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343 mt > Hematology, Liver, and GI Laboratory Values > Flashcards

Hematology, Liver, and GI Laboratory Values Flashcards

1
Q

Hematology lab tests report on (3)

A

– the cellular components of blood (platelets, red blood cells, white blood cells)
– the organs that produce blood cells (liver, spleen, bone marrow)
– diseases of the blood, bone marrow, and lymphatic system (e.g., anemia)

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2
Q

• Complete Blood Count (CBC) provides information on:

A

– The number of each type of blood cell (count)

– Morphology (size, shape, colour) of red blood cells

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3
Q

• A CBC is used for a number of reasons (3)

A

– Evaluate symptoms (e.g. fatigue, fever, or bruising)
– Diagnose conditions (e.g., anemia, infection, leukemia)
– Determine the stage of a disease (e.g., leukemia)

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4
Q

Complete Blood Count (CBC)

A

• Platelet (thrombocyte) count
• Red blood cell count
• Hemoglobin (Hgb)
• Hematocrit (Hct) or packed cell volume (PCV)
• Red blood cell indices
• White blood cell count
– CBC with Differential will also report the different types of white blood cells

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5
Q

RBCs (or erythrocytes) contain hemoglobin and are responsible for the transport and exchange of
oxygen to tissues

which triad of tests should be evaluated together because they are affected by the same
underlying conditions (e.g., anemia)?
A
  1. Red Blood Cell (RBC) Count: Reports the number of red blood cells in a cubic millimeter of whole blood
  2. Hemoglobin (Hgb): • Reports the amount of hemoglobin per litre of whole blood
    • Provides a direct indication of the blood’s oxygen carrying capacity
  3. Hematocrit (Hct): Reports the volume of red blood cells in whole blood, expressed as a percentage
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6
Q

what are the 3 indices for RBCs?

see equations on slide 7

A
  • Mean Corpuscular Volume (MCV): average size of red blood cells and classified as normocytic, microcytic,
    or macrocytic
  • Mean Corpuscular Hemoglobin (MCH): average weight of hemoglobin in a red blood cell and classified as normochromic, hypochromic, or hyperchromic
  • Mean Corpuscular Hemoglobin Concentration (MCHC): average concentration of hemoglobin in red blood cells

• Red cell distribution width (RDW): is a measure of cell size distribution

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7
Q

what does ferritin indicate?
vit B12?
folic acid?

A

Ferritin
– Stored iron-protein complex
– Provides a direct measure of how much iron is stored in the body

Vitamin B12
– Absorbed from the GI tract from meats, eggs, and dairy
• Vegan diet will require supplementation
– Low stomach acid (e.g., from PPI or excessive antacid use) will increase risk of deficiency
– Metformin may be linked to deficiency
– Deficiency produces macrocytic anemia

Folic Acid
– Absorbed from the GI tract from leafy green vegetables
– Involved in maturation of red blood cells
– Can accompany vitamin B12 deficiency

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8
Q

what does reticulocyte count indicate?

A

– Reticulocytes are immature red blood cells
– The count reflects the erythropoietic activity of bone marrow and therefore useful for diagnosis of anemia and monitoring response to medication therapy

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9
Q

• Erythrocyte Sedimentation Rate (ESR)

also referred to as the Westergren test

A

– Measures the rate of fall (sedimentation) of erythrocytes (red blood cells) in a
sample of blood placed in a tall, thin, vertical tube ⟹ usually this process is very slow
– Acute phase reactions (e.g., acute infection, inflammation) will introduce a positive charge in the plasma, which will promote RBC aggregation
– Faster ESR = more inflammatory factors present

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10
Q

White Blood Cells main types (5)

A

WBC (or leukocytes) protect the body against foreign organisms, substances, tissues, and viruses

– Neutrophils (Band and Segmented)
– Lymphocytes
– Monocytes
– Eosinophils
– Basophils
  • WBCs can be grouped as Granular and Agranular, based on the cellular characteristics
  • Each WBC type has a unique or specific method for protecting the body
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11
Q

name 3 Granular White Blood Cells

• Contain granules that are visible in the cytoplasm and have segmented or lobular nuclei

A

• Neutrophils
– Segmented Neutrophils will phagocytose foreign bodies (e.g., bacteria) and release proteins and other substances from the granules to destroy them
– Band Neutrophils are immature cells that are present in very small numbers. The proportion increases (e.g., >10%) when the body is fighting an infection.
• Eosinophils respond to areas of inflammation, allergic response, and parasitic disease. Granules in these cells contain histamine
• Basophils can develop into mast cells and have granules that contain heparin (prevents clotting), histamines (promote an allergic response), and proteolytic enzymes.

