By Cat Troiano

According to the Centers for Disease Control and Prevention (CDC), approximately 1.1 million Americans are living with human immunodeficiency virus (HIV), but one out of every seven of these individuals is unaware that he or she has the illness. When isolating those in the 13 to 24 year age group, the proportion of those who do not know that they have HIV jumps to more than 50 percent. The CDC also estimates that 50,000 new cases of HIV are diagnosed each year. By adhering to testing recommendations, a diagnosis of HIV is no longer considered a death sentence as it was during the 1980s. Today, once HIV is detected, available treatment can effectively manage the disease and empower many patients to live full and productive lives.

What Is HIV?

HIV is a virus that attacks the T-cells of the body’s immune system. T-cells are a type of white blood cell known as lymphocytes. The primary function of T-cells is to seek out and destroy pathogens as well as unhealthy cells, such as cancer cells. When the virus invades a T-cell, it replicates within the cell and destroys it. As HIV continues its attack, more and more of these T-cells are destroyed, resulting in a weakened immune system that can no longer fight off infections and certain cancers. By that point, once the T-cell count has dropped lower than 200 cells per millimeter, the disease has led to acquired immunodeficiency syndrome, or AIDS, which is the third and final stage in the HIV progression.

HIV Testing Guidelines

Although some patients who contract HIV may experience bouts of generalized symptoms similar to those of influenza, others remain asymptomatic during the earlier two stages of the disease. The only way to make a definitive diagnosis of HIV is through laboratory testing. The CDC currently advises routine HIV testing for every patient at least once between the ages of 13 and 64 years as well as for all pregnant women.

All patients should also be assessed for risk factors, which include the following:

• Having male to male sexual relations
• Having sexual relations with an HIV-positive partner
• Having sexual relations with someone without knowing that individual’s sexual history or HIV status
• Use of intravenous drugs, especially if sharing needles and other supplies with other individuals
• Previously diagnosed with a sexually-transmitted disease, hepatitis B, hepatitis C or tuberculosis
• Being a healthcare worker who may potentially have direct exposure to the blood of an HIV-positive patient
• Receiving a blood transfusion prior to 1985

Patients who carry any of these risk factors should be tested at least once annually.

HIV Antigen/Antibody Test

The HIV antigen/antibody test is the preferred laboratory test for initial HIV screening. When a patient is exposed to a bacteria or virus, which is known as an antigen, his or her immune system generates antibodies, also known as immunoglobulin, to neutralize the invading pathogen. The HIV antigen is known as p24. The HIV antigen/antibody test detects the level of p24 as well as two HIV antibodies, which are HIV-1 and HIV-2, the former of which is the more prevalent HIV antibody in the United States. Due to the test’s ability to detect p24, HIV can be detected in its earliest stage, as early as two to six weeks post patient exposure.

HIV Antibody Test

Any HIV antibody test that is performed in the United States is able to detect the presence of HIV-1 antibodies. This test can detect HIV as early as three to twelve weeks post patient exposure. Performance of any HIV screening test too soon after patient exposure can produce false-negative results. Once a patient tests positive on an HIV antigen/antibody test, the CDC recommends a follow up test with an HIV antibody test to confirm diagnosis. If both tests yield positive results, then the patient is considered HIV-positive, and treatment options will be presented by the patient’s physician. If the two test results do not concur, then ordering an HIV nucleic acid test is advised.

HIV Nucleic Acid Test (NAT)

The HIV nucleic acid test, which is also referred to as an HIV RNA quantitative test, screens for the actual virus in a blood sample by evaluating the level of HIV genetic RNA material. If the HIV antigen/antibody and the HIV antibody test results do not both yield positive results, this test can verify a patient’s HIV status.

Once a patient is diagnosed with HIV, the HIV NAT can be ordered to establish a baseline value of the individual’s viral load. The HIV NAT test is a useful method for monitoring that patient’s viral load levels periodically to determine the efficacy of their treatment protocol. The result of an HIV NAT is expressed as the quantity of HIV copies per milliliter of blood. When a patient’s treatment is effective, the number of copies/ml declines. Once that number drops lower than 200 copies/ml on a consistent basis, then the virus is said to be suppressed. This does not mean that the patient is cured of HIV. Rather, it indicates that the HIV viral load has reduced to undetectable levels, and the disease progression has been dramatically slowed.

