Erythrocyte Sedimentation Rate (ESR TEST)

What is this test?

Erythrocyte sedimentation rate (ESR) is a blood test. It measures how quickly erythrocytes, or red blood cells, separate from a blood sample that has been treated so the blood will not clot. During this test, a small amount of your blood will be put in an upright tube. A lab specialist will measure the rate that your red blood cells settle toward the bottom of the tube after 1 hour.

If you have a condition that causes inflammation or cell damage, your red blood cells tend to clump together. This makes them heavier, so they settle faster. The faster your red blood cells settle and fall, the higher your ESR. A high ESR tells your healthcare provider that you may have an active disease process in your body.

Why do I need this test?

You may need this test if you have symptoms of one of the diseases that may cause ESR to go up.

You may also need this test if you have already been diagnosed with a disease that causes a high ESR. The test can allow your healthcare provider to see how well you are responding to treatment.

The ESR blood test is most useful for diagnosing or monitoring diseases that cause pain and swelling from inflammation. Other symptoms may include fever and weight loss. These diseases include:

• Temporal arteritis

• Rheumatoid arthritis

• Polymyalgia rheumatica

ESR is not used as a screening test in people who do not have symptoms or to diagnose disease because many conditions can cause it to increase. It might also go up in many normal cases. ESR doesn't tell your healthcare provider whether you have a specific disease. It only suggests that you may have an active disease process in your body.

What do my test results mean?

Test results may vary depending on your age, gender, health history, and other things. Your test results may be different depending on the lab used. They may not mean you have a problem. Ask your healthcare provider what your test results mean for you.

ESR is measured in millimeters per hour (mm/hr). The normal values are:

• 0 to 15 mm/hr in men

• 0 to 20 mm/hr in women

ESR above 100 mm/h is most likely caused by an active disease. For instance, you may have:

• A disease that causes inflammation in your body

• An active infection

• Cancer

• Heart disease

• Kidney disease

• Blood disease

• Diabetes

• Collagen vascular disease

What might affect my test results?

Many things that are not active diseases can increase your ESR. These include:

• Pregnancy

• Old age

• Being female

• Having a menstrual period

• Having recently eaten a fatty meal

• Being obese

• Taking certain medicines

Sudden Cardiac Arrest

What is sudden cardiac arrest (SCA)?

Sudden cardiac arrest (SCA) is a condition in which the heart suddenly stops beating. When that happens, blood stops flowing to the brain and other vital organs. If it is not treated, SCA usually causes death within minutes. But quick treatment with a defibrillator may be lifesaving.

How is sudden cardiac arrest (SCA) different from a heart attack?

A heart attack is different from an SCA. A heart attack happens when blood flow to the heart is blocked. During a heart attack, the heart usually doesn't suddenly stop beating. With an SCA, the heart stops beating.

Sometimes an SCA can happen after or during recovery from a heart attack.

What causes sudden cardiac arrest (SCA)?

Your heart has an electrical system that controls the rate and rhythm of your heartbeat. An SCA can happen when the heart's electrical system is not working right and causes irregular heartbeats. Irregular heartbeats are called arrhythmias. There are different types. They may cause the heart to beat too fast, too slow, or with an irregular rhythm. Some can cause the heart to stop pumping blood to the body; this is the type that causes SCA.

Certain diseases and conditions can cause the electrical problems that lead to SCA. They include:

• Ventricular fibrillation, a type of arrhythmia where the ventricles (the heart's lower chambers) don't beat normally. Instead, they beat very fast and very irregularly. They can't pump blood to the body. This causes most SCAs.

• Coronary artery disease (CAD), also called ischemic heart disease. CAD happens when the arteries of the heart cannot deliver enough oxygen-rich blood to the heart. It is often caused by the buildup of plaque, a waxy substance, inside the lining of larger coronary arteries. The plaque blocks some or all of the blood flow to the heart.

• Some types of physical stress can cause your heart's electrical system to fail, such as

• Intense physical activity in which your body releases the hormone adrenaline. This hormone can trigger SCA in people who have heart problems.

• Very low blood levels of potassium or magnesium. These minerals play an important role in your heart's electrical system.

• Major blood loss

• Severe lack of oxygen

• Certain inherited disorders which can cause arrhythmias or problems with the structure of your heart

• Structural changes in the heart, such as an enlarged heart due to high blood pressure or advanced heart disease. Heart infections can also cause changes to the structure of the heart.

