What to do with lab results clients bring from direct-to-consumer tests

Treat a self-ordered panel like any other lab result, once you've found the lab's own report behind it. Check which lab ran the tests, what exactly was measured, the units and reference intervals on that report, and the conditions of the draw. Then file each result by its draw date in the client's history, next to their older results, and read it in that context rather than through the company's summary.

I build Sera, a lab-review workspace for practitioners, so read the last section with that in mind. The checks before it work the same with any system.

Find the lab's report, not just the summary

Direct-to-consumer testing companies usually sell the test, arrange the draw and present the results. The analysis itself is done by a clinical laboratory, which may be one the client has used before, such as Quest or Labcorp. What the client sees first is the company's version: a dashboard, a score, color-coded markers, sometimes written commentary.

That summary is not the same thing as the lab report. It may round values, leave out units, drop the lab's reference interval in favor of the company's own, or group markers into categories you can't trace back.

Ask the client for the laboratory report itself. It is often a PDF available from somewhere in their account, under a name like "lab report", "original results" or "download PDF". In the US, federal lab rules (42 CFR 493.1291) require a test report to show the name and address of the laboratory location that performed the test, the test performed, and the result with its units where applicable. If what the client sends has none of that, it is probably the company's summary, not the report.

If the client can't find a lab report, you can still use the numbers, but note in the file that they came from a summary and that the lab, units or intervals weren't confirmed.

Check what was actually measured

Marker names on a consumer report are often simplified, and some markers have close relatives that aren't interchangeable.

• CRP or hsCRP. Standard CRP is a test for active inflammation. hsCRP is the one with cardiovascular risk cut-offs of 1 and 3 mg/L, and the CRP range note says those cut-offs don't apply to standard CRP.
• Total or free. Total testosterone and free testosterone are different tests. So are total B12 and active B12.
• Serum or red cell. Magnesium, selenium, zinc, copper and folate can each be measured in serum or in red blood cells, with different ranges. Compare serum magnesium with RBC magnesium.
• Measured or calculated. Some values are calculated from others: non-HDL cholesterol, eGFR, the free androgen index. Check whether the report shows how a calculated value was derived.
• Fingerprick or venous. Ask how the sample was collected. If it was a fingerprick rather than a venous draw, note it, and don't assume the result is directly comparable with the client's past venous results.

Check the units and reference intervals

Copy each result in the unit printed on the lab report. Many markers change value with the unit: vitamin D in nmol/L is about 2.5 times the ng/mL figure, as the vitamin D range page shows with its 50 to 80 ng/mL (125 to 200 nmol/L) target. If the client's older results came from a lab using different units, note it rather than mixing them on one chart.

Then look at whose reference interval is printed. On the lab's report it is the lab's own interval, which the same federal rule says the lab determines. On a company summary it may be a narrower "optimal" range set by the company, often without a source. These are not the same, and a result flagged on one may sit comfortably inside the other.

Some markers depend heavily on the method. The TPO antibody note says the number isn't comparable between laboratories and should be read against the cut-off printed on the report. The TSH and free T4 notes say much the same for borderline results. When a direct-to-consumer result sits near a cut-off, the lab's own interval is the one to check.

Fill in the missing context

A self-ordered draw often comes with less context than one you planned. The client may have booked it at lunchtime, after breakfast, in the middle of a cold. Ask, and write down the answers:

• Fasting. A non-fasting sample runs higher for triglycerides. Fasting glucose and fasting insulin mean little if the client had eaten.
• Time of day. TSH runs highest overnight and early morning. Morning cortisol ranges are for a sample drawn at about 8 am.
• Cycle day. Estradiol, LH and FSH only mean something alongside the cycle day.
• Recent illness. Inflammation raises ferritin regardless of iron stores.
• Supplements. Ask what they were taking at the time, including anything with biotin. The FDA notes that biotin can significantly interfere with certain lab tests.
• The draw date. Take it from the lab report's collection date, not the date the results appeared in the app.

If the client doesn't know, write that. A result with unknown fasting status is still a result, but you'll read the lipids and glucose more cautiously.

Fit it into the history

A direct-to-consumer panel is usually broad and taken once. Its value is often less in what it says alone than in how it lines up with what came before.

File it by draw date with the client's older results, marker by marker. Then check:

• Does it agree with earlier results? A ferritin of 40 after two years in the 20s reads differently from a ferritin of 40 after years in the 90s.
• Is the lab the same as before? If not, compare against each report's own interval before reading a change as real.
• What's new? Broad panels often include markers the client has never had tested. A single first result is a starting point. Note it, and decide whether it's worth repeating under controlled conditions.
• What's flagged only by the company? If a marker is flagged on the company's summary but sits inside the lab's interval, say so plainly to the client. If it's outside the lab's interval too, treat it like any other out-of-range result, and refer to their doctor where it's outside your scope.

Clients often arrive worried by a summary full of red markers. Showing them where each result sits on the lab's report, and against their own history, is part of the work.

Where Sera fits

Sera reads digital lab PDFs from any lab and shows each value next to its page in the report, so you can check it before saving. A direct-to-consumer result goes into the same client timeline as everything else, by draw date. If what the client has is a company dashboard or screenshot rather than a lab PDF, you enter the values by hand. Every result keeps the unit the lab reported, and Sera flags a marker that arrives in two different units. It scores each result against optimal and sufficient bands whose sources and evidence grades are published, not against an unsourced company range. It doesn't store the lab's own interval, so check borderline results against the report. It doesn't diagnose or suggest treatment.

It's free for three clients. There's a 3-minute tour if you'd rather watch first.

Alina Radu is the founder of Sera and a software engineer. The idea started with her own Hashimoto's tests, scattered across years without the big picture.