Basic labs Flashcards
Hematology
The lab dept concerned with identifying disease related to the blood; CBC, UA, ESRs, coag studies, fluid cell counts
CBC
Complete blood count; RBCs and indices, WBC w/ or w/o diff, hemoglobin, hematocrit, platelets
RBC membrane
Elastic, lipid bilayer, cytoskeleton, membrane proteins
Hemoglobin structure
Iron, protoporphyrin, globin
Hemoglobin function
Carry oxygen (bind it and release it)
MCV
Mean corpuscular volume; estimates average size of red cell; classified as microcytic, normocytic, or macrocytic
MCH
Mean corpuscular hemoglobin; How much hemoglobin is inside the RBC; used in combo w/ MCHC; classified as hypochromic or normochromic
MCHC
Mean corpuscular hemoglobin concentration; used in conjunction with MCH to determine amount of hemoglobin; classified as hypochromic or normochromic
RDW
RBC distribution width; amt of size variation;used to quantify the amount of anisocytosis; graded by severity 1+, 2+, 3+
Normchromia
RBC should lack a nucleus; should be consistent in size and shape; should be deformable and selectively permeable
What are possible causes to have an increased number of macrocytes (MCV > 100fL) in the blood?
- B12/Folic acid deficiency
- Accelerated erythropoiesis (spitting out of new RBCs)
- liver disease
- post-splenectomy
- chemotherapy
- hypothyroidism
What are some possible causes/pathology of too many microcytes (MCV < 80 fL) and/or hypochromic (MCHC < 33%) in the blood?
Abnormal hemoglobin synthesis
*iron deficiency
*deficiency of heme synthesis (siderblastic anemia)
*deficiency of globin synthesis (thalassemia)
Chronic disease states
Piokilocytosis
Variation in shape
Presentation of target cells could be indicative of what?
- Liver dysfunction
- various anemias
- Hgb-opathies
- thalassemia
Presentation of spherocytes in the blood could be indicative of what?
- hereditary
- hemolytic anemia
- age
Presentation of Stomatocytes in the blood could be indicative of what?
Cirrhosis
What are the 6 types of WBCs?
- neutrophils
- lymphocytes
- monocytes
- eosinophils
- basophils
- Band (young neutrophils)
Which WBC usually comprises 40-75% of the WBCs in normal blood?
Neutrophils
Which WBC usually comprises 30-40% of the WBCs in normal blood?
Lymphocytes
Which WBC usually comprises 2-8% of the WBCs in normal blood?
Monocytes
Which WBC usually comprises 1-4% of the WBCs in normal blood?
Eosinophils
Which WBC usually comprises 0.5-1% of the WBCs in normal blood?
Basophils
Which WBC usually comprises 0-3% of the WBCs in normal blood?
Band cells (young neutrophils)
What is the function of neutrophils?
Phagocytosis and killing of microorganisms
Someone who has an infection or has been using steroids could expect to have an elevated # of which WBCs?
Neutrophils
A decreased number of neutrophils could mean:
- immune reaction
- gram negative sepsis
- drugs
What does it mean when someone has a left shift?
Means that the body is dumping out an increased number of band cell/immature neutrophils
What is the function of lymphocytes?
- production of anti-bodies by B cells
* cytotoxic T cells and Helper T cells
If someone has an increase in lymphocytes, they may have:
- viral infection
- EBV
- pertussis
If someone has a decrease in lymphocytes, they may have:
- immuno-deficiency (HIV)
- severe infection
- long term corticosteroid use
Atypical lymphocytes could mean the person is positive for:
Infectious mononucleosis (EBV)
Function of monocytes
Circulating precursors to the phagocyte
Called macrophage in the tissues
Monocytes, in the tissue, are called
Macrophages
What is the function of eosinophils?
Kill antibody coated parasite via granule release
When are eosinophil levels increased?
During parasitic infection and allergic reactions
Basophils are elevated during __________ and release ____________
Inflammation; histamine
What is the primary role of platelets?
Maintain vascular integrity
What is the essential function of platelets?
Blood clotting
What is the hemostatic function of platelets (thrombocytes)?