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12
Q

name 2 Agranular White Blood Cells

A

• Monocytes
– Mature into macrophages that will migrate out of the vasculature and into tissues
– Remove foreign substances, destroy and ‘clean up’ old cells and proteins, salvage iron from old RBCs and return it to transferrin
• Lymphocytes
– T Cells: cell-mediated immune response
– B Cells: responsible for recognition of foreign substances and bacteria
• Transform in to plasma cells, which can make antibodies

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13
Q

see slide 15 for WBC abnormalities

A

Neutrophilia, Neutropenia, eosinophilia, monocytosis, lymphocytosis, lymphopenia

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14
Q

liver fxns

A

– Regulates and stores substances
• e.g., carbohydrates, fats, and proteins
– Produces substances
• e.g., synthesizes albumin, clotting factors, bile
– Metabolizes and eliminates substances
• e.g., bilirubin metabolism, medications
• An abnormal liver test could indicate damage to the liver orbabnormal flow of bile
– Can be caused by a variety of diseases & medications

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15
Q

liver lab tests are used to (5)

A

– Detect the presence of disease
– Distinguish among different types of liver disorders
– Measure the extent of liver damage
– Follow response to treatments
– Monitor for side effects form certain medications

• Often need to employ a battery of tests to determine what is happening with the liver

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16
Q

Liver Laboratory Tests

4 main categories

A

Liver function (measures ability to synthesize proteins and other substances)
• Albumin
• Clotting Factors

Liver injury
• Aminotransferases (AST & ALT)

Test for cholestasis
• Alkaline Phosphatase
• Gamma-Glutamyl Transpeptidase (GGT)

Non-specific markers
• Bilirubin
• Lactic Acid Dehydrogenase (LDH)

17
Q

Liver Tests for Synthetic Capabilities (2)

A

Albumin (reference range*: 35-50 g/L)
– Major protein in the blood; contributes to osmotic pressure in serum; involved in transport of hormones, medications, anions, and other substances
– With chronic liver disease (e.g., cirrhosis) albumin concentration will steadily decrease
• Decline in osmotic pressure ⟹ peripheral edema and ascites

Clotting Factors
– Vitamin K-dependent factors: I, II (prothrombin), V, VII, IX, and X are synthesized and stored in the liver
– Once the reserves are depleted, clotting abnormalities (excessive bleeding, easy bruising) will occur
– Monitor by measuring INR

18
Q

Liver Tests to Assess Injury

Common sources of liver injury include medications, alcohol, hepatitis, non- alcoholic fatty liver disease (NAFLD)

A

Aminotransferases are intracellular enzymes that assist with protein metabolism, gluconeogenesis, and other metabolic processes
– Highest concentration found in liver, but also located in other tissues, including cardiacband skeletal muscle, kidney, brain, pancreas, lungs, and blood cells
– Alanine Aminotransferase [ALT]
• More specific for liver injury
• Reference Range*: 10-40 U/L
– Aspartate Aminotransferase [AST]
• Reference Range†: 10-36 U/L
– Consider the magnitude of increase as a measure of injury
• Mild (<5 x upper limit of normal [ULN]); Moderate 5-10 x ULN; Severe >10 x ULN
– As well as the rate in change of enzyme levels

19
Q

Cholestasis

what is it?
what are symptoms?

