Health Test Categories & Biomarkers

Alkaline phosphatase (ALP) is an enzyme found in various tissues, especially the liver, bile duct, bones, kidneys, and digestive system. It plays a role in the breakdown of proteins and is important for liver, bile duct, and bone health.

The ALP Test is used to help diagnose and monitor liver and bone disorders and assess treatment efficacy. Elevated levels may indicate liver or bone diseases, while decreased levels can suggest malnutrition or genetic conditions.

Abnormal Alkaline Phosphatase (ALP) Levels

Low ALP Levels - Causes

Nutritional deficiencies: zinc or magnesium
Malnutrition or malabsorption: including protein deficiency and celiac disease
Rare genetic conditions: Hypophosphatasia or Wilson's Disease
Hypothyroidism (underactive thyroid)
Medications: including oral contraceptives, hormone replacement therapy)

Low ALP Levels - Symptoms

Low ALP levels do not usually cause symptoms but may indicate underlying conditions, such as:

Fatigue
Bone pain or weakness
Delayed growth in children
Muscle weakness
Numbness or tingling
Seizures (in severe cases)

High ALP Levels - Causes

High ALP levels are generally due to underlying conditions, such as:

Liver diseases: hepatitis, cirrhosis, liver cancer
Biliary obstruction: bile duct obstruction, gallstones
Bone disorders: Paget's disease, bone metastasis, hyperparathyroidism, healing fractures
Other: congestive heart failure, pregnancy, adolescent bone growth
GI Issues: Ulcerative colitis or regional enteritis
Autoimmune liver diseases: primary biliary cirrhosis
Certain cancers: Hodgkin's disease, lymphoma, infiltrative diseases

(sarcoidosis), granulomatous disorders.

Medications: Oral contraceptives, antihypertensives.
Lifestyle factors: Excessive alcohol, obesity, or sedentary lifestyle intake can cause liver damage, raising ALP.

High ALP Levels - Symptoms

High (ALP) may not cause specific symptoms directly. However, the underlying conditions can cause various symptoms, depending on the cause.

Liver disease
Jaundice: Yellowing of the skin and eyes.
Abdominal pain: Particularly in the upper right side.
Fatigue: Persistent tiredness or weakness.
Itching: Generalized itching without a rash.
Bone Disorders
Bone pain: Particularly in the hips, spine, or legs.
Bone deformities: Abnormal bone growth or shape.
Increased fractures: Bones may break more easily.
Swelling or tenderness: In affected bones.
Gallbladder Issues
Abdominal pain: Especially after eating fatty foods.
Nausea or vomiting: Often after meals.
Fever: In cases of infection (cholecystitis).
Other Symptoms
Weakness: General weakness and malaise.
Loss of appetite: Especially with liver-related issues.

Absolute band neutrophils are immature neutrophils, a type of white blood cell that plays a key role in the body's immune response. Band neutrophils are typically released into the bloodstream when the body needs a rapid immune response, often in cases of infection, inflammation, or other stressors on the immune system.

The absolute band neutrophil count is a measure of the actual number of band neutrophils (immature neutrophils) present in a given volume of blood.

Abnormal Absolute Band Neutrophils

Low Absolute Band Neutrophils - Causes

Bone marrow suppression: Conditions like chemotherapy, radiation, or certain medications can suppress bone marrow function, leading to a lower production of neutrophils.
Aplastic anemia: This is a condition where the bone marrow fails to produce enough blood cells, including neutrophils.
Viral infections: Some viral infections, such as hepatitis or HIV, can lead to decreased neutrophil production.
Autoimmune diseases: Conditions like lupus can cause the immune system to attack healthy cells, leading to neutropenia (low neutrophil count).
Nutritional deficiencies: Severe vitamin B12 or folate deficiencies can result in low neutrophil levels.

Low Absolute Band Neutrophils - Symptoms

When band neutrophil levels are low, the immune system is weakened, increasing the risk of infections. Common symptoms include:

Frequent or recurrent infections
Mouth sores
Unexplained fever
Swollen lymph nodes
Fatigue

High Absolute Band Neutrophils (Bandemia) - Causes

Elevated levels of band neutrophils in the blood, known as a "left shift," may occur in response to bacterial infections, inflammation, or other conditions that stimulate the production and release of immature neutrophils from the bone marrow.

