Women's Health Information

LABORATORY TESTS

Laboratory tests are performed on patient specimens to help the physician diagnose and treat disease. These tests can also help evaluate the health of an individual and risk for disease. Laboratory test results are the only objective information a physician has on a patient’s condition. The laboratory can perform a variety of tests on blood, urine, feces, tissue, spinal fluid, joint fluid, pleural fluid and any of the other types of fluids in the body. Blood and urine are easily obtained and are the most frequent specimens tested.

How do I choose where to have my laboratory work done?

Frequently, patients are given laboratory test requests by their physician and told to have the laboratory send or call the laboratory test results to the physician when completed. The physician or nurse may recommend several possible laboratories or it may be left up to the patient to choose.

Here are just a few thoughts on choosing a "good" laboratory:

1. There are many different kinds of laboratories. Some do a wide variety of tests while others are very specialized.

Physician office laboratories: These laboratories usually do routine tests by methods that do not need a lot of expertise to perform. However, a laboratory test that may be easy to perform is not necessarily foolproof. These laboratories tend not to employ individuals specially educated to perform these tests such as clinical laboratory scientists (CLS) or clinical laboratory technicians (CLT). More than likely, office personnel perform the tests.

Reference laboratories: These laboratories generally do a high volume of testing on outpatient specimens that are delivered from the physician’s office, clinics, or hospitals. The tests done in these facilities include routine and special tests. They are staffed by CLSs and CLTs.

Hospital laboratories: These laboratories do most routine and special tests. They serve both in-patients and outpatients. They are staffed by CLSs and CLTs.

2. A "good" clinical laboratory will have a current CLIA certificate. Every laboratory should have a CLIA Certificate of Compliance from the Health Care Financing Administration. Possession of a CLIA Certificate of Compliance assures you that the laboratory undergoes regular inspections of laboratory testing processes and therefore laboratory test results reported by the laboratory should be accurate.
3. Individuals who are educated to perform laboratory tests are called CLS or CLT. A CLS has a BS degree and has not only technical skills but also knows what test results mean and assures the quality of testing by conducting quality assurance programs. A CLT has an associate degree and the technical skills necessary to perform laboratory tests accurately.
4. Sometimes you hear bad things about laboratories like wrong results reported, wrong patient tested, or wrong test done. These mistakes are rare in laboratories that are accredited by organizations such as the College of American Pathologists (CAP) that inspect the laboratory and in laboratories that employ qualified personnel like CLS and CLT.

What about home testing kits?

You can buy test kits at your drug store or grocery store to do some diagnostic tests at home. Tests for pregnancy, blood in the stools (occult blood), and glucose are available. If you chose to use one of these tests, be sure to follow the instructions exactly as they are printed or your results may not be correct.

Do I need any special preparations for my laboratory test?

Testing sometimes requires that you stop eating for a while before the sample is taken. In other tests you will be given a substance by mouth or injection before the sample is taken. The timing of specimen collection is very important as some body cells and chemicals will vary depending on the time of day and whether or not the patient has eaten. Another thing that can interfere with laboratory tests is drugs. This includes not only drugs prescribed by your doctor but also over the counter medicines like aspirin. Even vitamins you take can interfere with the results of laboratory tests. Be sure to ask your physician or the person drawing your blood if there are any special precautions you need to take before the specimen is taken. When they ask you if you are taking any medicine or drugs, be sure to include over the counter drugs and vitamins you are taking.

What determines the kind of laboratory test I have?

Some laboratory tests are screening tests while others are very specific for a certain disease or condition. Screening tests are usually done when the physician wants to evaluate your general health or the function of a body system or organ such as the liver. The results of screening tests may lead to other tests that will give more specific information.

What are the areas in the clinical laboratory and what do they do?

The clinical laboratory includes hematology, clinical chemistry, medical microbiology, immunology, and blood bank. Hematology tests blood specimens for anemia and leukemia. It also evaluates the blood cells to look for clues as to the presence of infection. This area of the laboratory performs testing that helps determine if you have a clotting or bleeding disorder. Clinical chemistry tests for chemicals in the blood and body fluids such as glucose, cholesterol and therapeutic drugs. Medical microbiology identifies the microorganisms that cause disease and identifies the most effective drug to fight the infection. Immunology performs a wide variety of testing that involves antigen and antibody reactions. They usually do the testing for HIV, syphilis, measles, and infectious mononucleosis. The blood bank matches donor blood with patient’s blood. It separates blood into many different types of components that can be transfused into patients. They also test donor blood for infectious diseases. Some blood banks match organs from donors and recipients.

Cytogenetic laboratories are special reference labs that do testing on body specimens to evaluate an individual’s chromosomes and genes. Some diseases are inherited and can be detected by analyzing an individual’s chromosomes and genes. Acquired diseases may also have chromosomal abnormalities and identification of these abnormalities will help in diagnosis of a disease. Cytogenetics is also important in following an individual’s response to treatment in malignant disorders like leukemia.

