Immune System

The immune system is a network of cells, tissues, and organs that work together to defend the body against attacks by “foreign” invaders. These are primarily microbes—tiny organisms such as bacteria, parasites, and fungi that can cause infections.

14.3.3 ETA PROTEIN

Optimal range: 0 - 0.2 ng/mL

The 14-3-3eta protein is a marker of synovial inflammation that is released into synovial fluid and peripheral blood in rheumatoid arthritis (RA) and erosive psoriatic arthritis.

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Acetylcholine Receptor (AChR) Antibody

Optimal range: 0 - 0.45 nmol/L

At the normal neuromuscular junction, a nerve cell tells a muscle cell to contract by releasing the chemical acetylcholine (ACh). ACh attaches to the ACh receptor — a pore or “channel” in the surface of the muscle cell — twisting it open and allowing an inward flux of electrical current that triggers muscle contraction.

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Activated partial thromboplastin time (APTT)

Optimal range: 26 - 36 seconds

The Activated partial thromboplastin time (aPTT) test tells you how many seconds (s) it takes your blood to form a clot after body tissue(s) or blood vessel walls were injured.

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ANA SCREEN, IFA

Optimal range: 0 - 0.01 Units

ANA IFA is a first line screen for detecting the presence of up to approximately 150 autoantibodies in various autoimmune diseases. A positive ANA IFA result is suggestive of autoimmune disease and reflexes to titer and pattern. Further laboratory testing may be considered if clinically indicated.

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ANA titer

Optimal range: 0 - 0 %

The ANA titer is a measure of the amount of ANA in the blood; the higher the titer, the more autoantibodies are present in the sample.

Patient samples are often screened for antinuclear antibodies after being diluted 1:40 and 1:160 in a buffered solution. If staining is observed at both the 1:40 and 1:160 dilutions, then the laboratory continues to dilute the sample until staining can no longer be seen under the microscope. The level to which a patient's sample can be diluted and still produce recognizable staining is known as the ANA "titer." 

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Anti-DBL-Strand DNA Ab

Optimal range: 0 - 4 IU/ml

The anti-dsDNA test identifies the presence of these autoantibodies in the blood.

The test for anti-dsDNA, along with other autoantibody tests, may be used to help establish a diagnosis of lupus and distinguish it from other autoimmune disorders.

The anti-double-stranded DNA antibody (anti-dsDNA) is a specific type of ANA antibody found in about 30% of people with systemic lupus. Less than 1% of healthy individuals have this antibody, making it helpful in confirming a diagnosis of systemic lupus. The absence of anti-dsDNA, however, does not exclude a diagnosis of lupus. 

The presence of anti-dsDNA antibodies often suggests more serious lupus, such as lupus nephritis (kidney lupus). When the disease is active, especially in the kidneys, high amounts of anti-DNA antibodies are usually present. However, the anti-dsDNA test cannot be used to monitor lupus activity, because anti-dsDNA can be present without any clinical activity. Three tests are currently used to detect anti-dsDNA antibodies, namely enzyme-linked immunosorbent assay (ELISA), the Crithidia luciliae immunofluorescence test, and a test called radioimmunoassay.

Low to moderate levels of the autoantibody may be seen with other autoimmune disorders, such as Sjögren syndrome and mixed connective tissue disease (MCTD).

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Anti-Smith Antibody

Optimal range: 0 - 7 U/mL

The Anti-Smith Antibody targets your body’s own proteins and is found almost exclusively in people with lupus. Though not all people with lupus have this antibody (only around 30%), those who do usually receive a diagnosis of lupus. Anti-Smith antibody is more common in blacks and Asians with SLE (around 60%) than in whites with SLE.

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Anticardiolipin Ab,IgG,Qn

Optimal range: 0 - 14 GPL U/mL

- Anticardiolipins are antibodies produced by the immune system against the platelet membrane phospholipids responsible for the coagulation of blood clots. 

- Anticardiolipin antibodies are often responsible (with lupus anticoagulants and beta-2 glycoprotein antibodies) for the abnormal formation of clots in veins (phlebitis) and arteries (arterial thrombosis). 

- They are involved in antiphospholipid syndrome, which occurs, for example, through repeated miscarriages during the second or third trimester of pregnancy. 