Who is at risk for sudden cardiac arrest (SCA)?

You are at higher risk for SCA if you:

• Have coronary artery disease (CAD). Most people with SCA have CAD. But CAD usually doesn't cause symptoms, so they may not know that they have it.

• Are older; your risk increases with age

• Are a man; it is more common in men than women

• Are Black or African American, especially if you have other conditions such as diabetes, high blood pressure, heart failure, or chronic kidney disease

• Have a personal history of heartbeats that aren't regular (arrhythmia)

• Have a personal or family history of SCA or inherited disorders that can cause arrhythmia

• Have a problem with drug or alcohol use

• Have had a heart attack

• Have heart failure

What are the symptoms of sudden cardiac arrest (SCA)?

Usually, the first sign of SCA is loss of consciousness (fainting). This happens when the heart stops beating.

Some people may have a racing heartbeat or feel dizzy or light-headed just before they faint. And sometimes people have chest pain, shortness of breath, nausea, or vomiting in the hour before they have an SCA.

What are the treatments after surviving sudden cardiac arrest (SCA)?

If you survive SCA, you'll likely be admitted to a hospital for ongoing care and treatment. In the hospital, your medical team will closely watch your heart. They may give you medicines to try to reduce the risk of another SCA.

They will also try to find out what caused your SCA. If you're diagnosed with coronary artery disease, you may have an angioplasty or coronary artery bypass surgery. These procedures help restore blood flow through narrowed or blocked coronary arteries.

Often, people who have had SCA get a device called an implantable cardioverter defibrillator (ICD). This small device is surgically placed under the skin in your chest or abdomen. An ICD uses electric pulses or shocks to help control dangerous arrhythmias.

Can sudden cardiac arrest (SCA) be prevented?

You may be able to lower your risk of SCA by following a heart-healthy lifestyle. If you have coronary artery disease or another heart disease, treating that disease can also lower your risk of SCA. If you have had an SCA, getting an implantable cardioverter defibrillator (ICD) can lower your chance of having another SCA.

WHAT IS A LIPID PANEL TEST

What is a lipid panel?

A lipid panel is a blood test that measures the amount of certain fat molecules called lipids in your blood. In most cases, the panel includes four different cholesterol measurements and a measurement of your triglycerides.

Having too many lipids (cholesterol and triglycerides) in your blood can lead to buildup in your blood vessels and arteries, which can cause damage and increase your risk of cardiovascular problems. Because of this, healthcare providers use lipid panels for both children and adults to evaluate the risk of cardiovascular diseases like heart disease, heart attack (myocardial infarction) and stroke.

Other common names for a lipid panel include:

• Lipid profile.

• Lipid test.

• Cholesterol panel.

• Coronary risk panel.

• Fasting lipid panel or non-fasting lipid panel.

What are the five tests in a lipid panel?

A lipid panel measures five different types of lipids from a blood sample, including:

• Total cholesterol: This is your overall cholesterol level — the combination of LDL-C, VLDL-C and HDL-C.

• Low-density lipoprotein (LDL) cholesterol: This is the type of cholesterol that’s known as “bad cholesterol.” It can collect in your blood vessels and increase your risk of cardiovascular disease.

• Very low-density lipoprotein (VLDL) cholesterol: This is a type of cholesterol that’s usually present in very low amounts when the blood sample is a fasting samples since it’s mostly comes from food you’ve recently eaten. An increase in this type of cholesterol in a fasting sample may be a sign of abnormal lipid metabolism.

• High-density lipoprotein (HDL) cholesterol: This is the type of cholesterol that’s known as “good cholesterol.” It helps decrease the buildup of LDL in your blood vessels.

• Triglycerides: This is a type of fat from the food we eat. Excess amounts of triglycerides in your blood are associated with cardiovascular disease and pancreatic inflammation.

While these are the main measurements in a standard lipid panel, some versions of the test may include other measurements.

What is a lipid panel used for?

Healthcare providers use lipid panels to help assess someone’s cardiovascular health by analyzing cholesterol in their blood and to help diagnose other health conditions.

Reasons a provider may order a lipid panel include:

• As a routine test to determine if your cholesterol level is normal or falls into a borderline-, intermediate- or high-risk category.

• To monitor your cholesterol level if you had abnormal results on a previous test or if you have other risk factors for heart disease.

• To monitor your body’s response to treatment, such as cholesterol medications or lifestyle changes.

• To help diagnose other medical conditions, such as liver disease.

