Test Directory - Understand Your Tests.

Test DIRECTORY

Explore our comprehensive menu of laboratory tests designed to support accurate, reliable results across every specialty.

APG LAB's test directory provides a comprehensive list of specialty and general laboratory testing services.

# A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

There are currently 15 names in this directory beginning with the letter I.

Ibuprofen, Serum or Plasma

Synonyms Advil® Motrin® Expected Turnaround Time 7 - 14 days Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary. Specimen Requirements Specimen Serum or plasma Volume 1 mL Minimum Volume 0.5 mL Container Red-top tube or green-top (heparin) tube. Gel-barrier tubes are not recommended. Collection Serum or plasma should be separated from cells within two hours of venipuncture. Submit serum or plasma in a plastic transport tube. Storage Instructions Submission/transport (<3 days): Room temperature. For storage beyond three days, specimen should be refrigerated or frozen. Patient Preparation Trough levels are most reproducible. Causes for Rejection Gel-barrier tubes Test Details Use Detect the presence of ibuprofen, a nonsteroidal anti-inflammatory drug Methodology High-pressure liquid chromatography with ultraviolet detection (HPLC/UV)

Imipramine

Synonyms Tofranil-PM® Tofranil® Test Includes Imipramine; desipramine (imipramine metabolite) Expected Turnaround Time 2 - 4 days Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary. Related Documents Sample Report Specimen Requirements Specimen Serum or plasma Volume 1 mL Minimum Volume 0.3 mL Container Red-top tube, lavender-top (EDTA) tube, or green-top (heparin) tube. Do not use a gel-barrier tube. The use of gel-barrier tubes is not recommended due to slow absorption of the drug by the gel. Depending on the specimen volume and storage time, the decrease in drug level due to absorption may be clinically significant. Collection Transfer separated serum or plasma to a plastic transport tube. For therapeutic monitoring, collect specimen immediately prior to next dose. Storage Instructions Room temperature Stability Requirements Temperature Period Room temperature 14 days Refrigerated 14 days Frozen 14 days Freeze/thaw cycles Stable x3 Causes for Rejection Gel-barrier tube Test Details Use Imipramine is the most thoroughly studied tricyclic antidepressant for the treatment of agoraphobia and panic disorder. Several small, placebo-controlled studies and open trials have confirmed the panic-blocking effects of this drug; however, many of these studies also employed behavioral therapy, thus obscuring the relative contribution of imipramine. A recent placebo-controlled, dose-response study confirmed that imipramine alone has significant antipanic and antiphobic effects. The best response was obtained at a dosage of 150−200 mg/day (mean, 185 mg/day). Most other studies also emphasize titrating the dosage to establish plasma concentrations within the range used for the treatment of depression; however, some patients may respond to doses 500 ng/mL Additional Information Imipramine is a tertiary tricyclic antidepressant prescribed for the treatment of various depressive disorders. Imipramine is metabolized to desipramine which is pharmacologically active and which is marketed separately. Both drugs have anticholinergic and antihistamine effects and are cardiotoxic. Imipramine reaches a peak serum concentration in one to two hours (desipramine two to six hours), has a half-life of 9 to 24 hours (desipramine 12 to 54 hours), and reaches steady-state levels in two to five days (desipramine 3 to 11 days). Drug interactions and effects in geriatric patients1 are the same as listed under amitriptyline. All the tricyclic antidepressants have significant drug interactions. Being potent inducers of hepatic drug-metabolizing enzymes, particularly CYP3A4, CYP1A2, and CYP2C9, the antiepileptic drugs, carbamazepine, phenytoin, phenobarbital, and primidone, stimulate the oxidative transformation of concurrently prescribed antidepressants.2 This results in decreased drug levels of the antidepressant. To a lesser extent, co-administration of oxcarbazepine, topiramate, and felbamate can also result in decreased antidepressant levels. Other tricyclic antidepressant drug interactions: hydrocortisone, methylphenidate, and phenothiazines increase tricyclic levels; tricyclics impair the antihypertensive effectiveness of clonidine and guanethidine; tricyclics and alcohol produce additive sedative effects, tricyclics and antiparkinsonism agents have potent anticholinergic side effects, and tricyclics and MAO inhibitors should not be co-administered because of the potential for antihypertensive and CNS crises. Tricyclics should be avoided in pregnant and lactating women because these drugs have not been established as safe. Geriatric patients are especially prone to postural hypotension, urinary retention, and sedation.1 In general, it has been reported that, “Therapeutic drug monitoring of antidepressants allows us to take into account the influence of factors such as co-medications, diet, smoking habit, impaired organ function, and compliance. Therapeutic drug monitoring and genotyping are thus complementary, and their combined use contributes to improve pharmacotherapy with antidepressants and other drugs.”3

