Abnormal blood test results pregnancy

Triple Screening In Pregnancy – Essential Elements, Process And Accuracy

One of the biggest fears for a pregnant woman is the risk of her baby having abnormalities such as Down Syndrome, Edwards Syndrome or nueral tube defects. The fear is understandable, as the anamolies can have a dibilitating effect on the child. With technology advancing at a pace like never before, it is now possible to find out the defects in the baby in the womb itself through the triple screening test.

What Is The Triple Screen Test?

A triple screen test, also called the kettering test or triple screen or the Bart’s test, is a blood screening test that checks alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), (1) and estriol.

  • AFP: Fetus produces the AFP protein.
  • hCG: The hormone is produced in the placenta.
  • Estriol: Both the placenta and the fetus produce estrogen called estriol.

    All the three leave their traces in the mother’s bloodstream. The test helps doctors analyze the possibility of birth defects in the baby.

    Need For A Triple Screening Test In Pregnancy:

    Going for a triple screening test in the second trimester of pregnancy would help you get a clue of possible abnormality in the fetus. The test is highly recommended for women who:

    • have a family history of birth defects.
    • are aged 35 years or more.
    • consumed harmful drugs or medications during pregnancy.
    • are exposed to high radiation levels.
    • are diabetic and using insulin.
    • are affected with viral infection during pregnancy.

    When And How Is Triple Test Performed?

    The triple screen test is performed between 15th and 20th week. The simple test involves drawing blood samples from you and testing them in a laboratory. The results are usually out within a few days.

    What Are Analyzed In The Triple Screen Test In Pregnancy?

    Triple screening test in pregnancy analyzes AFP levels, besides abnormal levels of hCG and estriol.

    • High AFP (also known as Maternal Serum AFP, or MSAFP) levels indicate spina bifida or anencephaly, a neural tube defect in growing baby.
    • Low AFP levels and abnormal hCG and estriol levels indicate Down Syndrome (Trisomy 21) (2), Edwards Syndrome (Trisomy 18) (3) or other chromosomal abnormalities.
    • The test also helps in identifying multiple pregnancy as well as the advancement of pregnancy.

    While analyzing the results, the risk is calculated after considering the following:

    • The age of the expectant mother.
    • If the mother is carrying more than one fetus. Multiple fetuses increase the levels of MSAFP because each fetus secretes its own AFP .
    • If she is diabetic because those dependent on insulin have 20% lower levels of MSAFP than normal women.
    • Gestational age of the baby. Incorrect calculation of gestation is a common cause for showing abnormal MSAFP levels.
    • Weight of the mother, as the MSAFP level decreases with the increase in the maternal weight.
    • Ethinicity is also considered before concluding on the triple screen test results. For example: African-American women have 10-15% higher MSAFP than Caucasian women.

    How Accurate Is Triple Test In Pregnancy?

    • Triple test is considered to be most accurate when performed between the 16th and 18th week of pregnancy. It has a 70% sensitivity and 5% false-positive rate.
    • The accuracy of a screening test is based on the number of times it correctly identified birth defects.
    • In 80 out of 100 fetuses, the triple and quad tests rightly found tube defects like spina bifida.
    • The tests correctly found anencephaly in 90 out of 100 fetuses.
    • In 69 out of 100 fetuses, the triple tests successfully detected down syndrome.
    • In 81 out of 100 fetuses, the quad tests successfully found down syndrome. (4)

    What Do Results Of Triple Screen Test Indicate?

    Screening tests do not diagnose a problem but signal the requirement for further tests. Same is the case with triple screen test, which is not diagnostic. The test only indicates the probability of a mother carrying a baby with a genetic disorder.

    The results of the triple screening are usually available in one or two weeks. A positive result means that there is an increased risk of chromosomal and neural tube defects. In such cases, the expectant mother is made to undergo diagnostic tests.

    Further Testing To Diagnose Abnormalities:

    Additional testing is required when triple screen results show something abnormal. As a conservative method, a second triple screen is usually performed, followed by a high definition ultrasound. The ultrasound test can check the age of the baby, its spinal cord, kidneys, heart, and brain for any defects.

