Dr. Prabhat AryaMD · Internal Medicine
ConditionsKnow your condition

The extra tests in your package, explained.

Health-check packages often add a handful of tests beyond blood count, sugar and cholesterol. A mildly raised PSA or a weakly positive RA factor worries many people; most of the time it is not what they fear. Here is what each one means.

Reviewed by Dr. Prabhat Arya, MBBS, MD (Internal Medicine)

Reviewed · Next review · Sources: NHS, MedlinePlus, WHO

Send your report for ₹199See every value

Read this first.

Go by the range printed on your own report. For several of these tests (lipase, cortisol, testosterone) the normal range depends heavily on the lab’s machine, so a number from one lab cannot be judged against another lab’s range.

Several of these are screening tests. A positive or raised screening result is a reason for a confirming test, not a diagnosis. Healthy people quite often have a weakly positive RA factor or a slightly raised PSA.

Timing matters for hormones. Testosterone and cortisol should be taken in the morning, around 8–10 am. An afternoon sample can look falsely low.

Tests for hepatitis B, hepatitis C and HIV are private medical information. A reactive result is treatable or controllable today, and family members can be protected.

Every value, one by one.

Serum amylase

An enzyme that digests starch; made by the pancreas and the salivary glands

Typical adult range about 30–110 U/L (varies by lab)

High usually means
Above about three times the top of the range, with severe upper tummy pain, it usually means acute pancreatitis (inflammation of the pancreas), most often from gallstones or alcohol. Milder rises are common and are often from the salivary glands (such as mumps), reduced kidney function, or a harmless form where amylase is bound to a protein and cleared slowly (macroamylasaemia).
Low usually means
Rarely meaningful.
Usually nothing to worry about when
It is mildly raised (under about three times the top of the range), you have no tummy pain, and lipase is normal.
See a doctor when
It stays mildly raised on a repeat without pain: at your next check-up. Raised with tummy pain: see the danger signs below.

Serum lipase

An enzyme that digests fat; made mainly by the pancreas, so more specific for it than amylase

High usually means
A very high lipase (three times the top of the range or more) with severe upper tummy pain is the typical sign of acute pancreatitis. Mild rises are seen with reduced kidney function, diabetes, gallbladder disease and some medicines.
Low usually means
Rarely meaningful on a routine check.
Usually nothing to worry about when
It is mildly raised, you have no tummy pain, and your kidney tests show reduced function, or a repeat is normal.
See a doctor when
It stays raised without pain: see a doctor at your next check-up. With tummy pain: see the danger signs below.

RA factor (rheumatoid factor)

An antibody often found in rheumatoid arthritis, but also in many healthy people

Typical adult range Negative, or below about 14–20 IU/mL (as printed)

High usually means
Positive RA factor is seen in most people with rheumatoid arthritis, but also in healthy people (more with age), and with long infections such as hepatitis C or TB, and other autoimmune conditions. A positive result without the typical joint symptoms does not mean rheumatoid arthritis. A negative result does not rule it out either.
Usually nothing to worry about when
It is weakly positive and you have no swollen joints, or only aches in the knees or back. Aches without swelling are usually not rheumatoid arthritis.
See a doctor when
You have painful, swollen joints, especially the small joints of the hands or feet, with morning stiffness lasting more than about 30 minutes: see a doctor within two weeks, whatever the RA factor. Early treatment protects the joints. An anti-CCP test helps confirm it.

HBsAg (hepatitis B surface antigen)

A part of the hepatitis B virus; if it is in your blood, the virus is present

Typical adult range Non-reactive / Negative

What it means
Reactive (positive) means hepatitis B virus is present now. If it is still positive after six months it is long-term (chronic) hepatitis B. Most people with it feel well; tablets control it when needed, and regular checks protect the liver. It spreads through blood, sex and from mother to baby, not through food, water or shared plates.
Usually nothing to worry about when
Non-reactive is the normal result. It means no current hepatitis B; it does not tell you if you are vaccinated (that is the anti-HBs test).
See a doctor when
It is reactive: see a doctor within two weeks for confirming and staging tests (LFT, HBV DNA, HBeAg, ultrasound). Pregnant: tell your obstetrician this week, so the baby gets the vaccine and protective injection at birth. Family and partner should be tested and vaccinated. See the hepatitis B and C page.

