Preferred Specimen(s) 0.3 mL serum Transport Container Serum Separator Tube (SST®) Transport Temperature Room temperature Specimen Stability Room temperature: 14 days Refrigerated: 14 days Frozen: 30 days

Preferred Specimen(s) 0.3 mL serum Minimum Volume 0.15 mL/allergen Transport Container Serum Separator Tube (SST®) Transport Temperature Room temperature Specimen Stability Room temperature: 14 days Refrigerated: 14 days Frozen: 30 days

"Preferred Specimen(s) 0.5 mL serum Minimum Volume 0.3 mL Transport Container Serum Separator Tube (SST®) Transport Temperature Room temperature Specimen Stability Room temperature: 14 days Refrigerated: 14 days Frozen: 30 days Includes If Brazil Nut (f18) IgE is ≥0.10 kU/L, Brazil Nut Component Ber e1 (f354) will be performed at an additional charge (CPT code(s): 86008). Methodology Immunoassay (IA) Assay Category Reference Range(s) See Laboratory Report Alternative Name(s) ImmunoCAP®

Preferred Specimen(s) 0.3 mL serum Transport Container Serum Separator Tube (SST®) Transport Temperature Room temperature Specimen Stability Room temperature: 14 days Refrigerated: 14 days Frozen: 30 days

Preferred Specimen(s) 0.3 mL serum Transport Container Serum Separator Tube (SST®) Transport Temperature Room temperature Specimen Stability Room temperature: 14 days Refrigerated: 14 days Frozen: 30 days

Preferred Specimen(s) 0.3 mL serum Transport Container Serum Separator Tube (SST®) Transport Temperature Room temperature Specimen Stability Room temperature: 14 days Refrigerated: 14 days Frozen: 30 days Methodology Immunoassay (IA) Assay Category This test was developed and its analytical performance characteristics have been determined by Quest Diagnostics. It has not been cleared or approved by FDA. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes. Alternative Name(s) ImmunoCAP®

Preferred Specimen(s) 0.3 mL serum Minimum Volume 0.15 ml/allergen Transport Container Serum Separator Tube (SST®) Transport Temperature Room temperature Specimen Stability Room temperature: 14 days Refrigerated: 14 days Frozen: 30 days

Preferred Specimen(s) 0.3 mL serum Transport Container Serum Separator Tube (SST®) Transport Temperature Room temperature Specimen Stability Room temperature: 14 days Refrigerated: 14 days Frozen: 30 days

BUN / Creatinine Ratio What are the other names for this test? Blood Urea Nitrogen, Urea Nitrogen, BUN to Creatinine Ratio, BUN What is a BUN test? A Blood Urea Nitrogen (BUN) determines the quantity of urea nitrogen in your blood. It gives information about the working conditions of the kidney and liver. Urea nitrogen is a waste product that develops during the breakdown of proteins in your blood. It produces by the liver. It filters from the healthy kidney and comes into the urine. The presence of some urea in your blood is not an issue. If you have high-value urea nitrogen in your blood, this may indicate a problem in your kidney. What is a creatinine test? Creatinine is a type of waste product that develops during the activity of muscles. Creatinine is present in your blood, like urea. Your kidneys purify it and push it out through the urine. The creatinine level in blood may vary with a person's muscle mass. Creatinine levels do not change due to muscle mass remaining uniform in general. Its high value in the blood may occur due to a disease of kidney function. What is a BUN/Creatinine Ratio test? A BUN/Creatinine ratio is a combination of BUN and creatinine tests. Your healthcare provider gets a fraction of both tests to judge the functions of kidneys. BUN and creatinine tests may be utilized separately to check kidney and liver disease. But their combinations provide detailed knowledge to your provider about your kidney health. A BUN/Creatinine ratio helps your