Infections (especially bacterial): The most common cause of elevated band neutrophils is infection. The body releases immature neutrophils to fight infection when the demand for neutrophils exceeds the supply.
Inflammatory conditions: Inflammatory diseases like rheumatoid arthritis or inflammatory bowel disease can also cause elevated levels of band neutrophils.
Acute stress: Physical stress, such as trauma, surgery, or burns, can increase band neutrophils.
Bone marrow disorders: Certain conditions, such as leukemia or other bone marrow disorders, can lead to abnormal production of white blood cells, including band neutrophils.
Sepsis: A severe infection that spreads throughout the body can trigger a high level of band neutrophils as part of an immune response.
Corticosteroid use: Corticosteroids, which are used to treat inflammation, can increase band neutrophil counts by altering immune system function.
Smoking: Chronic smoking has been associated with increased levels of band neutrophils.

Low Absolute Band Neutrophils - Symptoms

The symptoms associated with elevated band neutrophils are usually tied to the underlying cause, such as:

Fever (often associated with infection)
Fatigue
Pain or discomfort (due to infection or inflammation)
Signs of infection (e.g., redness, swelling, or discharge at the site of infection)
Shortness of breath (in severe cases like sepsis)

Promyelocytes are an early stage of white blood cells (specifically granulocytes) found in the bone marrow. They are precursors to more mature forms of white blood cells like neutrophils, eosinophils, and basophils. In healthy individuals, promyelocytes should be present only in the bone marrow, not in the bloodstream. Promyelocytes in a blood sample are abnormal and typically indicate a disruption in normal blood cell production. The detection of promyelocytes usually occurs as part of a complete blood count (CBC) or bone marrow biopsy when investigating abnormal blood cell production, anemia, or blood cancers.

The promyelocytes per 100 white blood cells blood test measures the percentage of total white blood cells or bone marrow cells that are promyelocytes. It provides a proportion of these cells relative to the overall white blood cell count. This test is used clinically for:

Bone marrow evaluation: When evaluating bone marrow function or disorders, this test helps determine if promyelocytes are present in excessive proportions, which would indicate a problem in blood cell maturation.
Diagnostic clarity: An increased percentage of promyelocytes in a bone marrow test (normally 1-5%) might indicate the early stages of diseases like AML, where the bone marrow produces large numbers of immature cells.
Peripheral blood: If promyelocytes are found in the bloodstream (where they normally should not be), a percentage can be given to evaluate how much of the white blood cell population is made of these immature forms, potentially indicating a serious blood disorder.

Abnormal Promyelocyte Levels

Causes of High Promyelocyte Levels

Acute promyelocytic leukemia (APL): This subtype of acute myeloid leukemia (AML) is characterized by an abnormal accumulation of promyelocytes in the bone marrow and peripheral blood. APL is the most common cause of high promyelocyte levels in the blood.
Other types of acute myeloid leukemia (AML): Besides APL, other types of AML can also lead to increased promyelocyte levels.
Bone marrow disorders: Conditions like myelodysplastic syndromes (MDS), which affect the bone marrow’s ability to produce healthy blood cells, may also cause an increase in promyelocytes.
Bone marrow stress: In some rare cases, conditions like severe infections or significant bone marrow stress (e.g., from chemotherapy or radiation) can lead to elevated promyelocytes as the bone marrow tries to produce more cells quickly.

High Promyelocyte Levels - Symptoms

Symptoms associated with high promyelocytes generally relate to underlying conditions, such as APL or AML. Common symptoms may include:

Fatigue and weakness - due to anemia (low red blood cell counts)
Frequent infections - due to reduced normal white blood cells
Bruising or bleeding - due to low platelet counts, which may present as frequent nosebleeds, easy bruising, or heavy menstrual bleeding
Bone pain - caused by the overcrowding of abnormal cells in the bone marrow
Shortness of breath
Paleness or pallor
Unexplained weight loss
Fever or night sweats

Vitamin D, 25-hydroxy D2 (25-OH D2), is a form of vitamin D measured to assess overall vitamin D levels in the body. It is derived from plant-based sources or supplements and is one of the two major forms of vitamin D, the other being 25-hydroxy D3 (derived from animal sources and sun exposure). The body converts D2 and D3 into an active form of vitamin D, which helps maintain bone health, supports immune function, and regulates calcium and phosphorus levels.

The 25-Hydroxy Vitamin D2 blood test measures the level of vitamin D2 in your body.

