Beruflich Dokumente
Kultur Dokumente
Use your textbook and other scholarly resources to find these laboratory values, their indications & the clinical significance. For the test results discuss why the lab value may be high or low and the clinical significance of that value.
Lab
1. Complete Blood count with Differential (CBC) RBC
Normal Range
Indication
The RBC count is closely related to the hemoglobin and hematocrit levels and represents different ways of evaluating the number of RBCs in the peripheral blood. It is repeated serially in patients with ongoing bleeding or as a routine part of the complete blood cell count. It is an intergral part of the evaluation of anemic patients.
References: Kathleen Deska Pagana & Timothy J. Pagana (October 7, 2009). Manual of Diagnostic and Laboratory tests. Mosbys, Fourth Edition.
Thoa Nguyen
Hct
The Hct is an indirect measure of the red blood cell (RBC) number and volume. It is used as a rapid measurement of RBC count. It is repeated serially in patients with ongoing bleeding or as a routine part of the complete blood cell count. It is an integral part of the evaluation of anemic patients.
Increased levels: Severe dehydration: with depletion of extracellular fluid, the total blood volume decreases, but the number of RBCs stays the same. Therefore the percentage of total blood volume that is taken up by the RBCs increases and the Hct increases. Decreased levels: Cirrhosis: this is a chronic state of fluid overload. The RBCs are diluted and make up a smaller percentage of the total blood volume. Therefore the Hct decreases.
This test is a measure Increased levels: Congenital heart of the total amount disease: cyanotic heart of Hgb in the blood. diseases cause It is used as a rapid chronically low Po2 indirect measurement levels. In response, the RBCs increase in number of the red blood cell References: Kathleen Deska Pagana & Timothy J. Pagana (October 7, 2009). Manual of Diagnostic and Laboratory tests. Mosbys, Fourth Edition. Hgb Male: 14-18 g/dL Female: 12-16 g/dL
Thoa Nguyen (RBC) count. It is repeated serially in patients with ongoing bleeding or as a routine part of the complete blood cell count. It is an integral part of the evaluation of anemic patients.
RBC indices
The RBC indices provide information about the size (MCV and RDW), weight (MCH), and hemoglobin concentrate (MCHC) of RBCs. This test is useful in classifying anemias. 80 95 fL To determine health problems (anemia) and measures volume or size of RBC.
Increased MCV: Chronic liver disease: the pathophysiology of this observation is multifactorial and includes poor nutrition, erythropoietin alternations, and the effects of chronic illness. Antimetabolite therapy: this form of chemotherapy for cancer treatment and, in lesser doses, for arthritis treatment, acts as vitamin B12 and folate inhibitors and can cause a macrocytic anemia. Alcoholism: this is
MCV
References: Kathleen Deska Pagana & Timothy J. Pagana (October 7, 2009). Manual of Diagnostic and Laboratory tests. Mosbys, Fourth Edition.
Thoa Nguyen
MCH
27 - 31 pg
Increased MCH: Macrocytic anemias: the MCH is increased if the size of the RBC is large. Decreased MCH: Microcytic anemia, Hypochronic anemia : the MCH is decreased if the size of the RBC is small or the hemoglobin is diminished. Increased MCHC: Spherocytosis: the automated cell counters false perception of an elevation in the MCHC is caused by a variation in the shape of the RBC. The RBC can hold only 37 g/dL hemoglobin. There can be no real hyperchromatism. Intravascular hemolysis: this is caused by free hemoglobin in the blood. The automated counter sees the free hemoglobin and incorporates that into its calculations. Cold agglutinins:
MCHC
32 - 36 g/dL
References: Kathleen Deska Pagana & Timothy J. Pagana (October 7, 2009). Manual of Diagnostic and Laboratory tests. Mosbys, Fourth Edition.
Thoa Nguyen
RDW
11% - 14.5%
Increased RDW: Hemoglobinopathies: fragmentation increases RDW variation. Furthermore, different RBCs have differenct amounts of pathologic hemoglobin and therefore will be affected by fragmentation to varying degrees. Hemolytic anemias: fragmentation increases RDW variation. Posthemorrhagic anemias: the marrows response to bleeding is to release premature RBCs into the bloodstream. These are larger than mature RBCs and contribute to RDW variation. Increased WBC count (leukocytosis): Infection: WBCs are integral to initiating and maintaining the bodys defense mechanism against infection. Leukemic neoplasia: these neoplastic cells are produced by the morrow and are released into the
The measurement of the total and differential WBC count is a part of all routine laboratory diagnostic evaluations. It is especially helpful in the evaluation of the
References: Kathleen Deska Pagana & Timothy J. Pagana (October 7, 2009). Manual of Diagnostic and Laboratory tests. Mosbys, Fourth Edition.
