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.   

C-PEPTIDE TEST 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

"Clinical Significance Calcium - Serum calcium is involved in the regulation of neuromuscular and enzyme activity, bone metabolism and blood coagulation. Calcium blood levels are controlled by a complex interaction of parathyroid hormone, vitamin D, calcitonin and adrenal cortical steroids. Calcium measurements are useful in the diagnosis of parathyroid disease, some bone disorders and chronic renal disease. A low level of calcium may result in tetany. Preferred Specimen(s) 1 mL serum Alternative Specimen(s) Sodium heparin (green-top) tube • Lithium heparin (green-top) tube Minimum Volume 0.5 mL Transport Container Serum Separator Tube (SST®) Transport Temperature Room temperature Specimen Stability Serum and plasma Room temperature: 7 days Refrigerated: 7 days Frozen: 28 days Reject Criteria Anticoagulants other than heparin Methodology Spectrophotometry (SP) Reference Range(s)      Male (mg/dL)    Female (mg/dL) <1 month:    8.4-10.6    8.4-10.6 1-11 months:    8.7-10.5    8.7-10.5 1-3 years:    8.5-10.6    8.5-10.6 4-19 years:    8.9-10.4    8.9-10.4 20-49 years:    8.6-10.3    8.6-10.2 >49 years:    8.6-10.3    8.6-10.4

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

"Clinical Significance Carbon Dioxide - Measurements are used in the diagnosis and treatment of numerous potentially serious disorders associated with changes in body acid-base balance. Preferred Specimen(s) 1 full unopened spun gel barrier tube Alternative Specimen(s) Plasma collected in: Sodium heparin (green-top) tube or lithium heparin (green-top) tube Minimum Volume 0.5 mL Collection Instructions Do not open tube Transport Container 1 full unopened spun gel barrier tube Transport Temperature Room temperature Specimen Stability Room temperature: 72 hours Refrigerated: 72 hours Frozen: 31 days Reject Criteria Anticoagulants other than heparin • Red-top tube (no gel) Methodology Spectrophotometry (SP) Reference Range(s) Carbon Dioxide    20-32 mmol/L Carbon Dioxide (High Altitude)    18-30 mmol/L Alternative Name(s) CO2 Content,Bicarbonate,HCO3

"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