Abnormal Vitamin D, 25-hydroxy D2 (25-OH D2)

Low Vitamin D2 Levels (Deficiency) - Causes

Dietary deficiency: Lack of foods rich in vitamin D, especially for individuals who follow plant-based diets (D2 is from plant sources, while D3 is more common in animal products).
Malabsorption: Celiac disease, Crohn's disease, and gastric bypass surgery can impair the body’s ability to absorb vitamin D.
Kidney or liver disease: These organs help convert vitamin D to its active form. Issues in either organ can lead to low levels.
Aging: As people age, their skin’s ability to produce vitamin D declines.
Obesity: Vitamin D can be stored in fat tissue, making it less available for the body.
Limited sun exposure: Vitamin D production in the skin relies on sunlight. So, limited sun exposure can lead to low overall vitamin D levels. This is a concern for those living at or above the 47th parallel.

Low Vitamin D2 Levels (Deficiency) - Symptoms

Bone pain and weakness: Vitamin D deficiency can lead to osteomalacia in adults, a condition causing bone pain or muscle weakness.
Fatigue: Low vitamin D levels can result in persistent tiredness.
Frequent illness: A weakened immune system can lead to frequent colds or infections.
Mood changes: Deficiency has been linked to depression and mood swings.
Bone loss: In severe cases, vitamin D deficiency can lead to osteoporosis (weak bones) over time.

High Vitamin D2 Levels (Toxicity) - Causes

Excessive supplementation: Vitamin D toxicity usually occurs due to overuse of supplements, as it’s difficult to reach toxic levels from sun exposure or food sources.
Rare medical conditions: Certain conditions, such as sarcoidosis or other granulomatous disorders, can cause the body to produce too much vitamin D.

High Vitamin D2 Levels (Toxicity) - Symptoms

Hypercalcemia: Excess vitamin D can lead to high calcium levels, causing symptoms such as:
Nausea and vomiting
Weakness and fatigue
Frequent urination
Thirst and dehydration
Kidney stones: Prolonged high levels of vitamin D can cause calcium deposits, potentially leading to kidney stones.
Heart issues: In severe cases, excess calcium can affect heart rhythms and lead to cardiovascular problems.

Vitamin D, 25-hydroxy D3 (25-OH D3), is the form of vitamin D produced in the skin in response to sunlight (UVB rays) and is obtained from animal-based foods. This form of vitamin D is considered the most potent and contributes the most to the body's overall vitamin D status. Vitamin D, 25-hydroxy D3 (25-OH D3) plays an essential role in various bodily functions; bone health, immune function, inflammation regulation, muscle function, and cardiovascular health.

The 25-Hydroxy Vitamin D3 blood test measures the level of vitamin D3 in your body.

What are the symptoms and causes of low Vitamin D3?

Symptoms

Bone pain: Vitamin D3 deficiency can lead to soft or brittle bones, resulting in discomfort or pain, especially in the lower back, hips, and legs.
Muscle weakness: Low levels can cause muscle aches or weakness, particularly in older adults.
Fatigue: Persistent tiredness or low energy can be a symptom of vitamin D3 deficiency.
Frequent infections: A weakened immune system may lead to repeated respiratory infections or illnesses.
Mood changes: Vitamin D3 deficiency has been linked to depression, anxiety, or mood swings.
Osteoporosis: Long-term deficiency increases the risk of osteoporosis and fractures due to poor bone mineral density.

Causes

Limited sun exposure: Living in areas with little sunlight (at or above the 47th parallel), using sunscreen frequently, or staying indoors often can reduce vitamin D3 production.
Dietary deficiency: Low intake of foods rich in D3, like fatty fish (salmon, mackerel), egg yolks, and fortified dairy products, can lead to low levels.
Malabsorption disorders: Crohn's disease, Celiac disease, or bariatric surgery can interfere with the body's ability to absorb vitamin D.
Liver or kidney disease: These organs convert vitamin D3 into its active form. So, any dysfunction can result in low levels.
Obesity: Vitamin D3 can be stored in fat cells, reducing its availability in the bloodstream.
Age: As people age, their skin becomes less efficient at synthesizing vitamin D3 from sunlight.

What are the symptoms and causes of HIGH Vitamin D3?

(Toxicity) - Symptoms

Hypercalcemia: High vitamin D3 levels can lead to too much calcium in the blood, causing symptoms like:
Nausea and vomiting
Excessive thirst and frequent urination
Weakness and fatigue
Confusion or difficulty concentrating
Kidney stones: Chronic high levels of vitamin D3 can result in calcium buildup, leading to kidney stones.
Bone pain: Paradoxically, too much vitamin D3 can weaken bones due to excessive calcium extraction from bones.

