specific IgE antibody test quantifies an individual's IgE response toDermatophagoides pteronyssinus, a species of house dust mites that can cause atopic reactivity and allergic disease affecting the eyes, airways, skin, and occasionally the circulation [1]. This test is an in vitro quantitative assay that is intended to be used in conjunction with other clinical information to aid in the diagnosis of allergic diseases [2].While allergen-specific serum IgE testing is considered comparable to skin testing in many instances, both the American Academy of Allergy, Asthma, and Immunology and the American College of Allergy, Asthma, and Immunology recognize that allergen-specific serum IgE testing may be preferred in some clinical situations. These include (1) the presence of widespread skin disease, (2) the recent use of antihistamines or other medications that can affect the results of allergy skin tests, (3) uncooperative patients, and (4) medical history suggesting that allergen skin testing would pose a significant risk for a serious allergic reaction [2].A definitive clinical diagnosis of allergy should not be based on the results of any single diagnostic method but should be made by a trained healthcare provider after all clinical and laboratory findings have been evaluated.More specific information about this allergen can be found on the following web page:https://www.thermofisher.com/diagnostic-education/hcp/us/en/resource-center/allergen-encyclopedia/whole-allergens.html?key=d1References1. Miller JD.Clin Rev Allergy Immunol. 2019;57(3):312-329.2. Bernstein IL, et al.Ann Allergy Asthma Immunol.2008;100(3 Suppl 3)S1-S148.

Allergy Testing

This test quantifies an individual's IgE response to dog dander. Allergen-specific serum IgE testing is considered comparable to skin testing and may be preferred in some clinical situations. However, a positive test result only indicates that a patient is sensitized to the allergen of concern. Many IgE-sensitized individuals do not develop any symptoms when exposed to the allergen. A diagnosis of allergy should only be made by a trained medical provider after conducting a thorough clinical evaluation [1].More specific information about this allergen can be found on the following website:https://www.thermofisher.com/phadia/us/en/resources/allergen-encyclopedia.htmlReference1. Bernstein IL, et al.Ann Allergy Asthma Immunol. 2008;100(3 Suppl 3):S1-S148.

Autoimmune & Inflammation

dsDNA Antibody is detected in patients with active systemic lupus erythematosus (SLE) and approximately 20% of patients with Mixed Connective Tissue Disease.

Autoimmune & Inflammation

dsDNA Antibody is detected in patients with active systemic lupus erythematosus (SLE) and approximately 20% of patients with mixed connective tissue disease.

Drug & Alcohol Testing

Ethyl glucuronide and ethyl sulfate are metabolites of ethanol (alcohol) that may be present in urine after ingestion of, or exposure to, drinks, foods, medication or other products containing ethyl alcohol. Incidental exposure to alcohol-containing products such as mouthwash or hand sanitizer have also been shown to produce positive alcohol metabolites test results. LC-MS/MS testing detects EtG and EtS regardless of the source. Therefore, we encourage you to interpret alcohol metabolite test results in light of the clinical picture.

Nutrition & Vitamins

Dehydroepiandrosterone (DHEA) is a steroid that is produced by both the adrenal cortex and the testis.3The levels of this steroid increase before the onset of puberty (adrenarche) and decrease significantly with age.4DHEA and DHEA-S are the major precursors of 17-ketosteroids.

Hormone Testing, Anti-Aging

DHEA is a weakly androgenic steroid that is useful when congenital adrenal hyperplasia is suspected. It is also useful in determining the source of androgens in hyperandrogenic conditions, such as polycystic ovarian syndrome and adrenal tumors.

Infectious Diseases

Used to evaluate diphtheria immunization response. Antibody levels of ≥0.10 IU/mL are considered protective. For Pre and Post vaccination testing to assess normal immune response, please refer to test code 10680-Diphtheria Antitoxoid, Pre and Post Vaccination.

