The Clinical Laboratory at the Heart and Brain Medical Center in Sofia performs medical tests for laboratory diagnostics, providing correct, quality and fast service to patients. The laboratory has state-of-the-art equipment and high-quality consumables and is certified for participation in the National System for External Quality Assessment of Clinical Laboratories – NSQA. The laboratory has a contract with the NHIF.

Laboratory diagnostic tests are performed here in the following areas:

Hematology

Complete blood count (18 parameters) with differential counting
Erythrocyte sedimentation rate (ESR)

Coagulation

Prothrombin time (in patients on anticoagulant therapy)
D-dimer

Clinical chemistry: biochemical tests from blood samples

Glucose
AST (GOT; AST)
ALT (GPT; ALT)
GGT
Total cholesterol (Total Cholesterol)
HDL-Cholesterol (HDL-Cholesterol)
LDL-Cholesterol (LDL-Cholesterol)
Triglycerides
Creatinine
Uric acid
Urea, BUN
Glucose profile triplicate, unfolded on the day
Glucose profile triplicate, unfolded over 120 minutes, after glucose loading
glycated protein: glycated haemoglobin (HbA1C)

Hormonal tests

Tumour markers

Virology and immunology

Urinalysis – qualitative and quantitative

Each test has certain requirements that are important for the patient to meet:

1. Biochemistry

The biochemical examination should be performed under standard conditions – fasting and thirst in the morning (after ensuring a 12-hour fast during the night hours or a minimum of 2 hours after the last meal) and 24-hour exclusion of alcohol intake. Also, abstinence from coffee and cigarette use is necessary before sample collection.

2. Urine

An average portion of the first morning urine or, exceptionally, urine voided at least three hours after the last urination is suitable for testing. The specimen should be collected after strict toileting of the external genitalia with soap and water.

3. Blood

Blood tests are a standard part of preventive care, routine and prophylactic health care. The physician often orders a blood test before or after the physical examination to have the results of a complete blood count. Blood tests may also be ordered to evaluate specific conditions. During a routine physical examination, the doctor may order one of the following tests:

Complete blood count, CBC.

A complete blood count (CBC) is one of the most commonly used blood tests in medical practice, providing very important information about the cells circulating in a person’s blood. Blood contains 3 types of cells – red blood cells (erythrocytes), white blood cells (leukocytes) and blood platelets (platelets) – located in a liquid part called plasma. Blood cells are produced and mature primarily in the bone marrow, then pass into the peripheral blood. The test is usually performed using automated blood analyzers that determine various parameters, including the number of cells in the blood as well as other specific characteristics of some of the cells.

White blood cells (leukocytes, WBC)

White blood cells have a barrier-protective role against bacterial and viral agents. When a bacterial infection is present, the number of white blood cells rises very rapidly.

Red blood cells (erythrocytes, RBC)

Erythrocytes are produced in the bone marrow and, when mature, are released into the bloodstream. The average lifespan of a red blood cell is 120 days, so the bone marrow must continually produce new erythrocytes to replace those that become obsolete or are lost in bleeding. The erythrocytes and the haemoglobin (Hb) they contain are involved in carrying oxygen from the lungs to the tissues, and carbon dioxide from the tissues to the lungs.

Haemoglobin (Hb or Hbg)

Hemoglobin is an iron-containing protein in erythrocytes that accounts for their characteristic red color. With the help of haemoglobin, red blood cells bind to oxygen in the lungs and carry it to tissues and organs in the body, and also transport carbon dioxide from tissues and organs to the lungs

Platelets (blood platelets, PLT)

Platelets are the smallest blood cells in size and play an important role in the blood clotting process. Low platelet levels are associated with an increased risk of bleeding and easy bruising of the skin. Elevated platelet counts are associated with a risk of increased clotting (thrombosis) or excessive bleeding if platelets are not functioning normally.

C-reactive protein (CRP)

C-reactive protein (CRP) is a cyclic, acute phase protein synthesized by the liver in the presence of inflammation. It is used as a reliable marker of inflammation in the body. An alternative marker is SUE (erythrocyte sedimentation rate). The difference is that CRP is a more sensitive and accurate indicator than SUE in the acute inflammatory phase that has already occurred. Although when CRP levels are elevated, SUE levels may be normal.