doctor diagnose and give you treatment for your kidney-related problems in a short time. What is the use of the BUN/Creatinine test? A BUN test is often conducted as a part of the BMP or CMP. These tests possess eight and fourteen measurements of different substances, respectively. Your provider recommends this test if you experience signs and symptoms of kidney disease. A test panel with BUN measurement helps to identify symptoms of kidney problems or monitor them in the emergency room. When should I need this test? Your provider may ask to place the order for BUN measurement besides screening tests if you experience risk factors for kidney disease, including diabetes, a family history of kidney-related problems, or cardiovascular problems, such as high blood pressure. Your healthcare provider recommends the BUN-Creatinine ratio test to   Diagnoses the reason for already developed symptoms of disease related to kidney like changes in the urinary tract, muscle cramps, swelling in the legs, or increased fatigue Screen the conditions before symptoms of kidney disease. Monitor the urea in your blood to get treatment for kidney problems If you ever had an abnormal BUN test result, your provider may suggest you repeat this test regularly to determine your condition and present kidney function. How do I need to perform a BUN/Creatinine Ratio test? You may need to provide a blood sample to your provider for a BUN test. A small needle is inserted in a vein in your arm to collect a blood sample in a test tube. A bandage applies to your vein. The test does not take time greater than 5 minutes. How to prepare for the test? Your doctor instructs you to avoid any medicine before the blood test. You can eat or drink during the BUN/Creatinine ratio test. Dehydration in your body may change the results of the test. A high level of protein intake before the test may lead to high BUN test results. A low-protein diet can be the reason for low BUN levels. You should be hydrated and take a balanced amount of protein before the test. Is there any risk to the test? A BUN is a blood test that does not have a high risk. You may experience a little pain at the point in your vein from where the blood collects. A chance of bleeding or bruising may also occur, but generally, these signs do not last long. What are my BUN/Creatinine Ratio test results mean? Your lab care will get the results of BUN and Creatinine tests. The lab care will divide the BUN count by the creatinine count. Your body produces more BUN compared to creatinine. The recommended ratio for a person is between 10:1 and 20:1. If results are higher than this, you have high BUN in your blood. It may indicate that there is no proper rate of flow of blood reaching your kidneys. A high ratio occurs due to gastrointestinal bleeding, extreme dehydration, or heart failure. Having a low value of BUN/Creatinine ratio can indicate liver disease. What else do I need to know about a BUN/Creatinine test? This test provides the ratio of BUN to Creatinine to observe your kidney function. Your provider may suggest another test if you have severe kidney disease. The additional tests may include GFR (Glomerular Filtration Rate), which checks the correct amount of filtering blood by your kidneys. If you see the symptoms of kidney disease, you can visit UmbrellaMD to get the order for the lab test. Getting complete information and treatment for diseases and their lab tests is essential. Umbrella Health Care Systems is an online healthcare provider that provides an opportunity to make an online appointment with a doctor. Your doctor will understand your test results and give treatment after an online meetup. You may learn more about the lab tests and details of the e-consultation service here.   