Treatment Options

There is still no vaccine available to prevent HIV infection. However, those who are at significantly high risk for HIV have the option of taking a daily medication that has been shown to be effective at reducing their chances of HIV infection. This preventative treatment is known as pre-exposure prophylaxis, or PrEP.

Preventative treatment can also be administered on an emergency basis to individuals who suspect that they were exposed to HIV within the previous 72 hours. For example, if a victim of sexual assault begins taking the medication as soon as possible within 72 hours of the incident for 28 days, the risk of HIV infection declines. Such preventative treatment is known as post-exposure prophylaxis, or PEP.

There is no cure for HIV, but the disease can be controlled through antiretroviral therapy (ART). When positive test results confirm an HIV diagnosis in its earlier stage, patients who undergo this method of treatment and monitor their condition closely under their physicians’ recommendations can reduce their viral load to undetectable levels. This retards the progression of the disease, staving off the development of AIDS and enabling patients to live normally for years.

According to the World Health Organization, the rate of HIV and AIDS-related deaths worldwide has been reduced by more than half that of 2004 when the rate peaked. Screening patients for HIV enables earlier treatment with ART, which ultimately saves lives.

By Cat Troiano

Diabetes is a prevalent chronic metabolic disease, and according to the American Diabetes Association, nearly 10 percent of the American population has this condition. Roughly 1.5 million new cases of diabetes are diagnosed in the United States each year, but 7.2 million American adults who have diabetes are undiagnosed. Understanding which patients should be tested for diabetes and which tests to order can be a proactive step toward reducing the number of undiagnosed cases and saving more lives.

Types and Risk Factors of Diabetes

Diabetes refers to a group of metabolic diseases in which the body is unable to produce or respond to insulin, which is needed for maintaining proper blood glucose levels.

Insulin is a hormone that is produced by beta cells in the pancreas. In a healthy individual, once dietary sugar from carbohydrates is metabolized, insulin is responsible for transporting the glucose from the blood to the body’s muscles and other tissues for use as energy. Any extra glucose gets stored in the liver for a future energy source. In an individual who has diabetes, glucose ends up accumulating in the bloodstream, resulting in hyperglycemia.

Type 1 diabetes, also known as diabetes insipidus, is characterized by the pancreas’ inability to produce insulin. The cause of type 1 diabetes is still unconfirmed, but it is believed to be an autoimmune disorder, and the incurable condition is typically diagnosed early in life. Patients with type 1 diabetes require lifelong treatment with insulin medication.

Type 2 diabetes, also known as diabetes mellitus, is the most prevalent form of diabetes and is characterized by insulin resistance. This means that although the pancreas does produce insulin, the body does not utilize the insulin efficiently to keep blood glucose levels within normal parameters. While type 2 diabetes was once primarily diagnosed in adult patients, the recent trend in rising childhood obesity rates has resulted in an increased rate of diagnosis in children.

Gestational diabetes is a form of diabetes that occurs during pregnancy. It is usually diagnosed in expectant mothers during the third trimester, and once the baby is born, the blood sugar level usually returns to normal.

Prediabetes is the condition that precedes type 2 diabetes in which the blood glucose level is abnormally high, but it is not yet high enough to confirm a diagnosis of diabetes.
According to the Centers for Disease Control and Prevention, one in three Americans has prediabetes. Failure to detect prediabetes and intervene to reverse its course will most likely result in diabetes. Unlike type 1 diabetes, which acts as an autoimmune disorder, type 2 diabetes, which is considered a lifestyle disease, can be prevented. Risk factors for type 2 diabetes include:

• Obesity
• Excess abdominal fat, indicated by a waist circumference measurement that is greater than 100 centimeters in men or greater than 88 centimeters in women
• Triglyceride level that exceeds 150 mg/dL
• HDL cholesterol level that is lower than 40 mg/dL
• Hypertension
• Sedentary lifestyle
• Prediabetes, indicated by a fasting glucose level that is greater than 100
• Family history of diabetes
• Previous history of gestational diabetes
• History of giving birth to a baby whose birth weight exceeded nine pounds
• Being 45 years of age or older
• Being of African-American, Native-American, Hispanic-American or Asian-American ethnicity

Patients who possess any of these risk factors must be screened for diabetes to enable early detection before the disease’s damaging complications occur.