Primary phase in platelet aggregation
If you think someone has a blood clotting disorder, you would want to order a CBC to look at their _______ count.
Platelet
If you think someone has a blood disorder, you would order a CBC to look at their
RBC indicies
If you think someone is anemic, polycythemia, or they are hypoxic for no obvious reason, you could order a CBC to look at their ________ & _________
Hemoglobin and hematocrit
What are the two main functions of electrolytes?
Maintain a healthy water balance and stabilize pH
Renal regulation involves which 4 electrolytes?
- sodium
- potassium
- carbon dioxide
- choride
Which specific salts are the major determinants of extracellular osmolality?
Sodium
Which electrolyte is found primarily extracellular?
Sodium
Does aldosterone conserve or release sodium?
Conserves it;
What stimulates aldosterone to signal the kidneys to reabsorb sodium?
Low levels of sodium
Natriuretic hormone conserves or releases sodium?
Releases
What stimulates natriuretic hormone to tell the kidneys to excrete sodium?
Elevated levels of sodium
Antidiuretic hormone (ADH) releases or reabsorbs H20?
Reabsorbs
What hormone controls the reabsorption of water at the distal tubules, either diluting or concentrating the amount of sodium?
Antidiuretic hormone (ADH)
Hyponatremia triggers ___________ hormone to increase reabsorption of water and conserve sodium to increase the levels of sodium in the body
Aldosterone
Hypernatremia triggers ____________ hormone to decrease reabsorption of water, thus excreting more sodium in the urine to decrease the levels of sodium
Natriuretic
Who is the major cation within the cell?
Potassium
Which electrolyte maintains the cell membrane’s electrical potential, esp. neuromuscular tissue?
Potassium
Minor changes in what electrolyte can have significant consequences to cardiac function?
Potassium
Which electrolyte contributes to the metabolic portion of acid/base balance by having the kidneys exchange hydrogen ions to maintain pH?
Potassium
This hormone is stimulated by increased levels of potassium and said hormone then acts on the kidneys to excrete more potassium
Aldosterone
As _________ electrolyte is reabsorbed, _________ electrolyte is lost
Na+; K+
Alkalosis tends to increase or decrease levels of potassium?
Increase
Alkalosis causes potassium to shift into or out of the cell?
Into
Acidosis tends to increase or decrease potassium levels?
Decrease
Acidosis causes potassium to shift into or out of the cell?
Out of
Total CO2 is a measurement of:
*carbonic acid (H2C03)
*dissolved carbon dioxide
Serum bicarbonate (HCO3-)
What is the primary role of carbon dioxide?
Maintains a stable pH and acid/base balance
What is the secondary role of carbon dioxide?
Maintain electrical neutrality
C02 is excreted and reabsorbed by which organ?
Kidneys
A person who is suffering from severe vomiting would have increased levels or decreased levels of CO2?
Increased
A person in metabolic alkalosis will have increased levels or decreased levels of C02?
Increased
A person with chronic diarrhea will have increased levels or decreased levels of C02?
Decreased
A person who chronically uses loop diuretics will have increased to decreased levels of C02?
Decreased
A person in renal failure will have increased or decreased levels of C02?
Decreased
A person in diabetic ketoacidosis will have increased or decreased levels of C02?
Decreased
A person who is literally starving will have increased or decreased levels of C02?
Decreased
Which electrolyte is the major extracellular anion?
Cl
which electrolyte moves in and out of the cell with sodium and potassium, respectively?
Chloride
Chloride is reabsorbed/excreted in direct opposition to?
Bicarbonate to maintain acid/base balance
What is the primary role of Chloride?
Maintain electrical neutrality and follows Na+ loss/excess to do this
What major affect do Chloride have?
It affects water balance because H20 moves with Na+ and Cl-
As Cl- moves into a cell, what moves out?
HC03-
As Cl- moves out of a cell, what moves in to help maintain acid/base balance?
HC03-
A basic metabolic panel (BMP) evaluates what organ(s) function(s)?