THE USE AND INTERPRETATION OF LABORATORY TESTS

In this section, we will explain the use of some common laboratory tests especially those that are frequently ordered on women. If you want further information on a particular test listed here go to the Web site listed. If you want information on a test that is not included here go to the American Society for Clinical Laboratory Sciences web site, http://www.ascls.org. You can type in your question, and a professional laboratorian will provide an answer.

ANEMIA

The most common laboratory screening test is the complete blood count or CBC. This test analyzes the red cells (erythrocytes), white cells (leukocytes) and platelets (thrombocytes) in your blood. The information from this test will assist the physician in determining if you are anemic, what type of anemia you have, or if you have leukemia, infection or inflammation. If this test is abnormal, your physician may order other tests to help pin point your problem.

What is anemia?

Anemia is a condition in which the hemoglobin content of your blood is low. Hemoglobin is the protein inside your red blood cells that carries oxygen to the tissues. It also carries carbon dioxide to the lungs where it is exhaled. If you are anemic, you may have pale skin, be short of breath when exercising or feel light-headed and faint. Usually the first test your physician will order if anemia is suspected is a complete blood count (CBC) to see if your hemoglobin concentration is decreased. Following is a description of the types of tests done in the laboratory to help diagnose and find the cause of anemia.

Laboratory tests for anemia:

1. Complete blood count (CBC): This test is performed on a blood specimen using a special analyzer. The analyzer counts the numbers of red cells (RBC), white blood cells (WBC), platelets. It also measures your hemoglobin concentration, your hematocrit (ratio of the red cell volume to the total volume of blood) and the size of your red cells. Some analyzers will count the number of different types of white cells. This is helpful in determining if you have a specific type of infection or malignant condition. If any of these tests are abnormal, your physician will probably order further testing. Since blood cells are made in your bone marrow, in some cases, the physician may order a bone marrow. In this test a small amount of bone marrow is withdrawn using a needle. The marrow is then stained and examined under a microscope.

Reference ranges for a CBC(for women):

Hemoglobin: 11.7-15.7 g/dL (117-157 g/L)

Hematocrit: 35-47% (.35-.47 L/L)

RBC count: 3.8-5.2 x 10⁶/mL (3.8-5.2 x 10¹²/L)

WBC count: 2.5-11.0 x 10³/ml (2.5-11.0 x 10⁹/L)

Platelet count: 150-440 x 10³/mL (150-440 x 10⁹/L)

MCV (red cell size): 80-100 fL

If your test results are not within these ranges, it does not necessarily mean that you have a problem. Up to 5% of normal individuals will have results outside the reference ranges. Further testing or repeat testing may be necessary to confirm the presence of disease.

2. Serum Iron studies: Iron deficiency anemia is one of the most common anemias in women. However, not all anemia is caused by iron deficiency. If your CBC result shows that your red cell count and hemoglobin are low and the red cells are small, you might have this anemia. Further testing is necessary to find the cause of your anemia.

There are several different types of tests that can be done to evaluate the amount of iron in the body. Usually these are ordered together to help the physician determine if you are iron deficient and why. If you are iron deficient, the physician must determine why and correct the problem. Is it because you have a diet poor in iron? Are you bleeding from the digestive tract? Are you losing a lot of blood during your menstrual period? The physician will usually give you iron supplements if you are iron deficient. He/she may continue to monitor you for a while after taking iron by doing additional CBC tests. This will help determine if your hemoglobin and red cells are increasing. You should not take iron supplements unless they are ordered by your physician. Too much iron can cause serious problems.

If you are taking a vitamin with iron, you need to let your physician know since this will complicate interpretation of the test results.

Reference ranges for iron studies:

Serum iron: 62-173 mg/dL

Total iron binding capacity (TIBC): 253-435 mg/dL

Serum ferritin: 10-200 ng/mL

3. Vitamin B12 and Folic Acid: These two chemicals are needed by the body to make new cells. If you are not taking in enough of these, you may become anemic and experience other problems. The kind of anemia caused by folic acid or vitamin B12 deficiency is called megaloblastic anemia.

Vitamin B12 is also known as cobalamin. You should include 5-7 mg of vitamin B12 per day in your diet. This amount is available in a mixed diet but if you are a strict vegetarian, you will not be taking in enough by food alone. Pregnancy may lead to a deficiency if the mother has a poor diet. Vitamin B12 is stored in the body and it takes several years to develop a deficiency if you do not take in enough.

Folic acid is found in most foods and is synthesized by bacteria in the gut. Overcooking destroys folic acid. The daily dietary recommendation if 200mg per day. The liver stores enough folic acid for 3-6 months if there is no folic acid in the diet. There is an increased need for folic acid in pregnancy and during breast feeding.

If your CBC result shows that your red cell count and hemoglobin are low and the red cells are large, you might have megaloblastic anemia. The physician may order a vitamin B12 and/or folic acid test. There are conditions that may falsely increase or decrease these two test results. Therefore, you should be as thorough as possible when giving your physician details of your history.

In some cases there is a reason to do another test called a Schilling Test. This test will help the physician determine if your vitamin B12 deficiency is due to the absence of a factor in the stomach (intrinsic factor) that must be present for you to absorb the vitamin B12 in the intestine. If this factor is missing, you have pernicious anemia. You will be given either regular injections of vitamin B12 or a nasal spray that contains vitamin B12 because you cannot absorb the vitamin in the intestine.

