Vitamin A (All trans Retinol)

Vitamin

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Fasting Required

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Measures vitamin levels.

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Vitamin A (All trans Retinol) - Comprehensive Test Information Guide

Why is it done?
- Measures serum concentration of all-trans retinol (the active form of vitamin A) to assess nutritional status and vitamin A adequacy
- Diagnose vitamin A deficiency in patients with symptoms including night blindness, dry eyes (xerophthalmia), skin changes, or immune dysfunction
- Evaluate malabsorption disorders such as celiac disease, cystic fibrosis, Crohn's disease, or chronic liver disease affecting fat-soluble vitamin absorption
- Assess vitamin A toxicity (hypervitaminosis A) in patients on high-dose supplementation or with excessive intake
- Monitor nutritional status in patients with protein-calorie malnutrition, severe infections, or metabolic stress
- Evaluate vision problems, skin conditions, or recurrent infections potentially related to vitamin A deficiency
- Screen high-risk populations including developing countries, premature infants, and patients with specific medical conditions
Normal Range
- Reference Range: 30-100 mcg/dL (micrograms per deciliter) or 1.05-3.49 μmol/L (micromoles per liter)
- Units of Measurement: mcg/dL (conventional units) or μmol/L (international units)
- Normal Result (30-100 mcg/dL): Indicates adequate vitamin A status with sufficient stores for normal physiological functions including vision, immune response, and skin health
- Low Result (<30 mcg/dL): Indicates vitamin A deficiency requiring evaluation for dietary insufficiency, malabsorption, or underlying disease; risk for xerophthalmia and impaired immunity
- High Result (>100 mcg/dL): May indicate vitamin A toxicity (hypervitaminosis A) if significantly elevated (>200 mcg/dL), or benign elevation from recent high intake; requires clinical correlation
- Borderline Values: 20-30 mcg/dL may represent early deficiency state requiring dietary intervention and monitoring; values 100-200 mcg/dL warrant assessment of supplementation practices
Interpretation
- Severe Deficiency (<20 mcg/dL): Critical state associated with xerophthalmia, corneal scarring, irreversible blindness, severe skin manifestations, and compromised immune function; requires urgent intervention
- Mild-to-Moderate Deficiency (20-30 mcg/dL): Early deficiency with symptoms including night blindness, Bitot's spots, follicular keratosis, and increased susceptibility to infections; responsive to dietary or supplemental intervention
- Adequate Status (30-100 mcg/dL): Normal physiological function; liver stores are adequate; no supplementation required unless dietary intake is questionable
- Mild Elevation (100-200 mcg/dL): May result from supplementation, dietary fortified foods, or high dietary intake; generally not associated with toxicity at this level; reassess supplementation practices
- Hypervitaminosis A (>200 mcg/dL, markedly elevated): Indicates toxicity risk with potential symptoms: acute toxicity (nausea, vomiting, headache, dizziness); chronic toxicity (bone pain, hair loss, dry skin, liver damage, teratogenicity); requires discontinuation of supplements and medical evaluation
- Factors Affecting Results: Hepatic function (liver disease reduces vitamin A transport); protein status (retinol-binding protein synthesis); renal function; recent dietary intake; zinc status (required for retinol absorption and metabolism); medications (certain drugs affect absorption)
- Clinical Significance: Vitamin A is essential for retinal photoreceptor function (dark adaptation), immune system regulation, epithelial cell differentiation, and reproductive function; deficiency is a leading preventable cause of blindness in developing countries
Associated Organs
- Primary Organ Systems: Visual system (retina), skin, immune system, liver, gastrointestinal tract, bone metabolism
- Eye/Vision Problems: Night blindness (nyctalopia), xerophthalmia (dry eye), Bitot's spots, corneal opacity, corneal scarring, retinal degeneration, and blindness in severe deficiency