Inflammatory Bowel Disease (IBD) Expanded Profile

Synonyms Atypical pANCA Glycominds IBDX Test Includes Antichitobioside carbohydrate antibodies (ACCA); antilaminaribioside carbohydrate antibodies (ALCA); antimannobioside carbohydrate antibodies (AMCA); anti- Saccharomyces cerevisiae antibodies (gASCA); atypical perinuclear antineutrophil cytoplasmic antibody (pANCA). Expected Turnaround Time 4 - 7 days Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary. Related Information Inflammatory Bowel Disease (IBD) Profile Related Documents For more information, please view the literature below. Bowel Disorders Evaluation Rule-out Cascade: Applying Exclusionary Criteria to Assist Diagnosis Crohn's Disease Prognostic Serological Marker Profile Inflammatory Bowel Disease Expanded Profile Sample Report Specimen Requirements Specimen Serum Volume 1 mL Minimum Volume 0.5 mL Container Red-top tube or gel-barrier tube Storage Instructions Refrigerate Causes for Rejection Hemolysis; lipemia; heat-treated specimen; gross bacterial contamination Test Details Use Aids in the diagnosis of inflammatory bowel disease (IBD) and the differential diagnosis of Crohn's disease (CD) and ulcerative colitis (UC); prognostic aid for clinical management of patients with CD. Limitations Results of this panel should be used in conjunction with clinical findings and other laboratory tests. Methodology Enzyme immunoassay (EIA) for ACCA, ALCA, AMCA, gASCA; indirect fluorescent antibody (IFA) for atypical pANCA Reference Interval When the only positive marker is pANCA, the interpretive comment on the report will read: "Suggestive of ulcerative colitis." When only one of ACCA, ALCA, AMCA, or gASCA is positive and pANCA is negative, the interpretive comment will read: "Suggestive of Crohn's disease. Pattern is not conclusive for disease behavior risk stratification." When only one of ACCA, ALCA, AMCA, or gASCA is positive and pANCA is positive, the interpretive comment will read: "Suggestive of inflammatory bowel disease. Pattern is not conclusive for any specific disease form." When any two of ACCA, ALCA, AMCA, or gASCA are positive and pANCA is positive or negative, the interpretive comment will read: "Suggestive of Crohn's disease with high risk of aggressive disease behavior (development of strictures or fistulae)." When any three or more of ACCA, ALCA, AMCA, or gASCA are positive and pANCA is positive or negative, the interpretive comment will read: "Suggestive of Crohn's disease with the very high risk of aggressive disease behavior (development of strictures or fistulae)." When all markers are negative, the interpretive comment on the report will read: "Pattern is not suggestive of inflammatory bowel disease." Additional Information Inflammatory bowel disease is a chronic disorder of the lower gastrointestinal tract that may occur in three forms: Crohn's disease (CD), ulcerative colitis (UC), and indeterminate colitis (IC). Its prevalence in the adult population approaches 0.3%.1 The differential diagnosis of the different forms of IBD is often difficult, time-consuming, and invasive.2 The gold standard for diagnosis is endoscopy with biopsies for histologic examination.3 In recent years, however, a number of serological markers have been introduced. The most commonly employed serological markers of IBD are anti-Saccharomyces cerevisiae antibody (ASCA) and atypical perinuclear antineutrophil cytoplasmic antibody (pANCA). ASCA positivity is found predominantly in patients with CD, while pANCA positivity is found predominantly in patients with UC.2 A combination of ASCA and pANCA has a specificity of as high as 99% for differentiation of CD from UC.3 Nevertheless, there are a substantial number of patients with IBD who are negative for both. The addition of novel serological markers improves the sensitivity of the conventional ASCA/pANCA combination.3 About two-thirds of patients with CD develop either a stricturing or penetrating disease course within 10 years after diagnosis. As many as 80% of all CD patients undergo surgery at least once during the course of their disease. Consequently, the identification of individuals susceptible to the development of more complicated disease behavior would allow for earlier and more aggressive treatment.4 This profile offers three novel markers: antichitobioside IgA (ACCA), antilaminaribioside IgG (ALCA), antimannobioside IgG (AMCA), together with anti-Saccharomyces cerevisiae IgG (gASCA) and pANCA. These markers provide additional diagnostic and prognostic information depending on the combination of results.3-6 The antibodies included in the panel are ASCA (anti-Saccharomyces cerevisiae antibodies), ALCA (antilaminaribioside carbohydrate antibodies), ACCA (antichitobioside carbohydrate antibodies), and AMCA (antimannobioside carbohydrate antibodies).3,5,6 Numerous studies of CD have demonstrated an association between ileal disease and the presence of ACCA,3 ALCA,3,6 AMCA,6 and ASCA.3,5-10 Among these antibodies, the association with localization to the small intestine increased with the number of positive antibodies and with the concentration of individual antibodies.3,5,6,9,11 A more aggressive or complicated disease course in CD (as indicated by stricturing or perforation of the intestine or need for surgery), has also been associated with the presence of ACCA,3,5 ALCA,3,5,6 AMCA,3,5 and ASCA.3,5,6,8-10 Among these antibodies, the association with complicated disease behavior or surgery increased with the number and concentration of antibodies.3,5,9,11

Influenza A and B, Direct Immunoassay

Synonyms Flu A and B Special Instructions Submit one specimen per test requested. Specify the exact specimen source/origin (eg, nasopharynx). Indicate a specific test number on the request form. Check expiration date of transport; do not use expired devices. Expected Turnaround Time 1 - 2 days Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary. Related Documents For more information, please view the literature below. Comprehensive Influenza Testing Sample Report Specimen Requirements Specimen Nasopharyngeal (NP) swab in viral transport medium or NP wash or aspirate Volume 2 to 3 mL NP wash, 0.5 mL NP aspirate dispersed in at least 2 to 3 mL transport medium or saline, or swab Minimum Volume 2 mL NP wash, 0.5 mL NP aspirate dispersed in at least 2 to 3 mL transport medium or saline Container Viral, Chlamydia, or Mycoplasma culture transport provided by LabCorp, or other appropriate transport medium; sterile leakproof container Storage Instructions Refrigerate. Causes for Rejection Bacterial swab specimen; specimen received in grossly leaking transport container; dry specimen; specimen submitted in fixative or additive; specimen received in expired transport media or incorrect transport device; inappropriate specimen transport conditions; specimen received after prolonged delay in transport (usually more than 72 hours); specimen stored or transported at room temperature; wooden shaft swab in transport device; unlabeled specimen or name discrepancy between specimen and request label Test Details Use Confirm the diagnosis of influenza type A or type B infection. This is a differentiated test and, therefore, will distinguish influenza type A from influenza type B. Methodology Direct immunoassay (IA) Reference Interval Negative