There are three types of anticardiolipin antibodies: IgG, IgA and IgM.

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Antinuclear Antibodies Direct (ANA Direct)

Optimal range: 0 - 0.99 Units

Antinuclear antibodies or ANAs are autoantibodies that react to substances within the nucleus of the cell. Antinuclear antibodies can react to almost anything with the nucleus including DNA, centromeres, histones, ribosomes, and other nuclear proteins.

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CARDIOLIPIN AB (IGA)

Optimal range: 0 - 11 APL

- Anticardiolipins are antibodies produced by the immune system against the platelet membrane phospholipids responsible for the coagulation of blood clots. 

- Anticardiolipin antibodies are often responsible (with lupus anticoagulants and beta-2 glycoprotein antibodies) for the abnormal formation of clots in veins (phlebitis) and arteries (arterial thrombosis). 

- They are involved in antiphospholipid syndrome, which occurs, for example, through repeated miscarriages during the second or third trimester of pregnancy. 

There are three types of anticardiolipin antibodies: IgG, IgA and IgM.

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CARDIOLIPIN AB (IGG)

Optimal range: 0 - 14 GPL

- Anticardiolipins are antibodies produced by the immune system against the platelet membrane phospholipids responsible for the coagulation of blood clots. 

- Anticardiolipin antibodies are often responsible (with lupus anticoagulants and beta-2 glycoprotein antibodies) for the abnormal formation of clots in veins (phlebitis) and arteries (arterial thrombosis). 

- They are involved in antiphospholipid syndrome, which occurs, for example, through repeated miscarriages during the second or third trimester of pregnancy. 

There are three types of anticardiolipin antibodies: IgG, IgA and IgM.

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CARDIOLIPIN AB (IGM)

Optimal range: 0 - 12 MPL

- Anticardiolipins are antibodies produced by the immune system against the platelet membrane phospholipids responsible for the coagulation of blood clots. 

- Anticardiolipin antibodies are often responsible (with lupus anticoagulants and beta-2 glycoprotein antibodies) for the abnormal formation of clots in veins (phlebitis) and arteries (arterial thrombosis). 

- They are involved in antiphospholipid syndrome, which occurs, for example, through repeated miscarriages during the second or third trimester of pregnancy. 

There are three types of anticardiolipin antibodies: IgG, IgA and IgM.

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CCP Antibodies IgG/IgA

Optimal range: 0 - 19 Units

Anti-cyclic citrullinated peptide (anti-CCP) is an antibody present in most rheumatoid arthritis patients.

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Complement C3

Optimal range: 90 - 180 mg/dL

Investigation of renal/joint/connective tissue disorders and their symptoms.

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Complement C3a

Optimal range: 54 - 202 ng/mL

C3 is the most abundant protein of the complement system. C3 can be cleaved in two divalent fragments, where C3b is the larger fragment. C3a is the smaller fragment that is released into the surrounding fluids. C3a can bind to receptors on basophils and mast cells triggering them to release their vasoactive amines (e.g. histamine). Because of the role of these biomarkers in anaphylaxis, C3a is called an anaphylatoxin. C3a is one of the most potent constrictors of smooth muscle cells. C3a has been shown to be a multifunctional pro-inflammatory mediator.

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Complement C4, Serum

Optimal range: 14 - 44 mg/dL

Complement component 4 (C4) is a blood test that measures the activity of a certain protein. This protein is part of the complement system.

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Complement C4a

Optimal range: 0 - 650 ng/mL

The complement C4 test is one of the most frequently used complement component tests. Your doctor may order a complement C4 test if you’re experiencing symptoms that indicate an autoimmune disease.

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Complement, Total (CH50)

Optimal range: 42 - 999999 U/mL

A total complement measurement, also known as a total hemolytic complement or a CH50 measurement, checks how well the complement system is functioning.

Complement was discovered by Jules Bordet as a heat-labile component of normal plasma that causes the opsonisation and killing of bacteria. The complement system refers to a series of >20 proteins, circulating in the blood and tissue fluids. Most of the proteins are normally inactive, but in response to the recognition of molecular components of microorganisms they become sequentially activated in an enzyme cascade – the activation of one protein enzymatically cleaves and activates the next protein in the cascade.