What are the other names for this test? Proinsulin C-peptide, Insulin C-peptide, Connecting Peptide Insulin What is a C-peptide test? A C-peptide test helps to determine the c-peptide levels in your blood or urine. This test observes how well your body is developing insulin amounts. A c-peptide test may detect the reasons for low blood glucose. Insulin is a hormone produced by the pancreas. Pancreas is an organ and gland that produces enzymes to make better digestion. It also releases hormones that regulate and control the sugar amount in your blood vessel. Insulin moves blood glucose or sugar to your cells to develop energy for your body. C-peptide develops by your pancreas when insulin is in the production phase. Both c-peptide and insulin come into your bloodstream within the same duration and quantities. C-peptide remains in your blood longer than insulin and does not show any side effects on your blood sugar levels. It is the reason c-peptides can measure in an accurate way. What is the purpose of this test? A c-peptide test is a routine test that helps to diagnose insulin disorders. This test may use to:   See whether your body has the ability to produce the required insulin. Observe if you are dealing with insulin resistance. Monitor treatment if you are already experiencing insulin problems or diabetes. Identify which type of diabetes you have, either type 1 or 2. In a few cases, it is difficult to know the type of diabetes. A c-peptide test may be required if you are uncertain about diagnosing diabetes after three years. Screens for blood glucose disorders Determine the reason for hypoglycemia (Low blood sugar) Monitor treatment for a pancreas tumor, also known as insulinoma. This condition happens very rarely in people. These tumors produce large insulin amounts and lead to low blood sugar. When do I need to take this test? You may need a c-peptide test if you are dealing with repeated hypoglycemia (Low blood sugar) and high insulin. This test helps to differentiate between your body's insulin and the other sources of insulin. Signs and symptoms of hypoglycemia, such as:   Increased hunger Sweating Confusion Blurry vision Seizures and loss of awareness in extreme cases Missing heartbeat (Palpitation) If you see the above symptoms, you can take the c-peptide test at a low price. Your healthcare provider may recommend this test if you already have experience with an insulinoma. This test can monitor how well the treatment is going and find tumor repetition. You may order this test if your provider wants to see if more insulin injections are needed if you have diabetes. A c-peptide test often helps maintain type 1 diabetes. This test may also give benefit you if you are dealing with type 2 diabetes and requires insulin amounts. What is the procedure for this test? The sample depends on the test type your provider recommends to you. You may need to provide a blood sample or a urine sample. For the blood test, the following are the steps of a c-peptide that include:   Your provider will ask you to stay relaxed and calm before the test. Take a seat in front of your provider and remove your cloth from one of the arms. A small needle will inject into the vein in your arm. Your blood sample will collect in a test tube A little discomfort or pain may happen during the test or at the time of injection of the needle. Regular activities may resume after the test. This test will finish within five minutes. How do I need to prepare for this test? A c-peptide test does not need any specific preparation. You may eat or drink if you have only this test. But when your provider asks for other blood tests, you may need to fast for at least several hours. You can inform your provider about medicines, supplements, or vitamins you use. Do not avoid your medication without the prescription of your doctor. Are there any risks involved in this test? A c-peptide test contains low risks when you give a blood sample to your provider. Vein differs from person to person. You may experience low risks when the needle injects into your vein, include   Infection Bruising Extreme Bleeding Slight pain Hematoma (Deposition of blood under the skin)   You may feel discomfort during swabs collection from your throat or nose. What do the test results indicate? The recommended range of c-peptide test results lies between 0.5 to 2.7 ng/mL (Nano grams per milliliter). The test results may vary on various factors, such as gender, sex, family history, medical history, and others. Sometimes the test results may also slightly change among laboratories due to the use of different references for measurement. You can consult your test result with a professional healthcare provider here. High c-peptide levels may indicate your body produces large insulin amounts. The following are the reasons that indicate high insulin levels:   Cushing’s syndrome Insulinoma (pancreas tumor) Kidney failure or damage Type 2 diabetes Low potassium levels in the blood Low c-peptide levels may indicate your body does not produce the required insulin. The following are the conditions that lead to low insulin levels:   Type 1 diabetes Type 2 diabetes (In a few cases) Addison disease Intake of high insulin amounts for treatment of diabetes. If you take insulin higher compared to the requirement, this may resist producing insulin by your pancreas) Extreme infection Liver disease C-peptide levels reduce if you have taken treatment for an insulin-producing pancreas tumor, which shows that the treatment is working in a proper way. Whenever the tumor returns back, it will lead to high c-peptide levels. What additional tests do I need along with this test? Your healthcare provider may suggest more tests to see the blood glucose levels and other related substances, including:   Diabetes Glucose test: This test will determine the glucose amount in the blood. Insulin assay: This test helps to determine insulin levels. Glucagon test: This test helps to determine another hormone produced by your pancreas. A1c test:  Also known as a glycosylated hemoglobin blood test. This test can determine your blood sugar levels for the past three months. What factors may affect the test result? C-peptide levels may increase if you are a person having diabetes and taking insulin for it. Damaged kidneys may also show altered c-peptide levels. The timing of the test is another factor for the c-peptide level.  

