01 Lab Values Park Flashcards
When getting a blood chemistry panel, what is included in an SMA-7?
Na, K, Cl, CO2, BUN, SCr, Glucose
What are the extra labs obtained in an SMA-12?
Albumin, Protein, Bilirubin, Alk Phos, Ca, Creatinine. This is also known as a CMP (complete metabolic panel)
What is the normal SCr range?
0.6-1.2 mg/dL. A GFR decrease by 50% will double Cr level
What is the normal BUN (blood urea nitrogen) range?
8-18 mg/dL. Increases in renal dysfunction, pancreatitis. Decreases in hepatic failure, pregnancy
What is a normal CrCl?
75-125 mL/min. Reflects GFR
What is the normal Albumin range?
4-6 g/dL. Reflects livers synthetic ability
What are some situations when the Albumin concentration can be decreased?
Overhydration. Malnutrition. Cancer. Severe burns. Pregnancy. Cirrhosis. Hepatitis. Liver failure (< 2.5 g/dL is a poor prognosis in liver disease)
What are some common drugs to consider that are highly protein-bound?
Phenytoin, Digoxin, Calcium
What is Phenytoin used for?
Epilepsy. Arrhythmia’s
What routes of administration are there for Phenytoin?
PO. IV
What is the formula for adjusted concentration with a protein bound drug?
[Measured total Concentration] / [(0.2 x albumin) + 0.1]
What is the normal Prothrombin Time (PT)?
10-13 seconds
What are the coagulation factors synthesized by the liver?
I, II (prothrombin), V, VII, IX, X. Vitamin K catalyzes the synthesis of clotting factors: II, VII, IX, X4
What is Warfarins main CYP enzyme?
2C9
What is the normal AST range?
0-40 U/L. Released into blood during acute cellular injury to hear or liver. Abnormal if > 4x ULN in liver disease
What is the normal ALT range?
0-40 U/L. ALT is more liver-specific. An increase in ALT means an increase in AST
What is Bilirubin?
A breakdown product of hemoglobin
What is the normal Total Bilirubin range?
0.1-1 mg/dL. Increases when liver is unable to conjugate bilirubin. Jaundice: > 2.5-3 mg/dL
What is the normal Alkaline Phosphate range?
30-120 U/L. Increased in Cirrhosis, Hepatitis, Pancreatitis, Bone disease, CHF
What can levels of Alpha-Fetoprotein (AFP) > 500 ng/mL indicate in adults?
May be indicative of Hepatocellular Carcinoma
What is the normal Amylase range?
40-120 U/L. Breaks down complex CHO into similar sugars. Produced in pancreas, increased in pancreatitis
What is the normal Lipase range?
0-160 U/L. Breaks down triglycerides into fatty acids. Produced in pancreas, increases in pancreatitis
What are some agents associated with causing pancreatitis?
Exenatide (Byetta). Januvia (Sitagliptin). Valproic acid. Didanosine (Videx). Lamivudine (Epivir). Sulindac (Clinoril). Statins; most ACE-I
What is the normal Creatinine Kinase (CK) range?
0-150 U/L, formerly known as CPK
What is the normal range for CK-MB (myocardium)?
0-12 U/L. > 25 U/L defects an MI (peak 12-24 hrs post-MI)
What are some other causes of increased Creatine Kinase?
Rhabdomyolysis. Shock. Infection. Seizures, etc.
What is the normal Troponin range?
0-0.5 ng/mL. A more specific and sensitive indicator of myocardial damage than CK-MB
What are the Troponin levels like with an MI?
Increases in 2-4 hours post-MI. > 2 ng/mL detects acute MI. Remains elevated 10-14 days (compared to 2-3 days elevation of CK-MB)
What are the normal TSH levels?
0.5-5 U/L. Causes the thyroid gland to produce two hormones; T3 and T4 (Thyroxine)
What are the levels like in Hypothyroidism?
TSH > 5; low T4. “Subclinical”: High TSH + Normal T4
What are the symptoms of Hypothyroidism?
Weight gain, fatigue, depression, dry skin, cold intolerance, constipation, bradycardia, peripheral edema
What are the levels like in Hyperthyroidism?
TSH < 0.5; High T4. “Subclinical”: Low TSH + Normal T4
What are the symptoms of Hyperthyroidism?
Weight loss, nervousness, heat intolerance, diarrhea, diaphoresis, irritability, tachycardia, tremor, hair thinning
What is the normal Total T4 range?
5-12 ug/dL
What is the normal Free T4 range?
0.8-2.2 ng/dL
What is the normal Triiodothyronine (T3) range?
75-200 ng/dL
What blood dyscrasia is Ribavirin associated with causing?