Neutrophils
55-70%
Low-viral disease, High-acute infection, Gout, Leukemia. Low-cancer, Leukemia High- hepatitis, Multiple myeloma
Lymphocytes
20-40%
Second line of Low- lymphocytic defense to bacterial Leukemia, Aplastic infection and foreign High- herpes, substances Brucellosis, Anemia References: Kathleen Deska Pagana & Timothy J. Pagana (October 7, 2009). Manual of Diagnostic and Laboratory tests. Mosbys, Fourth Edition. Monocytes
2-8%
Thoa Nguyen
Eosinophils
1-4%
Allergic and parasitic Low- stress, conditions Cortisone High-allergies, Asthma Healing process Low-stress, Hypersensitivity reaction, High-leukemia, inflammatory process.
Increased levels (thrombovytosis): Malignant disorder, Polycythemia vera: this is a hyperplasia of all the morrow cell lines, including platelets. Postplenectomy syndrome: the spleen normally extracts aging platelets from the bloodstream. With surgical splenectomy, that job is less effectively done by other organs. As a result, the platelet count increases. Rheumatoid arthritis, Iron deficiency anemia. Decreased levels: (Thrombocytopenia): Hypersplenism: : the spleen normally extracts aging platelets from the bloodstream. An enlarged spleen, however, extracts more platelets, both aging and new. The platelet count diminishes. Hemorrhage: the platelets are lost in the bleeding process. If not replaced by transfusion of platelets, it will take some time for the marrow to produce an adequate number of platelet. This problem is exacerbated with treatment that replenishes blood volume
Basophils
0.5-1.0%
PLT
150,000 400,000/mm3
The platelet count is an actual count of the number of platelets (thrombocytes) per cubic milliliter of blood. It is performed on patients who develop petechiae, spontaneous bleeding, increasingly heavy menses, or thrombocytopenia. It is used to monitor the course of the disease or therapy for thrombocytopenia or bone marrow failure.
References: Kathleen Deska Pagana & Timothy J. Pagana (October 7, 2009). Manual of Diagnostic and Laboratory tests. Mosbys, Fourth Edition.
Thoa Nguyen
7.4-10.4 fL
Increased levels: Valvular heart disease, Immune thrombocytopenia, Massive hemorrhage: the above illnesses are all associated with thrombocytopenia and a normally reactive bone marrow that will produce a great number of immature platelets in an attempt to maintain a normal platelet count. These immature platelets are large and increase the MPV. Decreased levels: Aplastic anemia, Chemotherapy-induced myelosuppression: when bone marrow production of platelets is inadequate, the platelets that are released are small. MPV will be reduced. Increased levels of comjugated (direct): Gallstones, Extrahepatic duct obstruction: theses diseases cause a blockage of the bile ducts. Bile, containing bilirubin, cannot be excreted. Blood levels rise. Extensive liver metastasis: the intrahepatic ducts or hepatic ducts become obstructed because of tumor. Bile, containing bilirubin, cannot be excreted. Blood levels rise. Increased levels of unconjugated (indirect):
2. Bilirubin
Total: 0.3 1.0 mg/dL Indirect: 0.2-0.8 mg/dL Direct: 0.1-0.3 mg/dL
This test is used to evaluate liver function. It is a part of the evaluation of adult patients with hemolytic anemias and newborns with jaundice.
References: Kathleen Deska Pagana & Timothy J. Pagana (October 7, 2009). Manual of Diagnostic and Laboratory tests. Mosbys, Fourth Edition.
Thoa Nguyen
0-35 Units/L (Females tend to have slightly lower levels than males)
Increased levels: Hepatitis, Skeletal muscle trauma, Acute pancreatitis: these diseases cause cell injury in these tissues. The cells die and lysis of the cell occurs. The contents of the cell (including AST ) are spewed out and are collected into the blood. Elevated AST levels thereby occur. Decreased levels: Acute renal disease, Beriberi, Diabetic ketoacidosis,
References: Kathleen Deska Pagana & Timothy J. Pagana (October 7, 2009). Manual of Diagnostic and Laboratory tests. Mosbys, Fourth Edition.