Random Blood Glucose Level

For an immediate blood test result in patients who present with symptoms of diabetes, a blood test that does not require fasting can be performed at any time. Symptoms of diabetes include:

• Increased water intake and urinary output
• Unexplained weight loss
• Persistent hunger
• Blurred vision
• Slow healing time for wounds and lacerations
• Frequent infections

A result of 200 mg/dL or higher on a random blood glucose level test is indicative of diabetes.
Fasting Blood Glucose Level

This test reveals a patient’s blood glucose level after fasting overnight. Diabetic patients typically check their own fasting blood glucose level on a daily basis by using a glucometer, which analyzes a drop of blood. Whenever a physician orders a comprehensive metabolic profile, the panel includes the blood glucose level. When patients are directed to fast prior to testing, as is typical when the panel includes a lipid profile, then the blood glucose level result is a fasting level. Fasting blood glucose levels are interpreted as:

Normal Range: 99 mg/dL or lower
Prediabetes Range: 100 to 125 mg/dL
Diabetes Range: 126 mg/dL or higher

When two different tests are performed on two different days and the fasting blood glucose level results on both tests fall within the prediabetic range, then steps must be taken, such as dietary changes and exercise routine implementation, to try to reduce the patient’s risk of his or her prediabetic status advancing to diabetes. There are also additional tests that can be ordered to better assess the patient’s blood glucose level trends.

HbA1c

The hemoglobin A1c (HbA1c) test, for which fasting is not required, is a blood test that reveals a patient’s average blood glucose level for the two to three-month timespan prior to testing. This test evaluates the percentage of glycated, or glucose-coated, hemoglobin in the blood. HbA1c test results are interpreted as:

Normal Range: 5.6 percent or lower
Prediabetic Range: 5.7 to 6.4 percent
Diabetic Range: 6.5 percent or higher

The HbA1c test can be performed to establish a baseline blood glucose level average, and it is also used to monitor diabetic management and progression. The HbA1c test should be ordered annually for patients who have prediabetes. The test may be ordered more often for patients with types 1 or 2 diabetes.

Since the HbA1c test assesses a two to three-month average blood glucose level, pregnancy and certain medical conditions in which the lifespan of a patient’s blood cells is shorter in duration than the typical 120 days, such as hemolytic anemia, can reduce the accuracy of the test.

Fructosamine Test

Like the HbA1c test, the fructosamine test also measures the glycated protein, in this case albumin, in the blood. The two tests differ in that the fructosamine test provides an average blood glucose level for the past two to three weeks instead of the HbA1c test’s result of a two to three-month average. The fructosamine test can be used to provide an earlier assessment of the patient’s glycemic control once dietary and other lifestyle changes are made and insulin therapy has begun.

Normal reference range for fructosamine: 200 to 285 mcmol/L

The higher the fructosamine test result is above 285, the less effective a patient’s current diabetic treatment protocol is in achieving glycemic control.

Oral Glucose Tolerance Test

The glucose tolerance test evaluates blood glucose levels over a two-hour duration, which offers a glimpse into how efficiently a patient’s body processes glucose. After an overnight fast, the first blood sample is drawn for a fasting blood glucose test. The patient is then required to drink a sugary solution, and then an additional blood sample is taken two hours later, for an additional blood glucose level reading. That reading that is taken at the two-hour mark is interpreted as:

Normal Range: 139 mg/dL or lower
Prediabetic Range: 140 to 199 mg/dL
Diabetic Range: 200 mg/dL or higher

The glucose tolerance test is extended to a three-hour duration with a third blood sample drawn when used to screen for gestational diabetes in pregnant women. If at least two of the three sample results are 200 mg/dL or higher, then gestational diabetes is diagnosed.

Ketones in the Urine
When the body does not have a sufficient amount of insulin available to utilize glucose for energy, body fat is burned for energy instead. When this occurs, a byproduct called ketones is produced and expelled from the body through urine. Ketones can be found in the urine and in the blood, and the presence of ketones is known as ketosis. Results for ketones in urine testing are interpreted as follows:

Negative: normal
Small: Less than 20 mg/dL
Moderate: 30 to 40 mg/dL
Large: Greater than 80 mg/dL

Having ketones in the urine can be indicative of diabetes. Diabetes is not only cause of ketosis, however. Other causes include anorexia, hyperthyroidism, long durations of vomiting, severe infections, high fevers, excess alcohol consumption and the currently popular ketogenic diet. When a diabetic patient’s ketone levels accumulate to moderate or large numbers and blood glucose levels are also high, the patient is then at risk for a potentially life-threatening condition called diabetic ketoacidosis.