Preferred Specimen(s) 0.3 mL serum Transport Container Serum Separator Tube (SST®) Transport Temperature Room temperature Specimen Stability Room temperature: 14 days Refrigerated: 14 days Frozen: 30 days

What are the other names for this test? Total calcium, Serum Calcium What is a calcium test? This test measures the quantity of calcium in the blood. A serum calcium test shows the condition of the kidney, bones, teeth, muscles, nerves, and heart. If you have high or low calcium values, it may be a sign of various diseases, which include kidney disease, digestive system disease, bone disease, parathyroid disorder, and other diseases.  Calcium is an important mineral that maintains the development and density of bones and teeth. It helps regulate the clotting of blood, bone metabolism, enzyme activity, and the neuromuscular system. It plays a vital role in the flow of blood throughout the body. Furthermore, it releases a hormone that affects the body's functions. The quantity of calcium is only 1 % in blood. The remaining 99 % calcium is present in bones and teeth. Having a normal range of calcium in the blood is essential for nerves, the heart, and muscles.   What is the use of a calcium blood test? This test has the primary aim of determining the general health of a person. Your doctor diagnoses and analyzes the different medical conditions that can affect many systems. It includes the digestive system, thyroid, parathyroid glands, kidneys, bones, and muscles.  Total calcium is the most common test that gives complete information about all calcium in the blood. There are two types of blood calcium present in the blood. The first is bound calcium that links with a protein. The second type is free calcium, which does not bind to the protein.  Why do I need a calcium blood test? Your healthcare provider recommends you take this test to see the level of calcium in your blood. In general, people of all ages may require this test to diagnose problems with their bones, teeth, nerves, kidneys, muscles, and heart. You can understand the high or low value of calcium in the blood by noticing its symptoms.  What are the symptoms of calcium deficiency? Hypocalcemia is a disease due to a deficiency of calcium in the blood. When compared to young people, older people are more likely to have low calcium levels. Its symptoms include:   Dryness in skin Brittle nails Muscles cramp or stiffness Numbness or Tingling in lips, tongue, fingers, and feet Damaged or rough hair Arrhythmia (A disturbance in the progress of the heartbeat) Symptoms of high calcium in the blood The deposition of calcium in the blood in excess amounts is a condition of hypercalcemia. Here are the symptoms of this disease, such as    Abdominal pain Constipation Nausea and vomiting Increase urge for urination  Frequent thirst Bone and muscles pain Confusion and fatigue Loss of memory  If you do not see any of the high or low symptoms of calcium in your blood, your doctor may suggest this test to examine:   Thyroid or parathyroid disease Digestive system  Occurrence of any type of cancer like breast, lung, kidney, neck, and multiple myeloma Kidney disease Lack of ability to absorb calcium in the blood (Intestine problems) What happens when the blood calcium level is too low? When the blood calcium level is too low, it may lead to kidney disease, malnutrition, and other diseases. Here are reasons for too low calcium levels in the blood   Having a low protein level in the blood that occurs due to liver disease or malnutrition  Hypoparathyroidism (It is a disease, in which parathyroid glands reduce the production of parathyroid hormone) Not getting enough calcium in your diet Kidney disease Liver disease Absence of vitamin D  Deficiency of magnesium in the body Pancreatitis  What are the causes of the high level of calcium in the blood? The high level of calcium may occur due to these conditions include   Hyperparathyroidism (It is a disease, in which parathyroid glands increase the production of parathyroid hormone) Specific types of cancer disease Bone disorder Bone tumor HIV/AIDS Taking foods that enrich with a large amount of calcium Intake of high quantity of vitamin D in the form of supplements What are the normal results of calcium tests? The normal range of this test little depends on the different laboratories. As they have different techniques of measurement. The normal level lies between 8.5 to 10.2 mg/dl or 2.15-2.55 mmol/L.  How to increase the calcium level? You may consent to see the doctor after completing this test. Your doctor recommends some medicines and foods that have a specific range of calcium according to your requirements. Some foods that help you to overcome the deficiency of calcium, include   Milk, butter, and dairy products Green leafy vegetables Oranges Nuts  Whole grains Legumes Broccoli How to prepare for this test? Your healthcare provider tells you to avoid taking drugs. It includes calcium salts, supplements of vitamin D, and thyroxine before the test to get accurate results. You may keep fast if you have received specific instructions.  What is the procedure for this test? This is a general blood test. You may need to provide the blood sample to your doctor. This test takes at least 5-10 minutes.  What else should I know about calcium blood tests? This test does not provide you with information about the calcium in your bones. Your doctor may recommend X-rays to check the bone density and other minerals in your bones.  It is better to take early action if you experience pain in your bones and muscles. You may need to perform this test to see the abnormality in calcium level. Your doctor asks you whether you have a high or low value based on your symptoms. This results due to kidney, liver, parathyroid, malnutrition and other diseases.   

Clinical Significance Canary Bird Feathers (e201) IgE - This test is an allergen-specific IgE antibody test that quantifies an individual’s IgE response to canary bird feathers. It is an in vitro quantitative assay, which 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 professional after all clinical and laboratory findings have been evaluated. Preferred Specimen(s) 0.3 mL serum Transport Container Serum Separator Tube (SST®) Transport Temperature Room temperature Specimen Stability Room temperature: 14 days Refrigerated: 14 days Frozen: 30 days

Preferred Specimen(s) 0.3 mL serum Transport Container Serum Separator Tube (SST®) Transport Temperature Room temperature Specimen Stability Room temperature: 14 days Refrigerated: 14 days Frozen: 30 days

Preferred Specimen(s) 0.3 mL serum Minimum Volume 0.15 mL/allergen Transport Container Serum Separator Tube (SST®) Transport Temperature Room temperature Specimen Stability Room temperature: 14 days Refrigerated: 14 days Frozen: 30 days

