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The ESR (Erythrocyte Sedimentation Rate) test measures how fast red blood cells (erythrocytes) settle in a tube over one hour.

When your body is inflamed, certain proteins, mainly fibrinogen, increase in the blood. These proteins cause the red blood cells to stick together in stacks. These stacks settle faster, leading to a higher ESR.

The ESR test shows that inflammation is present. However, it cannot tell you exactly where the inflammation is or what is causing it. That’s why doctors usually do this test along with other tests. This helps them understand and treat your health problems.

What Do the Results Mean?

Pathological Factors 

The HbA1c (Glycosylated Hemoglobin) test precisely measures the percentage of sugar-coated or glycated hemoglobin in your blood. The test results represent the proportion of hemoglobin in your blood that has been glycated. 

Hemoglobin, a vital protein found in red blood cells, is responsible for transporting oxygen throughout the body. Hemoglobin A is the most abundant form of hemoglobin, and when blood sugar levels increase, a higher proportion of hemoglobin A becomes glycated. As red blood cells have a lifespan of approximately 120 days, the sugar molecules remain attached to the hemoglobin for the duration of the cell's life. Consequently, the HbA1c (Glycosylated Hemoglobin) test offers insight into your average blood sugar levels over the past 8 to 12 weeks.

What Do the Results Mean?

Pathological Factors

Key: ⇧: Indicates High Levels , ⇩: Indicates Low Levels

Physiological Factors

 🧒Age: HbA1c tends to increase slightly with age, even in non-diabetics.

🫄Pregnancy: HbA1c levels typically decrease due to increased red blood cell turnover, especially in the second and third trimesters.

Lifestyle Factors

 🥗Diet: Consistently high sugar intake leads to elevated HbA1c over time.

😟Stress: Chronic stress can affect blood glucose levels and thus HbA1c.

😴Sleep: Poor sleep quality and sleep disorders may worsen glucose control and raise HbA1c.

🚬Smoking: Smoking can increase insulin resistance and raise HbA1c levels.

🍷Alcohol: Excessive alcohol use can cause fluctuations in blood sugar and affect HbA1c accuracy.

Disclaimer: This information is for educational purposes only and should not replace professional medical advice, diagnosis, or treatment. Always consult your healthcare provider for personalized guidance.

What Do Normal HbA1c Levels Mean?

A normal HbA1c level is generally below 5.7%. This indicates that your blood sugar has been well controlled over the past 2–3 months. Staying in this range suggests your body is managing glucose effectively and helps reduce the risk of future health problems.

What High HbA1c Levels Indicate?

An HbA1c level between 5.7% and 6.4% usually suggests prediabetes, where blood sugar is higher than normal but not yet in the diabetic range. A level of 6.5% or above typically indicates diabetes. 

What to Do if Your HbA1c Is Higher Than Normal?

If your HbA1c level is above the recommended range, try not to panic. Many people are able to bring it down with the right lifestyle changes, such as healthier eating, regular physical activity, and proper medication when needed. It is important to consult your doctor, who can guide you on the best steps for managing and improving your HbA1c.

What Do Low Levels of HbA1c Indicate?

Low HbA1c level (below 4%) is uncommon and may point to issues such as excess insulin use, anemia, or other conditions that shorten the lifespan of red blood cells. Since low readings can have different underlying causes, always consult a doctor to understand what they mean in your specific case.

Can HbA1c Results Be Inaccurate?

Yes. Certain conditions such as recent blood transfusion, pregnancy, liver or kidney disorders etc., can affect the test accuracy. If your results do not match your symptoms or overall health, your doctor may suggest repeating the test or additional testing. In hemoglobinopathies, where the normal form of hemoglobin (HbA1) is reduced or absent, HbA1c values may be inaccurate or may not be reported at all. In such cases, results should be interpreted along with other tests like fasting blood sugar, post-prandial blood sugar, or the Fructosamine test.

What Factors Can Affect HbA1c Results?

