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For healthy living, vitamins play a very important role. However, any deficiency or increased presence of these vitamins are not good for health. The deficiency of vitamins can be due to not taking proper diet while excess can be due to excessive supplementation. 

Vitamins are classified as Water soluble and Fat-soluble vitamins.

Fat-soluble vitamins include: Vitamin A, K, D (25-OH), and E

Water-soluble vitamins include Vitamin B-1 (Thiamine), B-2 (Riboflavin), B-3 (Niacin), B-5 (Pantothenic acid), B-6 (Pyridoxine), B-7 (Biotin), B-9 (Folate), B-12 (Cobalamin), and  Vitamin C. 

The most common vitamins which are found deficient include Vitamin D (25-OH), Vitamin B12, and Vitamin B9. 

Vitamin D (25-OH) helps our body absorb calcium and phosphorus, and maintain strong bones and teeth. Vitamin D (25-OH) test measures the level of Vitamin D (25-OH) in the blood which is a useful indicator of osteoporosis (bone weakness), rickets (bone malformation), and osteomalacia.

Vitamin B12 is also called Cobalamin. It is a water-soluble vitamin. Vitamin B12 plays an important role in the formation of normal red blood cells, repair of tissues, DNA synthesis, and genetic material in cells. It is not produced in the body and has to be taken in the diet. The diet sources which includes Vitamin B12 are red meat, fish, milk, poultry, yogurt, eggs, fortified cereals, bread, and other grain products. It can also be taken in the form of Vitamin B12 tablets or multivitamin pills. Low levels of Vitamin B12 results in macrocytic anemia (size of red blood cells larger than normal).

Vitamin B9 along with Vitamin B12 and iron plays an important role in the formation of red blood cells. It plays an important role in the functioning of nerves and cell replication in the body. In pregnant ladies, it is required for proper development of fetus spinal cord. Low levels of Vitamin B9 can lead to anemia. 

Diabetic screening includes two set of tests - Glycosylated Hemoglobin test and Glucose - Fasting blood test. 

Glycosylated Hemoglobin Test measures the percentage of glycosylated hemoglobin in blood which reflects the average blood glucose over a period of past two to three months (8 - 12 weeks).

Hemoglobin is a protein found in Red Blood Cells and is responsible for transporting oxygen. There are different types of hemoglobin among which Hemoglobin A is predominant. With the elevation of blood sugar levels, some glucose binds spontaneously to Hemoglobin A (this binding is called Glycosylation or Glycation) and remains bound for the complete lifetime of the RBC, which is normally 120 days. Higher the level of glucose in the blood, the greater the amount of it binding to Hemoglobin A. Hemoglobin A1c is the dominant form of Glycated Hemoglobin. As RBCs die and get replaced, Hemoglobin A1c is cleared and gets slowly replaced with non-glycosylated hemoglobin. Measurement of HbA1c level over a period of time gives an indication of the level of glucose in the blood over that specific period of time. This not only helps in the diagnosis of Diabetes but also is useful for monitoring the effectiveness of measures taken to reduce blood sugar levels.

Glucose - Fasting Blood Test is done to measure the levels of glucose in blood during the period of fasting.

Glucose is the main source of energy for the body. Carbohydrates consumed in the diet are broken down in the body to form glucose, which is absorbed by the intestines and transported by the blood to various organs. The cells of these organs utilize the glucose to produce energy when required, and the excess is stored either as glycogen in the liver for short-term storage or in fat tissues as triglycerides for long-term storage. The uptake, utilization, and storage of glucose after it has been absorbed in the intestine is facilitated by a hormone called insulin. This hormone is secreted by the pancreas. Insulin influences the transport of glucose to the organs like heart, brain, working muscles, etc. It also directs the storage of excess glucose. These actions of insulin reduces sugar levels in the blood.

After a meal, sugar levels increase in blood, and insulin is secreted in response to reduce the sudden increase in sugar levels until it becomes normal. If in this process glucose levels fall too low in blood, another pancreatic hormone called glucagon is released. This hormone, directs the liver to convert stored glycogen into glucose and releases it into the blood. Both these hormones, insulin and glucagon, create a feedback mechanism to keep blood glucose levels within the normal range. Any imbalance in their activity causes an excess or shortage of blood sugar.