Anti-HCV (hepatitis C antibody)

Antibodies to the hepatitis C virus: they show you have met the virus at some time

Typical adult range Non-reactive / Negative

What it means
Reactive means you have had hepatitis C at some time. About 3 in 10 people clear the virus by themselves but stay antibody-positive for life. A second test, HCV RNA, shows whether the virus is still there. If it is, a course of tablets cures more than 95% of people.
Usually nothing to worry about when
Non-reactive is the normal result. A reactive result with a negative HCV RNA means a past infection that has cleared.
See a doctor when
It is reactive: have an HCV RNA test and see a doctor within two weeks. Don’t wait for symptoms: hepatitis C damages the liver silently for years, and the cure is simple.

HIV 1 & 2 antibody (as offered)

A screening test for HIV infection

Typical adult range Non-reactive / Negative

What it means
Reactive on a screening test is not a diagnosis: it must be confirmed with further tests before anyone is told they have HIV. Screening can rarely be falsely reactive. If confirmed, daily treatment today lets people live a normal lifespan and, once the virus is undetectable, not pass it on to a partner.
Usually nothing to worry about when
Non-reactive is the normal result. If you had a possible exposure in the last three months, a repeat later is needed to be sure.
See a doctor when
It is reactive: have the confirming tests and see a doctor this week. Free, confidential testing and treatment are available at government ICTC and ART centres. A possible exposure in the last 72 hours: go the same day, as preventive medicines (PEP) must start early.

PSA, total (prostate-specific antigen)

A protein made by the prostate gland; men only

Typical adult range usually under 4 ng/mL (lower for men in their 40s and 50s, a little higher is common after 70)

High usually means
Most raised PSA is not cancer. The commonest causes are an enlarged prostate (very common after 50), a urine or prostate infection, and recent ejaculation, cycling, hard exercise, a catheter or a rectal examination. Prostate cancer is one possible cause, which is why a raised PSA is checked again. If you take finasteride or dutasteride (for the prostate or for hair loss), your PSA reads about half its true value, so a “normal” result may not be normal: tell your doctor.
Usually nothing to worry about when
It is just above the line and you had ejaculation, cycling or a urine infection shortly before. Repeat it after 48 hours without those, or 6 weeks after an infection has cleared.
See a doctor when
It is above the range on a repeat test, or has risen clearly since last year: see a doctor within a few weeks for an examination and, often, an MRI. Above about 10 ng/mL, or with bone pain or weight loss: within two weeks.

Testosterone, total

The main male hormone; women make small amounts

Typical adult range adult men roughly 300–1,000 ng/dL; women much lower (go by the female range on your report)

High usually means
In women, a raised testosterone with irregular periods, acne or extra facial hair is most often polycystic ovary syndrome (PCOS). In men, a high level usually comes from testosterone injections, gels or “body-building” products.
Low usually means
In men, the commonest causes are extra weight, diabetes, poor sleep or sleep apnoea, a recent illness, heavy alcohol use and some medicines (opioid painkillers, steroids). Ageing lowers it slowly. Less often it is the testes or the pituitary gland. An afternoon sample or a single low result is often normal on a repeat.
Usually nothing to worry about when
It is just below the range on one sample, taken in the afternoon or after a bad night or an illness. Repeat a fasting sample at 8–10 am.
See a doctor when
It is low on two morning samples and you have low sex drive, erection problems, loss of morning erections or tiredness: see a doctor this month. Do not start testosterone or body-building products on your own: they switch off your own production and can stop sperm making.