Hemolytic anemia is the primary clinical toxicity
What blood dyscrasia’s are Interferon-Alphas associated with causing?
Neutropenia, Leukopenia, Anemia, Thrombocytopenia
What measurements are taken in a CBC?
RBCs, Hgb, Hct, WBCs, MCV, MCHC
What is the normal RBC (Erythrocyte) range?
Males: 4.3-5.9x10^6. Females: 3.5-5x10^6
What is the normal Hemoglobin (Hgb) range?
M: 14-18. F: 12-16
What is the normal Hematocrit (Hct) range?
M: 40-50%. F: 34-47%. Its a percentage of red cells to the blood volume
What is the normal MCV range?
75-100. Useful in Anemia classification. Detects changes in cell size
What are the MCV ranges in Micro- and Macrocytosis?
Micro: < 75 (iron deficiency). Macro: > 100 (B-12 or folic acid deficiency)
What is the normal MCHC range?
33-37 g/dL. Measures concentration of hemoglobin. Changes in the Hgb content of red cells alter the cell color
What is Hypochromic?
Decreased about of Hgb in cells. Characteristic of iron deficiency anemia
What is the normal range for Total Iron Binding Capacity (TIBC)?
220-420
What is the normal WBC range?
3.5-10x10^3
What is Leukocytosis?
High WBCs
What is Leukopenia?
Low WBCs
What is considered Neutropenia?
ANC < 2,000
What is considered Agranulocytosis?
ANC < 500 (risk of infection significantly increases)
What is the normal Platelet range?
150-400x10^3. Thrombocytopenia (low platelet level). Thrombocytosis (high platelet level)
What medications are used for Thrombocytopenia?
Eltromopag (Promacta; oral tab). Romiplostim (Nplate; SubQ)
What agents are used for Low WBC (Neutropenia)?
G-CSFs: Filgastrim (Neupogen), Pegfilgastrim (Neulasta)
What agents are used for Low RBCs (Anemia)?
ESAs: Epoetin alfa (Epogen, Procrit), Darbepoetin (Aranesp)
What is the Rapid Plasma Reagin (RPR) used for?
Test for Syphilis
What is the abnormal range for QTc?
Males: > 470. Females: > 480msec. Increased risk of QT prolongation when > 500msec or > 60msec increase from baseline
What is the clinical presentation of Anemia?
Weakness. SOB. Dizziness. Chest pain. TACHYcardia. “Roaring in the ears”. HA. Impaired mentation. Cold hands or feet. Pale skin
What are some common drugs that can induce Anemia?
Bactrim. Cephs. Interferons. Levodopa. NSAIDs. Rifampin. Linezolid. Ribavirin, etc.
What is needed for RBC formation?
Need Iron, Folate, B12, and enough BM and Epo as well
How can renal failure lead to anemia?
Renal dysfunction –> Decreased erythropoietin synthesis –> Decreased RBC formation –> Anemia
What are some of the approved indications for Epoetin alpha?
Anemia d/t CKD. Anemia d/t concurrent myelosuppressive chemotherapy. Anemia associated with HIV (zidovudine) therapy
What laboratory parameters need to be monitored for Epoetin alfa?
Transferrin saturation and serum ferritin; hemoglobin
At what Hgb level should epoetin dose reduction or treatment interruption be considered?
Target hemoglobin levels >11. On HD: if Hgb approaches or > 11
What black box warnings are associated with Epoetin alfa?
Increased risk of death, serious cardiovascular events, and stroke was reported in CKD patients. MI and stroke if levels > 11
What is the reason for monitoring BP with Epoetin alfa?
Caution in patients with a history of HTN (contraindicated in uncontrolled HTN)
What laboratory parameter is used to calculate corrected calcium?
Albumin
How is corrected calcium calculated?
Corrected Ca = Measured Ca + 0.8 (4-alb)
What electrolyte abnormality may be corrected by Kayexalate?
Hyper K, given PO or PR
What is the MOA of Kayexalate?
Removes potassium by exchanging sodium ions for potassium ions in the intestine (especially the large intestine) before the resin is passed from the body (caution in bowel obstruction)
What are the BUN:SCr ratios used to assess for causes of acute kidney injury?
> 20:1 Prerenal, 10-20:1 Normal or Postrenal, < 10:1 intrarenal
What laboratory parameters should be monitored for lisinopril?
BUN, Serum creatinine, renal function, WBC, and potassium
What laboratory parameters need to be monitored for patients on heparin treatment?
Hgb, Hct, signs of bleeding; fecal occult blood test; aPTT, anti-Xa (shows efficacy)
Ampicillin requires dose adjustment for what organ functions?
Renal
What are the major toxicities associated with aminoglycoside therapy?
Nephrotoxicity, Ototoxicity