In the Schilling test you are given a dose of vitamin B12 by mouth and an injection of B12 several hours later. You collect all your urine for 24 hours and a blood sample will be drawn. The laboratory will test both your urine and blood.

Reference ranges:

Serum folate: 2-10 ng/mL

Red cell folate: 140-960 mg/mL

Serum B12: 200-1000 pg/mL

Schilling test: greater than 7.5% excretion

For more information on anemia go to this web-site:

http://webmd.lycos.com/topic_summary/1509

INFECTION AND LEUKEMIA

Infection: The white blood cells are your body’s defense against infection. When you have an infection, the white blood cells may increase in number to help fight the infection. Some of these white cells eat and kill the microorganisms causing the infection while other white cells make antibodies to fight the infection.

The CBC will help the physician determine if you have a bacterial or viral infection. Usually in bacterial infections your total white cell count will increase. In viral infections the count may be normal or decreased. This is helpful information because bacterial infections can be treated with antibiotics. Viral infections do not respond to antibiotics. There are other clues to infection in the blood that a clinical laboratorian will be able to pick out.

Reference range for WBC: 2.5-11.0 x 10⁹/L

Leukemia:Leukemia is another condition that can be detected by the CBC. Usually in leukemia, the white blood cell count is increased, sometimes 10 to 20 times normal. In addition the cells present are abnormal looking or very immature. If leukemia is suspected, additional tests will be done on the blood and a bone marrow will be performed. There are several different types of leukemia. Effective treatment depends on the accurate identification of the malignant cells by the laboratory. In most cases, cytogenetics is also done on the cells to see if there are chromosome abnormalities that will assist in identifying the type of leukemia, in prognosis and treatment. Some types of leukemia are more responsive to treatment than others.

In all cases, a bone marrow is performed when leukemia is suspected. This will provide a glimpse of the "factory" of white cells. The bone marrow will be filled with the abnormal cells even if there are only a few of these cells in the peripheral blood.

Acute lymphocytic leukemia: http://my.webmd.com/topic_summary/1530

Acute myelocytic leukemia: http://my.webmd.com/topic_summary/1533

Chronic lymphocytic leukemia: http://www.acor.org/leukemia/cll.html

Chronic myelocytic leukemia: http://inform.acor.org/mpd/CMLFAQ.html

Myeloproliferative disorders including essential thrombocythemia, polycythemia vera,

chronic myelocytic leukemia, agnogenic myeloid metaplasia:

http://www.acor.org/diseases/hematology/MPD/

BLEEDING AND CLOTTING DISORDERS

The body has a finely controlled system that prevents excessive bleeding and clotting when the blood vessels are injured. If this system has defective or deficient proteins, bleeding or clotting can occur. Clotting disorders are more common than bleeding disorders. It has been discovered that many bleeding and clotting disorders are inherited. Thus the cytogenetic laboratory also becomes involved in testing for these disorders.

Laboratory tests: The most common tests done are the prothrombin time (PT) and activated partial thromboplastin time (aPTT).

1. Prothrombin time (PT): This test can be used to screen for bleeding and clotting disorders. If abnormal results are found, further specific testing is necessary to determine the specific problem. More commonly, this test is performed to monitor anticoagulant therapy. Your physician will adjust your coumarin (coumadin) based on the results of this test. Coumarin acts by decreasing vitamin K. If you change your diet and take in a lot of this vitamin, your PT test will be affected.

2. Activated partial thromboplastin time (aPTT): This test is used to screen for bleeding and clotting disorders. Depending on the results, further specific testing will be done. This test is also used to monitor heparin therapy on hospitalized patients.

DIABETES

Diabetes mellitus: Diabetes mellitus occurs when an individual has a high blood sugar. It occurs because of a problem with insulin, which is a hormone produced by the pancreas. When insulin is not produced or used correctly by the body, sugar cannot get into the cells and produce energy.

There are several types of diabetes mellitus, which include insulin-dependent diabetes mellitus(Type I or juvenile diabetes), non-insulin-dependent diabetes mellitus(Type II or maturity onset diabetes) and gestational diabetes mellitus. Type I diabetes mellitus is characterized by a lack of insulin. Type II diabetes mellitus usually develops after the age of 40 and often can be controlled by diet, weight loss, and exercise. Sometimes drugs or insulin are also needed. Gestational diabetes can occur during pregnancy. If diabetes mellitus is not treated, the individual may develop vascular disease or disease of the nerves. These diseases may lead to complications such as blindness, kidney disease and amputations.

For more information please access the following Web site:

http://www.webmd.com

Choose diabetes

Gestational diabetes: Gestational diabetes mellitus is a form of diabetes characterized by a deficiency of insulin which occurs during pregnancy. The condition usually disappears after the birth of the child and the mother returns to normal.