Though it is a reliable test, several factors can influence accuracy:

• Blood disorders such as anemia, sickle cell trait, or chronic blood loss
• Recent blood transfusion 
• Kidney or liver diseases
• High-dose vitamin supplementation (such as vitamin C or E)
• Certain medications, including those for HIV or anemia
• Pregnancy (second and third trimester)
• Ethnic differences in hemoglobin structure (hemoglobinopathies)

What Follow-Up Tests May Be Required?

Based on your HbA1c results, your doctor may recommend additional tests to get a clearer picture of your health or to monitor possible complications. These may include: 

How Does HbA1c Differ from Other Blood Glucose Tests?

It is important to understand how the HbA1c (Glycosylated Hemoglobin) test differs from other common blood sugar tests: 

Fasting Blood Glucose (FBS): Measures blood sugar at a single point in time, usually after 8–12 hours of fasting.

Random Blood Glucose (RBS): Measures blood sugar at any time of the day, regardless of meals, giving a quick snapshot of current levels.

Oral Glucose Tolerance Test (OGTT): Measures how the body processes sugar by checking blood glucose before and after drinking a glucose solution.

Postprandial Blood Sugar Test (PPBS): Measures blood sugar levels after a meal (usually 2 hours post eating) to assess how well the body manages glucose following food intake.

The CBC (Complete Blood Count) test measures the number of red blood cells (RBCs), white blood cells (WBCs), and platelets. Each of these blood cells performs essential functions–RBCs carry oxygen from your lungs to the various body parts, WBCs help fight infections and other diseases, and platelets help your blood to clot. Therefore, determining their levels can provide significant health information. A CBC test also determines the hemoglobin level, a protein in RBC that carries oxygen from the lungs to the rest of your body. Evaluating all these components together can provide important information about your overall health.

The Urine R/M (Urine Routine & Microscopy) test involves gross, chemical, and microscopic evaluation of the urine sample.

1. Gross examination: It involves visually inspecting the urine sample for color and appearance. Typically, the urine color ranges from colorless or pale yellow to deep amber, depending on the urine’s concentration. Things such as medications, supplements, and some foods such as beetroot can affect the color of your urine. However, unusual urine color can also be a sign of disease.

   In appearance, the urine sample may be clear or cloudy. A clear appearance is indicative of healthy urine. However, the presence of red blood cells, white blood cells, bacteria, etc., may result in cloudy urine, indicating conditions such as dehydration, UTIs, kidney stones, etc. Some other factors, such as sperm and skin cells, may also result in a cloudy appearance but are harmless.

2. Chemical examination: It examines the chemical nature of the urine sample using special test strips called dipsticks. These test strips are dipped into the urine sample and change color when they come in contact with specific substances. The degree of color change estimates the amount of the substance present. Some common things detected include protein, urine pH, ketones, glucose, specific gravity, blood, bilirubin, nitrites, and urobilinogen.

3. Microscopic examination: This involves the analysis of the urine sample under the microscope for pus cells, red blood cells, casts, crystals, bacteria, yeast and other constituents.

The LFT (Liver Function Test) helps determine the health of the liver by measuring various key markers in the blood such as bilirubin, enzymes, and proteins. These components help detect inflammation, infection, diseases, etc., of the liver and monitor the damage due to liver-related issues.

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

The FBS (Fasting Blood Sugar) test measures the glucose level in the body under overnight fasting conditions. Glucose is the body's energy currency and is broken down through metabolism to produce energy. Hormones and enzymes produced by the liver and pancreas control this process. The hormone insulin, produced by the pancreas, regulates blood glucose levels. When these levels are high, such as after a meal, insulin is secreted to transport glucose into cells for energy production. Elevated glucose levels in the body after fasting may indicate a risk of developing prediabetes or diabetes, which can be of two types: type 1, caused by little or no insulin production, and type 2, caused by insulin resistance or decreased insulin production.

What Do the Results Mean?

Pathological Factors 

What Follow-Up Tests May Be Required?

Table: Tests Commonly Ordered Alongside Fasting Blood Sugar Test: