The Comprehensive Metabolic Panel (CMP) is a frequently ordered panel of tests that gives your doctor important information about the current status of your kidneys, liver, and electrolyte and acid/base balance as well as of your blood sugar and blood proteins. Abnormal results, and especially combinations of abnormal results, can indicate a problem that needs to be addressed. The CMP is typically a group of 14 specific tests that have been approved, named, and assigned a CPT code (a Current Procedural Terminology number) as a panel by Medicare, although labs may adjust the number of tests up or down. Since the majority of insurance companies also use these names and CPT codes in their claim processing, this grouping of tests has become standardized throughout the United States.
The CMP includes:
Both increased and decreased levels can be significant.
Proteins
Albumin, a small protein produced in the liver, is the major protein in serum. Total protein measures albumin as well as all other proteins in serum. Both increases and decreases in these test results can be significant.
Electrolytes
The concentrations of sodium and potassium are tightly regulated by the body as is the balance between the four molecules. Electrolyte (and acid-base) imbalances can be present with a wide variety of acute and chronic illnesses. Chloride and CO2 tests are rarely ordered by themselves.
Kidney Tests
BUN and creatinine are waste products filtered out of the blood by the kidneys. Increased concentrations in the blood may indicate a temporary or chronic decrease in kidney function. When not ordered as part of the CMP, they are still usually ordered together.
Liver Tests
- ALP (alkaline phosphatase)
- ALT (alanine amino transferase, also called SGPT)
- AST (aspartate amino transferase, also called SGOT)
- Bilirubin
ALP, ALT, and AST are enzymes found in the liver and other tissues. Bilirubin is a waste product produced by the liver as it breaks down and recycles aged red blood cells. All can be found in elevated concentrations in the blood with liver disease or dysfunction.
How is the sample collected for testing?
The CMP uses a tube of blood collected by inserting a needle into a vein in your arm. Ask your doctor whether you should be fasting for 10 to 12 hours prior to the blood draw. Depending on the reason for ordering the CMP, it may be drawn after fasting or on a random basis.
The CMP uses a tube of blood collected by inserting a needle into a vein in your arm. Ask your doctor whether you should be fasting for 10 to 12 hours prior to the blood draw. Depending on the reason for ordering the CMP, it may be drawn after fasting or on a random basis.
How is it used?
The CMP is used as a broad screening tool to evaluate organ function and check for conditions such as diabetes, liver disease, and kidney disease. The CMP may also be ordered to monitor known conditions, such as hypertension, and to monitor patients taking specific medications for any kidney- or liver-related side effects. If your doctor is interested in following two or more individual CMP components, he may order the entire CMP because it offers more information.
http://labtestsonline.org/understanding/analytes/cmp/tab/glanceThe CMP is used as a broad screening tool to evaluate organ function and check for conditions such as diabetes, liver disease, and kidney disease. The CMP may also be ordered to monitor known conditions, such as hypertension, and to monitor patients taking specific medications for any kidney- or liver-related side effects. If your doctor is interested in following two or more individual CMP components, he may order the entire CMP because it offers more information.
SED RATE
A sedimentation rate is common blood test that is used to detect and monitor inflammation in the body. The sedimentation rate is also called the erythrocyte sedimentation rate because it is a measure of the red blood cells (erythrocytes) sedimenting in a tube over a given period of time. Sedimentation rate is often abbreviated as sed rate or ESR. http://www.medicinenet.com/sedimentation_rate/article.htm
TSH (THYROID STIMULATING HORMONE)
The TSH test is often the test of choice for evaluating thyroid function and/or symptoms of hyperthyroidism orhypothyroidism. It is frequently ordered along with or preceding a T4 test. Other thyroid tests that may be ordered include aT3 test and thyroid antibodies (if autoimmune-related thyroid disease is suspected).
TSH testing is used to:
- Diagnose a thyroid disorder in a person with symptoms
- Screen newborns for an underactive thyroid
- Monitor thyroid replacement therapy in people with hypothyroidism
- Diagnose and monitor female infertility problems
- Help evaluate the function of the pituitary gland (occasionally)
- Screen adults for thyroid disorders, although expert opinions vary on who can benefit from screening and at what age to begin
When is it ordered?
The doctor may order a TSH test when someone has symptoms of hyperthyroidism or hypothyroidism and/or when a person has an enlarged thyroid gland.
- Increased heart rate
- Anxiety
- Weight loss
- Difficulty sleeping
- Tremors in the hands
- Weakness
- Diarrhea (sometimes)
- Light sensitivity, visual disturbances
- The eyes may be affected: puffiness around the eyes, dryness, irritation, and, in some cases, bulging of the eyes.
Symptoms of hypothyroidism may include:
- Weight gain
- Dry skin
- Constipation
- Cold intolerance
- Puffy skin
- Hair loss
- Fatigue
- Menstrual irregularity in women
It may be ordered at regular intervals to monitor the effectiveness of treatment when someone is being treated for a knownthyroid disorder.
TSH screening is routinely performed in the United States on newborns as part of each state's newborn screening program. The American Thyroid Association recommends that adults older than age 35 be screened for thyroid disease with a TSH test every five years, although other organizations, such as the U.S. Preventive Services Task Force, challenge this recommendation. Several organizations recommend instead screening women over 50 or those at high risk for thyroid disorders, such as pregnant and postpartum women.
What does the test result mean?