What are the other names for this test? Total CO2, Carbon dioxide content, CO2 content, Carbon dioxide blood test, TCO2, Bicarbonate blood test, bicarbonate test, HCO3, bicarb What is a carbon dioxide test? A carbon dioxide test helps to determine the carbon dioxide amount in your blood. Your body develops carbon dioxide, which is a waste byproduct of metabolism. Metabolism is a chemical process in which your body converts food into energy when needed. Carbon dioxide is an odorless, colorless gas that carries in your blood and transfers to your lungs. Each day you exhale carbon dioxide and inhale oxygen several times in your body. Most carbon dioxide in your body is present in the form of bicarbonate. Bicarbonate is an electrolyte that helps to maintain pH (acid-base) balance. High or low carbon dioxide levels may indicate health problems. What is the purpose of this test? A carbon dioxide test measures all forms of carbon dioxide in your blood, including bicarbonate, carbonic acid, and dissolved CO2. This test provides an approximate bicarbonate amount. A CO2 blood test often conducted with a series of tests known as an electrolyte panel. This test is a routine test to diagnose or monitor your health conditions related to electrolyte disorders, such as diseases of the kidneys, lungs, or liver, and increased blood pressure. Carbon dioxide may use to:   Diagnose conditions if you are at risk of liver, digestive, or lung disease. It is because your body utilizes carbon dioxide to maintain acid-base balance. These diseases have a connection when changes happen in the bicarbonate levels. Monitor how well treatment is going if you have a disease linked with bicarbonate levels. These may include Cushing or kidney disease. Observe the side effects of medicines such as metformin. It may lead to acidosis. Acidosis develops due to the deposition of acid or loss of bicarbonate from the body. When do I need to take this test? You may need a carbon dioxide test if you see symptoms of an electrolyte disorder. Signs and symptoms include   Weakness Fatigue Vomiting and diarrhea for a long time. Difficulty breathing Confusion If you see the above symptoms, you can order this test. What is the procedure for this test? A carbon dioxide test often performs with a blood sample. The following are the steps for this test after visiting the laboratory.   Sit in front of your provider. Be relaxed and stay in a fixed position. It is difficult for your provider to collect a blood sample if you do the muscle movement. Remove the portion of your cloth from the arm. A small needle will inject into a vein in your arm. A small amount of blood will collect in a test tube. Blood samples will store in the laboratory for examination of an allergy. You can go home for regular activities. This test usually takes five minutes. How do I need to prepare for this test? Your provider will guide you about special preparation for the carbon dioxide blood test. You may need to avoid specific medicines before the test. Do not stop medications before consulting with a professional healthcare provider. If your provider asks for additional blood tests, you may need to fast for several hours before the test.  Are there any risks involved in this test? A carbon dioxide test does not have high risks when you give a blood sample. Veins differ from person to person. Some people or children may have difficulty providing a blood sample compared to others. You may experience low risks when the needle injects into your vein. These risks include   Bruising Extreme Bleeding Slight pain Infection Hematoma (Deposition of blood under the skin) What do the test results indicate? The carbon dioxide test results depend on many factors, such as age, gender, and medical history. The test results may also slightly differ among laboratories. It is because each lab may use different methods for examination. The reference range for carbon dioxide is about 23 to 30 milliequivalents per liter (mEq/L). Abnormal results may show that your body does not maintain enough acid-base balance. It is because your kidneys or lungs contain a disorder to remove carbon dioxide. You may also have an electrolyte imbalance in your body. Various conditions lead to these problems. Your healthcare provider will understand your results when you take a carbon dioxide test. Low carbon dioxide levels may indicate the following conditions:   Addison disease (adrenal gland disorders) Metabolic acidosis - The buildup of large acids in your blood may occur due to kidney or liver disease or diarrhea for a long time. Lactic acidosis (deposition of lactic acid in the blood) Respiratory alkalosis - A condition of low acid levels in your blood may happen due to lung or breathing disorders, such as increased breathing. Ketoacidosis (Complications of type 1 and type 2 diabetes)    High carbon dioxide levels may show the following conditions:   Kidney failure or damage Metabolic alkalosis - Deposition of a large bicarbonate amount in your blood may occur due to vomiting, dehydration, and anorexia (eating disorders). Cushing disease - Cushing syndrome disorder in which your pituitary gland releases high adrenocorticotropic hormone (ACTH).  Hyperaldosteronism (adrenal gland disorder) Lung disease If you have higher carbon dioxide levels, you may need oxygen therapy and some medications to maintain carbon dioxide levels in the blood. You can eat more fruits and vegetables and fewer meats, eggs, and cereals for low carbon dioxide levels. Sodium bicarbonate and sodium citrate pills may also control metabolic acidosis. If you want to take treatment for high or low carbon dioxide levels, consult a healthcare professional. What factors may affect the test results? If you have abnormal carbon dioxide test results, you don't always have medical conditions that require treatment. Specific medicines may reduce or raise your bicarbonate levels in the blood.  What additional tests do I need along with a carbon dioxide blood test? Your healthcare provider may ask for an electrolyte panel test to measure other minerals, such as sodium, potassium, and chloride amounts. Get information about more laboratory tests from here.