For more information please access the following Web sites:

http://www.midwives.org.nz/gesdia.html

http://www.babycenter.com/tips/2058.html

Laboratory tests for diabetes:

1. Blood and urine glucose: If your physician suspects that you may have diabetes, he will order a blood glucose test and maybe a urinalysis. The blood specimen must be taken after a fast of 10-16 hours. The fasting blood glucose level is high in untreated diabetics and often sugar can be found in the urine. Generally a value greater than 140 mg/dL on more than one occasion is required for a diagnosis of diabetes. If your blood glucose is high or there is sugar in the urine, further tests may be done.
2. Oral glucose tolerance test (OGTT): This test may be done if the blood glucose test is abnormal or if glucose is found in the urine. You will be given a solution to drink that contains a high level of carbohydrate. Your blood will be drawn periodically after that to see if your blood sugar goes back to normal after a brief time. Urine is also tested to see if the glucose spills over into the urine. In diabetes, there is not enough insulin produced or the glucose cannot get into the cells. Therefore the glucose level remains high in the blood for two hours or more. For a diagnosis of diabetes, the specimen taken at 2 hours and one other specimen must have a glucose value of 200 mg/dL or higher.
3. Insulin test: This test may be done in those individuals who are older when they develop diabetes-like symptoms and it is suspected that they may have type II diabetes. The insulin level may be high indicating that the cells cannot use the insulin to get the glucose into the cells.

HEART ATTACK OR ACUTE MYOCARDIAL INFARCTION (AMI)

During an AMI, the cells in the heart die when there is a lack of blood supplied to the myocardial tissue. This usually occurs when the coronary arteries become blocked and cannot supply blood the heart muscle. When cells die they release their contents which find their way into the blood. By measuring the amount of these substances in the blood, it can be determined if you had a heart attack.

Laboratory tests: Cardiac markers in the blood are used to help in the diagnosis of a heart attack. Cardiac markers that are currently being used are the proteins myoglobin and Troponin I and the enzyme CK-MB which is a specific enzyme released when cardiac muscle dies. Some of these proteins immediately begin to increase in the blood while others do not increase for hours after the heart attack. Some remain increased in the blood longer than others. Therefore it depends on when you first experienced the symptoms of a heart attack as to which tests your physician will order. It is common for a patient to remain in the emergency room for several hours after the attack and have repeated blood samples drawn to see if the proteins and enzymes eventually increase.

For more information, please access the following web site:

http://www.webmd.com

Topic - Heart Disease

Document - Heart Attack

Go to Treatment and Diagnosis

Under Diagnosis - What tests will confirm a Heart Attack

Discussion of Cardiac Markers and EKG

EVALUATION OF THE DIGESTIVE TRACT

Bleeding from the digestive system may occur in the following conditions: colorectal cancer, peptic ulcer, inflammation of the intestines, stomach cancer, hemorrhoids and the abuse of aspirin or other medications that may irritate the digestive system. Blood in the stool is not always apparent. Sometimes there is a very small amount present and/or it is black in color.

Laboratory test: A fecal occult blood test is ordered on a patient to find hidden traces of blood in the feces (or stool). This test is very easy to do and is often performed by the patient at home. A sample of feces is put on a strip of paper that has a chemical on it. A color change indicates the presence of blood. Usually the test is repeated and performed at least three different times.

For more information, please access the following web site:

http://www.ama-assn.org/insight/gen_hlth/blood/fecal.htm

Access fecal occult blood test (hemoccult)

SEXUALLY TRANSMITTED DISEASES

Diseases that are acquired by having sex with a person who has the disease are called sexually transmitted diseases (STDs). Women are particularly at risk for these diseases because most often, they do not show any symptoms or only mild symptoms if any. Women who may have these infections therefore may remain untreated and develop complications such as ectopic (tubal) pregnancy, infertility, and chronic pelvic pain. There are more than 12 million cases of STDs reported in the United States yearly. These STDs include chlamydiosis, gonorrhea, HIV, Herpes simplex virus infection (HSV), human papillomavirus (HPV), and syphilis.

In most of these infections, laboratory testing is necessary for the physician to find out which disease is present so that he can provide the appropriate treatment. The sample, which is usually taken from the vaginal canal by the physician, is examined by using a microscope or other types of laboratory instrument. Depending on the organism suspected the physician may examine the sample in his office and is able to make a diagnosis right away. But in most cases, the sample must be sent to the laboratory for testing. The sample may be placed on special material that provides nutrients to allow the organism to grow. It usually takes at least 24-48 hours to identify the organism. In addition, the disease-causing organism that is grown can be tested against a variety of drugs that would kill the organism or stop it from causing any more damage to the body. In some cases, a blood sample may be obtained to detect substances in the body that would indicate the presence of the disease-causing organism. Blood samples are also sent to the laboratory where complex instruments are used to test for these substances.

These laboratory tests must be performed by qualified laboratory personnel to assure the accuracy and validity of the results. Laboratory personnel must be either a certified clinical laboratory scientist who has completed a bachelor’s degree in clinical laboratory sciences or a clinical laboratory technician who has completed an associate degree. These individuals are highly educated and trained to perform laboratory testing.

Listed below are some of the most common diseases that are transmitted sexually.

