How to Choose the Right At-Home Lab Test: Comparing Sample Types
Dried blood spot (DBS) testing is the game-changer that clinicians and researchers had hoped it would become when Ivar Christian Bang introduced it for newborn screenings in 1913. Bang is revered as the "founder of modern clinical microchemistry."
Fifty years later microbiologist Robert Guthrie's invention of filter paper to absorb the sample solidified the system's revolutionary role in diagnostics, screenings and treatment monitoring.
DBS samples are stable, easily transported and highly accurate. The technology has expanded disease prevention and control efforts worldwide and more recently into your home.
So what is dried blood spot testing and how is it different from other types of samples used in laboratory analysis?
DBS tests use blood drops obtained using a “finger stick” with a lancet. Individual drops are squeezed onto a special screening card. The sample is left to dry for several hours and then returned to a lab in the mail.
Unlike urine, blood serum and other biospecimens, dried blood samples are not considered hazardous, and if packaged correctly, are exempt from US Department of Transportation and US Postal Service regulations.
DBS tests are becoming the preferred method for sample collection. They’re stable and don’t require a specialist to collect the sample. In many cases, DBS are acceptable or preferred over urine, liquid blood or saliva samples. Applications for dried blood spot tests include:
- Cardiometabolic health profile
- Hormone measuring
- Antibody detection and analysis for thyroid diseases and infectious diseases
- Screenings for cancer, vitamin deficiency, diabetes and other health conditions
- Genetic mapping and diagnostics
What Are At-Home Lab Tests?
Testing falls into three categories: diagnostic, screening and monitoring. Diagnostic tests are used to determine the cause of symptoms. Screenings look for risks and early signs of a condition. Monitoring tests evaluate the progress of treatment, effects and outcomes. At-home lab tests are useful for all three categories.
How Do I Choose an At-Home Lab Test?
You've decided to join the positive trend in data-driven self-care and active aging. Naturally you want to know if a saliva, dried blood spot, vein blood draw or urine test is best. Following are considerations that can help you choose.
- Are you using the test for diagnosis, screening or monitoring?
- Does the facility use the most-up-to date technology?
- What credentials does the lab have? CLIA-certification is a must.
- How and when will you receive your results?
- Is a medical consultation to go over test results included?
- What sample is recommended to achieve your goal for the test?
- Will you be able to easily collect and return your sample?
What is CLIA Certification?
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 are federal regulatory standards that apply to a clinical laboratory testing performed on humans in the United States, except clinical trials and basic research.
Expect a CLIA-certified lab's test kit to include everything you need to collect your sample and send it in. A kit from a reputable lab will contain the small but essential items like alcohol wipes, lancet and a bandaid. Major must-haves are step by step instructions on how to collect your sample; a thorough questionnaire to gather medical history, symptoms, any medication or treatment program you are currently taking; and a return package with prepaid expedited shipping.
Your lab report should include benchmarks for results based on established medical guidelines for your age and gender. Lab comments explain your test results. Lab results are usually provided online. This lowers overhead cost, savings that can be potentially passed onto you. It also adds to the ease of at-home lab testing. Results are fast, thorough and easily shared with your physician.
Saliva vs Blood Tests for Hormone Measuring
Most of the body's sex hormones are bound by protein sex hormone binding globulin (SHBG) and other proteins. Hormones that are bound are not not usable by the body until they are released from the protein bond. Non-bound hormones, also called "free," are bioavailable (usable) to the body.
Most blood tests measure total hormone levels while saliva tests measure only free levels. Often it is not necessary to measure unbound levels. For instance, if age-related hormone deficiency is suspected and blood tests confirm low "total" levels, no other testing may be necessary. However, if low hormones are suspected and total levels are within range or high, then a saliva test may be warranted to measure bioavailability.
HRT requires an initial lab test to assess hormone levels to guide treatment plan development. Women's three major sex hormones are measured for the initial screening. Typically hormones are not measured again until three months after treatment to allow the body to adjust to the hormone supplementation. Once lab testing and patient feedback confirm program effectiveness, the purpose of testing changes from diagnostic to monitoring.
HRT is the use of lab-made hormones to supplement internally-produced hormones that the body no longer makes in sufficient quantity. Hormonal imbalance is most prominent in women who are approaching menopause or postmenopausal but some men go through "andropause," which is a marked decline in testosterone or other androgens. If not caught early, a cascade of unpleasant symptoms and even disease can develop. Men’s testosterone drops 1% each year beginning at 30.
Although men may feel the effects of decreased hormones, studies show they are less likely than women to connect it to hormones. It’s due to the fact that men seek medical care less frequently than women1 and male hormonal imbalance is rarely discussed.
See related articles and sources:
Complete Blood Count (CBC) and Other Blood Tests
According to the US National Library of Medicine, CBC measures many different parts and features of your blood, including:
- Red blood cells, which carry oxygen from your lungs to the rest of your body.
- White blood cells, which fight infection. There are five major types of white blood cells. A CBC test measures the total number of white cells in your blood. A test called a CBC with differential also measures the number of each type of these white blood cells.
- Platelets which help your blood to clot and stop bleeding.
- Hemoglobin, a protein in red blood cells that carries oxygen from your lungs and to the rest of your body.
- Hematocrit, a measurement of how much of your blood is made up of red blood.
Although DBS samples can be used for a CBC, at this time, liquid blood is still the preferred sample.
Women can purchase an at-home fertility test kit that meets fertility assessment guidelines defined by reproductive endocrinologists. The test is used as a baseline screening for preconception planning or to help uncover possible fertility issues before jumping into expensive fertility treatment programs. The test uses blood and saliva.
Fun Facts: History of Early Pregnancy Tests
The early pregnancy urine test hit retail shelves in the 70s. It was the first at-home test developed in modern history. But 3,500 years prior, ancient Egyptians had already figured out pregnant women's urine was distinctive.2
The earliest recorded use of urine testing to diagnose pregnancy was discovered in Egypt. If pregnancy was suspected, a woman was instructed to urinate on wheat and barley seeds and monitor the effects for several days. A written account found on a 3500-year-old piece of papyrus reads, “If the barley grows, it means a male child. If the wheat grows, it means a female child. If both do not grow, she will not bear at all.” 2
The theory has since been tested and concluded that 70% of the time pregnant women’s urine did promote growth.2 It appears that the ancient Egyptians may have identified the growth-inducing factors of pregnant women's urine—likely the presence of human chorionic gonadotropin (hCG).
In more than a few ways, medical care has come full circle. A century ago, house calls were the rule rather than the exception. Doctors provided treatment and collected lab samples in the patient’s home. Today doctor’s visits can take place in your home virtually through telemedicine. At-home lab tests are in tandem. With the click of a button, you can order an at-home lab test for fast home delivery, collect your sample, drop it in the mail and receive a complete analysis online in several days.
1. Banks I. No man's land: men, illness, and the NHS. BMJ. 2001;323(7320):1058-1060. doi:10.1136/bmj.323.7320.1058 Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1121551/
2. Pregnancy Test Timeline - history - Office of NIH History and Stetten Museum. History.nih.gov. https://history.nih.gov/display/history/Pregnancy+Test+Timeline. Published 2021.