Cortisol

The body’s stress hormone, made by the adrenal glands; highest in the early morning

Typical adult range morning (8–9 am) sample: roughly 5–23 mcg/dL; much lower later in the day

High usually means
Usually stress, a recent illness, poor sleep, pregnancy, or the contraceptive pill (which raises the protein that carries cortisol). A true excess (Cushing’s syndrome) needs special tests such as a dexamethasone suppression test or a late-night saliva test; one high random sample does not show it.
Low usually means
Most often steroid medicines: tablets, injections, strong skin creams and inhalers, and unlabelled “desi” powders or tonics that contain steroids. These switch off your own cortisol. Less often the adrenal or pituitary glands are not working (Addison’s disease or pituitary problems). An afternoon sample is normally low.
Usually nothing to worry about when
It is high on a single sample taken during stress or illness, or low on a sample taken in the afternoon.
See a doctor when
A morning cortisol is low and you feel very tired, dizzy on standing, lose weight or crave salt: see a doctor this week, and do not stop any steroid suddenly. High with rapid weight gain on the face and tummy, purple stretch marks, easy bruising or new high blood pressure and diabetes: this month.

Electrolytes (sodium, potassium, chloride)

Blood salts, often added to packages

What it means
Explained line by line, with the levels that need a doctor, on the kidney tests page.
Usually nothing to worry about when
Small changes just outside the range are common and often due to the sample or a medicine.
See a doctor when
Potassium 6.0 or more, or sodium below 125: the same day (details on the kidney tests page).

Results that go together.

PatternsTypical, not certain
When you seeIt usually means
High amylase and lipase, with severe upper tummy painAcute pancreatitis until proved otherwise. Hospital today.
Mildly high amylase, normal lipase, no painUsually salivary gland, kidney function or a harmless bound form. Repeat; no emergency.
Weakly positive RA factor, aching knees or back, no swellingUsually not rheumatoid arthritis. See the joint pain page for common causes.
Reactive anti-HCV, negative HCV RNAA past hepatitis C infection that has cleared. No treatment needed.
Raised PSA with a slow stream, getting up at night, recent urine infectionMost often an enlarged prostate or infection. Repeat the PSA after the infection clears; see a doctor if it stays up.
Low testosterone with extra weight, diabetes or loud snoringOften improves with weight loss and treating sleep apnoea. See the snoring and sleep apnoea page.

Get help today if

  • Severe upper tummy pain going through to the back, with vomiting, and a high amylase or lipase: go to hospital today; call 112 if you feel faint or breathless.
  • Low cortisol, or long-term steroid use, with vomiting, severe weakness, fainting or confusion: go to hospital now, or call 112; this can be an adrenal crisis.
  • Reactive HBsAg with yellow eyes plus drowsiness, confusion or vomiting blood: go to hospital now.
  • A possible exposure to HIV (unprotected sex, a needle injury) within the last 72 hours: go to a hospital or ART centre today for preventive medicine.

Call 112 or go to the nearest emergency department. Ambulance: 108 (102 in some states).

Read more.

Questions people ask.

  1. Does a high PSA mean prostate cancer?

    No. Most men with a raised PSA do not have cancer. An enlarged prostate, a urine infection, recent ejaculation or cycling are common causes. Repeat it after 48 hours without those, or 6 weeks after an infection. If it stays raised, a doctor examines you and often arranges an MRI before any biopsy is considered.

  2. My RA factor is positive. Do I have rheumatoid arthritis?

    Not necessarily. Many healthy people, especially older people, have a positive RA factor. Rheumatoid arthritis is diagnosed from swollen, painful joints and morning stiffness, with tests such as anti-CCP. If your joints are not swollen, a positive RA factor alone is not a reason for treatment.

  3. HBsAg is reactive. Is it serious?

    It needs care, not panic. It means hepatitis B virus is in your blood. Most people stay well for years; regular checks and, when needed, tablets protect the liver. Your family should be tested and vaccinated. See a doctor within two weeks for the next tests.

  4. Can hepatitis C be cured?

    Yes. A course of tablets, usually for 8 to 12 weeks, cures more than 95% of people. First an HCV RNA test confirms whether the virus is still present.

  5. When should testosterone be tested?

    In the morning, between about 8 and 10 am, ideally fasting, and when you are not recovering from an illness. A low result should be repeated on another morning before any decision is made.

Where this can be checked

These are trusted general sources. The advice on this page is Dr. Arya’s, written for patients in India. Ranges differ between labs: go by the range printed on your own report.

Your whole report, read by your doctor.

Send every page, old reports too. He reads them himself and tells you what changed and what to do.

Send your report for ₹199

Dr. Prabhat Arya · MBBS, MD (Internal Medicine)