Autoimmune & Inflammation

The DAT (Direct Coomb's test) is positive if red cells have been coated, in vivo, with immunoglobulin, complement, or both. A positive result can occur in immune-mediated red cell destruction, autoimmune hemolytic anemia, a transfusion reaction or in patients receiving certain drugs.

Anti-Aging

Offered as part of multiple lab tests

Hormone Testing, Men's Health

Offered as part of multiple lab tests

Drug & Alcohol Testing

The test is a screening assay using a homogeneous enzyme immunoassay method of analysis. Therapeutic urine drug monitoring is important for ensuring compliance to treatment strategies, as well as ensuring non-diversion for illicit purposes. Urine or oral fluid are the specimens of choice for routine monitoring of patients taking prescription drugs. Use of serum/plasma should be limited to anuretic patients, or where a patient's clinical appearance does not coincide with their prescribed medications. No single monitoring approach provides adequate information about the pattern or dose of patient drug use. Safest prescribing habits should include a combination of tools and laboratory test results to correctly detect drug use patterns. Urine drug test results equal to or greater than cutoff are reported as positive and results less than cutoff are reported as negative.

Sexual Health & STDs

This test is intended to be used as the primary screening test for the diagnosis of infection withChlamydia trachomatisorNeisseria gonorrhoeaeand is required for screening all potential semen or egg donors for in vitro fertilization or other reproductive procedures; reactive results may be sufficient to consider a donor ineligible.

Drug & Alcohol Testing

The test is a screening assay using a homogeneous enzyme immunoassay method of analysis. Therapeutic urine drug monitoring is important for ensuring compliance to treatment strategies, as well as ensuring non-diversion for illicit purposes. Urine or oral fluid are the specimens of choice for routine monitoring of patients taking prescription drugs. Use of serum/plasma should be limited to anuretic patients, or where a patient's clinical appearance does not coincide with their prescribed medications. No single monitoring approach provides adequate information about the pattern or dose of patient drug use. Safest prescribing habits should include a combination of tools and laboratory test results to correctly detect drug use patterns. Urine drug test results equal to or greater than cutoff are reported as positive and results less than cutoff are reported as negative.

Drug & Alcohol Testing, Heart Health & Cardiovascular

Digoxin is a cardiac glycoside derived from the digitalis plant. It is used to treat congestive heart failure and atrial dysrhythmias. Digoxin levels are monitored to assure adequate therapeutic levels are achieved and to avoid toxicity.

Hormone Testing, Men's Health

DHT is a potent androgen derived from testosterone via 5-Alpha-Reductase activity. 5-Alpha-Reductase deficiency results in incompletely virilized males (phenotypic females). This diagnosis is supported by an elevated ratio of testosterone to DHT.

Diabetes & Blood Sugar

The relationship between diabetes, cardiovascular disease, and chronic kidney disease is widely recognized. Among individuals with type 2 diabetes, cardiovascular disease is the leading cause of morbidity and mortality. Chronic kidney disease occurs in 20% to 40% of patients with diabetes and may be present at the time of diagnosis.While not considered to be a clinical entity itself, individuals with prediabetes are at increased risk for diabetes and cardiovascular disease. Additionally, observational evidence has linked prediabetes with early nephropathy, chronic kidney disease, small fiber neuropathy, diabetic retinopathy, and increased risk of macrovascular disease.