Why do I need a lipid panel blood test?

There are several reasons why you may need a lipid panel blood test. Healthcare providers use lipid panels often for screen and monitoring purposes.

If you have one or more risk factors for cardiovascular disease, your provider may suggest frequent screening through the use of a lipid panel to try to catch elevated cholesterol levels before you have symptoms. Risk factors for cardiovascular disease include:

• Being over age 45 if you’re a man or you were assigned male at birth and over 50 if you’re a women or you were assigned female at birth.

• Having a high cholesterol result on a previous test.

• Smoking cigarettes.

• Having obesity.

• Not getting enough physical activity.

• Having high blood pressure (hypertension).

• Having diabetes or prediabetes.

• Having a first-degree relative, such as a parent or sibling, who developed heart disease at an early age (under 55 in males and under 65 in females).

Children can also have high cholesterol, so your child may need a lipid panel blood test. Cholesterol levels in children are linked to three factors: heredity, diet and obesity. In most cases, kids with high cholesterol have a parent who also has elevated cholesterol

Do I need to fast for a lipid panel?

In most cases, you need to fast for 10 to12 hours before your lipid panel blood test. Fasting means not eating or drinking anything except water. In some cases, getting a lipid panel test without fasting is possible.

In any case, it’s important to ask your healthcare provider in advance about whether you need to fast before the test. Always follow the instructions that your provider gives you. If your provider has instructed you to fast and you accidentally break the fast (eat), please let your provider know because the test is not as useful without fasting

Should I be concerned if I have abnormal lipid panel results?

If your lipid results reveal that you have high levels of total cholesterol, LDL and/or triglycerides and/or low levels of HDL, it doesn’t necessarily mean that you have a medical condition or need treatment.

A healthy cholesterol range for you may depend on many factors. Your healthcare provider will take into consideration the following factors when interpreting your lipid panel results:

• Your age.

• Your overall health.

• Your medical history.

• Your current medications.

• Other risk factors you may have for cardiovascular disease.

Many providers use a special risk calculator using these factors to determine if you need further tests or treatment. If you have questions about your results, don’t be afraid to talk to your provider.

What are the next steps if my lipid panel results are abnormal?

Since many factors contribute to cardiovascular disease and every person is unique, there’s no one single way to treat abnormal levels of cholesterol and/or triglycerides.

If you have abnormal lipid panel results, your healthcare provider may recommend one or more of the following actions:

• Continued lipid monitoring.

• Lifestyle changes, such as changing your diet or starting an exercise routine.

• Starting a cholesterol-lowering medication.

What is a procalcitonin test?

A procalcitonin test measures the level of procalcitonin in your blood. A high level could be a sign of a serious bacterial infection, such as sepsis. Sepsis is the body's severe response to infection. Sepsis happens when an infection in one area of your body, such as your skin or urinary tract, spreads into your bloodstream. This triggers an extreme immune reaction. It can cause a rapid heartbeat, shortness of breath, decreased blood pressure, and other symptoms. Without quick treatment, sepsis can lead to organ failure or even death.

A procalcitonin test can help your health care provider determine if you have sepsis or another serious bacterial infection in the early stages. This may help you get treated promptly and avoid life-threatening complications.

Other names: PCT test

What is it used for?
A procalcitonin test may be used to help:

Diagnose sepsis and other bacterial infections, such as meningitis
Diagnose kidney infections in children with urinary tract infections
Determine the severity of a sepsis infection
Find out whether an infection or illness is caused by bacteria
Monitor the effectiveness of Antibiotics therapy

Why do I need a procalcitonin test?
You may need this test if you have symptoms of sepsis or another serious bacterial infection. These symptoms include:

Fever and chills
Sweating
Confusion
Extreme pain
Rapid heartbeat
Shortness of breath
Very low blood pressure
This test is usually performed in the hospital. It is mostly used for people who come to the emergency room for treatment and for people who are already in the hospital.

What do the results mean?
If your results show a high procalcitonin level, it's likely you have a serious bacterial infection such as sepsis or meningitis. The higher the level, the more severe your infection may be. If you are being treated for an infection, decreasing or low procalcitonin levels can show that your treatment is working.

Is there anything else I need to know about a procalcitonin test?
Procalcitonin tests are not as precise as other laboratory tests for infections. So your health care provider will need to review and/or order other tests before making a diagnosis. But a procalcitonin test does offer important information that can help your provider start treatment sooner and may help you avoid serious illness.