(Toxicity) - Causes

Excessive supplementation: Vitamin D toxicity is usually caused by overuse of vitamin D3 supplements, as it is rare to get toxic levels from sunlight or food alone.
Sarcoidosis or granulomatous disorders: These conditions can cause the body to produce excess active vitamin D, leading to high calcium levels in the blood.
Kidney dysfunction: Impaired kidney function can prevent proper excretion of excess vitamin D.

Metamyelocytes are immature white blood cells (WBCs) typically found in the bone marrow, where they develop into mature granulocytes (e.g., neutrophils). These cells are more mature than myelocytes and should mature into fully functional neutrophils within the bone marrow. Under normal conditions, metamyelocytes should not be present in the peripheral blood. When metamyelocytes appear in the blood, it's often a sign that your body is fighting an infection, or responding to other changes inside your body.

Testing for the presence of absolute metamyelocytes is usually done as part of a complete blood count (CBC) with differential, especially when there is suspicion of bone marrow stress or an underlying blood disorder. The absolute metamyelocytes test measures the number of metamyelocytes circulating per microliter (uL) or liter of blood. It can provide insight into how the bone marrow responds to infection, inflammation, or other stressors.

Abnormal Absolute Metamyelocytes

Abnormal (Elevated)Absolute Metamyelocytes - Causes

Infections: Severe or systemic bacterial infections (e.g., sepsis) can cause a "left shift," where immature forms of white blood cells, including metamyelocytes, are released into the bloodstream.
Bone marrow disorders
Myeloproliferative disorders: Conditions such as chronic myelogenous leukemia (CML) can cause the release of immature white blood cells, including metamyelocytes, into the bloodstream.
Myelodysplastic syndromes: The bone marrow produces abnormal cells, leading to immature cell release.
Chronic inflammatory diseases: Conditions such as rheumatoid arthritis or systemic lupus erythematosus (SLE) can result in bone marrow hyperactivity, producing immature granulocytes.
Severe anemia or hypoxia: The bone marrow compensates by increasing blood cell production, causing the release of immature forms like metamyelocytes into circulation.
Bone marrow-stimulating drugs: Medications like granulocyte colony-stimulating factor (G-CSF), used in cancer patients or those with neutropenia, can stimulate the bone marrow to release immature white blood cells.
Acute blood loss: Severe hemorrhage can stimulate rapid bone marrow response, causing the release of metamyelocytes as the body attempts to compensate.
Tissue damage or trauma: Major physical trauma, burns, or surgeries may cause an increase in metamyelocytes due to increased white blood cell production in response to tissue injury.
Leukemias: Certain types of leukemia, particularly acute and chronic myeloid leukemia, can cause excessive production of immature cells like metamyelocytes.

Abnormal (Elevated)Absolute Metamyelocytes - Symptoms

Since metamyelocytes in the blood usually indicate an underlying condition, symptoms depend on the cause of the abnormal levels. Common symptoms associated with elevated metamyelocytes include:

Infections: Fever, chills, body aches, fatigue, and signs of localized or systemic infection.
Bone marrow disorders: Fatigue, unexplained bruising, frequent infections, bleeding, and weight loss.
Anemia: Fatigue, weakness, pale skin, dizziness, shortness of breath.
Chronic inflammation: Joint pain, swelling, chronic fatigue, and low-grade fever.
Leukemia: Persistent fatigue, weight loss, easy bruising, frequent infections, swollen lymph nodes.

Myelocytes are immature white blood cells that develop in the bone marrow and then mature into white blood cells, such as neutrophils, eosinophils, and basophils. They are not normally found in the bloodstream in significant numbers

The lab test for myelocytes typically involves counting the number of myelocytes per 100 white blood cells (WBCs) seen under a microscope.

Testing for myelocytes in the bloodstream is usually evaluated as part of a complete blood count (CBC) with differential or a bone marrow biopsy. The test is useful in identifying bone marrow activity, particularly when immature white blood cells are released into circulation as a response to stress, infection, or malignancy.