    An invasive procedure called amniocentesis (5) may be performed if the abnormal results repeat. It helps in checking the baby’s chromosomes and tracking the problems, if any. Performing further tests could diagnose the issue and help consider an option that is good for both the unborn baby and mother.

    Are There Any Risks Associated With Triple Test?

    The non-invasive blood test procedure has little risk to both mother and the fetus. There could be some discomfort while drawing blood but no side effects are linked to triple screening test in pregnancy.

    Variations Of Screen Tests:

    Sometimes, the term ‘multiple-marker screening test’ is used instead of triple screening test. This includes double test and quadruple test.

    1. Double Test:

    Double marker test is a blood test where free beta hCG and PAPP-A (pregnancy associated plasma protein) markers are checked in the blood.

    High level of Free Beta hCG indicates risk of Down Syndrome and low level Trisomy 18 and 21.

    Low level of PAPP-A indicates risk of Down Syndrome and Trisomy 18 and 21.

    Double marker test is done between 10-13 weeks of pregnancy. A double test is considered obsolete in the UK.

    2. Quadruple Test:

    It is also called quad test or quad screen or tetra screen. While the triple screen measures the levels of AFP, hCG and estriol in your blood, quad screen additionally tests for a hormone called ‘Inhibin A’, which is made by placenta. The quad screen is performed between 14 and 22 weeks.

    When taken between 15 and 18 weeks of gestational age, the quad screen has 81% sensitivity and 5% false-positive rate for detecting Down syndrome.

    Pregnancy test

    A pregnancy test measures a hormone in the body called human chorionic gonadotropin (HCG). HCG is a hormone produced during pregnancy. It appears in the blood and urine of pregnant women as early as 10 days after conception.

    How the Test is Performed

    A pregnancy test is done using blood or urine. There are 2 types of blood tests:

    • Qualitative, which measures whether the HCG hormone is present
    • Quantitative, which measures how much HCG is present

    The blood test is done by drawing a single tube of blood and sending it to a laboratory. You may wait anywhere from a few hours to more than a day to get the results.

    The urine HCG test is most often performed by placing a drop of urine on a prepared chemical strip. It takes 1 to 2 minutes for a result.

    For the urine test, you urinate into a cup.

    For the blood test, the health care provider uses a needle and syringe to draw blood from your vein into a tube. Any discomfort you might feel from the blood draw will only last a few seconds.

    How the Test will Feel

    For the urine test, you urinate into a cup.

    For the blood test, the health care provider uses a needle and syringe to draw blood from your vein into a tube. Any discomfort you might feel from the blood draw will only last a few seconds.

    Why the Test is Performed

    This test is done to:

    • Determine if you are pregnant
    • Diagnose abnormal conditions that can raise HCG levels
    • Watch the development of the pregnancy during the first 2 months (quantitative test only)

    Normal Results

    HCG level rises rapidly during the first trimester of pregnancy and then slightly declines.

    What Abnormal Results Mean

    HCG level should almost double every 48 hours in the beginning of a pregnancy. HCG level that does not rise appropriately may indicate a problem with your pregnancy. Problems related to an abnormal rising HCG level include miscarriage and ectopic (tubal) pregnancy.

    An extremely high level of HCG may suggest a molar pregnancy or more than one fetus, for example, twins.

    Your provider will discuss the meaning of your HCG level with you.


    Urine pregnancy tests will only be positive when you have enough HCG in your blood. Most over-the-counter home pregnancy tests will not show that you are pregnant until your expected menstrual cycle is late. Testing before this will often give an inaccurate result. The HCG level is higher if your urine is more concentrated. A good time to test is when you first get up in the morning.

    If you think you are pregnant, repeat the pregnancy test at home or at your provider’s office.

    • Pregnancy test


    Jeelani R, Bluth MH. Reproductive function and pregnancy. In: McPherson RA, Pincus MR, eds. Henry’s Clinical Diagnosis and Management by Laboratory Methods. 23rd ed. Philadelphia, PA: Elsevier; 2017:chap 25.