A high TSH result often means an underactive thyroid gland that is not responding adequately to the stimulation of TSH due to some type of acute or chronic thyroid dysfunction. Rarely, a high TSH result can indicate a problem with the pituitary gland, such as a tumor producing unregulated levels of TSH. A high TSH value can also occur when someone with a known thyroid disorder or who has had their thyroid gland removed is receiving too little thyroid hormone medication.
A low TSH result can indicate an overactive thyroid gland (hyperthyroidism) or excessive amounts of thyroid hormone medication in those who are being treated for an underactive (or removed) thyroid gland. Rarely, a low TSH result may indicate damage to the pituitary gland that prevents it from producing adequate amounts of TSH.
Whether high or low, an abnormal TSH indicates an excess or deficiency in the amount of thyroid hormone available to the body, but it does not indicate the reason why. An abnormal TSH test result is usually followed by additional testing to investigate the cause of the increase or decrease.
The following table summarizes test results and their potential meaning.
| TSH | T4 | T3 | INTERPRETATION |
|---|---|---|---|
| High | Normal | Normal | Mild (subclinical) hypothyroidism |
| High | Low | Low or normal | Hypothyroidism |
| Low | Normal | Normal | Mild (subclinical) hyperthyroidism |
| Low | High or normal | High or normal | Hyperthyroidism |
| Low | Low or normal | Low or normal | Non-thyroidal illness; rare pituitary (secondary) hypothyroidism |
How the Test is Performed
How to Prepare for the Test
How the Test Will Feel
Why the Test is Performed
Normal Results
What Abnormal Results Mean
Risks
- Excessive bleeding
- Fainting or feeling light-headed
- Hematoma (blood accumulating under the skin)
- Infection (a slight risk any time the skin is broken)
C1 esterase inhibitor (C1-INH) is a protein found in the fluid part of your blood that controls C1, the first component of the complement system. The complement system is a group of proteins that move freely through your bloodstream. The proteins work with your immune system and play a role in the development of inflammation. There are nine major complement proteins. They are labeled C1 through C9.
Complement factors are very important in testing for autoimmune diseases, especially systemic lupus erythematosus. C1-INH is an important marker for hereditary angioedema, and it also plays a role in other diseases.
This article discusses the test that is done to measures the amount of C1-INH in your blood.
No special preparation is needed.
When the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing.
Your doctor may order this test if you have signs of hereditary angioedema. Hereditary angioedema is caused by low levels of C1-INH.
C1 esterase inhibitor: 16 to 33 milligrams per deciliter (mg/dL).
Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.
The examples above show the common measurements for results for these tests. Some laboratories use different measurements or may test different specimens.
Abnormal results may be due to certain types of angioedema.
Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining blood from some people may be more difficult than from others.
Other risks associated with having blood drawn are slight but may include:
C1 inhibiting factor; C1-INH
C4 LEVEL
Complement component 4 is a blood test that measures the activity of a certain protein that is part of the complement system. The complement system is a group of proteins that move freely through your bloodstream. The proteins work with your immune system and play a role in the development of inflammation.
There are nine major complement proteins. They are labeled C1 through C9. This test measures C4.
See also:
How the Test is Performed
Blood is drawn from a vein, usually from the inside of the elbow or the back of the hand. The site is cleaned with germ-killing medicine (antiseptic). The health care provider wraps an elastic band around the upper arm to apply pressure to the area and make the vein swell with blood.
Next, the health care provider gently inserts a needle into the vein. The blood collects into an airtight vial or tube attached to the needle. The elastic band is removed from your arm.
Once the blood has been collected, the needle is removed, and the puncture site is covered to stop any bleeding.
In infants or young children, a sharp tool called a lancet may be used to puncture the skin and make it bleed. The blood collects into a small glass tube called a pipette, or onto a slide or test strip. A bandage may be placed over the area if there is any bleeding.
The sample is then sent to the laboratory where the amount of C4 is measured.
How to Prepare for the Test
No special preparation is needed.
How the Test Will Feel
When the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing.
If your child is to have this test performed it may be helpful to explain how the test will feel, and even practice or demonstrate on a doll. The more familiar your child is with what will happen to them, and the purpose for the procedure, the less anxiety he or she will feel.
Why the Test is Performed
C3 and C4 are the most commonly measured complement components. Complement activity may be measured to determine how severe a disease is or if treatment is working.
A complement test may be used to monitor patients with an autoimmune disorder. For example, patients with active lupus erythematosus may have lower-than-normal levels of the complement proteins C3 and C4.
Complement activity varies throughout the body. For example, in patients with rheumatoid arthritis, complement activity may be normal or higher-than-normal in the blood, but much lower-than-normal in the joint fluid.
Normal Results
- Males: 12 to 72 mg/dL
- Females: 13 to 75 mg/dL
Note: mg/dL = milligrams per deciliter
Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.
The examples above show the common measurements for results for these tests. Some laboratories use different measurements or may test different specimens.
What Abnormal Results Mean
Increased complement activity may be seen in:
- Cancer
- Ulcerative colitis
Decreased complement activity may be seen in:
- Bacterial infections (especially Neisseria)
- Cirrhosis
- Glomerulonephritis
- Hepatitis
- Hereditary angioedema
- Kidney transplant rejection
- Lupus nephritis
- Malnutrition
- Systemic lupus erythematosus
Alternative Names
C4