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Cyclic Citrullinated Peptide Antibody

Optimal range: 0 - 19.9 Units

To help diagnose rheumatoid arthritis (RA) and differentiate it from other types of arthritis.

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Dilute Russell's viper venom time (dRVVT)

Optimal range: 29 - 42 seconds

Dilute Russell's viper venom time (dRVVT) is a laboratory test often used for detection of lupus anticoagulant (LA). Russell's viper venom [RVV] isolated from the snake Daboia russelii contains a potent activator of factor X which in the presence of phospholipid, prothrombin and calcium ions clots fibrinogen to fibrin. In individuals with a lupus anticoagulant the antibody binds to the phospholipid inhibiting the action of the RVV and prolonging the clotting time. 

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DRVVT SCREEN

Optimal range: 0 - 45 seconds

Dilute Russell's viper venom time (dRVVT) is a laboratory test often used for detection of lupus anticoagulant (LA). Russell's viper venom [RVV] isolated from the snake Daboia russelii contains a potent activator of factor X which in the presence of phospholipid, prothrombin and calcium ions clots fibrinogen to fibrin. In individuals with a lupus anticoagulant the antibody binds to the phospholipid inhibiting the action of the RVV and prolonging the clotting time. 

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ds-DNA Antibody, IgG

Optimal range: 0 - 29.9 IU/ml

Evaluating patients with signs and symptoms consistent with systemic lupus erythematosus (SLE).

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Erythrocyte Sedimentation Rate (ESR)

Optimal range: 0 - 32 mm/hr

The erythrocyte sedimentation rate (ESR or sed rate) is a relatively simple, inexpensive, non-specific test that has been used for many years to help detect inflammation associated with conditions such as infections, cancers, and autoimmune diseases.

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Histamine, Plasma

Optimal range: 0 - 0.99 ng/mL

Histamine is a substance that is produced by the body as part of an allergic reaction.

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- To determine whether you have human leukocyte antigen B27 (HLA-B27) on the surface of your cells

- To help assess the likelihood that you have an autoimmune disorder associated with the presence of HLA-B27.

- Autoimmune disorders occur when the immune system mistakenly targets the body’s own cells and tissues.

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The HLA-B27 test is primarily ordered to help strengthen or confirm a suspected diagnosis of ankylosing spondylitis (AS), reactive arthritis, juvenile rheumatoid arthritis (JRA), or sometimes anterior uveitis. The HLA-B27 test is not diagnostic; that is, it is not a definitive test that can be used to diagnose or rule out a disorder. The result adds information and is one piece of evidence used along with the evaluation of signs, symptoms, and other laboratory tests to support or rule out the diagnosis of certain autoimmune disorders, such as ankylosing spondylitis and reactive arthritis.

The HLA-B27 test may be ordered as part of a group of tests used to help diagnose and evaluate conditions causing arthritis-like chronic joint pain, stiffness, and inflammation. This group of tests may include a rheumatoid factor (RF) with either an erythrocyte sedimentation rate (ESR) or a C-reactive protein (CRP). HLA-B27 is sometimes ordered to help evaluate someone with recurrent uveitis that is not caused by a recognizable disease process.

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Immature Grans (Abs)

Optimal range: 0 - 0.1 x10E3/µL

Immature granulocytes are white blood cells that are immature. Whenever your body is fighting an infection, it will increase its white blood cell count, and more white blood cells will be immature.

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Immature Granulocytes (%)

Optimal range: 0 - 0.5 %

Immature granulocytes are white blood cells that are immature. Whenever your body is fighting an infection, it will increase its white blood cell count, and more white blood cells will be immature.

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Immunofixation Result, Serum

Optimal range: 0 - 0 %

Immunofixation electrophoresis or immunosubtraction capillary electrophoresis identifies the type of immunoglobulin protein(s) present as monoclonal bands on a protein electrophoresis pattern. Typically, this testing determines the presence and type of monoclonal proteins (e.g., IgG kappa).