Chlamydiosis

Chlamydiosis is the most common bacterial sexually transmitted disease in the United States. There are approximately 4 million infections annually and these are found primarily among teens and young adults. It is estimated that 1 in 10 adolescent girls and 1 in 20 women of reproductive age are infected. Unfortunately, about 75% of individuals who have the infection do not know that they have the infection because they do not show any signs of the disease. Without testing, the infection remains undetected and untreated and may continue for as long as 15 months.

Complications

Without proper treatment, 20-40 percent of infected women may develop a complication called pelvic inflammatory disease (PID). Women with PID will experience chronic pelvic pain or damage to their reproductive organs that may result to infertility. Another major complication of PID is ectopic pregnancy, that is, when a fertilized egg implants in the fallopian tube or in other parts of the reproductive tract other than inside the uterus. An ectopic pregnancy is sometimes deadly.

Laboratory Testing

To diagnose chlamydiosis, the physician would need to collect a sample from the patient’s urethra or endocervix. Samples are collected by vigorously swabbing or scraping the cervical canal and then the samples are sent to the laboratory for testing. The clinical laboratory scientist looks for signs that the organism chlamydia is present in the sample.

For more information about chlamydia visit http://www.cdc.gov/nchstp/dstd/chlamydia_facts.htm

Gonorrhea

Gonorrhea is caused by bacteria that can be treated by antibiotics. Although the number of adults that have gonorrhea has decreased over the last few years, the number of affected individuals between ages 15-19, especially among females has increased or remained the same. Over 50% of women with gonorrhea are without symptoms. Without testing, diagnosis, and treatment, 10-40% of women with gonorrhea will eventually develop PID.

Laboratory Testing

Samples such as urethral discharge or discharge from the endocervix are collected from the patient suspected of gonorrhea. These samples are sent to the laboratory for testing. In male patients, diagnosis is made by obtaining genital samples that can be placed on a glass slide, stained, and examined under the microscope for the presence of the organisms. In female patients. Samples from the cervix contain numerous bacteria that look like the gonorrhea bacteria. Therefore, testing of female samples is more complicated and requires that the organisms grow to be identified which may take several days. Fortunately, there are newer methods to detect and identify the gonorrhea in the laboratory such as what is called DNA probes.

For more information about gonorrhea visit

http://www.cdc.gov/ncidod/dastlr/gcdir/gono.html

Human Immunodeficiency Virus (HIV)

Human Immunodeficiency Virus (HIV) causes AIDS. Women in particular are at risk of acquiring or transmitting HIV when they are infected with other sexually transmitted diseases such as chlamydia or gonorrhea. When genital ulcers such as those produced by syphilis or herpes are present, then, these women are at a greater risk for acquiring or transmitting this virus.

During the past ten years, HIV infection among women in the United States has greatly increased particularly in women of color. African American and Hispanic women are the most affected, representing more than three-fourths of AIDS cases reported. HIV/AIDS continues to be one of the leading causes of death among U. S. women between the ages of 25-44. Women may become infected with HIV when they have sex with a partner who uses drugs and share needles with them. Women who use noninjection drugs such as crack or cocaine are also at risk of getting the infection sexually when they trade sex for drugs or money.

Laboratory Testing

To prevent the spread of HIV, counseling and early diagnosis are important. Testing for HIV antibody is highly accurate. HIV antibody is a substance that can be detected in the person’s blood when he or she has been exposed to the virus. Before a person is considered "positive" for HIV, the blood sample must produce a "positive" result for both a screening test and a confirmatory test. Antibodies usually appear about 3 months after infection with HIV, but sometimes may take up to 6 months. If the test is negative at 3 months, it must be repeated at 6 months after exposure.

For more information about HIV/AIDS and AIDS testing visit http://www.cdc.gov/nchstp/hiv_aids/testing.htm

http://www.cdc.gov/nchstp/hiv_aids/pubs/facts.htm

Genital Herpes

Herpes simplex virus (HSV) causes genital herpes. Herpes simplex type 1 usually cause the common "fever blisters" or mouth sores while Herpes simplex type 2 causes genital ulcers. However, both types may cause either oral or genital infection. Once a person becomes infected with HSV, it remains for life and the disease may occur again periodically. Most people infected with the virus do not have any symptoms and do not know that they are infected while others may produce genital sores repeatedly. There are approximately 30 million persons in the United States that may have genital HSV infection. The infection may be acquired through direct contact such as kissing, sexual act or at any time there is a skin-to-skin contact. There is no known cure for genital herpes although there is a drug, Acyclovir that may help control the symptoms.

Complications

In most individuals, HSV infection is not apparent and may not show any symptoms. In persons whose immune system is weak, the infection becomes more serious. In addition, if the woman infected is pregnant, HSV-2 can transmitted to the infant and may cause harmful effects to the newborn. If the woman has active genital herpes at delivery, a cesarean-section delivery is usually performed.

Laboratory Testing

Genital herpes can be diagnosed by a health care provider by visual inspection and by taking some samples from the sore and sending it to the laboratory to see if the herpes virus is present.

