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Test 3 (Unit 12) Lab Interpretation > Lab Interpretation > Flashcards

Lab Interpretation Flashcards

1
Q

Sensitivity

A

The ability to correctly identify who HAS a disease

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2
Q

Specificity

A

The ability to correctly identify who does NOT have the disease

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3
Q

Positive Predictive Value

A

Proportion of positive tests that are truly positive. Also referred to as the “precision rate.” Proportion of positive tests that are truly positive.

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4
Q

Negative Predictive Value

A

Number of true negatives out of all people who test negative.

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5
Q

Complete Blood Count (CBC)

A 
White Blood Cell (WBC)
Red Blood Cell (RBC)
Hemoglobin (HgB)
Hematocrit (HcT)
Mean Corpuscular Volume (MCV)
Mean Corpuscular Hemoglobin (MCH)
Mean Corpuscular HgB Concentration (MCHC)
Red Cell Distribution Width (RDW)
Platelets (PLT)

CBC Fishbone

WBC // Hemoglobin / Hematocrit // PLT

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6
Q

White Blood Cell Count…

A

WBC is sensitive… but non-specific!

Elevated due to infection, acute stress, air pollution, medications, leukemias

Depressed: yellow fever, amebiasis

“You know something is wrong somewhere, but it doesn’t give you the full clinical picture”

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7
Q

White Blood Cell Differential

A

Takes more time, and may be more expensive…

Ordered when CBC count is elevated

Differential Count:
Basophils (0.5 - 1%)
Eosinophils (1-4%)
Neutrophils (40-60%)
Monocytes (2-8%)
Lymphocytes (20-40%)

Differential % always equal 100%.

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8
Q

Absolute Differential

A

WBC count by % of cell type

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9
Q

Basophils

A

Least common of all the WBCs

Increase in response to same conditions that cause increased eosinophils

Release histamine, bradykinin & serotonin activated by injury or infection

Medications - increase: antithyroid therapy / decrease glucocorticoids, antonioplastics

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10
Q

Eosinophils

A

Defend against parasitic infection

Part of the allergic response

Often found in sputum of patients with asthma

Medications that increase eosinophils: Digoxin, Heparin, PCN, Propanolol

Medications that decrease it: corticosteroids

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11
Q

Neutrophils

A

Most numerous WBC but most short-lived

Increased production during acute stress

Types:
Banded/”Bands” –> Immature (5%)
Segmented/”Segs” –> Mature (95%)

Left Shift: Increased # of bands (immature). When someone is acutely ill, body will respond by producing more baby neutrophils

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12
Q

Causes of Neutrophilia

A

Bacterial infection
Medications: Lithium, Steroids, Heparin
Cigarette Smoking
Obesity

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13
Q

Causes of Neutrophilia

A

Bacterial infection
Medications: Lithium, Steroids, Heparin
Cigarette Smoking (increased # of ‘segs’)
Obesity (increased # of ‘segs’)

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14
Q

Monocytes

A

Produced by Marrow –> Circulates 5-8 days –> Enter tissue and becomes histiocyte

Not common in circulating blood

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15
Q

Lymphocytes

A

2nd most numerous WBC
Main function: immune response
T & B cells

Medications that decrease lymphocytes: glucocorticoids, immunosuppressants

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16
Q

Lymphocytes (continued)

A

Elevated: mononucleosis, TB, pertussis, influenza

Depressed: AIDS, Aplastic Anemia, MS, GBS. Medications that cause depression: steroids

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17
Q

Leukocytosis

A

Usually due to neutrophils of lymphocytes

of neutrophils increases the severity of infection

Total WBC count reflects quality of immune system

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18
Q

% of Neutrophils…

A

Indicates severity of infection

19
Q

Total WBC…

A

Reflects quality of immune system

20
Q

Leukocytes Scenario #1

A

25 yo with pneumonia

Total WBC = 18,000
Neutrophils = 60% (10,800)

Moderate infection with good immune response!

21
Q

Leukocytes Scenario #1

A

25 yo with pneumonia

Total WBC = 18,000
Neutrophils = 60% (10,800)

Moderate infection with good immune response!

22
Q

Leukocytes Scenario #2

A

85 yo with pneumonia

Total WBC = 11,500
Neutrophils = 80% (9,200)
Bands = 10%

Severe infection with poor immune response

23
Q

Leukocytes Scenario #2

A

85 yo with pneumonia

Total WBC = 11,500
Neutrophils = 80% (9,200) // Normal is 40-60
Bands = 10%

Severe infection with poor immune response

24
Q

Red Blood Cells (Erythrocytes)

A

Produced in bone marrow. Stimulated by erythropoietin.