    Warner EA, Herold AH. Interpreting laboratory results. In: Rakel RE, Rakel DP, eds. Textbook of Family Medicine. 9th ed. Philadelphia, PA: Elsevier; 2016:chap 14.

    High ESR Blood Test Results (Elevated RBC Sed Rate Levels)

    What is sed rate?

    Sed rate is a short form for Erythrocyte sedimentation rate and abbreviated to ESR Test too.

    Sedimentation rate blood test is measured by letting an amount of blood to separated and settled to the bottom of a tube in a certain amount of time, so that the RBC sed rate is the volume of Red blood Cells precipitated in an hour time.

    What is sed rate used for?

    Why my doctor want me to take ESR blood test?

    The main purpose to measure the rate of RBC sedimentation is to monitor the inflammation progress, Inflammation means normally increased body defense due to existence of injury or casual agent such as the trauma, post surgery, infection by bacteria or worms, and allergic reaction in response to immunological reasons as in Systemic Lupus Erythromatosus and Rheumatoid Fever or Non immunological causes as acquired allergies by drugs.

    Such Inflammatory response triggers the body proteins and cells in so called “Exudate”, RBC become heavy and ill due to high weight blood content.

    ESR usually important component of general medical checkup

    ESR and C-Reactive Protein are tests used both as bio-markers of inflammation to improve diagnostic sensitivity and specificity

    We can conclude why doctor choose ESR to diagnose diseases?

    To clarify what causes the symptoms such as in whooping cough or pertussis.

    To confirm or verify previous diagnosis of a disease such as TB.

    To screen people of a high risk for a specific disease like aged people

    To preliminary diagnosis such Arthritis, temporal arthritis, systemic vasculitis, and polymyalgia rheumatica.

    To indicate the severity of a disease such in Sore throat and tonsillitis

    To state the progression of a disease

    To decide the effectiveness of a treatment especially with antibiotics

    Sedimentation normal rates are:

    Sed rate values is higher in women than men and more higher in older people than younger.

    When Eryth. Sed. Rate exceeds predefined normal value we report that ESR is High.

    Sedimentation rate Normal levels in general,

    Men 0–15 millimeters per hour (mm/hr), or 0–20 mm/hourr for men older than 50

    Women 0–20 mm/hr, or 0–30 mm/hr for women older than 50

    Children 0–10 mm/hour

    Neonatal to puberty: 3 to 13 mm/h, but other laboratories place an upper limit of 20

    Newborns 0–2 mm/first hour

    You can comment with your results to explain it for you.

    What is sed rate westergren blood test or westerngren ESR?

    A diagnostic technique used in blood measurement of Blood Sed rate.

    Sed rate by modified westergren method is:

    Certain long tube called westergren tube

    An amount of anticoagulant usually Citrate is placed into tube.

    Equivalent amount of fresh blood is mixed with anticoagulant and covered.

    The tube is hanged vertically perpendicular to the ground

    Record Precipitated volume every hour.Stages in erythrocyte sedimentation:

    There are 3 stages in erythrocyte sedimentation 1) Stage 1 : Rouleaux formation – First 10 minutes 2) Stage 2 : Stage of sedimentation or settling – 40 mins 3) Stage 3 : Stage of packing – 10 minutes, sedimentation slows and cells start to pack at the bottom of the tube

    The Westergren method is the most sensitive of the sedimentation rate methods because of the longer tube, but it requires more blood.

    The Wintrobe method requires a smaller amount of blood and involves no dilution. In addition, once the ESR has been read, the Wintrobe tube can be centrifuged to obtain a macrohematocrit, and blood films can be made from the buffy coat. However, because of the shorter column of blood, the Wintrobe methods is not as sensitive as the Westergren.

    WINTROBE ESR Method Normal Values

    WESTERGREN ESR Method Normal Levels

    Less than age 50 yrs

    Male 0 – 10 mm/hr

    Female 0 – 20 mm/hr

    Children 4 – 14 yrs 0 – 20 mm/hr

    Greater than 50 yrs age

    Male 0 – 20 mm/hr

    Female 0 – 30 mm/hr

    Erythrocyte Sedimentation rate blood test results Explained

    1- Causes of ESR greater than 100 mm/1st Hour

    Autoimmune diseases, such as systemic lupus erythematosus, rheumatoid arthritis, or inflammation of the thyroid gland (Graves’ disease).