Thoa Nguyen
This test is used to identify hepatocellular disease of the liver. It is also an accurate monitor of improvement or worsening of these diseases. In jaundiced patients an abnormal alanine aminotransferase will incriminate the liver rather than red blood cell hemolysis as a source of the jaundice.
Significantly Increased levels: Hepatitis, Hepatic necrosis, Hepatic ischemia. Moderately Increased Levels: Cirrhosis, Cholestasis, Hepatic tumor, Hepatotoxic drugs, Obstructive jaundice, Trauma to striated muscle, Severe burns. Mildly Increased Levels: Myositis, Pancreatitis, Myocardial infarction, Infectious mononucleosis, Shock: injury or disease affecting the liver, heart, or skeletal muscles will cause a release of this enzyme
into the bloodstream, thus elevating serum ALT levels. 5. Gamma-Glutamyl transpeptidase (GGTP)
Male anf Female >45 years: 8-38 units/L Female <45 years: 527 units/L
This is a sensitive indicator of hepatobiliary disease. It is also used as an indicator of heavy and chronic alcohol use.
Increased levels: Liver diseases: liver and biliary cells contain GGTP. When injured or diseased, these cells lyse and the GGTP leaks into the bloodstream. Myocardial infarction: the pathophysiology is not clear. It may be associated with hepatic insult or the proliferation of capillary endothelial cells in the granulation tissue that replaces the infracted myocardium. Alcoholism ingestion, Pancreatic diseases. Increased levels: Primary cirrhosis, Intrahepatic or Extrahepatic biliary obstruction, Primary or metastatic liver tumor: ALP is found in the liver
30-120 units/L
References: Kathleen Deska Pagana & Timothy J. Pagana (October 7, 2009). Manual of Diagnostic and Laboratory tests. Mosbys, Fourth Edition.
Thoa Nguyen
Male: 55-170 units/L This test is used to Female: 30- 135 support the diagnosis units/L of myocardial muscle injury (infarction). It can also indicate neurologic or skeletal muscle diseases.
100-190 units/L at 37 C degree (lactate pyruvate)
Increased levels of total CK: disease or injury affecting the heart muscle, skeletal muscle, or brain.
This is an intracellular enzyme used to support the diagnosis of injury or disease involving the heart, liver, red blood cells, kidneys, skeletal muscles, brain, and lungs.
Increased levels: myocardial infarction: these patients classically have significant elevations in LDH-1 and, to a lesser degree, LDH2. Pulmonary disease: Elevations in LDH-2 and LDH-3. Hepatic disease: elevations in LDH-5. Red blood cell disease: elevations in LDH-1. Skeletal muscle disease and injury: elevations in LDH-5. Increased levels: Acute, noninfectious inflammatory reaction, (arthritit, acute rheumatic fever, Reiter syndrome, Crohn disease). Bacterial infections such
9. C-Reactive Protein
<1.0 mg/dL
C-Reactive Protein is an acute-phase reactant protein used to indicate an inflammatory illness. It is believed to be of
References: Kathleen Deska Pagana & Timothy J. Pagana (October 7, 2009). Manual of Diagnostic and Laboratory tests. Mosbys, Fourth Edition.
10. Glucose
This test is a direct measurement of the blood glucose level. It is most commonly used in the evaluation of diabetic patients.
References: Kathleen Deska Pagana & Timothy J. Pagana (October 7, 2009). Manual of Diagnostic and Laboratory tests. Mosbys, Fourth Edition.
Thoa Nguyen
This test is used to monitor diabetes treatment. It measures the amount of hemoglobin A1c in the blood. This test provides an accurate long-term index of the patients average blood glucose level.