- Skin Manifestations: Follicular keratosis, hyperkeratosis, dry scaly skin, impaired wound healing, dermatitis, and alopecia (hair loss)
- Gastrointestinal and Hepatic Disorders Associated with Deficiency: Celiac disease, Crohn's disease, ulcerative colitis, cystic fibrosis, chronic pancreatitis, short bowel syndrome, bile duct obstruction, cirrhosis, hepatitis, fatty liver disease
- Immune System Effects: Increased susceptibility to infections (respiratory, gastrointestinal, urinary); impaired T-cell and antibody responses; increased morbidity and mortality from infectious diseases
- Bone and Skeletal Effects: Hypervitaminosis A causes bone pain, hyperostosis, premature epiphyseal closure in children, and increased fracture risk; deficiency may affect bone development
- Reproductive and Teratogenic Effects: Deficiency impairs spermatogenesis and sexual dysfunction; hypervitaminosis A is highly teratogenic causing birth defects (craniofacial, cardiac, CNS, thymic anomalies); particularly concerning in first trimester
- Central Nervous System: Hypervitaminosis A can cause pseudotumor cerebri (benign intracranial hypertension) with headache, papilledema, and visual disturbances
Follow-up Tests
- For Confirmed Deficiency: Comprehensive metabolic panel (liver function tests, albumin, prealbumin); zinc level (required for vitamin A metabolism); lipid panel (affects absorption); retinol-binding protein (RBP); prothrombin time/INR
- To Evaluate Underlying Causes: 72-hour fecal fat (steatorrhea); tissue transglutaminase (tTG) antibodies for celiac disease; immunoglobulin A level; fecal chymotrypsin; pancreatic enzymes (amylase, lipase); cystic fibrosis genetic testing
- Ophthalmological Evaluation: Slit-lamp examination to assess for corneal involvement, Bitot's spots, xerosis; visual acuity testing; electroretinography for retinal function assessment in severe deficiency
- For Suspected Toxicity: Liver function tests (AST, ALT, alkaline phosphatase, bilirubin); retinol-binding protein; alkaline phosphatase (bone turnover); imaging if pseudotumor cerebri suspected
- Complementary Micronutrient Assessment: Vitamin D (25-hydroxyvitamin D); vitamin E (alpha-tocopherol); vitamin K; other fat-soluble vitamins; vitamin B12; folate; iron studies
- Monitoring Frequency: After supplementation: retest in 4-8 weeks to assess response; for chronic conditions requiring long-term supplementation: retest every 6-12 months; for toxicity follow-up: retest 2-4 weeks after discontinuation of excess supplementation
- Other Related Tests: Carotenoid levels (beta-carotene, lycopene, lutein); oxidative stress markers; immunoglobulin levels; absolute lymphocyte count; specific antibody responses
Fasting Required?
- Fasting Status: YES - Fasting is required for accurate results
- Fasting Duration: Minimum 8-12 hours overnight fast (preferably 12 hours); water intake is permitted
- Rationale for Fasting: Vitamin A is fat-soluble; food intake, especially fat, affects plasma concentration and transport by lipoproteins; fasting establishes standardized baseline conditions for accurate and comparable results
- Medications to Avoid: Do NOT take vitamin A supplements 24 hours before the test; avoid other fat-soluble vitamin supplements; continue all other routine medications unless specifically instructed otherwise by physician; certain medications like corticosteroids, bile acid sequestrants, and mineral oil should be noted
- Dietary Restrictions: No food intake from midnight before the test; no fatty meals for 24 hours prior (reduces postprandial lipemia); avoid alcohol 24 hours before testing
- Additional Patient Preparation: Maintain usual sleep schedule the night before; avoid strenuous exercise for 24 hours prior; stress reduction recommended; arrive well-hydrated; inform phlebotomist of any medications affecting absorption (antibiotics, anticonvulsants, statins); blood collection in morning (8-9 AM) preferred for standardization
- Specimen Requirements: Serum sample (blood draw in SST or gold-top tube); protect from light exposure during collection and handling (vitamin A is light-sensitive); refrigerate immediately; process promptly as vitamin A degrades over time; results most accurate when tested within 24-48 hours

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