Lab correlation and Review: Schoenwald Flashcards
Abnormal labs are usually not called to the provider
But CRITICAL lab values are:
called to the provider or their nursing staff
–Critical labs are those values that are potentially life threatening to a patient
Critical Lab Values: Hematology
- WBC: ____
- HCT: ____
- differential >___% Bands, immature cells present
- WBC <2.0 or >35.0 x 10³
- HCT <14% or >60%
- > 30% bands, immature cells present
Critical Lab Values: Hematology
- Platelets _______
- INR >____
- Platelets <20,000 or >1,000,000
- >4.0
Critical Lab values:
Serum glucose: < ____or >___ mg/dl
- Serum potassium ____ mEq/L
- Serum Sodium ______
- <40 or >500 mg/dl
- <2.5 or >6.5 mEq/L
- <120 or >160
Critical Lab values:
Arterial blood gases
- pO2 < _____ mmHg
- pH ____
- pCO2 ___
pO2 <40 mm Hg
pH <7.2 or >7.6
pCO2 <20 or >70 mm Hg
Critical Lab Values:
-Microbiology
- Positive blood culture
- Gram stains on CSF and body fluids
- Positive strep screens
- Positive influenza
- Positive COVID 19 test
- Positive C diff testing (+/-)
Microbiology report interpretation:
-what makes it unique?
Report interpretation different than general lab reports
Note: the status of the report
- it might say final, Or preliminary (which means the status might change)
- gram stain result: will be available right away
- the culture result takes longer
-antimicrobial susceptibility report: they test the bug (organism) against different ABX (if an ABX doesn’t work it will be Resistant ®, if it shows the abx works (ie Susceptible= S)
-
If MIC is greater than a number, this means
the bug (organism) is resistant to the antibiotic
Pregnancy tests:
-urine test?
- Measure serum/urine human chorianic gonadotropin (HCG)
- HCG secreted by placental trophoblast after fertilization
- HCG present as soon as 3-10 days after conception
Pregnancy test: HCG rises rapidly within _______
-rapidly rises in the first few weeks of pregnancy, serum levels generally higher than urine
- After 30 days, HCG about the same level in either urine or serum
- Qualitative and Quantitative tests available
Quantatitive HCG:
- measures _____
- used as a tool to assess ______
- *beta subunit
- gestational age
Quantitative HCG is elevated in (what conditions?)
- **ectopic pregnancy but generally not quite as high as normal pregnancy
- Also used as a tumor marker-germ cell tumors (choriocarcinoma and embryonal cell cancers)
(note: may be ordered for males in the setting of tumors)
Gestation:
<1 week–> HCG=
-at 4 weeks?
- 5-50
- 1000-30,000
Limitations of pregnancy testing
- Test performed too early after conception
- Urine tests need concentrated urine to be reliable
- False positive results from some medications (anticonvulsants, antiparkinsonian, tranquilizers)
Liver Disease:
- list Diminished factors
- ____ is elevated in the setting of liver disease
INR can be elevated in liver disease (since INR is dependent on vit K dependent factors (2,7,9.10)
DIC (disseminated intravascular Coagulation) and Fibrinolysis:
-diminished factors?
1, 5, 8
Congenital deficiency’s:
-diminished factors?
all of them
Heparin:
diminished factors?
Factor 2
Warfarin:
diminished factors?
2,7, 9, 10, 11
Autoimmune disease:
diminished factors?
8
Vit K deficiency:
-diminished factors?
2,7,9,10, 11
PT (protime)
- normal range?
- critical range?
normal 11-12.5 seconds,
>20 seconds is critical
INR critical level=
> 4
PT (protime):
- measures which pathways?
- used for _____ monitoring
- **Measures extrinsic and common pathways (Factors II,V,VII and X)
- Warfarin monitoring
PT:
-elevated in ______
liver disease due to lack of Vitamin K dependent factors (II,VII,IX, and X)
INR=
-normal level
=international normalized ratio
-Normal <1.1 -no anticoagulation
INR:
-therapeutic range?
2.0-3.0 (general- may vary slightly by clinician preference and disease process)
PTT:
- normal?
- Therapeutic ?
- Normal 30-40 seconds,
- Therapeutic 1.5 x normal control)
PTT:
- measures which pathways?
- Monitor for _____ therapy
intrinsic and common pathways of coag cascade
-Monitor for heparin therapy(Heparin inactivates prothrombin(Factor II)
T/F: PTT can be used to monitor LMW heparin
FALSE. DOES NOT monitor low molecular weight heparin therapy (Lovenox)
LMWH activates antithrombin and has indirect inhibition of Factor ___
XA
_______ can be utilized for monitoring LMWH
Factor XA assay
PTT:
measures which factors?
Factor II, V,VIII,IX,X,XI, and XII
PT= _____ pathway
**extrinsic
PTT= _____ pathway
intrinsic
PTT= partial thromboplastin time
D-dimer:
-normal?
normal varies**
D-dimer:
-describe
=Protein fragment present as blood clots dissolve
=Fibrin degradation product
Ultrasensitive D-dimer test is also known as _______
quantitative
D-dimer is elevated in DVT and ___
PE
D-dimer has a High ______ predictive value for DVT and PE
**negative
D-dimer is also utilized in _____ panel
**DIC panel
Fibrinolysis (summary?)
Thrombin–> Fibrinogen to Soluble fibrin—> Crosslinked fibrin—> crosslinked fibrin DP’s and D-dimer**
Common Risk Factors For Clotting(also Reasons for elevated _______
-list reasons
**d-dimer)
- Major surgery or trauma
- Hospitalization or living in a nursing home
- Prolonged immobility—this can include long trips by plane, car, etc. or prolonged bed rest
- Use of birth control or hormone replacement therapy
- Broken bone, cast
- **Pregnancy or recent childbirth
- **Antiphospholipid syndrome
- Certain cancers
- Inherited clotting disorder such as **factor V Leiden mutation
- hx of prior venous thromboembolism (VTE)
- Obesity
- Smoking