"Clinical Significance Cardio IQ® Cholesterol, Total - Total serum cholesterol analysis is useful in the diagnosis of hyperlipoproteinemia, atherosclerosis, hepatic and thyroid diseases. Preferred Specimen(s) 1 mL serum Minimum Volume 0.5 mL Transport Container Transport tube Transport Temperature Refrigerated (cold packs) Specimen Stability Room temperature: 7 days Refrigerated: 7 days Frozen: 90 days   Reject Criteria Gross hemolysis • Moderate to grossly icteric Patient Preparation If a cholesterol measurement is to be performed along with triglycerides, but not part of a lipid panel, then the patient should be fasting 9-12 hours prior to collection. If the cholesterol is ordered as part of a lipid panel, then a fasting sample is not required. The assay manufacturer Beckman Coulter advises: "N-Acetyl Cysteine (NAC), when administered in therapeutic concentrations (for the treatment of acetaminophen overdose), has been...determined to interfere with assays for...cholesterol, uric acid" where "NAC interference may lead to falsely low results." According to Beckman Coulter, the NAC interference should be insignificant by 12 hours after completion of the initial loading dose of an IV infusion treatment regimen consisting of an initial loading dose of 150 mg/kg administered over 1 hour, a second dose of 50 mg/kg administered over 4 hours and a third dose of 100 mg/kg administered over 16 hours. Methodology Spectrophotometry (SP) Reference Range(s) <20 Years    <170 mg/dL ≥20 Years    <200 mg/dL Alternative Name(s) Cholesterol, Total, Cardio IQ®,CardioIQ®

"Clinical Significance Cardio IQ® HDL Cholesterol - HDL Cholesterol is inversely related to the risk for cardiovascular disease. It increases following regular exercise, moderate alcohol consumption and with oral estrogen therapy. Decreased levels are associated with obesity, stress, cigarette smoking and diabetes mellitus. Preferred Specimen(s) 1 mL serum Minimum Volume 0.5 mL Transport Container Transport tube Transport Temperature Refrigerated (cold packs) Specimen Stability Room temperature: 48 hours Refrigerated: 7 days Frozen: 28 days Patient Preparation If an HDL cholesterol measurement is to be performed along with triglycerides, but not part of a lipid panel, then the patient should be fasting 9-12 hours prior to collection. If the HDL-cholesterol is ordered as part of a lipid panel then a fasting sample is not required. Methodology Spectrophotometry (SP) Reference Range(s)      Male (mg/dL)    Female (mg/dL) <20 Years    >45    >45 ≥20 Years    ≥40    ≥50 Alternative Name(s) HDL Cholesterol, Cardio IQ®,CardioIQ®

"Clinical Use Assess metabolic dysfunction and cardiometabolic risk Clinical Background In the context of aging and weight gain, individuals can develop insulin resistance (IR). IR is characterized by cells being less sensitive to the effects of insulin and not absorbing enough glucose from the bloodstream. Metabolic syndrome (MetS), which affects more than a third of adults in the United States,1 is a cluster of clinical features that reflect an underlying state of IR. IR and MetS can progress to type 2 diabetes mellitus (DM) and cardiovascular disease (CVD).2 Early identification of metabolic dysfunction leading to IR and MetS provides an opportunity for early intervention to prevent disease progression and associated complications. One early indicator of metabolic dysfunction is excess insulin production, which reflects a developing IR state (Table 1).3,4 In response to reduced insulin sensitivity, pancreatic beta-cells may produce high levels of insulin to maintain normal levels of blood glucose. High levels of C-peptide, a byproduct of insulin processing, are also produced as insulin sensitivity decreases. By measuring combined serum levels of insulin and C-peptide, an ""IR score"" can be calculated that represents the likelihood of an individual having IR.3 Individuals with IR can subsequently develop prediabetes and diabetes, which is reflected in fasting glucose and hemoglobin A1c (HbA1c) levels (Table 1). In addition to its role in diagnosing diabetes and prediabetes, HbA1c measurement also improves risk prediction for diabetic progression compared with fasting plasma glucose and oral glucose tolerance tests, which measure glucose levels only in the short term.5 HbA1c assays more reliably estimate average glucose (eAG) levels over a longer term (2 to 3 months).6" Methodology Enzymatic Reference Range(s) <5.7 % of total hemoglobin Alternative Name(s) Hemoglobin A1c, Cardio IQ®,CardioIQ®