Increased levels: Newly diagnosed diabetic patient: this test is not used to diagnose new diabetics because the range normal is so broad; it is best used to asses glycemic control during treatment. Poorly controlled diabetic patient, Nondiabetic hyperglycemia: patients with these illnesses tend to have persistently elevated glucose levels that cause an elevated GHb glycated proteins. Pregnancy: in some women with gestational diabetes or prediabetes, persistently high levels of glucose occur that cause elevated GHb and glycated proteins levels. Decreased levels: Hemolytic anemia, Chronic blood loss: RBC survival is shortend. Therefore there is less time for glycocylation, and GHb and glycated proteins levels decrease. Chronic renal failure: these patients have reduced hemoglobin levels as a result of lack of erythropoietin, which is produced in the kidney. HbA1 is also decreased. Increased serum iron levels: hemosiderosis or hemochromatosis: these
12. Iron
References: Kathleen Deska Pagana & Timothy J. Pagana (October 7, 2009). Manual of Diagnostic and Laboratory tests. Mosbys, Fourth Edition.
Thoa Nguyen Female: 60-160 mcg/dL metabolism in patients when iron deficieny, overload, or poising is suspected.
14. Transferrin
References: Kathleen Deska Pagana & Timothy J. Pagana (October 7, 2009). Manual of Diagnostic and Laboratory tests. Mosbys, Fourth Edition.
15. Ferritin
16. Protein
Evaluation and fractionation of serum proteins is used to diagnose, evaluate, and monitor the disease course in patients with cancer,
References: Kathleen Deska Pagana & Timothy J. Pagana (October 7, 2009). Manual of Diagnostic and Laboratory tests. Mosbys, Fourth Edition.
Thoa Nguyen intestinal/renal protein-wasting states, immune disorders, liver dysfunction, impaired nutrition, and chronic edematous states. 17. Albumin 3.5 5 g/dL To detect albumin deficit.
Increased Albumin Levels: Dehydration: as intravascular volume diminishes, albumin concentration measurements must increase mathematically Decreased Albumin Levels: malnutrition: lack of amino acids available for building proteins contributes to this observation. Probably the liver dysfunction associated with malnutrition also contributes to the low albumin levels. Increased Alpha1 Globulin Levels: inflammatory disease: alpha1-antitrypsin is an acute-phase reactant protein that is increased with diseases associated with inflammation, necrosis, infarction, malignancy, or burns. Decreased Alpha1 Globulin Levels: juvenile pulmonary emphysema: patients have a genetic decrease or absence of this enzyme, which is important to normal pulmonary function. Increased levels: Familial hypercholesterolemia, Familial hyperlipidemia:
18. Globulin
19. Cholesterol
<200 mg/dL
Cholesterol testing is used to determine the risk for coronary heart disease. It is
References: Kathleen Deska Pagana & Timothy J. Pagana (October 7, 2009). Manual of Diagnostic and Laboratory tests. Mosbys, Fourth Edition.
TGs identify the risk of developing coronary heart disease. This test is part of a lipid profile that includes the measurement of cholesterol and lipoproteins. This test is also performed on patients with suspected fat metabolism disorders.
References: Kathleen Deska Pagana & Timothy J. Pagana (October 7, 2009). Manual of Diagnostic and Laboratory tests. Mosbys, Fourth Edition.
Thoa Nguyen
Lipoproteins are considered to be an accurate predictor of heart disease. As part of the lipid profile, these tests are performed to identify persons at risk for developing heart disease and to monitor the response to therapy if abnormalities are found.
Increased levels: familial HDL, lipoproteinemia: genetically, the patient is predetermined to have high HDL levels. excessive exercise: HDL can rise with chronic exercise for 30 minutes three times a week. When the exercise greatly exceeds that minimum, HDL can become significantly elevated. Decreased levels: Metabolic syndrome: this syndrome associated with an atherogenic lipid profile that includes decreased HDL, increased triglycerides, elevates fasting glucose, high blood pressure, and abdominal obesity measured by waist circumference. Familial low HDL: genetically, the patient is predetermined to have low HDL levels. As a result, these patients are at high risk for CHD. Hepatocellular disease: HDL is made in the liver. Without liver function, HDL is not made and levels fall. Increased levels: Familial LDL lipoproteinemia: genetically, the patient is predetermined to have high LDL levels. nephritic syndrome: The loss of proteins diminishes the plasma
LDL
<130 mg/dL
References: Kathleen Deska Pagana & Timothy J. Pagana (October 7, 2009). Manual of Diagnostic and Laboratory tests. Mosbys, Fourth Edition.
Thoa Nguyen
References: Kathleen Deska Pagana & Timothy J. Pagana (October 7, 2009). Manual of Diagnostic and Laboratory tests. Mosbys, Fourth Edition.