01 Lab Values Park Flashcards by Chris Clark

When getting a blood chemistry panel, what is included in an SMA-7?

Na, K, Cl, CO2, BUN, SCr, Glucose

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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)

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What is the normal SCr range?

0.6-1.2 mg/dL. A GFR decrease by 50% will double Cr level

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What is the normal BUN (blood urea nitrogen) range?

8-18 mg/dL. Increases in renal dysfunction, pancreatitis. Decreases in hepatic failure, pregnancy

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What is a normal CrCl?

75-125 mL/min. Reflects GFR

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What is the normal Albumin range?

4-6 g/dL. Reflects livers synthetic ability

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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)

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What are some common drugs to consider that are highly protein-bound?

Phenytoin, Digoxin, Calcium

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What is Phenytoin used for?

Epilepsy. Arrhythmia’s

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What routes of administration are there for Phenytoin?

PO. IV

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What is the formula for adjusted concentration with a protein bound drug?

[Measured total Concentration] / [(0.2 x albumin) + 0.1]

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What is the normal Prothrombin Time (PT)?

10-13 seconds

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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

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What is Warfarins main CYP enzyme?

2C9

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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

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What is the normal ALT range?

0-40 U/L. ALT is more liver-specific. An increase in ALT means an increase in AST

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What is Bilirubin?

A breakdown product of hemoglobin

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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

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What is the normal Alkaline Phosphate range?

30-120 U/L. Increased in Cirrhosis, Hepatitis, Pancreatitis, Bone disease, CHF

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What can levels of Alpha-Fetoprotein (AFP) > 500 ng/mL indicate in adults?

May be indicative of Hepatocellular Carcinoma

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What is the normal Amylase range?

40-120 U/L. Breaks down complex CHO into similar sugars. Produced in pancreas, increased in pancreatitis

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What is the normal Lipase range?

0-160 U/L. Breaks down triglycerides into fatty acids. Produced in pancreas, increases in pancreatitis

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What are some agents associated with causing pancreatitis?

Exenatide (Byetta). Januvia (Sitagliptin). Valproic acid. Didanosine (Videx). Lamivudine (Epivir). Sulindac (Clinoril). Statins; most ACE-I

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What is the normal Creatinine Kinase (CK) range?

0-150 U/L, formerly known as CPK

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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