Mental Health & Neurological, Hormone Testing

Measurement of dopamine levels in urine or blood in addition to urinary vanillylmandelic acid (VMA) and homovanillic acid (HVA) levels may aid in the biochemical diagnosis and monitoring of neuroblastomas [1]. This test may also be useful in evaluating dopamine-secreting pheochromocytomas and paragangliomas (PPGLs) [2].Neuroblastomas occur predominantly in children and are the most common malignancy under 1 year old. Neuroblastomas are catecholamine-metabolizing tumors, and thus catecholamine metabolites (including VMA and HVA) are more reliable than catecholamines as biochemical markers for neuroblastomas [1]. However, urinary VMA and HVA levels may have limited accuracy for diagnosis of neuroblastomas with high-risk metastatic biology [1]. Because poor prognosis is associated with immaturity of catecholamine metabolism, dopamine levels in urine or blood have been proposed as an additional marker to aid in diagnosis and monitoring of neuroblastomas [3].Most PPGLs secrete catecholamines, but the relative amount of dopamine, norepinephrine, and epinephrine varies widely. Measurements of plasma free or urinary fractionated metanephrines (ie, the O-methylated catecholamine metabolites) are recommended by the Endocrine Society for the initial biochemical testing of PPGLs [4]. In patients with high clinical suspicion but normal blood pressure and normal levels of metanephrines, measurement of dopamine and its metabolites (HVA and methoxytyramine) may help diagnose PPGLs that predominantly secrete dopamine [2].The results of this test should be interpreted in the context of pertinent clinical and family history and physical examination findings.References1. Eisenhofer G. Monoamine-producing tumors. In: Rifai R, et al. eds.Tietz Textbook of Laboratory Medicine. 7th ed. Elsevier Inc; 2022.2. Jain A, et al.Pediatr Nephrol. 2020;35(4):581-594.3. Brodeur GM, et al.J Clin Oncol. 1993;11(8):1466-1477.4. Lenders JW, et al.J Clin Endocrinol Metab. 2014;99(6):1915-1942

Infectious Diseases, Autoimmune & Inflammation

Documents recentstreptococcalinfection.

Drug & Alcohol Testing

Ethylglucuronide (EtG) and Ethylsulfate (EtS) are metabolites of ethanol. While EtG has been used as a long-term biomarker in urine testing for more than 7 years, EtS has more recently been incorporated into testing programs. Scientific literature indicates that EtG may be detectable for up to 80 hours and that EtS may be detectable for 24 hours or more after ethanol ingestion - depending on cutoff, metabolism, and usage patterns. Under certain conditions, in-vitro (outside of the body, in the specimen container) formation of EtG may also occur when certain bacteria and ethanol or ethanol-producing bacteria are both present in a urine specimen. No published reports of in-vitro synthesis of EtS exist, however, even under the same conditions in which EtG may be synthesized in-vitro.EtS is typically present in urine at a lower concentration than EtG, although the ratio of EtG to EtS varies significantly between individual donors. In order to be reported positive for EtG, Quest Diagnostics’ clinical reporting criteria require that EtS be present in a specimen at a minimum concentration of 100 ng/mL whenever EtG is present at a concentration greater than or equal to 500 ng/mL.As with EtG, the presence of EtS in a urine specimen does not establish the source of the ethanol containing product and the possibility of "incidental exposure" and post-collection specimen changes needs to be considered when interpreting results. EtG and EtS testing, as with any controlled substance testing, measure only the presence and concentration of EtG (or EtS) in a given urine specimen. Quest Diagnostics recommends clinical correlation and/or healthcare provider review when interpreting EtG and EtS results.

Drug & Alcohol Testing, Hormone Testing

Offered as part of multiple lab tests

Drug & Alcohol Testing, Hormone Testing

Offered as part of multiple lab tests

Heart Health & Cardiovascular

D-Dimer is one of the measurable by-products of activation of the fibrinolytic system. Quantitation of D-Dimer assesses fibrinolytic activation and intravascular thrombosis. D-Dimer is of particular value in excluding the diagnosis of venous thromboembolism among patients at high risk.