Kidney, bone, parathyroid, pancreas, liver
End product of protein metabolism in the liver
Urea
Combines with urea and free ammonia in liver
Nitrogen
BUN (blood urea nitrogen) indirectly measures:
Renal function
GFR
Liver function
BUN levels are influenced by
Protein intake
Hydration status
GI Bleeds
Which two components make up a renal function study?
BUN and creatinine
Hyperuricemia is seen in:
Alcoholism
Leukemia
Metastatic cancer
DM
Hypouricemia can be caused by:
Idiopathic
Chronic renal disease
Acidosis
Hypothyroidism
1/2 of total calcium is bound mainly to?
Albumin
Calcium is necessary for:
Metabolic enzymatic pathway
Calcium is vital to:
Muscle contraction
Cardiac and neural blood clotting
Calcium levels can be used to evaluate:
Parathyroid function
Calcium metabolism
Calcium levels are used to monitor:
Renal failure
Renal transplantation
Hyperparathyroidism
Various malignancies
Complete Metabolic Panel consists of:
- sodium
- potassium
- chloride
- BUN
- creatinine
- glucose
- calcium
- aspartate aminotransferase
- alk phos
- protein
- bilirubin
- carbon dioxide
- alanine aminotransferase
- albumin
Alkaline phosphates (ALP) is used to detect and monitor disease of:
Liver and Bone
The most sensitive test in indication of a metastatic tumor of the liver
Intra-hepatic ALP
An increase in extra-hepatic ALP is primarily indicative of:
New bone growth
You may see an increase in extra-hepatic ALP with all of the following:
Osteoblastic metastatic tumor Paget’s disease Healing Fx’s RA Hyperparathyroidism
Bilirubin levels can be used to evaluate?
Liver function
Hemolytic anemia
Jaundice in newborns
What happens to RBCs in the spleen?
Broken down into heme and globin; heme is further catabolized into biliverdine
In the spleen, biliverdin is converted to bilirubin. This is indirect/unconjugated or direct/conjugated bilirubin?
Indirect/unconjugated
Where does bilirubin go from indirect/unconjugated to direct/conjugated?
In the liver
What protein makes up roughly 60% of the total protein in the blood?
Albumin
What is the major effect of albumin within the blood?
To maintain colloidal osmotic pressure
What is the function of albumin, other than to maintain osmotic pressure?
Transportation of hormones, vitamins, enzymes, and meds
Where is albumin synthesized?
Liver
Which protein levels can reflect liver function and nutritional status?
Albumin
Total serum protein is a combo of:
Albumin and globulins
Who monitors liver and kidney functions?
Proteins
Where are globulins synthesized?
Liver and immune system
What are some of the functions of globulins
- helps determine chances of infection/multiple myeloma
- fights infection
- transports metal (iron)
Aspartate aminotransferase (AST) enzyme is release and levels rise when
An injury or disease has caused cells to lyse, specifically heart muscle cells, liver cells, or skeletal muscle cells
Alanine Aminotransferase (ALT) is an enzyme whose levels will rise when
There is a dysfunction in the liver
Alanine aminotransferase is sensitive and specific to
Hepatocellular disease
What cells secrete amylase?
Acinar cells
If a patient comes in with acute abdominal pain, what enzyme should you evaluate?
Amylase
Increased levels in amylase could indicate:
Acute/chronic pancreatitis
GI disease
Acute cholecystokinin
Lipase can be used to detect:
Acute pancreatitis
Renal insufficiency
Intestinal infarction or obstruction
Which enzyme is more useful in the late diagnosis of acute pancreatitis, and why?
Lipase b/c it peaks later than amylase and remains elevated longer than amylase.
Which enzyme is more useful in the early diagnosis of acute pancreatitis?
Amylase b/c it peaks sooner than lipase
Total cholesterol is the most accurate predictor of the risk of:
Coronary artery disease
Which organ metabolizes ingested cholesterol?
Liver
Subnormal levels of cholesterol could indicate:
Severe liver disease or malnutrition
Positional changes affect the results of what?