An increase in CRP values is seen in the following cases:

• In inflammation- bacterial, viral, fungal infections; after heart attack and after surgery;
• in case of systemic inflammatory diseases, i.e. rheumatoid arthritis;
• in allergic reactions;
• in the last trimester of pregnancy.

Prostate-specific antigen (PSA)

PSA, also known as the prostate tumour marker, is a blood test that can alert to problems in the prostate and so help to take action earlier and more quickly. Prostate-specific antigen is a protein that is produced by the cells of the prostate. In small amounts, PSA gets into the blood, where it can be measured through a blood sample.

Normal PSA values are 0 to 4 ng/ml, but when there is a problem with the prostate, its values rise. Such problems can be: inflammation, greatly increased prostate size and others. It is for this reason that if you have elevated PSA values, you should not worry – it does not automatically mean prostate cancer. A complete urological examination is necessary to determine the exact cause of an increase in the marker. Prostate specific antigen is used as a screening method for early diagnosis of prostate cancer. Its diagnostic value is increased in combination with rectal tuchi, prostatic acid phosphatase (PCP), transrectal ultrasonography and prostate gland biopsy. The level of prostate specific antigen in the blood is often elevated in men with prostate cancer. In addition to prostate cancer, elevated PSA levels are also found in inflammation of the prostate gland (prostatitis), benign prostatic hyperplasia (prostate adenoma).

To avoid false-positive results, it is recommended that PSA testing be performed before or 10 days after urological manipulations that result in elevated PSA. Elevated prostate-specific antigen levels do not always mean prostate cancer. On the other hand, normal blood PSA values do not exclude the possibility of prostate cancer. Screening PSA testing every two years is recommended for men 50 to 70 years of age.

TSH/TSH (Thyroid Stimulating Hormone)

Thyroid stimulating hormone (TSH, thyrotropin) is produced by basophil cells of the anterior pituitary and has a circadian (circadian) release rhythmicity controlled by TSH-releasing hormone produced by the hypothalamus.

Thyroid stimulating hormone determination is the initial test for diagnosing thyroid diseases. Even small changes in the concentration of thyroid hormones cause an opposite (much more pronounced) change in the concentration of TSH. Thyroid stimulating hormone is therefore a very specific and sensitive parameter for monitoring thyroid function, but also for detecting and excluding diseases of the hypothalamus-pituitary-thyroid axis. Determination of TSH is useful in monitoring the effect of treatment in patients with hypothyroidism: low levels are found with excessively high doses of thyroid hormone replacement.

Normal thyroid-stimulating hormone values indicate balanced treatment. Recommendations for TSH testing – diagnosis of thyroid disorders.

Glycated hemoglobin (HbA1c)

By examining blood glucose levels, it is possible to determine the instantaneous metabolism of carbohydrates in the body. Determination of glycated haemoglobin (HbA1c) levels provides information on the glycaemic status of the patient retrospectively (between 8-12 weeks back).

Your doctor may order the HbA1c test for several main reasons:

• If you have abnormal fasting blood glucose levels (impaired fasting glycemia) or when performing an oral glucose tolerance test (testing your blood glucose levels after certain glucose intake at certain times);
• To diagnose and assess the likelihood of suffering from a pre-diabetic condition such as impaired glucose tolerance;
• As part of the process of diagnosing diabetes mellitus.

Glycated haemoglobin provides a long-term assessment of the outcome of insulin treatment in already proven insulin-dependent diabetes, i.e. whether the patient is maintaining target blood glucose levels at those insulin doses. This is the so-called glycaemic control assessment.

The glycation rate is monitored over 120 days – this is the lifetime of the erythrocytes to which the commented feature refers. In reality, the indicator informs about daily average blood glucose values over a period of three months. In other words, HbA1C indicates the degree of “brightening” within three months. After this period, erythrocytes are gradually renewed. The new HbA1C indicator will reflect the blood sugar values for the next three months, and so on. Testing this indicator is vital for diabetics as it allows efficient control of the disease and a quick check on the efficacy of the treatment administered. Normal glycated haemoglobin values have been found to be 4 to 5.7%. This rule is valid for both sexes, for any age – including children and adolescents.

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Results can be obtained on-site at the medical center or electronically, with complete confidentiality of the tests performed.

The clinical laboratory has a contract with the NHIF.