Glucose - Fasting blood Test helps to determine if the body is able to utilize or store glucose efficiently. High levels of sugar in blood indicate diabetes or resistance to insulin. Type 1 Diabetes is caused when insulin is not produced or produced in very little quantity. Type 2 Diabetes is caused when insulin is produced but is not being effectively utilized by the body. In both these cases, blood sugar levels rise, while cells remain deprived of nutrition.

CRP Test measures the levels of CRP in blood to detect the presence of an inflammation or to monitor the treatment and progress of an inflammatory condition. C-reactive Protein or CRP is an acute phase reactant protein which is produced and secreted by the liver in response to an inflammation in the body, which may be caused by tissue injury, infection, or autoimmune diseases. CRP levels increase in patients with trauma, heart attack, autoimmune diseases, bacterial infections, sepsis, post surgery, cancer, etc. CRP levels are often increased before the onset of other symptoms of inflammation such as pain, fever, etc. CRP levels in blood fall as the inflammation subsides.

It is a non-specific test. It can neither diagnose a condition by itself nor can it determine the location of a particular inflammation or disease. Other tests along with physical examination are performed to diagnose a particular condition and determine the location.

A variant of the CRP test is the High Sensitivity C-reactive Protein Test (hs-CRP) which is more sensitive for CRP levels and can detect blood CRP levels at a lower concentration than the standard CRP Test. The hs-CRP Test is performed usually to determine the risk of development of cardiovascular diseases in otherwise healthy individuals.

The Creatine Kinase Test measures the levels of Creatine Kinase in the blood. Creatine Kinase (CK) is an enzyme which is found in the brain, heart, skeletal muscle, and other tissues. In case of muscle damage, increased amounts of CK are released into the blood. 

In the blood, normally small amount of CK is present which comes from the skeletal muscles primarily. In case of any damage to the muscle or interference with the production of muscle, energy can lead to increased levels of CK. Also, these levels may rise if there is any change with the use of muscle energy. The examples of such conditions include strenuous exercise and myositis (inflammation of muscles). 

Muscle diseases (myopathies) such as muscle dystrophy can also lead to an increase in the levels of CK. However, significantly high levels of CK are observed in Rhabdomyolysis which there is an extreme breakdown of skeletal muscle tissue. 

A Lipid Profile test assesses the level of specific fat molecules called lipids in the blood and helps determine the risk of heart ailments. This test determines the amount of different types of lipids, including total cholesterol, low-density lipoprotein (LDL) cholesterol, very-low-density lipoprotein (VLDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides. Lipids play a pivotal role in the functioning of the body. They are crucial components of the cell membranes and hormones, provide cushioning, and are a storehouse of energy. Any alterations in the lipid levels may lead to potential heart ailments, making their monitoring crucial.

The Rheumatoid Factor - Quantitative test detects and measures the concentration of rheumatoid factor (RF), an antibody produced by the immune system, in your blood. Increased levels of rheumatoid factor can be detected in the blood in certain autoimmune conditions, particularly rheumatoid arthritis. However, an RF test is not very specific as a rheumatoid factor can also be found in the body in diseases other than RA, such as Sjögren’s syndrome and systemic lupus erythematosus (SLE). RF may also be produced in the body during persistent bacterial and viral infections. Hence, clinical evaluation and other diagnostic tests are crucial for a comprehensive assessment and accurate diagnosis.

IgE test measures the amount of IgE (immunoglobulin E) in the blood. It is an antibody produced by the immune system in response to danger. Normally, it is present in very small amounts in the blood. It belongs to the class of immunoglobulins which include five types of immunoglobulins:  IgA, IgG, IgM, IgD, and IgE. 

Immunoglobulins are produced by plasma cells (specific immune cells) when the body recognizes bacteria, viruses, other microorganisms or any other unknown substances as harmful foreign antigens to the immune system. 

The production of IgE is seen in cases of response to allergens such as asthma and response to parasitic infections. Other allergens can include plant pollen, eggs, peanuts, bee venom, strawberries, and other allergens substances. 

These IgE antibodies, once produced, bind to white blood cells and lead to the release of substances like histamine. This further causes constriction of bronchi in the lungs in allergic or asthmatic persons. Other signs and symptoms which can develop in these patients include running nose, skin itching, itchy eyes. 