Diabetes is the seventh leading cause of mortality, but with the availability of several different laboratory tests that can be called upon to diagnose and monitor diabetes, patients today have an excellent chance of controlling their condition, enabling them to live a normal life for a full lifespan.

Image courtesy of the National Institutes of Health

By Cat Troiano

According to the American Liver Foundation, nearly 30,000 adults are diagnosed with liver cancer each year, and the number of mortalities exceeds 20,000 annually. Additional diseases threaten the liver, including some that can be just as deadly and some that can be prevented. Evaluating liver function is a key first step toward detecting liver disease at an early stage.

Liver at Large

Weighing in at roughly three pounds, the liver, which is situated on the right side of the abdomen, is one of the largest organs of the human body, ranking as the second-largest organ after skin. The liver is unique in that when it sustains damage, it has the ability to regenerate as long as at least 25 percent of its tissue remains healthy. Technically a gland that is classified as part of the digestive system, the liver carries a lot of responsibilities. Functions of the liver include:

• The liver produces bile, a substance that aids in digestion and is made up of bilirubin, electrolytes, cholesterol and water.
• The liver produces albumin, which is a protein found in blood serum.
• The liver breaks down and metabolizes proteins.
• The bile that is produced in the liver metabolizes fats.
• The liver metabolizes carbohydrates to maintain blood glucose levels.
• The liver stores carbohydrates as glycogen, which can be called on by the body for use when a burst of energy is needed.
• The liver also stores a supply of vitamins, including A, B12, D, E and K.
• The liver also stores ferritin, a form of iron that comes from hemoglobin and is utilized in the production of new red blood cells.
• The liver filters hormones as well as foreign substances, such as drugs and alcohol, from the blood.
• The liver plays a role in the body’s immune function.

With so many vital roles that affect overall health, monitoring the liver’s ability to carry out these tasks efficiently is an important step in diagnosing diseases that can hinder liver function.

Diseases of the Liver

There are several diseases that affect the liver. Some examples of liver diseases include:

• Cirrhosis – a disease in which scar tissue overtakes healthy liver tissue. This process, called fibrosis, has a number of causes, including excessive alcohol use, toxins and hepatitis. Alcoholic liver disease is the leading worldwide cause of cirrhosis of the liver.
• Hepatitis – a liver infection in which the liver becomes inflamed. Viruses, toxins and autoimmune response can cause hepatitis.
• Fatty liver disease – a condition in which fat accumulates in the liver’s cells. While alcoholism is a frequent culprit, obesity can also result in fatty liver disease.
• Primary sclerosing cholangitis (PSC) – an incurable disease characterized by inflammation of the bile ducts. The cause of PSC remains unknown.
• Gilbert’s syndrome – a non-threatening condition in which bilirubin is not fully broken down, resulting in mild jaundice.
• Fascioliasis – a parasitic infection that is caused by liver flukes.
• Liver cancer – the sixth most commonly diagnosed form of cancer

Symptoms of liver disease include jaundice, light-colored stools, dark-colored urine, appetite loss, nausea, diarrhea, fatigue, unexplained changes in weight and abdominal swelling or discomfort, but the liver may sustain extensive damage before symptoms present. Early detection through routine laboratory screening is valuable so that treatment protocols can be initiated to restore the liver’s form and function when possible.

Liver Tests and Values

A comprehensive metabolic profile is an effective routine laboratory test for analyzing a patient’s liver function. There are six results on a comprehensive metabolic profile that represent liver function.

Alanine amino transferase (ALT, or SGPT) is an enzyme that aids in metabolizing protein and converting food into energy molecules. ALT is found primarily in a healthy liver, with only low levels detected in the blood. When the liver sustains damage, however, the damaged cells release ALT into the bloodstream. An abnormally high level of ALT in the blood is indicative of liver disease.

Aspartate amino transferase (AST, or SGOT) is an enzyme that metabolizes the amino acid alanine. AST is normally found in the liver, as well as in the heart and muscles. When the liver, heart or muscles sustain damage, elevated amounts of AST are released into the bloodstream. While a high ALT level is evidence of liver disease, a normal ALT level combined with a high AST level can be indicative of a heart condition or muscle damage.

Alkaline phosphatase (ALP) is an enzyme that is found in the liver, bile ducts and bone. Damage to any of these structures causes an elevation in the ALP level in the bloodstream. High ALP levels may indicate liver disease, a bile duct obstruction or a bone disease.

