The following information provides a helpful guide to typical blood test results and was designed to assist our patients.
ALT - Alanine aminotransferase. This is one of the so called liver enzymes (see AST below) that may be tested by Dr. Donovan, especially for patients on specific medications (hydroxychloroquine, methotrexate, mycophenolate, tofacitinib). Drugs that cause an irritation of the liver cause ALT levels in the blood to rise.
ANA - Antinuclear antibody. One of the screening tests for lupus. A high value (where the bottom number is 640 or larger - i.e. 1:640) may suggest that you need more tests to definitively determine if you have lupus. A low test (ie. 1:80, 1:160 1:320) is common in the population and does not necessarily indicate a patient has an autoimmune disease. ANA testing may not be included in your blood tests because it is not a part of routine testing for every patient with hair loss.
Dr. Donovan Articles on ANA: Hair Loss and Lupus
Anti-DS DNA - Anti-double stranded DNA. A confirmatory test for lupus. Anti DS DNA is not a basic screening test but may be ordered in patients with high ANA levels of other concerns for autoimmune disease.
Anti-endomysial antibodies - Tests often ordered in the work up and evaluation for celiac disease
Anti-tissue transglutaminse antibodies - Tests often ordered in the work up and evaluation for celiac disease
AST - Aspartate aminotranferase. This is one of the so called liver enzymes (see ALT above) that may be tested by Dr. Donovan, especially for patients on specific medications (hydroxychloroquine, methotrexate, mycophenolate, tofacitinib). Drugs that cause an irritation of the liver cause AST levels in the blood to rise.
Vitamin B12 - Vitamin B12 levels. Low vitamin B12 levels need attention, and in our clinic this is typically less than 300.
Biotin - Biotin, or vitamin B7, is a B vitamin. It is commonly prescribed for hair loss without much evidence of being helpful.
Dr. Donovan's Articles on Biotin 1: Are you biotin deficient?
Dr. Donovan's Articles on Biotin 2: Is biotin deficiency common in women?
Dr. Donovan's Articles on Biotin 3: Seborrheic Dermatitis and Biotin: What is the link?
Celiac Screen - Screening Tests ordered to evaluate whether a patient has gluten sensitivity. Includes anti-endomysial and tissue transglutaminase but may contain other tests as well.
Dr. Donovan's Articles on Celiac Screening: What is the best test to screen for celiac disease?
Cholesterol tests - a measure of the 'fats' in the blood. We often test cholesterol because men and women with genetic hair loss as well as scarring alopecia have a higher chance of being diagnosed with high cholesterol. Some medications can raise cholesterol, such as JAK inhibitors, cyclosporine and isotretinoin.
Dr. Donovan's Articles on Cholesterol 1: Low LDL: A New Association
Dr. Donovan's Articles on Cholesterol 2: High Cholesterol and Heart Disease in Men with Balding
Dr. Donovan's Articles on Cholesterol 3: When will the medical community recognize the importance of testing cholesterol?
Creatine kinase (CK) - A blood test to assess damage to muscles, including heart and skeletal muscle. CK may be elevated in a variety of conditions
Cortisol - A blood test to assess activity of the adrenal glands, and specifically secretion of cortisol. Typically ordered at 8 AM. Both high cortisol levels and low cortisol levels may be concerning.
CRP - A non specific measure of inflammation, similar to ESR
Vitamin D - Vitamin D deficiency is common. Here in Canada, studies have shown that about two-thirds of the population is low in vitamin D and levels tend to be lower in winter than summer. The exact role of vitamin D in hair loss is still being worked out but it's clear that individuals with alopecia areata and genetic hair loss have lower vitamin D levels than individuals without hair loss. Normally, optimal levels of vitamin D are above 30 ng/mL or 75 nmol/L.
Dr. Donovan's Articles on Vitamin D 1 : Vitamin D in Alopecia Areata
Dr. Donovan's Articles on Vitamin D 2 : More Pieces to the Vitamin D Puzzle
Dr. Donovan's Articles on Vitamin D 3 : Does replacing low vitamin D help most people?
DHEAS - One of the androgen hormones, known as dehydroepiandrostenedione. Both men and women produce DHEAS. For some individuals, reducing DHEAS levels with anti-androgen medications can benefit hair loss
DHT - One of the androgen hormones, known as dihydrotestosterone. Both men and women produce DHT. Medications such as finasteride and dutasteride lower DHT levels. DHT levels fluctuate greatly and are generally unreliable to measure directly.
Dr. Donovan's Articles on DHT 1: Should I get a blood test for DHT?