Inheritest® Carrier Screen, Society-guided Panel (14 Genes)

Synonyms Pan-ethnic Carrier Screening Test Includes Screening for 14 genes, including fragile X carrier screening and spinal muscular atrophy (SMA) carrier screening. This test includes: ASPA, BLM, CFTR, FANCC, FMR1, GBA, HBA1, HBA2, HBB, HEXA, IKBKAP, MCOLN1, SMN1 and SMPD1. Special Instructions Test orders must include an attestation that the provider has the patient's informed consent for genetic testing. See sample physician office consent form: Consent for Genetic Testing. Call Integrated Genetics at 855-422-2557 to obtain access to genetic counseling. Expected Turnaround Time 11 -14 days Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary. Related Information Hemoglobinopathy Profile With Reflex to α-Thalassemia Inheritest® Carrier Screen, Ashkenazi Jewish Panel (48 Genes) Inheritest® Carrier Screen, Comprehensive Panel (144 Genes) Tay-Sachs Disease, Biochemical Tay-Sachs Disease, Biochemical, Leukocytes Related Documents For more information, please view the literature below. Inheritest® NGS Carrier Screen – Provider Brochure Inheritest® NGS Carrier Screen – Patient Brochure Inheritest® NGS Clinical Questionnaire Specimen Requirements Specimen Whole blood Volume 10 mL Container Yellow-top (ACD-A) tube (preferred) or lavender-top (EDTA) tube; yellow-top (ACD-B) tube is not acceptable Storage Instructions Maintain specimen at room temperature or refrigerate at 4°C. Causes for Rejection Frozen specimen; hemolysis; quantity not sufficient for analysis; improper container; blood specimens more than four days post draw Test Details Use Carrier testing by analyzing 14 genes for more than 1,200 pathogenic variants associated with more than 13 autosomal recessive or X-linked disorders including fragile X syndrome and spinal muscular atrophy. Limitations Technologies used do not detect germline mosaicism and do not rule out the presence of large chromosomal aberrations, including rearrangements, or variants in regions or genes not included in this test, or possible inter/intragenic interactions between variants. Variant classification and/or interpretation may change over time if more information becomes available. False positive or false negative results may occur for reasons that include: rare genetic variants, sex chromosome abnormalities, pseudogene interference, blood transfusions, bone marrow transplantation, somatic or tissue-specific mosaicism, mislabeled samples, or erroneous representation of family relationships. This test was developed and its performance characteristics determined by Esoterix Genetic Laboratories LLC. It has not been cleared or approved by the Food and Drug Administration. Methodology Next generation sequencing (NGS): Genomic regions of interest are selected using the Agilent® SureSelectXT® hybridization capture method for target enrichment and sequenced via the Illumina® next generation sequencing platform. Sequencing reads are aligned with the human genome reference GRCh37/hg19 build. Targeted regions are sequenced to at least 200X mean base coverage with a minimum of 99% of bases at > or = 20X coverage. Analytical sensitivity is estimated to be >99% for single nucleotide variants and small insertions/deletions (99% for the targeted variants. Spinal muscular atrophy: DNA is amplified by real-time polymerase chain reaction (PCR). The number of copies of exon 7 of SMN1 is assessed relative to internal standard reference genes. A mathematical algorithm calculates 0, 1, 2 and 3 copies with statistical confidence. If one copy of SMN1 is detected, primer and probe binding sites are sequenced to rule out variants that could interfere with copy number analysis. If no copies of SMN1 are detected, SMN2 copy number is assessed by digital PCR analysis relative to an internal standard reference gene. Copy number analysis cannot detect carriers with either 2 or, very rarely, 3 copies of SMN1 and no copies of SMN1 on the other chromosome. Fragile X syndrome: DNA is amplified by the polymerase chain reaction (PCR) to determine the size of the CGG repeat region within the FMR1 gene. PCR products are generated using a fluorescence labeled primer and sized by capillary gel electrophoresis. If indicated, Southern blot analysis is performed by hybridizing the probe StB12.3 to EcoRI- and EagI- digested DNA. The analytical sensitivity of both Southern blot and PCR analyses is 99% for expansion mutations in the FMR1 +/- one for repeats less than 60, and +/- two to four for repeats in the 60 - 120 range. For repeats greater than 120, the accuracy is +/- 10%. If 55-90 trinucleotide repeats are detected in carrier screening females, a PCR assay targeting AGG sequences within the CGG repeats is performed to assess the number and position of AGG interruptions. Pathogenic and likely pathogenic variants are reported after confirmation by Sanger sequencing or an appropriate technology. Non-deletion variants are specified using the numbering and nomenclature recommended by the Human Genome Variation Society (HGVS, http://www.hgvs.org). Variants of uncertain significance and benign variants are not reported. Variant classification is consistent with ACMG standards and guidelines.1 Detailed variant classification information is available upon request.