    Diseases caused by attack of autoantibodies to the body’s cells are called immunological auomimmuonolgical disorders, in such diseases the body antibodies attack the body cells and proteins instead of attacking foreign substances, many organs affected and the body become very ill which impact on health of Red blood cells, thus sed rate of Red cells become very high, usually ESR is over 100 mm after the first hour.

    Other tests: WBC less than 4.0 *10^9 cells

    RF is Positive in RA patients

    LE cells test is Positive in SLE Patients.

    Positive Autoantibodies Anti-dsDNA and antinuclear antibody test (ANA), over 1.0 in cut-off reports

    Ani-TSH Positive test in grave’s disease.

    Arthritis due to gout show Uric Acid test over than 6.0 mg/dl

    Hb% may be lower than 8.0 mg/dl due to chronic inflammation Anemia.

    Cancer, such as lymphoma or multiple myeloma.

    Lymphoma are kind of cancers affect lymphatic tissue and caused by viruses as Epstein-bar virus or HIV and cause signs like painless enlargement of lymph nodes, in addition to feeling tired with fevers, night sweats, itchiness, and weight loss.

    Multiple Myeloma or Kahler’s disease is sub-kind of lymphomas in which some kind of defensive blood cells called plasma cells become cancerous and abnormally proliferate and accumulate in bone marrow and other marrows. Plasma cells contain and produce Bence Jones proteins in excessive amounts causing inflammation of kidney, however those cells are helpful in normal levels.

    Elevated ESR in malignancies is a result of excessive protein content in patient’s blood fluid.

    ESR blood test usually over 100 mm after first hour however High ESR extends as the cancer persists.

    Other testing results: FBC show WBC over 50.000 cells or over 500.000 cells mostly lymphocytes (normal 4 – 11 *10^9 cell/mL)

    Urine Bence Jones protein test is Positive in multiple myeloma disease exclusively.

    2-Causes of moderate high ESR results

    Chronic kidney disease.

    Why Sed rate increases in kidney diseases? the reasons may be due to inflammation of kidney units called Nephrons which is the the responsible organs in kidney functioning, Loss of Nephrons function leads to kidney failure to filtrating the blood of toxins and thus accumulate in the blood and cause blood cells to overburden, and this is enough to become very high blood sedimentation speed.

    ESR is 50 – 75 mm/1st hour in adults, over 100 in late stages.

    Other testing results:

    Creatinine is 1.5 – 10.0 mg/dlInflammatory diseases due to Bacterial infection of Kidney, bone, joint, skin, or heart valve infections, such as pneumonia, pelvic inflammatory disease, or appendicitis.

    ESR is moderately elevated usually 15 – 40 mm/ first hour, 25 – 80 after second hour.

    Other test results:CRP titres more than 12.0 mg/dl and up to 48.0 mg/dl in 24 hours

    FBC show abnormal white blood cells morphology and count as well as mild anemia.Pregnancy and preeclampsia (toxemia of pregnancy).

    Pregnancy is normal increase in body processes due to gestation, the matter which cause high loaded blood flow with nutrients for he fetus, causing temporarily increased sed rate, However toxemia of pregnancy caused by infiltration of fetus proteins into mother’s blood stream, which do the same role in overloading blood fluid.

    ESR blood test is mild/moderate high, first hour sed rate between 20 – 40 mm.

    Anemia, Hb% lower than 9.0 in such cases due to iron deficiency during pregnancy.

    Other causes of high esr count

    Inflammation of joints (such as polymyalgia rheumatica) and blood vessels (such as giant cell arteritis).

    3- Causes of low ESR values

    Values of ESR between 0 – 10 and 20 mm

    Sed rate are in normal ranges in certain diseases such as:

    High blood sugar levels.

    Sickle cell disease.

    Congestive Heart failure

    Sed rate False Positive Negative Results

    Please read carefully the factors and requirements to understand why ESR results may be not correct.

    Best time to take ESR test is during he day, Fasting before esr test is preferred about 4 – 6 hours for those not suffering from clear complains.