For more information on genital herpes visit http://www.cdc.gov/nchstp/dstd/Genital_Herpes_facts.htm

Genital Warts

Human papillomavirus (HPV) is a virus that may cause genital warts although in many cases, people who are infected with this virus do not show any symptoms. The major concern about HPV infection is the strong association of HPV infection with the development of cervical cancer. There are approximately 25 types of HPV that can infect the genital area. These types are classified into "high risk" and "low risk" types, based on their association with cancer. One risk factor therefore for cervical cancer is infection with a "high risk" type of HPV. There is no known cure for HPV infection.

Laboratory Testing

Genital warts may be diagnosed by visual examination and confirmed by biopsy although biopsy is seldom performed.

For more information concerning genital warts visit http://wonder.cdc.gov/wonder/prevguid/p0000480/entire.htm

Syphilis

Syphilis is another bacterial sexually transmitted disease that can be cured with antibiotics if proper diagnosis and treatment are performed. The number of syphilis cases among women of all ages has greatly increased and the rate is more than twice among males in the age 15 —19 age group during the last several years. Syphilis rates in African American women are 7 times greater than the female population as a whole.

The bacterium that causes syphilis can be passed on from one person to another by contact with syphilis sores that maybe located in the external genitalia, vagina, or rectum. Sores may also be present in the mouth or on the lips. Newborn babies may get the infection from the mother. If the pregnant woman who has syphilis does not receive any treatment, there is a 40% chance that the baby maybe stillborn or may die shortly after birth. Babies who survive may suffer from many serious health problems such as mental retardation and seizures.

Laboratory testing

The health care provider may collect samples from the syphilis sore and examine the material for the bacterium under the microscope. In addition, after the person becomes infected with the syphilis bacterium, the body produces antibodies that may be detected by a blood test. The blood test is safe, accurate, and inexpensive. All pregnant women should have themselves tested for syphilis because it can possibly infect and kill the unborn baby.

For more information on syphilis visit

http://www.cdc.gov/nchstp/dstd/Syphilis_Facts.htm

Trichomonas vaginalis

This organism is a sexually transmitted parasite that causes vaginitis. The infection is characterized by intense itching, and a frothy, profuse discharge in women. Men may also be infected but generally have no symptoms. They are able, however, to pass the infection to their sexual partner.

The classic test for the organism is to examine some of the discharge [wet mount] and look for the characteristic movement of T. vaginalis. A small amount of the discharge is placed on a glass slide and examined under the microscope. The organisms may also be seen during the microscopic examination of a urine specimen.

For more information go to the following sites:

http://adam.excite.com/info/?id=001331

Autoimmune Diseases

Autoimmune diseases are a group of diseases characterized by production of autoantibodies [auto=self]. These blood proteins, which are made by blood cells called lymphocytes, are designed to protect the body from foreign antigens such as bacteria or viruses. In the case of autoimmune diseases, these antibodies attack antigens in the patient’s own cells and cause damage to the body. As a result, the patient often has widespread skin or connective tissue damage. Diseases in this group include Sjorgen’s syndrome, Systemic lupus erythematosus [SLE], scleroderma, and ankylosing spondylitis.

Women in the age group of 20-40 are at highest risk for developing these diseases. Black women are particularly at risk and also those who have a family member with the disease. There is no cure but drugs can control symptoms and progression.

The laboratory test that is often ordered to screen for presence of any one of these diseases is the antinuclear antibody test [ANA]. In this test the patient’s blood is tested to determine if any of these autoantibodies are present. Based on the pattern that is observed under the microscope, certain autoimmune diseases can be ruled out. Confirmatory tests for others can then be performed. The final diagnosis will be based on results of the laboratory tests and the patient’s clinical symptoms.

Lupus/ANA

http://adam.excite.com/info/?id=003535[ has information about the ANA test]

http://dir.yahoo.com/Health/Diseases_and_Conditions/Autoimmune_Diseases/

[has information about other search pages]

http://www.lupus.org/lupus/lupusfaq.html%2312 [contains commonly asked questions about lupus]

http://lupus.miningco.com/health/diseases/lupus/msubdiag.htm?pid=2750&cob=home

[general information]

Sjorgen’s Syndrome

http://lupus.about.com/health/diseases/lupus/msubsjog.htm?pid=2750&cob=home

http://www.rheumatology.org/patients/factsheet/sjogrens.html

Rheumatoid Arthritis

Rheumatoid arthritis[RA] is another disease that is often seen in women. Symptoms can be similar to those of SLE or other autoimmune diseases. The onset of RA is often between the ages of 30-60 and the disease presents with a variable course — periods in which the symptoms become worse followed by periods in which the symptoms lessen. RA is characterized by joint inflammation, pain, and stiffness. Damage to the joint may limit mobility and range of motion as well as cause joint deformity.

Patients with RA produce a characteristic protein [antibody] that can be tested for in serum. This is referred to as the rheumatoid factor [RF]. A small amount of the patient’s blood is mixed with the reagent. A positive result indicates the presence of RF. This test may also be positive in a few people who do not have RA.

For more information go to the following Web sites:

http://adam.excite.com/info/?id=003548[information about the lab tests for RA]

http://arthritis.about.com/health/diseases/arthritis/mbody.htm[general information]

http://arthritis.about.com/health/diseases/arthritis/msub7.htm[general information]

http://www.merck.com/pubs/mmanual/section5/chapter50/50a.htm%23A005-050-0039

[information about RA including the laboratory tests]

http://www.hopkins-arthritis.com/rheumatoid/rheum_clin_pres.html [general information]

http://www.MedicineNet.com/Art.asp%3Fli=MNI%26amp;ag=Y%26amp;ArticleKey=466

[general information]

http://www.nih.gov/niams/healthinfo/rahandout/contents.html[general information]

Urinalysis

This procedure is one of the most common laboratory tests performed. The urine specimen is easy to collect. Results of a urinalysis serve as a screen for problems such as infection or kidney failure in the renal system [kidneys and bladder] as well as for diseases in other organs [diabetes].

Parts of the urinalysis include:

• A physical exam where the color and clarity are noted. A specific gravity or measure of the amount of dissolved substances is also performed.

• A chemical screen using a dipstick [a plastic stick with chemicals] which measures substances such as blood, glucose, protein, and bilirubin .

• A microscopic examination to detect formed elements such as cells, crystals, casts, bacteria or other organisms which are not visible to the naked eye.

For more information go to the following Web sites:

http://health.yahoo.com/health/Diseases_and_Conditions/Disease_Feed_Data/Urinalysis/

[general information]

http://adam.excite.com/info/?id=003579

http://adam.excite.com/info/?id=003581[information about glucose test]

Rh Immune globulin [Rhogam^@]

Rh immune globulin is a substance given to an Rh negative pregnant woman to prevent her from developing antibodies against the Rh antigen on her unborn child’s [fetus] red blood cells[RBC]. During pregnancy a few fetal RBCs can enter the mother’s circulation. When this happens, her immune system recognizes these as ‘foreign’ and makes antibodies to attack these RBCs. Development and attachment of these antibodies to the fetus’s blood cells can lead to anemia, and in severe cases, fetal death. After birth they may cause increased cell destruction leading to jaundice in the newborn.

Rh immune globulin can be given during the pregnancy to an Rh-negative woman as a preventive measure to prevent development of these antibodies. It may be given again after the birth of an Rh-positive baby.

To determine if a woman is eligible to receive Rh immune globulin, her blood will be tested to determine her ABO group and Rh type. If lab tests show she possesses the Rh factor she is termed ‘Rh positive’, if not she is Rh negative. A test will also be performed to see if she has already developed antibodies against her baby’s cells. To determine if she should receive Rh Immune globulin after the birth of her baby, there will be a special test to determine how many fetal cells have entered her circulation during delivery Rh immune globulin is given as an injection and the amount will depend on how many fetal cells have entered her blood.

For more information go to the following Web sites:

http://adam.excite.com/info/?id=001600

http://adam.excite.com/info/?id=003407

http://adam.excite.com/info/?id=001559

http://adam.excite.com/info/?id=003345 (ABO blood typing)

THYROID FUNCTION TESTS

These tests are performed to help in the diagnosis of thyroid disorders such as hyperthyroidism or hypothyroidism. Hyperthyroidism represents an overactive thyroid gland and is characterized by the production of excess amounts of thyroid hormones, T₄ and T₃. Hypothyroidism represents an underactive thyroid gland and is characterized by decreased production of thyroid hormones, T₄ and T₃. In a normal individual thyroid hormone levels are balanced and that balance is maintained by a hormone produced by the pituitary gland, thyroid-stimulating hormone (TSH). If too little thyroid hormones are present in the blood, TSH is produced which tells the thyroid gland to produce more thyroid hormones. Conversely, if too much thyroid hormones are present in the blood, TSH is not produced and the thyroid gland slows production of thyroid hormones. Thyroid disorders occur when there is a problem in maintaining this balance.

The following is a discussion of the most commonly ordered thyroid function tests. The specimen for each of these tests is obtained by drawing a blood sample. The blood sample is allowed to clot and the serum or liquid portion is removed for testing.

1. Thyroid-Stimulating Hormone (TSH)

The TSH test is frequently the first test ordered to determine if an individual has a thyroid disorder. This laboratory test measures the level of TSH in an individual's blood. TSH is the pituitary hormone that tells the thyroid gland to produce more thyroid hormones, T₄ and T₃. Typically, TSH will be decreased in hyperthyroidism (excess levels of T₄ and T₃), but increased in hypothyroidism (decreased levels of T₄ and T₃). The TSH test is also used to monitor a patient's response to treatment for either hyperthyroidism or hypothyroidism.

2. Free Thyroxine T₄ (F T₄)

This hormone is a hormone produced by the thyroid gland. In the blood the majority of T₄ circulates bound to proteins and only a small amount is unbound or free. The free T₄ is responsible for the hormone’s action. This laboratory test measures free T₄ in an individual's blood. This test is frequently ordered together with the TSH level to identify hyperthyroidism in which the F T₄ would be increased or hypothyroidism in which the F T₄ would be decreased.

3. Free Triiodothyronine T₃ (F T₃)

This hormone is a hormone produced by the thyroid gland. In the blood the majority of T₃ circulates bound to proteins and only a small amount is unbound or free. The free T₃ is responsible for the hormone’s action. This test measures the amount of free T₃ (F T₃) in an individual's blood. The measurement of F T₃ provides similar information to the physician as the F T₄, helping to identify hyperthyroidism and hypothyroidism.

4. Total Thyroxine (Total T₄)

This hormone is a hormone produced by the thyroid gland. In the blood the majority of T₄ circulates bound to proteins and only a small amount is unbound or free. This test measures the total amount of T₄ (protein-bound and free) that is circulating in the blood. It is used together with the Triiodothyronine T₃ Uptake (T₃UP) to rule out the possibility of hyperthyroidism or hypothyroidism in conditions associated with decreased or increased protein levels such as acute or chronic illness, pregnancy or use of oral contraceptives. For example, an elevated Total T₄ and elevated T₃UP indicates hyperthyroidism while an elevated Total T₄ and decreased T₃UP indicates a condition associated with increased protein levels like pregnancy. On the other hand, a decreased Total T₄ and decreased T₃UP indicates hypothyroidism while a decreased Total T₄ and increased T₃UP indicates a condition associated with decreased protein levels like liver disease.

5. Total Triiodothyronine (Total T₃)

This hormone is a hormone produced by the thyroid gland. In the blood the majority of T₃ circulates bound to proteins and only a small amount is unbound or free. This test measures the total amount of T₃ (protein-bound and free) that is circulating in the blood. Total T₃ results provide similar information as Total T₄.

6. Triiodothyronine T₃ Uptake (T₃UP or T₃U)

This test measures the specific thyroid hormone binding proteins in the blood and is called T₃ Uptake because T₃ is used in the test procedure. The measurement of T₃ Uptake is used to help determine if elevated T₃ or decreased T₃ levels are due to changes in protein levels and not the result of thyroid disease. If the test result comes back "decreased T₃UP", this indicates decreased uptake of T₃ in the test procedure and is caused by increased levels of thyroid hormone binding proteins. Likewise, if a test result comes back "increased T₃UP", this indicates increased uptake of T₃ in the test procedure and is caused by decreased levels of thyroid hormone binding proteins. The T₃UP should always be used in conjunction with a Total T₄ or Total T₃ to assess an individual's thyroid status in the presence of changes in protein levels.

For more information on the thyroid and laboratory tests go to the Web-site:

http://www.thyroid.com/services.htm

CYTOGENETICS TESTING

1. Triple Marker screening on pregnant women

A pregnant woman’s blood specimen may be tested for the presence of three substances produced by the fetus. These serve as a screen to help detect the presence of fetuses at high risk of having a chromosome abnormality. Many chromosomally abnormal fetuses produce more or less of the three substances than does the chromosomally normal fetus. The three substances found in the maternal blood serum are alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG) and unconjugated estriol. Triple marker screening (TMS) detects 65% of Down syndrome fetuses, 60 % of trisomy 18 fetuses and many other chromosomally abnormal fetuses. This test is only a SCREEN and a positive result does not mean the fetus has an abnormality. A high rate of false positives are allowed in order to detect a high percentage of abnormals. All pregnancies that screen positive undergo further definitive testing to determine the true status of the fetus.

2. Amniocentesis

Amniocentesis involves inserting a needle into the uterus and withdrawing a sample of the amniotic fluid that surrounds the fetus. The placement of the needle is carefully watched by ultrasound monitoring. The fluid contains cells and many biochemicals produced by the fetus. Many tests may be performed on the amniotic fluid or fetal cells to allow the mother and physician to manage the pregnancy or prepare for the birth of an infant who may have an abnormality.

A frequent laboratory test performed on the cells is chromosome analysis to detect genetic imbalances that may produce mental retardation and/or abnormal development in the fetus. This test involves growing the cells in cultures and examining the chromosomes. An example of an imbalance of genetic material is found in Down Syndrome. Down Syndrome results when there is an extra copy of chromosome number 21.

Amniocentesis is offered most frequently to pregnant women as they age since the rate of chromosome abnormalities in live born infants increases significantly for mothers beyond 33-35 years old. A mother giving birth at age 45-50 has a one in ten risk of having a chromosomally abnormal infant. For mothers of all ages, Down Syndrome affects one in each seven hundred live born infants. Other chromosome abnormalities, such as trisomy 13, trisomy 18 and the abnormalities involving the sex chromosomes, may also be detected by chromosome analysis.

Another laboratory test often performed on amniotic fluid specimens is for the presence of acetylcholinesterase (AChE) to detect openings of the central nervous system. Spina bifida or anencephaly involve openings to the spinal cord or brain. This laboratory test will detect approximately 95% of affected fetuses with outside openings to the central nervous system.

©2002 UTHSCSA School of Allied Health Sciences, Department of Clinical Laboratory Sciences.
All rights reserved. Updated 1/3/2005.
For comments or questions about this Web site contact neuen@uthscsa.edu.