Inheritest® Core Panel

Inheritest® Core Panel TEST: 451964 Test number copied CPT: Contact coding department at 800-222-7566 ext. 6-8400. Include LOINC® in print Special Instructions Please include patient gender. Specimens must be accompanied by a completed consent form. Expected Turnaround Time 9 - 14 days Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary. Related Information Fragile X Syndrome, PCR With Reflex to Southern Blot Hemoglobinopathy Profile With Reflex to α-Thalassemia Inheritest® Carrier Screen, Comprehensive Panel (144 Genes) Inheritest® Carrier Screen, Society-guided Panel (14 Genes) Tay-Sachs Disease, Biochemical Related Documents For more information, please view the literature below. Inheritest® Core Panel – Physician Brochure Inheritest® NGS Carrier Screen – Provider Brochure Inheritest® NGS Carrier Screen – Patient Brochure Specimen Requirements Specimen Whole blood Volume 10 mL Container Yellow-top (ACD-A) tube (preferred) or lavender-top (EDTA) tube; yellow-top (ACD-B) tube is not acceptable Storage Instructions Maintain specimen at room temperature or refrigerate at 4 degrees C. Causes for Rejection Frozen specimen; hemolysis; quantity not sufficient for analysis; improper container; blood specimens more than four days post draw Test Details Use Carrier screening for cystic fibrosis (97 mutations), spinal muscular atrophy, and fragile X syndrome Limitations False positive or false negative results may occur for reasons that include: genetic variants, technical handling, blood transfusions, bone marrow transplantation, mislabeling of samples, or erroneous representation of family relationships. This test was developed, and its performance characteristics determined, by Esoterix Genetic Laboratories. It has not been cleared or approved by the US Food and Drug Administration (FDA). Methodology CFplus: DNA is isolated from the sample and tested for the 97 CF mutations listed. Regions of the CFTR gene are amplified enzymatically and subjected to a solution-phase multiplex allele-specific primer extension with subsequent hybridization to a bead array and fluorescence detection. Some mutations are then specifically identified by bidirectional dideoxysequencing. Fragile X syndrome: DNA is amplified by the polymerase chain reaction (PCR) to determine the size of the CGG repeat region within the FMR1 gene. PCR products are generated using a fluorescence labeled primer and sized by capillary gel electrophoresis. If indicated, Southern blot analysis is performed by hybridizing the probe StB12.3 to EcoRI- and EagI- digested DNA. The analytical sensitivity of both Southern blot and PCR analyses is 99% for expansion mutations in the FMR1 gene. Reported CGG repeat sizes may vary as follows: +/- one for repeats less than 60, and +/- two to four for repeats in the 60 - 120 range. For repeats greater than 120, the accuracy is +/- 10%. If 55-90 trinucleotide repeats are detected in carrier screening females, a PCR assay targeting AGG sequences within the CGG repeats is performed to assess the number and position of AGG interruptions.