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Immunoglobulin A, Qn, Serum

Optimal range: 87 - 352 mg/dL

IgA antibodies are found in areas of the body such the nose, breathing passages, digestive tract, ears, eyes, and vagina. IgA antibodies protect body surfaces that are exposed to outside foreign substances. This type of antibody is also found in saliva, tears, and blood. About 10% to 15% of the antibodies present in the body are IgA antibodies. A small number of people do not make IgA antibodies.

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Immunoglobulin D, Quant, Serum

Optimal range: 0 - 14.11 mg/dL

Immunoglobulin D (IgD) is an antibody isotype that makes up about 1% of proteins in the plasma membranes of immature B-lymphocytes where it is usually coexpressed with another cell surface antibody called IgM.

Remains in the bloodstream to fight bacteria. Functions mainly as an antigen receptor on B cells that have not been exposed to antigens. It has been shown to activate basophils and mast cells to produce antimicrobial factors.

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Immunoglobulin E, Total

Optimal range: 6 - 495 IU/ml

Immunoglobulin E (IgE) are antibodies produced by the immune system. 

IgE antibodies are found in the lungs, skin, and mucous membranes. They cause the body to react against foreign substances such as pollen, fungus spores, and animal dander. They are also involved in allergic reactions to milk, some medicines, and some poisons.

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Immunoglobulin G, Qn, Serum

Optimal range: 586 - 1602 mg/dL

Immunoglobulin G (IgG), the most abundant type of antibody, is found in all body fluids and protects against bacterial and viral infections.

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Immunoglobulin M, Qn, Serum

Optimal range: 26 - 217 mg/dL

Immunoglobulin M (IgM), which is found mainly in the blood and lymph fluid, is the first antibody to be made by the body to fight a new infection. Expressed on the surface of B cells (monomer) and in a secreted form (pentamer) with very high avidity (forms multiple binding sites with antigen). Eliminates pathogens in the early stages of B-cell mediated (humoral) immunity before there is sufficient IgG. 

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Interleukin-2, Serum

Optimal range: 0 - 31.2 pg/mL

Interleukin 2 (IL-2) is a pleiotropic (=having multiple effects from a single gene) cytokine produced primarily by mitogen- or antigen- activated T lymphocytes. Interleukin 2 is an important disease marker in hemophagocytic lymphohistiocytosis (HLH), but there are no published data on its diagnostic value in adults.

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Interleukin-6

Optimal range: 0 - 1.8 pg/mL

Interleukin-6 is involved in inflammation and infection responses and also in the regulation of metabolicregenerative, and neural processes.

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Jo 1 Antibodies, IgG, Serum

Optimal range: 0 - 0.99 Units

This test measures the amount of antibodies to anti-Jo-1 in blood. It is used to help diagnose and manage muscle diseases that affects the immune system such as polymyositis (a type of chronic inflammation of the muscles) associated with autoimmune disease.

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Liver-Kidney Microsomal Antibodies

Optimal range: 0 - 20 Units

These antibodies target a human body’s produced enzyme called cytochrome P450 2D6, a protein found primarily in liver cells which catalyze many reactions involved in drug metabolism. The development of the LKM antibodies is strongly associated with type 2 autoimmune hepatitis.

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Lupus Anticoagulant

Optimal range: 0 - 0.1 GPL

Lupus anticoagulants are antibodies against substances in the lining of cells. These substances prevent blood clotting in a test tube.

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PHOSPHATIDYLETHANOLAMINE AB (IGA)

Optimal range: 0 - 10 U/mL

Anti-phosphatidylethanolamine (aPE) is an autoimmune condition characterized by the presence of circulating antibodies against phosphatidylethanolamine (PE), and is associated with clinical symptoms of thrombosis and repeated pregnancy loss.

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PHOSPHATIDYLETHANOLAMINE AB (IGG)

Optimal range: 0 - 10 U/mL

Anti-phosphatidylethanolamine (aPE) is an autoimmune condition characterized by the presence of circulating antibodies against phosphatidylethanolamine (PE), and is associated with clinical symptoms of thrombosis and repeated pregnancy loss.

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PHOSPHATIDYLETHANOLAMINE AB (IGM)

Optimal range: 0 - 10 U/mL

Anti-phosphatidylethanolamine (aPE) is an autoimmune condition characterized by the presence of circulating antibodies against phosphatidylethanolamine (PE), and is associated with clinical symptoms of thrombosis and repeated pregnancy loss.