The severity of the reaction depends upon the body’s exposure to allergens which can be observed from mild reddening and itching of skin to problems in breathing (respiratory distress) to vomiting and diarrhea to conditions of shock. 

The Peripheral Smear Examination test is performed to check the characteristics of blood cells including:

1. Red blood cells (RBCs)
2. White blood cells (WBCs)
3. Platelets

By placing the blood sample on a specifically treated slide, these blood components are analyzed under a microscope for their shape, size, and number. Any irregularity in these cells indicates blood disorders or abnormality, the presence of parasites in the blood, etc. This test is also a beneficial tool in monitoring a blood disease or deciding whether a certain medication or therapy is working effectively or not.

The Lipase test measures the total amount of lipase enzyme present in the blood. The lipase enzyme breaks down fats (lipids) into smaller molecules. In the gut, it is crucial for digestion, transportation, and the usage of dietary fats and oils. The main source of lipase is the pancreas–the same gland that makes insulin. After a meal, your pancreas releases pancreatic lipase into your digestive tract, where it breaks down triglycerides from fats and oils into smaller molecules like monoglycerides and fatty acids that are easier to absorb. A deranged level of lipase may indicate disease affecting the pancreas.

An Amylase test determines the amount of amylase enzyme in your blood. This enzyme helps in the breakdown of complex dietary carbohydrates into simple carbohydrates for absorption. The digestion of carbohydrates begins in the mouth since the amylase is secreted by the salivary glands too. However, the majority of the amylase is produced by the pancreas and secreted into the duodenum of the small intestine. The amount of amylase in the blood rises either due to its increased secretion into the blood or decreased elimination by the kidneys. Higher levels of amylase for longer periods indicate pancreatic complications and need medical intervention.

The Testosterone Total test measures the level of testosterone hormone available in the blood. This includes two forms of testosterone: free testosterone and bound testosterone. Bound testosterone is attached to proteins, mainly to sex hormone-binding globulin (SHBG) and albumin. It cannot enter the body's cells or directly affect tissues and organs. Instead, it acts as a store of testosterone in the blood and can be released when the body needs it. Free testosterone is not attached to any proteins and is the active form. It can easily transport to various tissues, and affects key functions like sex drive, muscle growth, bone strength, and energy levels.

Following tests are a part of the Advanced cardiac risk markers package:

Apolipoprotein A-I (apo A-I) is a protein that plays an important role in the transportation and metabolism of lipids and is the main protein component in high-density lipoprotein. Apo A-I is ordered in someone who has a personal or family history of abnormal lipid levels and/or premature cardiovascular disease. It may be ordered when your doctor is trying to determine the cause of a person's high cholesterol.

The Homocysteine Test measures the levels of homocysteine in the blood. Homocysteine is an amino acid which at increased levels in the body can damage the inner lining of the blood vessels that increases the chances of blood clot formation. The Homocysteine Test measures the levels of homocysteine in the blood. The Homocysteine Test is performed to screen for heart attack and stroke, especially in people with no known risk factors but with a family history of cardiovascular diseases. This test also detects and diagnoses an inherited disease called homocystinuria in newborns and infants and even detects deficiency of Vitamin B6, B12, or Folic acid.

Apolipoprotein B/ A1 Ratio helps in evaluating your risk of developing cardiovascular disease (CVD); It is also used to monitor treatment for high cholesterol. This test is not widely used for a screening test but may be ordered if a person has a family history of heart disease and/or high cholesterol and triglycerides (hyperlipidemia).

High sensitive CRP: High sensitive C reactive protein is a test that measures the amount of C reactive protein in the blood. The level of this marker is elevated in cases of inflammation in the body. This test can evaluate your risk of heart diseases such as coronary artery disease.

Lipoprotein-A: This test measures the amount or activity of Lipoprotein in the blood. It helps in determining your risk of developing cardiovascular disease (CVD), including your risk of coronary heart disease (CHD) and ischemic stroke.

Apolipoprotein-B is ordered, when a healthcare practitioner is evaluating someone's risk of developing CVD and when a person has a personal or family history of heart disease and/or abnormal lipid levels, especially when the person has significantly elevated triglyceride levels.