Inhibin B

Special Instructions This test may exhibit interference when sample is collected from a person who is consuming a supplement with a high dose of biotin (also termed as vitamin B7 or B8, vitamin H, or coenzyme R). It is recommended to ask all patients who may be indicated for this test about biotin supplementation. Patients should be cautioned to stop biotin consumption at least 72 hours prior to the collection of a sample. Expected Turnaround Time 4 - 7 days Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary. Related Information Follicle-stimulating Hormone (FSH) Inhibin A, Ultrasensitive Related Documents Sample Report Specimen Requirements Specimen Serum Volume 0.6 mL Minimum Volume 0.3 mL (Note: This volume does not allow for repeat testing.) Container Red-top tube or gel-barrier tube Collection If red-top tube is used, transfer separated serum to a plastic transport tube. Storage Instructions Refrigerate Stability Requirements Temperature Period Room temperature 7 days Refrigerated 21 days Frozen 21 days Freeze/thaw cycles Stable x3 Causes for Rejection Nonserum sample received Test Details Use Assess the function of the antral follicles of the ovaries in women or the Sertoli cells of the testes in men Limitations This procedure may be considered by Medicare and other carriers as investigational and, therefore, may not be payable as a covered benefit for patients. Methodology Enzyme immunoassay (EIA) Reference Interval See table. Inhibin B Male (Age) Range (pg/mL) Female (Age) Range (pg/mL) <12 m 68.0−630.0 <6 y <73.0 12 to 23 m 87.0−419.0 6 to 9 y <129.0 2 to 5 y 42.0−268.0 10 y <103.0 6 to 9 y 35.0−167.0 11 y 20.0−186.0 10 y 50.0−310.0 12 to 18 y <362.0 11 y 104.0−481.0 Early follicular <261.0 12 to 17 y 74.0−470.0 Late follicular <286.0 18 to 49 y 66.9−300.0 Periovulatory 49 y 34.9−289.2 Midluteal <164.0 End luteal <107.0 Postmenopausal <17.0 Additional Information Historically, inhibin was the name given to a component of serum that was found to inhibit secretion of follicle-stimulating hormone (FSH) by the pituitary.1,2 In recent years, a number of inhibin proteins have been characterized and specific immunoassays have been developed for both inhibin A and inhibin B.1 These hormones are members of the transforming growth factor-B super family.2 Structurally, the inhibins consist of dimers of two dissimilar protein subunits. The α-subunit is common to both inhibins. The α-subunit of inhibin B is covalently linked to a β-B subunit by disulfide bridges. In women, inhibin B is produced primarily by small developing antral follicles of the ovaries.1 The Sertoli cells of the testes are the primary source of this hormone in men.1 In young girls, the concentrations of inhibin B increase as puberty progresses.3,4 Therefore, its measurement could aid in determining gonadal maturity and diagnosing precocious puberty in girls.3 Once women reach reproductive age, inhibin B levels change with the menstrual cycle.3 Inhibin B is thought to play an important role in the regulation of FSH levels during the early and midfollicular phase.1 Levels are maximal in the midfollicular phase with a spike at ovulation before falling to basal levels in the luteal phase. In postmenopausal women, inhibin B levels fall to <5 pg/mL. A woman's fertility declines with age, in large part, due to a drop in the number of follicles in the ovary, also referred to as diminished ovarian reserve. It has been suggested that the measurement of inhibin B, used in conjunction with other evaluating criteria, can be useful in evaluating the status of ovarian reserve.5 This assessment can be of value in estimating the probability of successful retrieval of oocytes through assisted reproductive technologies or in assessing the potential for natural pregnancy as a woman ages.1,5,6 In the early perimenopausal phase of the menopausal transition, the circulating follicular phase levels of inhibin B decline before changes in estradiol or inhibin A are observed.5-8 Follicular phase inhibin B measurement may be useful for predicting the onset of menopause. During the in vitro fertilization treatment, it is important to choose the correct level of ovarian stimulation. Insufficient stimulation can lead to a cancelled cycle due to a poor response,7,9-11 and too much stimulation can run the risk of ovarian hyperstimulation syndrome (OHSS). Inhibin B measurement has been used as an aid in determining OHSS cycles and in managing this dangerous condition. In males, inhibin B is produced by the Sertoli cells of the testes and serves as the primary regulator of FSH secretion detectable throughout life. Levels are relatively high in infant boys and decrease gradually to their lowest levels between 6 to 10 years of age.12,13 During childhood, the basal serum inhibin B levels have been used as a direct marker of the presence and function of testicular tissue and have been applied to the diagnosis of patients with cryptorchidism or ambiguous genitalia.12 A traditional test for testicular function in prepubertal boys with testicular disorders is to measure the increase in testosterone after administration of human chorionic gonadotropin (hCG).14 Inhibin B levels have been shown to be correlated well with results of hCG stimulation tests.14 Inhibin B can also be used as a direct marker of Sertoli cell function and spermatogenesis in adult males.1,12,15,16 Serum inhibin B levels have been shown to correlate with testicular volume and sperm density. Very low levels of inhibin B are found in men with no or negligible sperm production.17 A combined measurement of inhibin B and FSH has been shown to be a better indicator of spermatogenesis adequacy than either marker alone.18

Insulin

Synonyms Immunoreactive Insulin Special Instructions This test may exhibit interference when sample is collected from a person who is consuming a supplement with a high dose of biotin (also termed as vitamin B7 or B8, vitamin H, or coenzyme R). It is recommended to ask all patients who may be indicated for this test about biotin supplementation. Patients should be cautioned to stop biotin consumption at least 72 hours prior to the collection of a sample. Expected Turnaround Time Within 1 day Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary. Related Information C-Peptide Suppression Diagnostic Fast Glutamic Acid Decarboxylase (GAD) Autoantibody IA2 Autoantibodies (Endocrine Sciences) Insulin Autoantibodies (IAA) (Endocrine Sciences) Multiple-specimen Testing Pancreatic Polypeptide Tolbutamide Tolerance Related Documents Sample Report Specimen Requirements Specimen Serum Volume 0.8 mL Minimum Volume 0.3 mL (Note: This volume does not allow for repeat testing.) Container Red-top tube or gel-barrier tube Collection If a red-top tube is used, transfer separated serum to a plastic transport tube. Avoid hemolysis. Storage Instructions Refrigerate. Stability Requirements Temperature Period Room temperature 1 day Refrigerated 14 days Frozen 14 days Freeze/thaw cycles Stable x3 Patient Preparation Patient should be fasting at time of collection. Causes for Rejection Citrate plasma specimen; hemolyzed specimen Test Details Limitations This insulin assay is performed using a 2-site electrochemiluminescent immunoassay on the Roche automated platform.1 This test could be effectively used for those patients not receiving exogenous insulin or those receiving unmodified human insulin. Test 004333, Insulin is highly specific for human insulin, as shown in the table below. This test does not react, for instance, with several of the insulin analogs used to treat diabetes as indicated in Table 1 below. The efficacy of each test depends on the patient treatment and goal of the ordering physician. It is important that the physician ordering and interpreting the results understands the specificity of the test. Table 1: Cross reactivity to insulin analogs1-3 • Human insulin: 100% • Insulin aspart: <1% • Insulin glargine: <1% • Insulin lispro: <1% • Insulin glulisine: <1% • Insulin detemir: <1% Notes: • Circulating antibodies to insulin, both autoantibodies and antibodies to therapeutic insulin, can interfere with the immunoassays for insulin.4,5 • As with all tests containing monoclonal mouse antibodies, erroneous findings may be obtained from samples taken from patients who have been treated with monoclonal mouse antibodies or who have received them for diagnostic purposes.1 In rare cases, interference due to extremely high titers of antibodies to streptavidin and ruthenium can occur.1 The test contains additives that minimize these effects. Methodology Electrochemiluminescence immunoassay (ECLIA) Reference Interval 2.6−24.9 μIU/mL Additional Information Insulin is a peptide hormone with a molecular weight of approximately 6000 daltons. Serum insulin determinations may be performed on patients with symptoms of hypoglycemia4,5 where insulinoma is a possible etiology. Patterns of secretion by insulinomas may be sporadic or constant. Insulinoma is a rare functional tumor of pancreatic origin that secretes insulin inappropriately, causing hypoglycemia. Whipple originally described the tumor and classic diagnostic criteria called "Whipple's Triad". The criteria included: 1) neurologic symptoms of hypoglycemia 2) low glucose (<50 mg/dL) which are corrected immediately by giving glucose or carbohydrate. Today, as described above, we would add inappropriately elevated insulin levels during an episode of hypoglycemia. Usually hypoglycemia is induced with a fast or exercise, and the diagnostic criteria may include a 48 to 72 hour fast with insulin levels greater than 5 μU/mL during a hypoglycemic episode.4 Hypoglycemia can, however, also be facilitated intentionally or unintentionally (factitious hypoglycemia),4,5 C-peptide levels along with insulin levels may be helpful in ruling out factitious insulin use, however note the limited reactivity of various insulin analogs. Accordingly, one use of the insulin test is to screen patients with low glucose for insulinoma if other factors such as glucose-lowering drugs or reactive hypoglycemia are excluded. Insulin levels can be also useful in predicting susceptibility to the development of type II diabetes.4 However, the American Diabetes Association recommendations for the diagnosis of diabetes do not include the measurement of insulin levels.6 Insulin levels may also be measured to estimate the patient's capacity for insulin secretion (eg, glucagon test) or in the evaluation of insulin sensitivity (eg, oral glucose tolerance test). Although the adequacy of pancreatic insulin synthesis is frequently assessed via the determination of C-peptide, fasting insulin is also measured to assess insulin resistance. In treated patients therapeutic administration of insulin can lead to the formation of insulin binding antibodies. Insulin binding antibodies invariably interfere with insulin measurement methods and results are unreliable. For patients with known autoantibodies to insulin should measure free and total insulin to assess biologically active fraction of insulin (free insulin) and total insulin. Measurements of free and total insulin, C-peptide, insulin antibodies and hemoglobin A1C are often tested in conjunction to clarify the contribution of endogenous and exogenous insulin to overall diabetic management. See Test 501561 for Free and Total Insulin.