Abnormal Myelocyte Results

Myelocytes in the Blood - Causes

Myelocytes are usually found in the bone marrow. However, when detected in the blood, it suggests an abnormal release of immature WBCs. Causes of elevated myelocytes include:

Infections: Severe or systemic bacterial infections, especially in cases of sepsis, can cause the bone marrow to release immature white blood cells like myelocytes.
Bone marrow disorders
Chronic myeloid leukemia (CML): A type of blood cancer that leads to the overproduction of immature granulocytes.
Myelodysplastic syndromes (MDS): These conditions cause abnormal production of blood cells in the bone marrow.
Leukemias: Both acute and chronic myelogenous leukemias may cause high levels of immature WBCs, including myelocytes, to be released into the blood.
Severe inflammation or inflammatory diseases: Chronic inflammatory conditions such as rheumatoid arthritis or inflammatory bowel disease may cause the bone marrow to release immature white blood cells.
Stress or trauma: Physical trauma, major surgeries, burns, or severe stress on the body can cause increased white blood cell production, leading to myelocytes appearing in the blood.
Severe anemia: Hemolytic anemia or significant blood loss may cause the bone marrow to overcompensate, releasing immature cells like myelocytes.
Medications or therapies: Certain treatments, like chemotherapy or granulocyte colony-stimulating factor (G-CSF), can stimulate the bone marrow to release myelocytes into the bloodstream.

Elevated Myelocytes - Symptoms

Elevated myelocytes are not a disease, but are a sign of an underlying condition. Symptoms will depend on the primary cause:

Infection symptoms: Fever, chills, fatigue, and signs of localized or systemic infection.
Bone marrow disorders/leukemia: Fatigue, unexplained bruising or bleeding, frequent infections, swollen lymph nodes, and weight loss.
Chronic inflammation: Joint pain, swelling, and low-grade fever in conditions like rheumatoid arthritis.
Anemia symptoms: Pale skin, dizziness, fatigue, and shortness of breath in cases of severe anemia.

This test measures the absolute number of myelocytes in a specified blood volume.

Elevated Absolute Myelocytes

Elevated Absolute Myelocytes - Causes

Elevated absolute myelocytes, known as a 'left shift', usually occur due to stress on the bone marrow or a response to certain underlying conditions:

Severe bacterial infections: In cases of severe infection, such as sepsis, the bone marrow may release immature cells like myelocytes into the bloodstream to meet the increased demand for white blood cells.
Bone Marrow Disorders
Chronic myeloid leukemia (CML): A type of blood cancer characterized by an overproduction of immature white blood cells, including myelocytes.
Myeloproliferative disorders: These conditions lead to excessive production of various blood cells, including myelocytes.
Myelodysplastic syndromes (MDS): A group of disorders caused by dysfunctional blood cell production, which may lead to immature white blood cells, like myelocytes, entering the bloodstream.
Chronic inflammatory conditions: Chronic conditions, such as Rheumatoid Arthritis, Systemic Lupus Erythematosus (SLE), or Inflammatory Bowel Disease (IBD) can stimulate the bone marrow to release immature white blood cells like myelocytes.
Severe anemia (hemolytic anemia or aplastic anemia): Severe anemia, especially if caused by blood loss or destruction of red blood cells, may prompt the bone marrow to overcompensate by releasing immature cells into circulation.
Physical stress or trauma (burns or surgery): Significant physical stress can stimulate the bone marrow to release immature cells like myelocytes as part of the body’s response to injury.
Medications or treatments: Chemotherapy or use of Granulocyte Colony-Stimulating Factor (G-CSF), often given to stimulate white blood cell production in patients undergoing cancer treatment or with neutropenia, can cause the release of myelocytes into the bloodstream.
Leukemias and other hematologic cancers: Both acute and chronic leukemias (e.g., Acute Myeloid Leukemia (AML) and Chronic Myeloid Leukemia (CML)) may result in a significant increase in myelocytes and other immature white blood cells in circulation.

Elevated Myelocytes - Symptoms

The presence of myelocytes in the peripheral blood is typically an indicator of an underlying condition. Symptoms vary depending on the cause:

Infection symptoms: Fever, chills, fatigue, and signs of infection such as localized pain, swelling, or systemic signs of sepsis.
Bone marrow disorders or leukemia: Fatigue, easy bruising, frequent infections, swollen lymph nodes, bone pain, unexplained weight loss, and night sweats.
Anemia symptoms: Pale skin, fatigue, dizziness, shortness of breath, and weakness due to reduced red blood cell count.
Chronic inflammation: Joint pain, swelling, and stiffness in autoimmune diseases like rheumatoid arthritis.
Physical stress or trauma: Symptoms related to injury, burns, or major surgery, such as pain, swelling, or decreased function.

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