Total cholesterol
Lipoproteins transport _______, ______, and _______ through the blood system
Cholesterols, triglycerides, other soluble fats
Lipoproteins levels are influenced by:
Genetics
Diet
Lifestyle
Medications
LDL carries cholesterol from ______ to ________
Liver, cells
High levels of LDL could be indicative of:
CAD
Peripheral vascular disease
Low levels of LDL could be indicative of:
Cardio-protective mechanism
HDL is produced where?
Liver
What is the purpose of HDL?
Remove cholesterol from the tissue and vascular endothelium
What is HDL’s goal?
Remove lipids from endothelium and protect against heart disease
High levels of HDL could be indicative of:
Cardio-protective mechanism
Low levels of HDL could be indicative of:
Risk of CAD
Who is in charge of carrying triglycerides?
VLDL
Glycerol + fatty acid = ?
Triglycerides
Which organ forms triglycerides?
Liver
How are triglycerides transported?
Mainly by VLDL; LDL to a lesser extent
What is the main purpose of triglycerides?
Storage for energy
What are the essential functions that are controlled by the thyroid?
Regulation of energy metabolism
BMR
Promotion of protein synthesis and growth
Prostate specific antigen is found where?
Prostatic lumen
PSA is used to monitor treatment for:
BPH
Infection
Cancer
Hemoglobin A1C is primarily used to:
Diagnose and monitor diabetes treatment
What test is used to determine the cause of metabolic acidosis?
Anion gap
Anion gap is the difference between
Cations and anions in the extracellular fluid
An increased anion gap could signify:
- renal failure
- renal tubular acidosis
- lactic acid
- diabetic ketoacidosis
- Alcoholic ketoacidosis
- Starvation
- GI loss
- hypoaldosteronism
Decreased anion gap could signify:
- multiple myeloma
- excess alkali ingestion
- chronic vomiting/suction
- hyperaldosteronism
Arterial blood gasses are used to monitor:
- patients on ventilators
- nonventilator patients
- preoperative baseline parameters
- regulate electrolyte therapy
What are the 4 acids found in blood?
Carbonic acid (H2CO3)
Dietary acids
Lactic acid
Ketoacidosis
An increase in H+ in the blood = _________in pH, which means the blood is _________?
Decrease; acidic
An decrease in H+ in the blood = ___________ in pH, which means the blood is ____________.
Increase; alkaline
UA is a non-invasive study for patient’s with:
Abdominal pain Back pain Dysuria Hematuria Urinary frequency Urinary leakage Fever of unknown origin (FUO)
If the urine is cloudy, could mean the presence of:
Pus
WBCs
RBCs
Bacteria
If the urine is dark red, it could indicate
Bleeding from the kidney
If the urine is bright red, it could indicate:
Bleeding from the lower urinary tract
If the urine is dark yellow, it could indicate the presence of
Bilirubin
If the urine is green, it could indicate the presence of:
Pseudomonas infection
What medication can make the urine orange?
Pyridium
What medication can make the urine brown?
Nitrofurantoin
What medication can make the urine bright yellow/orange?
Rifampin
Strong, sweet smell of acetone in urine could indicate:
Diabetic ketoacidosis
Foul odor to urine could indicate:
UTI
Fecal odor to urine could indicate
Enterovesicle fistula
Acidic urine could indicate possible:
Metabolic/resp. Acidosis
Starvation
Dehydration
High protein diet
Alkaline urine could indicate the possibility of:
UTI
Bacteria
Diet high in citrus fruits/veggies
Some medications (streptomycin, neomycin)
Increase in bilirubin in the urine could indicate:
Obstruction of the bile duct (i.e. gallstone)
What labs do you need for the kidney?