"Clinical Use Assess relative risk of cardiovascular disease (CVD) Assess risk of a recurrent cardiovascular event in patients with coronary heart disease (CHD) Reclassify intermediate CVD risk patients into a high-risk category Help guide therapeutic decisions for patients with borderline or intermediate CVD risk Clinical Background C-reactive protein (CRP) is a non-specific acute-phase protein produced by the liver in response to tissue injury, infection, and inflammation. CRP levels rise as much as 1,000-fold after an acute event; these high levels can be used to diagnose and monitor acute inflammatory states. Levels within the normal, non-acute-phase range (≥10 mg/L) can help assess cardiovascular risk. The high-sensitivity CRP (hs-CRP) test is used for this purpose because it can accurately determine CRP levels in the low range of 1 to 10 mg/L. Mildly elevated CRP levels have been linked to increased risk for various cardiovascular-related disorders, including coronary heart disease (CHD), peripheral artery disease (PAD), stroke, and sudden cardiac death.1 The predictive value of hs-CRP for cardiovascular events is independent of other established risk factors, including LDL-cholesterol.2 Mildly elevated hs-CRP levels also predict recurrent CHD events and poor prognosis in some patients, including those who have PAD.3 Furthermore, in patients receiving statin or ezetimibe therapy, measurement of hs-CRP levels can improve the prediction of myocardial infarction.4 Because hs-CRP levels are associated with cardiovascular risk, they can contribute to risk stratification. Recommendations on the clinical utility of hs-CRP test results are divided, however. The American Association of Clinical Endocrinologists supports using hs-CRP as part of the Reynold's Risk Score for predicting CHD events.5 The US Preventive Services Task Force similarly found that adding hs-CRP to traditional risk factors provides more accurate risk assessment but found that more evidence was required to support that measuring hs-CRP improves clinical outcomes.6 The American College of Cardiology/American Heart Association Task Force recommends using hs-CRP test results as a possible ""risk enhancer"" for risk-based treatment decisions.7 After a quantitative risk assessment based on the pooled cohort equations for evaluating the 10-year risk of a CVD event, hs-CRP results may inform that moderate intensity statin treatment is appropriate for patients with ""borderline"" or ""intermediate"" CVD risk.7 Note that this test is not intended for the diagnosis or monitoring of acute inflammatory states. A standard (conventional) CRP test is available for those purposes (test code 4420). Individuals Suitable for Testing Individuals without a previous history of CHD, especially those with intermediate CHD risk Patients with stable or acute CHD Method Nephelometric method utilizing latex particles coated with CRP monoclonal antibodies Standardized against the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC)/ Bureau Communautaire de Référence (BCR)/College of American Pathologists (CAP) CRP reference preparation Analytical sensitivity: 0.2 mg/L Results are reported in mg/L Interpretive Information Ideally, the average of 2 hs-CRP measurements, done 2 weeks apart, should be used when interpreting hs-CRP values. hs-CRP values in the range of 3.1 to 10 mg/L indicate an approximate 2-fold increased risk of CVD compared with values <1.0 mg/L. Levels persistently above 10 mg/L may indicate an acute inflammatory process; sources of infection or inflammation should be sought and the test repeated at least 2 weeks after the inflammatory response has resolved.8 In a patient with borderline 10-year CVD risk (5% to <7.5%), hs-CRP levels ≥2 mg/L support considering moderate intensity statin treatment.7 In a patient with intermediate 10-year CVD risk (7.5% to 20%), hs-CRP levels ≥2 mg/L support initiating moderate intensity statin treatment.7 Increased CRP levels are associated with elevated blood pressure, elevated body mass index, cigarette smoking, metabolic syndrome, diabetes, low HDL levels, high triglyceride levels, use of estrogen or progesterone, and chronic infections or inflammation. Decreased levels are associated with moderate alcohol intake, physical activity, weight loss, and medications including statins, fibrates, and niacin.8" Methodology Immunoturbidimetric Assay Reference Range(s) ≤17 years    Not established >17 years    Optimal <1.0 mg/LJellinger PS et al. Endocr Pract. 2017;23(Suppl 2):1-87. For ages >17 years hs-CRP  (mg/L)    Risk According to AHA/CDC Guidelines <1.0 Lower relative cardiovascular risk. 1.0-3.0 Average relative cardiovascular risk. 3.1-10.0 Higher relative cardiovascular risk. Consider retesting in 1 to 2 weeks to exclude a benign transient elevation in the baseline CRP value secondary to infection or inflammation. >10.0 Persistent elevation, upon retesting, may be associated with infection and inflammation. Alternative Name(s) hs-CRP, Cardio IQ®,CardioIQ®