Bilirubin is a waste product that is produced when red blood cells break down at the end of their typical 120-day lifespan. Bilirubin then circulates through the liver, where it is filtered from the blood to exit the body through stool. Liver damage or disease as well as certain types of anemia can result in an elevated bilirubin level. Jaundice is a visible sign in a patient who has a very high bilirubin level.

Albumin is a protein that is produced in the liver, and it accounts for roughly 60 percent of total protein found in the blood. Albumin is essential for nourishing the body’s tissues as it aids in transporting vitamins, minerals and hormones throughout the body. When the liver is damaged, a low albumin level in the blood results.

Total protein, or albumin/globulin(A/G) ratio, represents the combined total of albumin and globulin, which accounts for the remaining 40 percent of protein that is found in the blood. Proteins are the building blocks for all cells and tissues through the body. In a patient with severe liver disease, the level of either albumin or globulin is low.

The normal ranges for liver values are:

ALT: 7 to 55 U/L
ALP: 45 to 115 U/L
AST: 8 to 48 U/L
Bilirubin: 0.1 to 1.2 mg/dL
Albumin: 3.5 to 5.0 g/dL
Total Protein: 6.3 to 7.9 f/dL

Other Liver Function Tests

When any of the aforementioned liver function values yield abnormal results on the comprehensive metabolic profile, additional tests may be ordered to aid in diagnosis. Such laboratory tests include:

Gamma-glutamyl transferase (GGT) is an enzyme that is present in the highest concentrations within the liver. While GGT levels increase as a result of liver damage incurred by any of the liver diseases, it is the first liver enzyme to become elevated when bile duct obstruction occurs. Therefore, the GGT test is useful in determining if an elevated ALP level is due to a blocked bile duct. It can also help to rule out bone disease as a cause of the elevated ALP level.

The normal reference range for GGT is 9 to 48 U/L.

Lactate dehydrogenase (LD, or LDH) is an enzyme that is found in nearly all cells throughout the body. Its highest concentrations are found in those of the liver, kidneys, heart, muscles and lungs, making the result of this test nonspecific when performed alone. When an LD is performed to compare the result against those of the comprehensive metabolic profile, it can be helpful in pinpointing the organ that has sustained tissue damage. A high LD is indicative of tissue damage.

The normal reference range for LD is 122 to 222 U/L.

Prothrombin time (PT) is a measurement of how long the blood takes to clot. Prothrombin is a protein that aids in blood coagulation. Since prothrombin is produced in the liver, the level of prothrombin that is produced can decrease if the liver is damaged or diseased, resulting in a longer blood clotting time.

The normal reference range for patients who are not taking blood thinning medications is 9.5 to 13.8 seconds.

Alpha-feto protein (AFP) is a protein that results when liver cells regenerate. Chronic liver diseases can result in ongoing elevated AFP levels in the blood. The AFP test is also a valuable tumor marker test in that very high levels of AFP are indicative of hepatocellular carcinoma and hepatoblastoma, which are two forms of liver cancer.

The normal reference range for AFP is 0 to 15 IU/ml.

Additional specific laboratory tests, such as the acute hepatitis panel and the autoimmune antibody test, can be ordered to screen for hepatitis A, B and C or autoimmune hepatitis. Diagnostic imaging tests, such as ultrasound or CT scan, may be ordered to visually reveal liver damage, structural abnormalities or masses. A liver biopsy and tissue pathology may be ordered when liver cancer is suspected.

Who Should Be Tested?

While a comprehensive metabolic panel is typically ordered as part of a routine health examination, physicians should also order the screening and/or additional liver tests in patients who are at risk for liver disease. Such situations include:

• Patients who present with the aforementioned symptoms of liver disease
• Patients who are alcoholics
• Patients with family histories of liver disease
• Patients who are overweight or obese
• Patients who may have been exposed to any of the hepatitis viruses

Some herbal remedies and a number of medications, including acetaminophen, non-steroidal anti-inflammatory drugs, statins, hormonal drugs, some antibiotic drugs and antihypertensive drugs as well as certain medications used to treat gastroesophageal reflux, diabetes, gout, allergies, fungal infections, cancer and seizures, can have adverse effects on the liver. Patients who take any such medications should be tested periodically to monitor liver health.

Treatment for liver disease depends on the specific condition that is diagnosed. Some forms of liver disease can be treated with changes in lifestyle habits, such as losing weight or ceasing alcohol consumption, while more severe forms of liver disease may progress to the point of requiring a liver transplant. Adopting healthy lifestyle habits and undergoing periodic routine laboratory tests the enable early detection offer patients the best chance for preserving liver function.