A

• Substances normally excreted by the liver into the bile accumulate
– Impaired secretion from hepatocytes
– Obstruction of bile flow through intra-or extrahepatic bile ducts
• Symptoms
– Jaundice
– Pruritis
– Xanthomas (lipid deposition in the skin)
– Malabsorption of fat-soluble vitamins (ADEK)
– Anorexia

20
Q

Liver Tests to Identify Cholestasis

A

• Alkaline Phosphatase (ALP)
• Reference Range*: 25-100 U/L
– Enzyme transports metabolites across cell membranes
– Also found in placenta, bone, and gastrointestinal cells
– An increase in ALP may indicate skeletal disease, extra-or intrahepatic biliary obstruction
– Cholestasis enhances ALP synthesis and release
– Concurrent rise in GGT would indicate an underlying hepatobiliary disease

21
Q

Liver Tests to Identify Cholestasis

A

• Gamma-Glutamyl Transferase (GGT)
• Also called: Gamm-Glutamyl Transpeptidase
• Reference Range*: <70 U/L (men) <55 U/L (women)
– Biliary excretory enzyme
– Also present in kidney, spleen, heart, brain, but NOT bone or placenta
– Concurrent rise in ALP would indicate an underlying hepatobiliary disease
– Often see a rise in GGT associated with alcohol abuse

22
Q

Assessment of ALP and GGT

see chart on slide 25

A 
ULN = upper limit of normal
• ALP 4x ULN ⟹ cholestasis
• ALP ≤3x ULN ⟹ Non-specific … check GGT
GGT > Ref Range = Hepatic Source
GGT within Ref Range =  Non-Hepatic Source
23
Q

Liver Tests – Nonspecific Markers

what is the diff b/w unconjated and conjugated

A

– Produced from metabolism of hemoglobin as the liver breaks down red blood cells
– Total bilirubin level is a sum of unconjugated and conjugated bilirubin

  • Unconjugated (or indirect) bilirubin is insoluble in water and bound to albumin
  • Conjugated (or direct) bilirubin is conjugated with glucuronide in the liver (increases water solubility) and secreted through the biliary tract into the small intestine or stored in the gall bladder
24
Q

Hyperbilirubinemia

A

• Elevated total bilirubin levels
Jaundice: yellow skin and sclera

Assessing levels of unconjugated and conjugated bilirubin can help identify the medical condition
• Elevated unconjugated only ⟹ hepatic dysfunction
• Both elevated ⟹ obstruction of biliary tract

Medication-related causes: hemolytic anemia
• Antimalarials
• Benzodiazepines
• Sulfonamides

25
Q

Liver Tests – Nonspecific Markers

A

• Lactic Acid Dehydrogenase (LDH)
• Reference Range*: 140-280 U/L
– Metabolic enzyme
– Present in almost every tissue in the body
– Elevated levels indicate cell damage
• Used to identify liver disease (as well as lung disease and lymphoma

26
Q

which meds require routine surveillance of liver function?

A

• Most medications do not require routine surveillance of liver function
– None of the liver tests correlate directly with hepatic clearance rates for
medications
– Review product monograph, tertiary literature to determine if liver testing is
required to assess therapy
• HIV medications / Statins / Tuberculosis medications / Isotretinoin / Rheumatoid Arthritis
medications
– Symptoms (e.g., jaundice) would warrant liver tesq

27
Q

Someone with compromised liver function will affect what medications?

A

Medications with high first pass metabolism ordinarily have low bioavailability
• Someone with compromised liver function will not metabolize the drug as well, leading to lower first pass metabolism and higher bioavailability ⟹ may require dose reduction
– Prodrug (requires activation by liver)
• Someone with compromised liver function will not activate the drug as well, leading to lower amounts of active drug ⟹ may require dose increase

28
Q

GI tests

which 2 enzymes?

A
  • Amylase Reference Range
  • Lipase

– Digestive enzymes secreted by the pancreas and salivary glands
– Elevation could suggest:
• Problems with exocrine function of the pancreas (e.g., pancreatitis)
• Problems with the gallbladder or blockade of the ducts (e.g., gallstones, cholecystitis, appendicitis)
• Inflammation or blockade of salivary gland (e.g., mumps)
• Chronic kidney disease (because enzyme levels in the blood are not being cleared properly)

29
Q

what does Serum Creatinine (SCr) indicate?

A

– Creatinine is a waste product formed by the breakdown of creatine
• Elimination is primarily by filtration through the glomerulus
⟹ serum concentration is used to assess glomerular filtration rate

30
Q

what does Blood Urea Nitrogen (BUN) indicate?

A

– Urea is an end product of protein metabolism and primarily excreted by the kidney
• Concentration is directly affected by protein intake and nitrogen metabolism and indirectly affected by renal function

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