GFR, BUN, Creatinine, Electrolytes, magnesium, protein/albumin and globulins, PH and PCO2
primary determinant of extracellular fluid volume
Na
important for function of excitable cells such as nerves, muscles, and heart
K
important for fluid balance and acid base status
Cl
Protein/albumin and globulins - kidney
- detects nutritional status
- severe infection, dehydration, renal disease
Magnesium - kidney
regulated by kidneys
PH and PCO2 -kidney
move together
Metabolic alkalosis
pH>7.45
CO3>30
Cause: vomiting, diarrhea, dehydration
Metabolic acidosis
pH<7.35
CO3<24
cause: increased acid production, decreased renal acid secretion
Labs you need for bone
calcium, phosphate and alkaline phosphate, magnesium, vitamin D
Phosphate (PO4) and alkaline phosphate
necessary for bone formation, acid base balance, storage and transfer of energy
Magnesium - bone
concentrated in bone and muscles
-regulated by kidneys
What labs are needed for the pancreas?
glucose, amylase, lipase
Glucose - pancreas
measures blood glucose
Lipase- pancreas
used to detect acute pancreatitis
What labs are needed for the liver?
glucose, alkaline phosphate, total bilirubin, ammonia (NH3), protein/albumin and globulins, AST, ALT, lipid panel
Total bilirubin
- processed by the liver
- elevated bilirubin could indicate cirrhosis, hepatitis, jaundice
Ammonia (NH3)
- evaluates liver function and metabolism
- the liver converts ammonia from blood to urea
- if the liver is damage, then increased ammonia levels are noted
Protein/albumin and globulins
- detects nutritional status
- increased causes: hepatitis
- decreased causes: liver disease
AST
found in liver, cardiac muscle, kidney, brain and lungs
ALT
primarily found in the liver but also in muscle
Both AST and ALT
- are indicators of liver disease
- sensitive to hepatic inflammation and necrosis
What labs are needed for the parathyroid?
calcium
What labs are needed for the thyroid?
TSH, T3 and T4 levels
Low TSH, high T3 and T4
hyperthyroidism
High TSH, low T3 and T4
hypothyroidism
What labs are needed for the prostate?
PSA
What labs are needed for the lungs?
pH and PCO2
pH and PCO2 - lungs
move opposite
Respiratory alkalosis
pH > 7.45
CO2 < 35
Cause: COPD, CHF, Pain
Respiratory acidosis
pH < 7.35
CO2 >45
Cause: ALS, asthma, COPD
What labs are needed for GU?
UA
34
UA
should be clear yellow
Red Blood Cell - lifespan
120 days
Hemoglobin
- measurement based on spectrometric absorbance
- assesses anemia, blood loss, and bone marrow suppression
- function: carry oxygen, bind and release
Hematocrit
- assesses blood loss and fluid balance
- also called PCV, is a ratio
- 3:1 ratio
Platelets
Clotting
-thrombocytopenia or thrombocytosis
Thrombocytopenia
low platelet count
Thrombocytosis
high platelet count
White Blood Cells
neutrophils, lymphocytes, monocytes, eosinophils, basophils
Neutrophils
40 to 75%
- phagocytosis and killing microorganisms
- elevated = infections, steroid use
- left shift
Lymphocytes
30 to 40%
- production of antibodies (B-cells)
- cytotoxic and helper function (T-cells)
- viral infections, EBV, pertussis, immune-deficiency (HIV), corticosteroids, severe infection
Monocytes
- part of the innate immune system
- circulating precursor to the phagocyte
- called a macrophage in the tissues
- replenishing resent macrophages under normal states
- move quickly in response to inflammation signals
Eosinophils
1 to 4%
- kills antibody - coated parasites via granola release
- increased during parasitic infection and allergic reactions >4%
- reaction to foods, allergens or acid reflux, can inflame or injure the esophageal tissue
Basophils
0.5 to 1%
- AKA: mast cells
- very rarely seen <1%
- elevated during inflammation (HSN)
- play a role in both parasitic infections and allergies
What is bilirubin?
it is an orange-yellow pigment formed in the liver by the breakdown of hemoglobin and excreted in bile
Used to evaluate bilirubin
- liver function
- hemolytic anemia
- jaundice in newborns
Bilirubin - total
sum of 70-85% indirect (unconjugated) and direct (conjugated)
Total bilirubin process - spleen
- RBC breakdown into heme and globin
- Heme: catabolized to form Biliverdin in the spleen
Total bilirubin process - converted
- biliverdin is converted to bilirubin
- this is indirect (unconjuated) bilirubin
Where is unconjugated bilirubin converted?
spleen
Total bilirubin process - liver
- indirect bilirubin is conjugated with glucuronide
- becoming direct (conjugated) bilirubin
Where is direct (conjugated) bilirubin converted?