 

By Cat Troiano

According to the American Cancer Society, one out of nine men is diagnosed with prostate cancer, and it is the third leading cause of cancer-related death in men. The present survival rate, in which one out of 41 men succumb to the illness, is higher than the alarming rate of diagnosis, thanks to screening tests.

Risk Factors and Testing Guidelines

Cases of prostate cancer are often detected before any symptoms present. Men who are experiencing changes in urination habits or in reproductive function should consult with their physician, who will order a prostate-specific antigen test and a digital rectal examination at once to screen for prostate cancer. In the absence of these signs, prostate cancer screening recommendations are made based upon each patient’s age and risk factors.

•  Men who are 50 years of age or older and have a remaining life expectancy of at least 10 years should undergo               prostate cancer screening.
• Prostate cancer screening should begin at 45 years of age in men who have elevated risks of developing the illness.

Such risks include:
o Being African-American
o Having a father, son or brother who was diagnosed with prostate cancer before the age of 65
• Men who have a family history of two or more direct relatives who were diagnosed with prostate cancer before the age of 65 should undergo prostate cancer screening from the age of 40.

Prostate cancer is a slow-growing cancer, and thus screening is not typically advised for men who do not have an expected remaining lifespan of at least 10 years. In these cases, the men who happen to have prostate cancer will more likely die with prostate cancer rather than from prostate cancer.

What Is PSA?

The prostate is a male reproductive gland that is located underneath the bladder and in between the seminal vesicle and the rectum, and it surrounds the uppermost portion of the urethra. The prostate’s role is to produce prostate fluid, which combines with semen, and to expel semen into the urethra during ejaculation. Prostate-specific antigen (PSA) is a protein enzyme that breaks down the molecular weight of proteins in semen, rendering semen a more fluidlike form. PSA is produced by both healthy and cancerous cells of the prostate gland, and while much of it is released into semen, some is also released into the bloodstream. Men who have prostate cancer will have a significantly higher concentration of PSA in their blood.

Using PSA as a Tumor Marker

The PSA test, which is performed on a blood serum sample, is used as a tumor marker screening method. The most commonly ordered laboratory test for prostate cancer screening is the total PSA test, which provides results that represent the sum of two forms of PSA in the blood. The two forms are known as free PSA and complexed PSA. Free PSA is that which is not bound to other proteins in the blood, a presentation that is more typical from benign, or noncancerous, prostate cells. Complexed PSA, or cPSA, is that which binds with other proteins and is a more typical result from malignant prostate cells. If the total PSA test result is slightly higher than the normal reference range, then a free PSA test may be ordered to help guide physicians in the decision of whether or not to pursue the recommendation of a prostate biopsy. If the free PSA level is high, then the high total PSA level may be the result of a benign condition as opposed to prostate cancer.

The PSA Test Result

The general normal reference range for a PSA test is less than 4 ng/mL in men who are less than 60 years of age.

As long as the result is less than 2.5 ng/mL, the American Cancer Society recommends repeated screenings every two years. If the result is 2.5 ng/mL or greater, then screenings should be ordered annually. The upper normal reference range limits for PSA levels increase in men beyond 60 years of age. The reference ranges for older age groups are:

• 4.5 ng/mL or less for men aged 60 to 69
• 6.5 ng/mL or less for men aged 70 to 79
• 7.2 ng/mL or less for men aged 80 or older

A digital rectal examination (DRE) to palpate the prostate for any lumps, enlargement or other physical abnormalities is performed as part of a routine physical examination. Blood should be drawn before performing a DRE since this can temporarily elevate the PSA level in some patients.

There are other noncancerous causes of an elevated PSA result. Some of these conditions include:

• Benign prostatic hyperplasia, more commonly referred to as an enlarged prostate, is a condition in which the prostate cell production and growth accelerates. The result is a larger prostate that can compress the urethra, which can potentially cause partial or complete urinary blockage. Benign prostatic hyperplasia is part of the aging process and affects most men as they age.
• Prostatitis is an infection of the prostate which is often bacterial in nature. Unlike benign prostatic hyperplasia, prostatitis can affect men of any age, but it is more commonly diagnosed in those who are less than 50 years of age.
• Urinary catheterization or any medical procedure that can cause irritation or inflammation of the prostate and surrounding structures can lead to an elevated PSA level.
• Ejaculation within 24 hours prior to testing can cause a slight elevation in PSA, which may raise a red flag in someone whose normal PSA level has been borderline on previous screenings.
• Aging raises the normal limits of the PSA level, as noted above.
• Certain chemotherapy drugs can alter the PSA level.