Insulin, Two Specimens

Interferon-γ Receptor Deficiency: IFNGR1 (Known Mutation)

Test Includes All coding nucleotides of the specified gene(s), plus at least two and typically 20 nucleotides flanking each coding region. Special Instructions This option is available when the mutation is known and can be documented by the ordering physician. If the mutation cannot be documented, please order test 252519. Test orders must include an attestation that the provider has the patient's informed consent for genetic testing. See sample physician office consent form: Consent for Genetic Testing. In the case of family tests (ie, known mutations), please submit the result report of the first patient tested in the family (the index case), if not performed at a LabCorp facility. Other family members are subsequently tested for the specific mutation found in the first patient tested. Expected Turnaround Time 21 - 28 days Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary. Related Documents For more information, please view the literature below. Consent for Genetic Testing (Consentimiento para análisis genético) Test Details Methodology DNA sequencing

Interferon-γ Receptor Deficiency: IFNGR2 (Known Mutation)

Special Instructions This option is available when the mutation is known and can be documented by the ordering physician. If the mutation cannot be documented, please order test 252522. Test orders must include an attestation that the provider has the patient's informed consent for genetic testing. See sample physician office consent form: Consent for Genetic Testing. In the case of family tests (ie, known mutations), please submit the result report of the first patient tested in the family (the index case), if not performed at a LabCorp facility. Other family members are subsequently tested for the specific mutation found in the first patient tested. Expected Turnaround Time 21 - 28 days Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary. Related Documents For more information, please view the literature below. Consent for Genetic Testing (Consentimiento para análisis genético) Test Details Methodology DNA sequencing

Iodine, Serum or Plasma

Expected Turnaround Time 2 - 4 days Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary. Related Documents Sample Report Specimen Requirements Specimen Serum or plasma Volume 0.5 mL Minimum Volume 0.4 mL Container Royal blue-top (EDTA) tube or royal blue-top tube without EDTA Collection Submit original unopened tube or serum or plasma removed from a royal blue-top tube, and transfer to a certified metal-free plastic transport tube (PeopleSoft N° 111166) for shipment to the laboratory. Storage Instructions Maintain specimen at room temperature. Stability Requirements Temperature Period Room temperature 14 days Refrigerated 14 days Frozen 14 days Freeze/thaw cycles Stable x3 Causes for Rejection Certified metal-free plastic transport tube not submitted Test Details Use Monitor exposure to iodine; evaluate for iodine deficiency disorders (IDDs), excessive iodine intake, or iodine in the workplace IDDS by Age Group Age Groups Health Consequences of Iodine Deficiency Zimmerman MB. Iodine deficiency. Endocrine Reviews. The Endocrine Society. 2009; 30:376-408. All ages Goiter Increased susceptibility of thyroid gland to nuclear radiation Fetus Abortion Stillbirth Congenital anomalies Perinatal mortality Neonates Infant mortality Endemic cretinism Children and adolescents Impaired mental function Delayed physical development Adults Impaired mental function Reduced work productivity Toxic nodular goiter; iodine-induced hyperthyroidism Increased occurrence of hypothyroidism in moderate-to-severe iodine deficiency; decreased occurrence of hypothyroidism in mild-to-moderate iodine deficiency Other forms of thyroid problems, namely iodine-induced hypothyroidism, autoimmune thyroiditis, and hyperthyroidism associated with excessive iodine intake have become a greater concern than deficiency disorders.1 Limitations This test was developed and its performance characteristics determined by LabCorp. It has not been cleared or approved by the Food and Drug Administration. Methodology Inductively coupled plasma/mass spectrometry (ICP/MS) Reference Interval 40.0−92.0 μg/L