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PHOSPHATIDYLSERINE AB (IGA)

Optimal range: 0 - 20 U/mL

The presence of phosphatidylserine antibodies may be associated with thrombosis, fetal loss and thrombocytopenia.

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PHOSPHATIDYLSERINE AB (IGG)

Optimal range: 0 - 10 U/mL

The presence of phosphatidylserine antibodies may be associated with thrombosis, fetal loss and thrombocytopenia.

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PHOSPHATIDYLSERINE AB (IGM)

Optimal range: 0 - 25 U/mL

The presence of phosphatidylserine antibodies may be associated with thrombosis, fetal loss and thrombocytopenia.

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Prothrombin Time (PT)

Optimal range: 9 - 11.5 seconds

Prothrombin time (PT) is a blood test that measures the time it takes for the liquid portion (plasma) of your blood to clot.

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Prothrombin Time (PT) INR

Optimal range: 0.8 - 1.1 seconds

Prothrombin time (PT) is a blood test that measures the time it takes for the liquid portion (plasma) of your blood to clot. 

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RA Latex Turbid

Optimal range: 0 - 13.9 IU/ml

The rheumatoid arthritis (RA) latex turbid test is a laboratory test that’s used to help your doctor diagnose rheumatoid arthritis and other autoimmune diseases.

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Reptilase Clotting Time

Optimal range: 14 - 20 seconds

The reptilase clotting time measures the rate of fibrin clot formation after the addition of reptilase, a proteolytic enzyme derived from the venom of Bothrops atrox, to citrated plasma.

Reptilase is a thrombin-like enzyme. 

Unlike thrombin, which cleaves fibrinogen to produce fibrinopeptides A and B, reptilase cleaves the fibrinogen molecule to release only fibrinopeptide A.

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Rheumatoid factor

Optimal range: 0 - 14 IU/ml

A rheumatoid factor test measures the amount of rheumatoid factor in your blood. Rheumatoid factors are proteins produced by your immune system that can attack healthy tissue in your body.

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TGF-b1

Optimal range: 344 - 2382 pg/mL

Transforming Growth Factor (TGF) plays a crucial role in tissue regeneration, cell differentiation, embryonic development, and regulation of the immune system. Transforming growth factor beta is found in hematopoietic (blood-forming) tissue and initiates a signaling pathway that suppresses the early development of cancer cells. It enhances the deposition of extracellular matrix and may play potential role in wound healing and cirrhosis formation. Many cells synthesize TGF-b and almost all of them have specific receptors for this peptide.

TGF Beta-1 is a protein that has important regulatory effects throughout innate immune pathways.  This protein helps control the growth and division (proliferation) of cells, the process by which cells mature to carry out specific functions (differentiation), cell movement (motility), and the self-destruction of cells (apoptosis).  The TGF Beta-1 protein is found throughout the body and plays a role in development before birth, the formation of blood vessels, the regulation of muscle tissue and body fat development, wound healing, and immune system function (especially regulatory T-cells).

TGF Beta-1 can impair T-regulatory cell function, which in turn contributes to the activation of autoimmunity, yet TGF Beta-1 also plays a role in suppressing autoimmunity. Neurologic, autoimmune and many other systemmic problems also are found with high TGF Beta-1.

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Thrombin time

Optimal range: 11.3 - 18.5 seconds

Thrombin is an enzyme in the blood that acts on the clotting factor fibrinogen to form fibrin, helping blood to clot. The thrombin time assesses the activity of fibrinogen.

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Transforming Growth Factor beta, Plasma

Optimal range: 463 - 5423 pg/mL

Transforming growth factor (TGF-beta) is a multifunctional peptide growth factor that has an important role in the regulation of cell growth, differentiation, and repair in a variety of tissues.

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Tryptase

Optimal range: 2.2 - 13.2 ug/L

Tryptase is an enzyme that is released, along with histamine and other chemicals, from mast cells when they are activated as part of a normal immune response as well as in allergic (hypersensitivity) responses.

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VEGF, Plasma

Optimal range: 0 - 115 pg/mL

VEGF stands for Vascular Endothelial Growth Factor. VEGF is a growth factor that promotes the growth of new blood vessels.

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