Monitoring
Monitoring and adjusting treatment
Laboratory diagnostics can be used to monitor the course of the disease and the effect of the therapy. Through this monitoring, treatments and/or medication can be adjusted (in time) or stopped as soon as the laboratory values are 'normal'. This prevents overtreatment.
Below are examples of the added value of laboratory testing for monitoring:
Cardiovascular
-
Heart failure
BNP and NT-proBNP
When the heart muscle experiences increased stress, BNP (Brain-type Natriuretic Peptide) is released from heart muscle cells. BNP causes blood vessels to dilate, reducing the heart strain. Along with BNP, the physiologically inactive byproduct NT-proBNP is also released. Blood levels of both compounds provide insight into heart failure (severity). Because multiple causes can lead to elevated BNP and NT-proBNP, this test's strength lies primarily in ruling out heart failure when there is strong clinical suspicion of the condition. The test is also suitable for following up medication effects (monitoring) and estimating heart failure risk (prognosis).
-
Thrombosis
Blood coagulation test
Patients with an increased risk of thrombosis are treated with anticoagulants (blood thinners). Dosing requires precise monitoring: too much anticoagulant increases the risk of severe bleeding, too little leads to blood clots. Monitoring blood coagulation status is crucial for proper dose adjustment. Blood clotting time can be determined using the PT test (prothrombin time) and/or the APTT test (activated partial thromboplastin time). Anticoagulation medication can be adjusted based on test results. The test is also available as a home test, allowing patients to monitor their blood coagulation values and adjust medication themselves.
Cancer
-
Kahler's disease
M-proteïne test
In Kahler's disease, an excess (a clone) of only one type of plasma cells is created, which also results in an excess of one type of protein. This is called a monoclonal protein or M-protein. Finding a monoclonal protein in the blood is often a first step in diagnosing multiple myeloma. The common technique for an M-protein measurement in blood is electrophoresis. In combination with the determination of the free light chains in blood, this gives a sensitivity to the disease of more than 99%. Sometimes a urine test is necessary to detect free light chains, the so-called Bence-Jones proteins, in urine.
An emerging new technique for blood testing is mass spectrometry (MS), which allows for much more sensitive and specific testing for monoclonal proteins. A simple blood sample is sufficient to detect traces of the M-protein and thus accurately monitor disease activity. This makes this test, in addition to diagnosis, also suitable for prognosis, stratification and monitoring. As a result, a painful bone marrow biopsy is needed less often.
-
Bladder cancer
FISH-test
The molecular cytological test detects bladder cancer cells in urine based on specific DNA abnormalities in these cells on chromosomes 3, 7, and 17 and absence of the 9p21 locus. The abnormalities are visualized via fluorescence in-situ hybridization (FISH). The test is used in combination with standard diagnostic procedures in bladder cancer investigation. The test detects bladder tumors in all stages and grades.
Diabetes
-
Diabetes
Glucose testing
Diabetes diagnosis is based on persistently elevated blood glucose levels. Treatment depends on severity and may include diet modification, oral medications, and/or insulin injections. Effective treatment requires crucial glucose monitoring. The acceptable range for variation is narrow, necessitating continuous (round-the-clock) monitoring. Patients can self-monitor using finger-prick glucose tests or continuous glucose monitoring sensors. Regular glucose measurements combined with appropriate interventions help maintain balanced glucose levels.
Glycated hemoglobin (HbA1c)
Blood glucose readily binds to hemoglobin (Hb), forming glycated hemoglobin (HbA1c). The HbA1c blood value indicates average blood glucose levels over several months. HbA1c levels are typically measured during routine diabetes check-ups. This test provides valuable complementary information to daily glucose self-monitoring for diabetes management.
Renal
-
Renal function
Creatinine blood test
This test measures blood creatinine levels. Creatinine production depends on body height and muscle mass, resulting in typically higher values for men compared to women and children.
Creatinine urine test
Creatinine clearance indicates the kidneys' ability to filter blood and excrete waste products through urine. A 24-hour urine creatinine measurement provides comprehensive information about kidney function.
Combined creatinine and cystatin C testing
Elderly typically have lower blood creatinine levels due to reduced muscle mass. Including cystatin C measurement alongside creatinine provides more reliable kidney function assessment, particularly in elderly patients.