Dr. Donovan's Articles on DHT 2: Finasteride Inhibitor 5 Alpha Reductase
ENA - Extractable nuclear antigen. One of the blood tests often ordered during more sophisticated work ups for autoimmunity. This test is not a standard screening test.
ESR - stands for "erythrocyte sedimentation rate." This is a very non specific test that measures inflammation in the body. There are hundreds of reasons for a high ESR.
Ferritin - A Measure of Iron Stores in the Body. Low ferritin may indicate iron deficiency.
Dr. Donovan's Articles on Iron 1: What does an elevated ferritin mean?
Dr. Donovan's Articles on Iron 2: Ferritin Levels: Factual or Frantic?
Dr. Donovan's Articles on Iron 3: The Benefits of Checking Iron in Women with Hair Loss
Dr. Donovan's Articles on Iron 4: The General Principles of Taking Iron
FSH - Follicle Stimulating Hormone. An important hormone regulating the menstrual cycle. FSH levels rise at ovulation. Levels of FSH rise as women enter menopause.
HDL - stands for "high density lipoprotein." A high HDL level is good. HDL is sometimes called the good cholesterol. Women with genetic hair loss may be at risk for lower HDL
Dr. Donovan's Articles on HDL: Low HDL: A New Association
HEMATOCRIT - a measure of how much of the blood is made up of red blood cells (thickness of the blood)
HEMOGLOBIN - a measure of a key protein inside red blood cells that carries oxygen. Low hemoglobin levels indicate anemia
Iron - Measuring serum iron is not helpful screening test for most with hair loss but may be ordered in patients requiring more advanced work ups and evaluations. The proper test for evaluating iron issues is called ferritin (see above).
LDL - stands for "low density lipoprotein" A low LDL level is good. A high LDL level may indicate the need for diet or medication change.
LH -Luteinizing Hormone. An important hormone regulating the menstrual cycle. LH levels rise greatly at ovulation.
MCH - stands for "mean corpuscular hemoglobin" and measures the amount of hemoglobin packed in the red blood cells.
MCHC - stands for "mean corpuscular hemoglobin concentration" - another measure of the concentration of hemoglobin in your red blood cells
MCV - stands for "mean corpuscular volume". This is a measure of the average size of a red blood cell. There are many conditions that lead to red blood cells becoming too big or too small. Iron deficiency for example, causes a low MCV, but so do many other conditions.
Platelet count - platelets help with blood clotting. A low platelet level can be associated with bleeding problems and a high platelet count can be associated with clotting problems
RBC count - another measure of the number of red blood cells
RDW - stands for "red cell distribution width" or how uniform in size your red blood cells are. High levels and low levels can mean and array of different things
Testosterone - a measure of the male type (androgen) hormone in the blood. Both men and women have androgens.
Triglycerides - one of the fats in the blood. High trigylceride levels are harmful. A variety of medications used in treating hair loss can cause a rise in triglyceride levels (i.e. isotretinoin)
TSH - stands for "thyroid stimulating hormone" levels. A HIGH TSH may indicated hypothyroidism and a LOW TSH level may indicate hyperthyroidism.About 1 out of every 15-20 individuals will be diagnosed with a thyroid disorder in their lifetime. These thyroid conditions are 8 times more common among women. While it's true that many with thyroid disease will notice symptoms, about one half will not notice any problems at first. Hair loss is frequently part of the collection of symptoms that come with thyroid dysfunction. Testing for thyroid disease in women with hair loss is important.
Dr. Donovan's Articles on TSH 1: Lab Tests for Thyroid Problems
Dr. Donovan's Articles on TSH 2: Stopping Biotin Supplements Before Thyroid Tests
WBC count - the "white blood cell" count. White blood cells are the key cells of the immune system and are said to be the 'infection fighting cells'
Zinc - A essential mineral in body. A significant portion of the population is at risk for zinc deficiency. Zinc deficiency is not common in North America. Nevertheless, zinc deficiency does exist in a number of subgroups in the North American population and is likely more common than appreciated. About 12 % of the general population and up to 40-50 % of the elderly are at risk for zinc depletion in North America. In many parts of the world, zinc deficiency is extremely common. In North America, zinc deficiency is frequently asymptomatic - meaning that individuals with low zinc don't necessarily have symptoms. Zinc deficiency can be associated with hair loss as well as a variety of issues related to immune system function and infection.
Dr. Donovan's Articles on Zinc 1: Zinc Dosing and Hair Loss
Dr. Donovan's Articles on Zinc 2: The Complex Relationship Between Zinc and Inflammation