Iron

Expected Turnaround Time Within 1 day Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary. Related Documents Sample Report Specimen Requirements Specimen Serum (preferred) or plasma (lithium heparin only). EDTA plasma causes decreased results. Volume 1 mL Minimum Volume 0.5 mL Container Gel-barrier tube, transport tube, or green-top (heparin) tube; do not use EDTA or oxalate anticoagulants. Collection Separate serum or plasma from cells within 45 minutes of collection. Storage Instructions Maintain specimen at room temperature. Stability Requirements Temperature Period Room temperature 14 days Refrigerated 14 days Frozen 14 days Freeze/thaw cycles Stable x3 Causes for Rejection Severe hemolysis; improper labeling; improper collection; EDTA or oxalate plasma specimens Test Details Use Aid in the evaluation of a number of conditions involving red cell production and destruction, iron metabolism, or iron transport Methodology Colorimetric Reference Interval See table. Male Range (μg/dL) 0 to 30 d 35−160 1 m to 1 y 18−126 2 to 12 y 28−147 13 to 17 y 26−169 >17 y 38−169 Female Range (μg/dL) 0 to 30 d 27−133 1 m to 1 y 18−126 2 to 12 y 28−147 13 to 17 y 26−169 18 to 60 y 27−159 >60 y 27−139

Iron and Total Iron-binding Capacity (TIBC)

Synonyms Fe and TIBC TIBC and Iron Total Iron-binding Capacity (TIBC) Transferrin Saturation Unsaturated Iron-binding Capacity (UIBC) Test Includes Percent of saturation; serum iron; total iron binding capacity; unsaturated iron binding capacity Expected Turnaround Time Within 1 day Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary. Related Documents For more information, please view the literature below. Hereditary Hemochromatosis Sample Report Specimen Requirements Specimen Serum (preferred) or plasma (lithium heparin only). EDTA plasma causes decreased results. Volume 2 mL Minimum Volume 0.5 mL Container Gel-barrier tube, transport tube, or green-top (heparin) tube; do not use EDTA or oxalate anticoagulants. Collection Separate serum or plasma from cells within 45 minutes of collection. Storage Instructions Maintain specimen at room temperature. Stability Requirements Temperature Period Room temperature 14 days Refrigerated 14 days Frozen 14 days Freeze/thaw cycles Stable x3 Patient Preparation Have sample drawn before patient is given therapeutic iron or blood transfusion. Iron determinations on patients who have had blood transfusions should be delayed for at least four days. Causes for Rejection Hemolysis; specimen clotted; improper labeling; EDTA or oxalate plasma specimens Test Details Use Differential diagnosis of anemia, especially with hypochromia and/or low MCV. The percent saturation sometimes is more helpful than is the iron result for iron deficiency anemia. Evaluate thalassemia and possible sideroblastic anemia; work-up hemochromatosis, in which iron is increased and iron saturation is high. Decrease in iron level after performance of Schilling supports the diagnosis of vitamin B12 deficiency, vide infra. Evaluate iron poisoning (toxicity) and overload in renal dialysis patients, or patients with transfusion dependent anemias. Use of TIBC in iron toxicity may be less useful than previous believed.1 TIBC or transferrin is a useful index of nutritional status. Uncomplicated iron deficiency: Serum transferrin (and TIBC) high, serum iron low, saturation low. Usual causes of depleted iron stores include blood loss, inadequate dietary iron. RBCs in moderately severe iron deficiency are hypochromic and microcytic. Stainable marrow iron is absent. Serum ferritin decrease is the earliest indicator of iron deficiency if inflammation is absent. Anemia of chronic disease: Serum transferrin (and TIBC) low to normal, serum iron low, saturation low or normal. Transferrin decreases with many inflammatory diseases. With chronic disease there is a block in movement to and utilization of iron by marrow. This leads to low serum iron and decreased erythropoiesis. Examples include acute and chronic infections, malignancy and renal failure. Sideroblastic anemia: Serum transferrin (and TIBC) normal to low, serum iron normal to high, saturation high. Hemolytic anemias: Serum transferrin (and TIBC) normal to low, serum iron high, saturation high. Hemochromatosis: Serum transferrin (and TIBC) slightly low, serum iron high, saturation very high. Protein depletion: Serum transferrin (and TIBC) may be low, serum iron normal or low (if patient also is iron deficient). This may occur as a result of malnutrition, liver disease, renal disease (eg, nephrosis) or other entities. Liver disease: Serum transferrin variable; with acute viral hepatitis, high along with serum iron and ferritin. With chronic liver disease (eg, cirrhosis), transferrin may be low. Patients who have cirrhosis and portacaval shunting have saturated TIBC/transferrin as well as high ferritin.2 Chronic dialysis for renal failure: monitor iron levels in patients undergoing dialysis. To follow treatment of iron overload with deferoxamine or with regimen of recombinant human erythropoietin and phlebotomy.3 Limitations Ferritin levels are also useful for iron deficiency. Low iron level may not indicate iron deficiency in acute infection with leukocytosis. Low iron levels may be misleading in chronic infection, inflammation and malignancy; high ferritin levels occur in many such states, however, the most sensitive test for iron deficiency is bone marrow examination.4 TIBC and transferrin are increased in patients on oral contraceptives, with normal saturation. Gross hemolysis may interfere with serum iron. Methodology Colorimetric Contraindications Parenteral iron before sample is drawn will cause misleading high iron results. Recent blood transfusion may have only a small positive effect on iron. Additional Information Serum iron is increased in hemosiderosis, hemolytic anemias especially thalassemia, sideroachrestic anemias, hepatitis, acute hepatic necrosis, hemochromatosis, and with inappropriate iron therapy. Iron may reach high levels with iron poisoning. Some patients who receive multiple transfusions (eg, some hemolytic anemias, thalassemia, renal dialysis patients) will have increased serum iron levels. Serum iron is decreased with insufficient dietary iron, chronic blood loss (including the hemolytic anemias paroxysmal nocturnal hemoglobinuria), inadequate absorption of iron and impaired release of iron stores as in inflammation, infection and chronic diseases. The combination of low iron, high TIBC and/or transferrin and low saturation indicates iron deficiency. Without all of these findings together, iron deficiency is unproven.2 Low ferritin supports the diagnosis of iron deficiency. Detection of iron deficiency may lead to detection of adenocarcinoma of gastrointestinal tract, a point which cannot be overemphasized. In recovery from pernicious anemia, especially just after B12 dose, iron levels are low. In fact, the drop in serum iron 1 to several days after the Schilling test flushing dose of vitamin B12 may be more useful in diagnosis than the radioactivity of the 24-hour urine collection. Serum iron is reported to drop with acute infarct of myocardium. TIBC is increased in iron-deficiency, use of oral contraceptives, and in pregnancy. TIBC is decreased in hypoproteinemia due to many causes, and is decreased in a number of inflammatory states. Increased saturation occurs with HLA-related (classical) hemochromatosis before ferritin is greatly increased, and also with iron overload (eg, cirrhosis and portacaval shunt), in hemolytic anemias and with iron therapy. Saturation >70% in females, >80% in males is described as prerequisite for parenchymal loading; however, sample contamination and the vagaries of fluctuation in serum iron levels can make such criteria misleading on occasion.2 The serum ferritin is a more sensitive test than the serum iron or TIBC for iron deficiency and for iron overload.2 When all these tests are used together, as is often necessary, they usually can distinguish between iron deficiency anemia and the anemia of chronic disease. The best and most reliable evaluation of total body iron stores is by bone marrow aspiration and biopsy. The best evaluation of iron deficiency in childhood (unless lead toxicity is suspected) is free erythrocyte porphyrins. With recombinant erythropoietin therapy serum iron, transferrin saturation, and ferritin levels decline due to rapid utilization by stimulated erythropoiesis with resultant decrease in storage iron.3,5 While iron is usually considered in relation to hematopoiesis and oxygen transport functions of red cells, it is also of prime import to the lymphomyeloid systems.6