Rheumatic Disorders
-
Rheumatoid Arthritis
Anti-CCP test
In rheumatoid arthritis (RA), the autoimmune response involves developing specific antibodies against citrullinated proteins. These are proteins where the amino acid arginine has been converted to citrulline. The immune system recognizes citrullinated proteins as foreign, resulting in antibody production - known as anti-citrullinated protein antibodies (ACPAs). These antibodies, highly specific for RA, are detectable in blood. They often appear very early in disease progression, sometimes long before symptoms develop, making them excellent biomarkers for early RA detection. The widely used anti-CCP test (anti-cyclic citrullinated peptide) is based on these ACPAs. Anti-CCP is measured in serum using ELISA. Combined with clinical presentation and RF testing, this anti-CCP test aids in RA diagnosis.
Anti-MCV test
Another biomarker in the ACPA family is anti-mutated citrullinated vimentin (anti-MCV). This diagnostic marker is measured in serum using ELISA. While the anti-CCP test uses synthetic antigens (2-3 epitopes), the anti-MCV test employs natural human antigens (40 epitopes). This makes the anti-MCV ELISA highly sensitive and specific for early-stage RA detection. The sensitivity for early RA detection appears to increase further when both anti-CCP and anti-MCV are measured. The anti-MCV test is also valuable for disease severity prognosis and therapy monitoring.
Thyroid
-
Thyroid Function Testing
TSH
The thyroid is regulated by TSH (thyroid-stimulating hormone), produced in the pituitary gland. In underactive thyroid conditions, blood TSH levels are elevated above normal. In overactive conditions, blood TSH levels are below normal. Abnormal TSH levels indicate disrupted TSH production. Additional testing of thyroid hormones T3 and T4 can further investigate abnormal TSH production. T4 concentration measurement is particularly important when clinically suspecting rare thyroid dysfunction or pituitary dysfunction.
T3 and T4
The thyroid produces two hormone types: T4 (thyroxine) and T3 (triiodothyronine). T4 is a precursor to the active thyroid hormone T3. Combined T4 and TSH values provide insight into thyroid function. T3 measurement is particularly important when thyroid hormone resistance is suspected.
Gastrointestinal tract and liver
-
Liver fibrosis
ELF Test
Early detection of liver fibrosis is possible using the ELF test. The blood test measures three direct markers of fibrosis:
1. hyaluronic acid (HA)
2. procollagen III amino-terminal peptide (PIIINP)
3. Tissue Inhibitor of Matrix Metalloproteinase 1 (TIMP-1)The ELF test can be used as a screening tool for patients with risk factors for liver fibrosis, such as obesity, type 2 diabetes and/or metabolic syndrome. If diagnosed in time, the liver damage can usually be reversed by treatment of underlying cause(s).
Because the ELF score correlates with the severity of liver fibrosis, the test can be used to determine the prognosis of liver disease. A higher score indicates a greater risk of progression to cirrhosis. Iin addition, the test is also suitable for monitoring disease course and treatment response. Repeated measurement of the ELF score allows evaluation of the effects of interventions, such as lifestyle modifications or pharmacotherapy.
Last but not least, the ELF test often eliminates the need for an invasive liver biopsy. The test results support clinical decision-making, leading to more efficient care and potential cost savings.
General Health Screening and Drug Monitoring
-
Medication monitoring
Biologics
Biologics represent a new class of medications derived from animal or human proteins. They are used to treat inflammatory conditions such as rheumatoid arthritis and certain gastrointestinal and skin diseases by inhibiting inflammatory proteins and cells. These expensive medications can elicit varying individual responses. Although they closely resemble human proteins, they may still be recognized as foreign and trigger an immune response. Antibody formation can neutralize the biologic's effectiveness. Medication monitoring can track how and whether an individual responds to biologic treatment.
Remote monitoring is available through finger-prick blood testing. Using a special test kit, blood samples can be collected at home and sent to the laboratory. The lab measures both the amount of biologic in the blood and the antibody response. Based on these measurements, dosage can be adjusted promptly. Medication monitoring is essential for cost-effective use of expensive biologics.