Lifespan: 120 days

Anemia: at least a 10% decrease in RBC

25
Q

Decreased RBC caused by:

A

(1) Increased destruction of RBC
(2) Decreased production
(3) Blood loss

Increased RBC: Polycythemia
Primary
Secondary: Lung & Heart disease, High altitude, tobacco use

26
Q

Decreased RBC caused by:

A

(1) Increased destruction of RBC
(2) Decreased production
(3) Blood loss

Increased RBC: Polycythemia
Primary. Likely an enlarged spleen, liver. May present with DVT, or hypertension
Secondary: Lung & Heart disease, High altitude, tobacco use. Hypoxia is the thing that drives this

27
Q

Hemoglobin & Hematocrit

A

HCT: Total volume of RBCs relative to volume of whole blood

3 variables: fluid volume, RBC size, RBC count
*Useful only if pt is euvolemic

HGB: pain portion fo RBCs
1/3 of the HCT value
Sex-dependent; age-dependent. Adults have higher value than children. Men have higher values than women.

28
Q

Hemoglobin & Hematocrit

A

HCT: Total volume of RBCs relative to volume of whole blood

3 variables: fluid volume, RBC size, RBC count
*Useful only if pt is euvolemic

HGB: pain portion fo RBCs
1/3 of the HCT value
Sex-dependent; age-dependent. Adults have higher value than children. Men have higher values than women.

Hemoglobin increased when the RBC # increases

29
Q

MCV - Mean Corpuscular Volume

A

Will look at when evaluating someone for anemia

Measures the volume and average size of RBCs

Q: What is the most common cause of microcytic anemia? –> Iron deficiency

30
Q

Anisocytosis

A

RBCs are of unequal sizes

31
Q

MCH

A

Measurement of HGB in the RBC
Divide HGB by the RBC

Helps find the source of anemia

32
Q

MCHC

A

Measure how tightly hemoglobin is paced in RBC

33
Q

Red Cell With Distribution (RDW)

A

Volume variation in size of RBCs. Increased variation in size - reticulocytosis (higher in patients who have had some kind of bleed).

34
Q

Platelets

A

Smallest formed elements in blood
Important for blood clotting and homeostasis

Increased in myeloproliferative disorders

Decreased: heparin, lupus

35
Q

Von Willibrans Disease

A

Normal # of platelets, but don’t have the ability to stick together

36
Q

CASE STUDY #1

A

Dx: Aspiration pneumonia

(1) Parkinson’s - often have dysphagia
(2) Crackles to right lower lobe (aspiration, usually right lobe)

High WBC, high neutrophils
BUN is quite elevated (28) –> likely dehydration
Infiltrate is not showing up because dehydration

What is her prognosis and why?
Look at WBC count, neutrophil % (and segs, bands)
She has a pretty significant infection. Her neutrophils are at 77% (normal range is 40-60%)
WBC is 16,000 - that is OK, is managing a good response

37
Q

Basic Metabolic Panel

A

Glucose / BUN / Creatinine / CO2 / Potassium / Sodium / Calcium / Chloride

38
Q

Comprehensive Metabolic Panel

A

BMP elements (above) PLUS Protein, Albumin, LFTs

LFTs are AST (SGOT), ALT (SGPT), ALK PHOS, Bilibunin

39
Q

Why order a Metabolic Panel?

A

(1) Volume Status - response to interventions and fluid
(2) Renal and Liver status
(3) Monitor electrolytes

40
Q

Caution…

A

SSRIs can cause hyponatremia

41
Q

Albumin

A

Has never seen a high albumin level

Low albumin is caused by kidney disease, liver disease, undernutrition, Crone’s Disease

Be careful when prescribing Warfarin

42
Q

Thyroid Panal

A

TSH and Free T4 for screen (Free T4 not affected by the amount of protein in someone’s blood)

43
Q

ESR

A

Crude measurement of inflammation (over 100, likely a serious underlying disease).

44
Q

BNP

A

Released primary from the heart. When there are high filling pressures, this is secreted (will be higher when patient is having heart failure exaccerbation).

Test 3 (Unit 12) Lab Interpretation (1 decks)

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