Isocyanate MDI

Expected Turnaround Time 3 - 4 days Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary. Related Information Individual Allergens Related Documents Sample Report Specimen Requirements Specimen Serum Volume 0.2 mL Container Red-top tube or gel-barrier tube Storage Instructions Room temperature Stability Requirements Temperature Period Room temperature 14 days Refrigerated 14 days Frozen 3 months Freeze/thaw cycles Stable x3 Test Details Methodology Thermo Fisher ImmunoCAP®

Common Lab Tests

Complete Blood Count

This test, also known as a CBC, is the most common blood test performed. It measures the types and numbers of cells in the blood, including red and white blood cells and platelets. This test is used to determine general health status, screen for disorders and evaluate nutritional status. It can help evaluate symptoms such as weakness, fatigue and bruising, and can help diagnose conditions such as anemia, leukemia, malaria and infection.

Prothrombin Time

Also known as PT and Pro Time, this test measures how long it takes blood to clot. This coagulation test measures the presence and activity of five different blood clotting factors. This test can screen for bleeding abnormalities, and may also be used to monitor medication treatments that prevent the formation of blood clots.

Basic Metabolic Panel

This test measures glucose, sodium, potassium, calcium, chloride, carbon dioxide, blood urea nitrogen and creatinine which can help determine blood sugar level, electrolyte and fluid balance as well as kidney function. The Basic Metabolic Panel can help your doctor monitor the effects of medications you are taking, such as high blood pressure medicines, can help diagnose certain conditions, or can be part of a routine health screening. You may need to fast for up to 12 hours before this test.

Lipid

Panel

The lipid panel is a group of tests used to evaluate cardiac risk. It includes cholesterol and triglyceride levels.

Liver Panel

The liver panel is a combination of tests used to assess liver function and establish the possible presence of liver tumors.

Hemoglobin A1C

This test is used to diagnose and monitor diabetes.

Urinalysis

Often the first lab test performed, this is a general screening test used to check for early signs of disease. It may also be used to monitor diabetes or kidney disease.

Cultures

Cultures are used to test for diagnosis and treatment of infections. Illnesses such as urinary tract infections, pneumonia, strep throat, MRSA and meningitis can be detected and tested for appropriate antibiotic treatment.

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