What is a lactate dehydrogenase (LDH) test?

This test measures the level of lactate dehydrogenase (LDH), also known as lactic acid dehydrogenase, in your blood or sometimes in other body fluids. LDH is a type of protein, known as an enzyme. LDH plays an important role in making your body's energy. It is found in almost all the body's tissues, including those in the blood, heart, kidneys, brain, and lungs.

When these tissues are damaged, they release LDH into the bloodstream or other body fluids. If your LDH blood or fluid levels are high, it may mean certain tissues in your body have been damaged by disease or injury.

Other names: LD test, lactic dehydrogenase, lactic acid dehydrogenase

What is it used for?
An LDH test is most often used to:

Find out if you have tissue damage
Monitor disorders that cause tissue damage. These include anemia, liver disease, lung disease, and some types of infections.
Monitor chemotherapy for certain types cancer. The test may show if treatment is working.
Why do I need an LDH test?
You may need this test if other tests and/or your symptoms indicate you have tissue damage or disease. Symptoms will vary depending on the type of tissue damage you have.

You may also need an LDH test if you are currently being treated for cancer.

What do the results mean?

Higher than normal LDH levels usually means you have some type of tissue damage or disease. Disorders that cause high LDH levels include:

Anemia
Kidney disease
Liver disease
Muscle injury
Heart attack
Pancreatitis
Infections, including meningitis, encephalitis, and infectious mononucleosis (mono)
Certain types of cancer, including lymphoma and leukemia. A higher than normal LDH level may also mean treatment for cancer is not working.
Although the test can show if you have tissue damage or disease, it does not show where the damage is located. If your results showed higher than normal LDH levels, your provider may need to order more tests to make a diagnosis. One of these tests may be an LDH isoenzyme test. An LDH isoenzyme test measures different forms of LDH. It can help your provider find out about the location, type, and severity of tissue damage.

What is D-dimer test?

D-Dimer is one of the fibrin degradation products. So when a body part is damaged or is bleeding from somewhere, the body tries to stop the bleeding by clumping together the cells there to make a network. That network is formed from a protein called fibrin. So vibrating starts together at the bleeding site and makes a blood clot. That blood clot is due to the crises crossing of fibrin. When the healing is done, or when the body thinks that the cloud is no longer necessary, it starts to degrade that clot and starts breaking down the fibrin. When the fibrin breaks down, it forms fibrin degradation products or FDPs. And one of the FDP is D-Dimer.

Why do we need D-Dimer during COVID?

The test shows the presence of clots in the body when COVID becomes serious. We get a lot of clots in the body in the lung especially, because of which reason the lungs cannot breathe. The blood flow is hampered due to clotting. So, the body tries to break down these clots. D dimer is detectable for up to eight hours after formation until the time the kidney clears it out.

What does the high or low level of D-Dimer mean?

A higher level of D dimer in the body shows that there is a lot of clot presence in the body which can be a dangerous sign when affected with COVID. So we use D-Dimer to assess for severity of COVID disease and if the patient is going to need oxygen in the future, because the higher their D-dimer, higher is the number of clots in the lungs and the higher the chances that they will need oxygen.

What Is a CRP Test?



C-reactive protein (CRP) test, is mainly conducted for patients who are hospitalised for Covid virus treatment, but a large number of doctors are recommending the same test even to those Covid positive patients who are in home isolation with moderate to mild symptoms.

CRP is not a diagnostic test but it has prognostic value. Then, why are doctors recommending it to patients in home isolation?

What is a CRP test?

It is a blood test and it tells about inflammation level in the body during any ailment and indicates about the infection level. It can be done for any ailment. The higher value of CRP level than the normal level indicates that the infection is increasing. CRP tests is a marker which shows the level of C-reactive protein, which is made by the liver, in the blood.

Why is it recommended for the treatment of Covid patients?

Doctors are conducting it mandatorily for the patients with critical conditions who are in hospital care, because it is one of the indicators showing the body’s reaction to the ongoing treatment.



“If the CRP, which is also recommended in the guidelines for Covid treatment, is normal then the patient’s body is reacting to the treatment positively and if it is higher than the required, then doctors need to check the infection level in the body through other tests like CT scan,” said Doctor SS Johal, who runs a hospital in Jalandhar and also has Level-3 facility for the treatment of Covid patients.

“It is recommended for those in home isolation too if they do not show any improvement in their symptoms even after the passing of a week or so,” he added.