"Clinical Significance Cardio IQ® Triglycerides - Serum Triglyceride analysis has proven useful in the diagnosis and treatment of patients with diabetes mellitus, nephrosis, liver obstruction, other diseases involving lipid metabolism, and various endocrine disorders. In conjunction with high density lipoprotein and total serum cholesterol, a triglyceride determination provides valuable information for the assessment of coronary heart disease risk. Preferred Specimen(s) 1 mL serum Minimum Volume 0.5 mL Transport Container Transport tube Transport Temperature Refrigerated (cold packs) Specimen Stability Room temperature: 5 days Refrigerated: 7 days Frozen: 28 days Patient Preparation Triglyceride test only: Patient should fast 9-12 hours prior to collection. As part of lipid panel testing: A fasting sample is not required. Methodology Spectrophotometry (SP) Reference Range(s) ≤9 Years    <75 mg/dL 10-19 Years    <90 mg/dL ≥20 Years    <150 mg/dL Alternative Name(s) Triglycerides, Cardio IQ®,CardioIQ®

Clinical Significance Cardio IQ® Vitamin D, 25-Hydroxy - Measurement of serum 25-OH vitamin D concentrations provide a good index of circulating vitamin D activity in patients not suffering from renal disease. Lower than normal 25-OH vitamin D levels can result from a dietary deficiency, poor abosrption of the vitamin or impaired metabolism of the sterol in the liver. A 25-OH vitamin D deficiency can lead to bone diseases such as rickets and osteomalacia. Above normal levels can lead hypercalcemia. This assay employs liquid chromatography tandem mass spectrometry to independently measure and report the two common forms of 25-hydroxy vitamin D: 25OH D3 - the endogenous form of the vitamin and 25OH D2 - the analog form used to treat 25OH Vitamin D3 deficiency. Preferred Specimen(s) 0.5 mL serum Minimum Volume 0.3 mL Collection Instructions Collect blood in a standard red-top serum Vacutainer® tube. Allow blood to clot at room temperature. Centrifuge and separate the serum from the cells immediately. Alternatively, collect blood in a Serum Separator Tube (SST®), allow to clot at room temperature. Centrifuge and remove from the gel within 48 hours. Transport Container Transport tube Transport Temperature Refrigerated (cold packs) Specimen Stability Room temperature: 21 days Refrigerated: 21 days Frozen: 21 days Reject Criteria Gross hemolysis • Grossly lipemic • Heparinized or EDTA plasma • Serum not separated from Serum Separator Tube (SST®) gel or clot within 48 hours • Grossly icteri Includes Vitamin D, 25-OH, Total; Vitamin D, 25-OH, D3; Vitamin D, 25-OH, D2 Patient Preparation Fasting preferred, but not required Methodology Chromatography/Mass Spectrometry Assay Category This test was developed and its analytical performance characteristics have been determined by Quest Diagnostics. It has not been cleared or approved by FDA. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes. Reference Range(s) Vitamin D, 25-OH, Total    30-100 ng/mL25-OHD3 indicates both endogenous production and supplementation. 25-OHD2 is an indicator of exogenous sources, such as diet or supplementation. Therapy is based on measurement of Total 25-OHD, with levels <20 ng/mL indicative of Vitamin D deficiency, while levels between 20 ng/mL and 30 ng/mL suggest insufficiency. Optimal levels are ≥30 ng/mL. Vitamin D, 25-OH, D3    Not established Vitamin D, 25-OH, D2    Not established Alternative Name(s) Vitamin D, 25-Hydroxy, LC/MS/MS, Cardio IQ®,CardioIQ®

Preferred Specimen(s) 0.3 mL serum Transport Container Serum Separator Tube (SST®) Transport Temperature Room temperature Specimen Stability Room temperature: 14 days Refrigerated: 14 days Frozen: 30 days

Clinical Significance Casein (f78) IgE - This test is an allergen-specific IgE antibody test that quantifies an individual’s IgE response to casein. It is an in vitro quantitative assay, which is intended to be used in conjunction with other clinical information to aid in the diagnosis of food allergy [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]. Food-specific IgE tests are extremely sensitive. However, a positive test result only indicates that a patient is IgE sensitized to the food of concern. Many IgE-sensitized patients do not develop any symptoms when this food is ingested. A diagnosis of food allergy should only be made by a trained medical provider, after conducting a thorough clinical evaluation [2,3]. While food-specific IgE test results may contribute to that evaluation, they cannot replace it. In this regard, detection of food-specific IgE in serum provides evidence of IgE sensitization, but a history of clinical reactivity to the food of concern, is required to make a diagnosis of IgE-mediated food allergy. Moreover, several forms of food hypersensitivity are not associated with the presence of food-specific IgE in serum. Preferred Specimen(s) 0.3 mL serum Minimum Volume 0.15 mL/allergen Transport Container Serum Separator Tube (SST®) Transport Temperature Room temperature Specimen Stability Room temperature: 14 days Refrigerated: 14 days Frozen: 30 days