If a PSA test result is higher than the accepted normal range, further diagnostic testing will be ordered to rule out cancer as the cause. Such tests typically include a trans-rectal ultrasound and prostate biopsy. If the pathology report confirms the presence of cancerous cells, the PSA test results can be used in conjunction with the histopathology results as part of the cancer staging process.

Prostate Cancer Treatment Options

Once a patient is diagnosed with prostate cancer, treatment options should be discussed with an oncologist. Some options that are available include:

• Prostatectomy, which is surgical removal of the prostate
• Brachytherapy, or internal radiation therapy, such as the implantation of radioactive seeds
• External beam radiation therapy, such as CyberKnife® radiation
• Cryotherapy, or cryoablation, in which prostate cancer cells are destroyed by freezing
• Hormone therapy to lower the body’s level of androgen, which is a male hormone that stimulates the growth of prostate cancer cells
• Chemotherapy

When discussing treatment options, factors such as age, expected lifespan, the stage of the cancer, the presence of other health conditions and patient concerns regarding potential side effects of treatment must all be considered. Once a treatment protocol has begun, PSA tests can serve to monitor the efficacy and progress of the treatment. Decreasing levels of PSA indicate that the treatment is working.

All male patients should have a prostate cancer risk assessment discussion with their primary care physicians at age 40, and PSA testing should then be ordered in accordance with screening guidelines. PSA testing should also be ordered for all male patients who present with any signs of symptoms of possible prostate problems. Four out of five cases of prostate cancer are diagnosed during the early stage, and when treatment is promptly sought, the 15-year relative survival rate is 96 percent.

By Cat Troiano

Pregnancy is an exciting time for moms-to-be as they anticipate the birth of their baby, and they rely on their physicians for guidance through each trimester. In addition to proper nutrition, stress reduction, plenty of sleep and safe activity levels, periodic checkups are essential in achieving the healthiest possible status for both the mother and for her developing fetus. Prenatal laboratory tests are an important part of these appointments so that any potential health issues can be addressed to ensure a safe pregnancy and uncomplicated delivery.

Types of Prenatal Tests

From pregnancy confirmation through delivery, expectant mothers undergo various laboratory tests to monitor their health as their bodies undergo hormonal shifts and metabolic changes to accommodate the growth and development of their fetuses. The types of prenatal tests that may be ordered include:

• Routine tests
• Selective tests
• Genetic tests

While some tests are ordered for every woman who is pregnant, others are only performed under certain conditions.

Confirming Pregnancy

Human chorionic gonadotropin (hCG) is a hormone that is produced by the cells of the placenta once conception takes place, and the level continues to increase every two to three days during the first 8 to 11 weeks of pregnancy.

A qualitative hCG test evaluates the presence of hCG in a blood or urine sample to confirm a patient’s pregnancy status:

• An hCG level that is lower than 5 mIU/ml is a negative result for pregnancy.
• An hCG level that is between 6 and 24 mIU/ml is inconclusive, and the test will need to be repeated to determine if the level increases.
• An hCG level that exceeds 25 mIU/ml is a positive result for pregnancy.

A quantitative hCG test is performed on a blood sample for monitoring purposes to ensure that the level of hCG is increasing appropriately during the first trimester. A low hCG level is not always indicative of a problem, and plenty of women with low hCG levels have given birth perfectly healthy babies. However, if the level does not increase, problems such as etopic pregnancy and miscarriage must be ruled out. Conversely, a higher than normal hCG level must also be investigated to rule out possible causes, such as a multiple pregnancy.

Routine Tests for All

Once the qualitative hCG test confirms a patient’s pregnancy status, routine laboratory screening tests are ordered for all expectant women.

A complete blood count (CBC) is performed during the first and third trimesters. This blood test, which evaluates the red blood cells, hemoglobin, white blood cells and platelets, enables the detection of the following conditions:

• Anemia, which can occur during pregnancy when the mother isn’t taking in adequate amounts of iron, folate or vitamin B12, posing the risk of delivering a premature or low birth-weight baby
• Infections, which can be passed along to the fetus
• Gestational thrombocytopenia, which is a condition that can develop during mid-to-late pregnancy and results in a low platelet count, reducing the blood’s ability to clot and increasing the risk of hemorrhaging

A urinalysis is performed at each prenatal appointment throughout the pregnancy. This urine screening enables the detection of these conditions:

• Gestational diabetes, which is a form of diabetes that can develop during pregnancy if hormonal changes result in high glucose levels and ketones in the urine
• Preeclampsia, which is a potentially fatal condition that can arise during pregnancy and is characterized by high blood pressure and high protein levels in the urine, putting the mother at risk for seizures, stroke, heart failure or coma and putting the fetus at risk for being stillborn

A urine bacterial culture may also be performed to detect bladder and urinary tract infections.