liver
Conjugated
bilirubin travels from liver to small intestine
Unconjugated
bilirubin is bound to albumin in the blood
Total Cholesterol
- most accurate predictor of the risk of Coronary Heart Disease
- liver metabolizes ingested cholesterol
- positional changes can affect results (its in hospital are expected to have lower level of TC than outpatients)
LDL
“Bad Cholesterol”
- LDL carry cholesterol from liver to cells
- High levels = > risk CAD/Peripheral Vascular Disease
- Low levels = cardio-protective
HDL
“Good Cholesterol”
- unsaturated fats
- mainly in liver, used to remove cholesterol from tissue and vascular endothelium
- high levels = cardio-protective
- low levels = >risk of CAD
Triglycerides
- type of fat (lipid) found in the blood and stored in fat cells
- risk for atherosclerosis
- formed in the liver
- transported by LDL and VLDL
- acts as a storage for energy
Total Cholesterol/HDL Ratio
- predictor of heart disease risk
- calculated by total cholesterol/HDL
VLDL
- very low density lipoprotein
- predominant carrier of triglycerides
Urine Analysis
monitors chronic renal disease and some metabolic disease
Yellow color measures
hydration and dehydration
Cloudy color urine
pus, WBC’s, RBC’s, or bacteria
Dark red urine
bleeding with kidney (hematuria)
Bright red urine
bleeding from the lower urinary tract (hematuria)
Dark yellow urine
could indicate presence of bilirubin
Green urine
pseudomonas infection
Food that can affect urine color
beet, blackberries, rhubarb - pink or red
Mediations that can affect urine color
Pyridium - organe
Nitrofurantoin - brown
Rifampin - yellow orange
Odor
- strong sweet smell of acetone = diabetic ketoacidosis
- foul order = urinary tract infection
- fecal order = enterovesicle fistula
pH - acidic
possible metabolic/respiratory acidosis, starvation, dehydration, high protein die
<6.5
pH - alkaline
UTI, bacteria, high diet in citrus fruits/veggies, some medications
>7.0
Specific Gravity
- AKA weight of particles in urine
- measures the concentration of chemical particles (wastes and electrolytes) in urine
- high = concentrated urine (dehydration )
- low = diluted urine (chronic renal disease)
- good indicator of kidneys ability to concentrate urine and hydration
Proteinuria
usually measure albumin
Proteinuria - indicator
- glomerular damage
- basement membrane
Proteinuria - possible dx
- nephrotic syndrome
- DM complications
- High BP
- UTI
Proteinuria - persistence
- requires further workup
- 24 hour urine or electrophoresis
Leukocyte Esterase (WBC)
positive = UTI, need for C&S
Nitrites
positive = UTI, need for C&S
Ketones
positive = poorly controlled diabetic or hyperglycemia from massive fatty acid catabolism
Aldosterone
- conserves Na+
- stimulated by >levels increases renal excretion of K+
- opposite of Na+ regulation
- aldosterone hormone
Aldosterone hormone
stimulated by low levels of Na+ causing kidneys to reabsorb Na+ thus increasing Na+
Hyponatremia
- triggers aldosterone
- increases reabsorption
- sonservation of Na+
- Na+ level increases
Hypernatremia
- triggers natriuretic
- decrease reabsorption
- excretion of Na+
- Na+ level decrease
Aldosterone blockers cause
- modest diuresis of natruesis
- inhibits potassium and hydrogen ion secretion
Vitamin D
indicator of risk for osteoporosis
Glucose - liver
criteria for diagnosing DM
Normchromia
normal RBCs that lack a nucleus and organelles
Hyperchromia
- MCHC <36% RBC with decreased surface to volume ratio
- seen in hemolysis and burn
- spherocytes
Spherocytes
cells with no central pallor
Macrocytes
MCV>100 fL
- macrocytic anemia
- macrocytes seen in acute blood los, polychromasia is usually present
Hypochromia
central area of pallor, literally means low color, many times this is seen in IDA often referred to a microcytic/hypochromic anemia