Drug & Alcohol Testing

Offered as part of multiple lab tests

Drug & Alcohol Testing

Ethanol is the most commonly abused substance whose primary effect on the central nervous system varies with blood concentration. Not all individuals experience the same effects at a given blood level. Additionally, other central nervous system depressants can have an additive effect when taken in combination with ethanol. Approximately 5% of ethanol is excreted unchanged in urine. A positive urine ethanol result may suggest recent ethanol exposure and/or consumption; however, in diabetic patients with a urinary tract infection, ethanol is commonly present in urine as a result of glucose fermentation by yeast in the urine. When fermentation is not suspected, and urine ethanol is adjusted by a sample's creatinine concentration, urine ethanol may be used to estimate blood ethanol concentrations, as urine ethanol concentrations are approximately 130% of blood concentrations, if the patient is in the elimination phase. Caution should be exercised with interpretation of urine ethanol results; it is not recommended that a clinical decision be based solely on a urine ethanol result as there are several different scenarios that may have yielded the result.

Drug & Alcohol Testing

Offered as part of multiple lab tests

Infectious Diseases

Used to evaluate diphtheria immunization response. Antibody levels of > or = to 0.10 IU/mL are considered protective. For Pre and Post vaccination testing to assess normal immune response, please refer to Test Code 10680, Diphtheria Antitoxoid, Pre and Post Vaccination.Tetanus is caused by Clostridium tetani. Immunization with Tetanus Antitoxoid is effective with boosters in immunocompetent individuals. Antibody levels of > or = to 0.10 IU/mL are considered protective. However, tetanus can still occur in some individuals with such antibody levels. These results should not be used to determine the necessity to administer antitoxin when clinically indicated. For Pre and Post vaccination testing to assess normal immune response, please refer to Test Code 91424, Tetanus Antitoxoid, Pre and Post Vaccination.

Hormone Testing, Men's Health

Offered as part of multiple lab tests

Hormone Testing, Men's Health

Offered as part of multiple lab tests

Drug & Alcohol Testing

Ethyl glucuronide (EtG) and ethyl sulfate (EtS) are minor metabolite of ethanol metabolites and excreted in urine for a longer time than ethanol. Positive EtG and/or EtS test results thus provide a strong indication that the person has recently consumed alcohol, even when ethanol is no longer detectable. The test is a definitive assay using liquid chromatography mass spectroscopy (LC/MS/MS) methodology. Therapeutic urine drug monitoring of these metabolites is important for ensuring compliance to treatment strategies. Urine or oral fluid are the specimens of choice for routine monitoring of patients taking prescription drugs. Use of serum/plasma should be limited to anuretic patients, or where a patient's clinical appearance does not coincide with their prescribed medications. No single monitoring approach provides adequate information about the pattern or dose of patient drug use. Safest prescribing habits should include a combination of tools and laboratory test results to correctly detect drug use patterns.

Infectious Diseases

Dengue hemorrhagic fever and Dengue shock syndrome are caused by infection of the RNA flavivirus transmitted by a mosquito vector. Paired acute and convalescent specimens that exhibit a significant change in titer are useful to confirm clinical diagnosis of infection.

Hormone Testing

Offered as part of multiple lab tests

Sexual Health & STDs

Detection of treponemal antibodies may indicate recent, past, or successfully treated syphilis infections, therefore, the test cannot be used to differentiate between active and cured cases. A reactive syphilis antibody test result may be used to disqualify a potential blood, cell or tissue donor.

Women's Health

Offered as part of multiple lab tests

Drug & Alcohol Testing

The monitoring of the parent compounds and metabolites in urine of the group of drugs classified as Antidepressants.

Nutrition & Vitamins

Monitor response to antiresorptive therapy in postmenopausal women and individuals with osteoporosis. Does not replace bone mineral density (BMD) screening to diagnose osteoporosis.

Drug & Alcohol Testing

Offered as part of multiple lab tests

Nutrition & Vitamins

Cortisol is increased in Cushing's Disease and decreased in Addison's Disease (Adrenal insufficiency).

Diabetes & Blood Sugar, Autoimmune & Inflammation

Offered as part of multiple lab tests

Diabetes & Blood Sugar, Autoimmune & Inflammation

Offered as part of multiple lab tests