Blood typing and antibody screening is performed during the first trimester and repeated during the 28th or 29th week of pregnancy to verify that the mother’s and fetus’ blood types are compatible and that there are no Rh factor antibodies present.

A group B streptococcus (GBS) bacteria culture is performed during the 35th to 37th week of pregnancy. A baby can contract GBS during birth, which can result in the newborn developing meningitis or pneumonia.

If any abnormalities are discovered in these test results, additional tests may be ordered. Diligent monitoring, combined with appropriate treatment, is imperative in managing the condition. For example, if the CBC results show a hemoglobin count that is lower than the normal range of 12 to 15.5 grams per deciliter, additional tests, such as the ferritin serum test or the serum folate test, can determine if the anemic state is the result of an iron or folate deficiency, respectively. Once a deficiency is confirmed, appropriate supplementation can then be prescribed to correct the deficiency.

Other tests that are recommended by the American College of Obstetrics and Gynecology for all expectant mothers include screenings for the following diseases, which can result in complications or be passed to the fetus:

• Human immunodeficiency virus
• Human papilloma virus
• Rubella, or German measles immunity
• Varicella zoster virus (chicken pox) immunity
• Hepatitis B
• Chlamydia
• Syphilis

Mothers who have histories of certain medical conditions or who carry other risk factors may need to undergo additional tests.

Selective Tests for Mothers at Risk

Just as an expectant mother who has been managing hypertension should expect diligent blood pressure monitoring throughout her pregnancy to avert the development of preeclampsia, mothers with other health conditions must be equally diligent in staying on top of their health status. Some examples of laboratory screenings that are ordered in such cases include:

• The glucose challenge and/or glucose tolerance test, for those with pre-existing diabetes, those who have a prior history of gestational diabetes or those whose urinalysis results include elevated glucose levels and ketones
• TSH, for those with a history of a thyroid condition, such as hypothyroidism
• Zika virus test, for expectant mothers who have recently traveled to areas where this mosquito-borne illness is prevalent
• Tuberculosis test, for those who are HIV positive or who reside with someone who has tuberculosis

To minimize the chances of complications during pregnancy, labor and delivery, attentive monitoring and testing are recommended for all expectant mothers who carry higher risks. Some of these risks include:

• Obesity
• Pregnancy that was achieved with the help of fertility drugs
• Pre-existing conditions, such as hypertension, diabetes, thyroid disease, autoimmune disorders, HIV and kidney disease
• Pregnancy during the teen and over-35 age groups
• Lifestyle habits, including smoking, alcohol consumption and illicit drug use

In addition to patient risk factor assessment, an important part of the patient history chart is the notation of all known family medical history, including the existence of hereditary conditions.

Genetic Tests

Genetic tests can determine whether or not the fetus has a particular hereditary disease that was carried by either parent. Genetic tests can be performed on the mother or father prior to conception if there is a family history of the disease to confirm whether or not she or he is a carrier of the disease or actually has the illness. Some examples of hereditary diseases include:

• Sickle cell anemia
• Alpha thalassemia
• Beta thalassemia
• Hemophilia A
• Cystic fibrosis
• Down syndrome
• Muscular dystrophy
• Polycystic kidney disease
• Huntington’s disease

The fetus can also be tested for genetic diseases and defects. The prospective parents should discuss the options with the physician and weigh the risks and benefits of fetal testing procedures. Throughout the pregnancy, sonogram imaging will be performed to monitor the growth and development of the fetus and to detect physical abnormalities.

Once a pregnancy is confirmed, performing all routine tests as well as selective tests when appropriate will enable early detection of any metabolic changes or other medical conditions that arise so that safe treatment plans can be implemented to manage the condition. This aspect of prenatal care is valuable in maximizing the expectant mother’s chance of safely carrying her baby to term, experiencing a delivery that is free of complications and welcoming a healthy new bundle of joy.

Thank you to www.niddk.nih.gov for the image