    Test must be set 1 hour after collection or up to 6 hours if sample refrigerated.

    Read Results every 60 minutes, any delay will alter the results.

    The ESR is affected by a number of mechanical and technical factors.

    Anticoagulant is EDTA or Sodium Citrate (blue-top tube), other anticoagulants cause shrinkage to RBC

    Tube perpendicular to surface, any Horizontal degrees will accelerate Sedimentation and end up to false high esr.

    Some Newer Westergren tubes have a cotton plug in the “zero” end which prevent leakage of blood from the open end of the tube.

    Because the red cell shape affects the rate of fall of the cells, it should be apparent that sickle cells and spherocytes will result in a potential falsely decreased ESR. Other conditions that result in poikilocytosis (variation in the shape of the red cells) will produce similar results.

    There is considerable dispute about the effect of severe anemia on the ESR. Some laboratories correct the ESR in cases of severe anemia.

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    What does an abnormal MCH Blood Test Result mean?

    “MCH” is a short abbreviation of Mean Corpuscular Hemoglobin. It calculates the average hemoglobin amount within red blood cells of a person. In medicine, a carrier protein that supplies the oxygen to body cells through a blood stream is called hemoglobin. There could be a number of reasons for an abnormally low or high MCH level, ranging from the indication of chronic illnesses or nutritional deficiency.

    When MCH test is conducted?

    This test is conducted when a person experiences:

    • Weakness or fatigue
    • Bruising or bleeding due to infection
    • Noticeable inflammation

    MCH test is conducted to assess the hemoglobin level in blood or to examine the macrocytic anemia. This test is also called MCHC test. The major macrocytic anemia symptoms are fatigue, headache, ataxia, diarrhea, reflex problems, tongue soreness, tachycardia, and dyspnea. If you are suffering from these indications, then you are advised to visit a physician for treatment.

    Causes for High MCH blood test score

    If the test score is 35 or higher, the MCH is abnormally high. Normal range for hemoglobin level is from 26 to 33.

    • Abuse of alcohol
    • Macrocytic anemia is another reason that involves the production of large blood cells with high hemoglobin level. Its major symptoms are pallor, heart palpitations and unexplained fatigue. Usually, it is a result of vitamin B12 or folic acid deficiency.
    • Other possible reasons include:
      • Underactive thyroid
      • Liver disease
      • Medication side effect.

    Causes for Low MCH blood test score

    When MCH test score is below 26, it indicates the hemoglobin level is abnormally low.

    Image Courtesy : www.justmedicure.com

    • Iron deficiency
    • Blood loss
    • Microcytic anemia: it is a medical state that involves the production of small blood cells with low hemoglobin level.
    • Hemoglobinopathy: a condition that alters the hemoglobin structure.

    It is important to know the reason behind your low hemoglobin level before going for a solution.

    • Your body would require a specialized treatment if the cause is cancer, bone marrow defect or kidney problem.
    • Try alternative medication if certain drug type is the major cause.
    • Reconsider your diet by adding more minerals and create supplement regiment is the cause is a nutritional Mostly, the body suffers from the deficiency of Vitamin B12, Vitamin C, Iron or Folate.

    Seeking medical advice if MCH blood test result is abnormal:

    It’s not necessary that an abnormally low or high MCH blood test score would indicate a serious medical issue. However, sometimes it is important to cure the problem before it gets serious. You are advised to consult your physician and take mineral enriched meals to overcome the deficiency.

    Seeking the medical advice would be helpful as your doctor would unveil the accurate cause of abnormal MCH test through other CBC components like MCHC test that estimates the hemoglobin concentration or MCV test that calculates the average red blood cells’ size.

    In some cases, the doctor may also execute blood test to assess the nutritional level to assess if a nutritional deficiency is a major cause. Thyroid function panel might be conducted to assess the function and health of thyroid gland if thyroid disease is a suspect. Hence, different tests could be recommended to know the reason behind abnormal MCH blood test results, depending on the assessment of prevailing symptoms and overall health.

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    High ESR Blood Test Results (Elevated RBC Sed Rate Levels)


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